WorldWideScience

Sample records for surgery

  1. Surgery

    Science.gov (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  2. Surgery

    Science.gov (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

  3. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  4. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  5. Maze Surgery

    Science.gov (United States)

    ... Center > Maze Surgery Menu Topics Topics FAQs Maze Surgery Article Info En español Electrical impulses in your ... called an arrhythmia. Why do I need Maze surgery? Maze surgery is also called the Maze procedure. ...

  6. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  7. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  10. Hemorrhoid surgery

    Science.gov (United States)

    ... surgery. Hemorrhoid surgery may involve: Putting a small rubber band around a hemorrhoid to shrink it by blocking blood flow. Stapling a hemorrhoid to block blood flow, causing it to shrink. Using a ...

  11. Plastic Surgery

    Science.gov (United States)

    ... idea for teens? As with everything, there are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board-certified plastic surgeons spend a lot of time ... the right reasons. Many plastic surgery procedures are just that — ...

  12. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    3 Department of Paediatric Surgery, Sophia's Children Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands. 4 Department of Paediatric Surgery, Emma's Children Hospital/Academic Medical Centre, Amsterdam, The Netherlands. 5 Department of Radiology, Red Cross War Memorial Children's Hospital, ...

  13. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. PAEDIATRIC SURGERY. P Stevens,1 E Muller,1 P Becker2. 1 Department of Paediatric Surgery, Steve Biko Academic Hospital, University of Pretoria. 2 South African Medical Research Council.

  14. Rodding Surgery

    Science.gov (United States)

    ... usually undertaken as a scheduled elective procedure. An optimal age for a first rodding surgery has not ... which may prevent or postpone the need for replacement. The smallest diameter expanding rods are still too ...

  15. Lung surgery

    Science.gov (United States)

    ... the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to ... Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed ...

  16. Bariatric Surgery

    Science.gov (United States)

    ... action of certain hormones, such as ghrelin —“the hunger hormone.” People have these types of surgery if ... organizations to further patient education on hormone related issues. Network Sponsors The Hormone Health Network is supported ...

  17. Epilepsy Surgery

    Science.gov (United States)

    ... and the portion of your brain that's involved: Memory problems. The temporal lobe handles memory and language functions, so surgery on this part ... computerized tomography (SPECT). The scan image varies in color depending on the amount of blood flow in ...

  18. After Surgery

    Science.gov (United States)

    After any operation, you'll have some side effects. There is usually some pain with surgery. There ... anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions. ...

  19. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Barnett J, Mohanty A, Desai SK, Patterson JT. Neurosurgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, ...

  20. Bariatric surgery

    Science.gov (United States)

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  3. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  4. Bariatric surgery

    Directory of Open Access Journals (Sweden)

    Alojz Pleskovič

    2013-07-01

    Full Text Available Background: In almost six decades different surgical techniques have been developed to treat patients with morbid obesity. Various surgical techniques are generally divided with respect to their effect into restrictive, malabsorbtive and humoral and a combination of these. Surgically modified human metabolism ameliorates metabolic diseases, particularly diabetes, even in nonobese patients. The understanding of metabolic effects changed the traditional paradigm of bariatric surgery from simple weight-loss procedure to metabolic surgery affecting whole-body metabolism. Proper surgical technique for individual patient is the most important factor influencing long- term results, comorbidities and quality of life. Recommendations for patient selection, surgical methods and pre- and postoperative patient management are to be respected. Metabolic surgery principles and current concepts are presented.

  5. Cosmetic surgery.

    OpenAIRE

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks.

  6. PLASTIC SURGERY

    African Journals Online (AJOL)

    surgery or subcutaneous mastectomy utilizing a periareolar or circumareolar ... old. Informed consent was obtained. The height of the patients was measured from heel to vertex with a standard height measuring device. The chest circumference was ... The procedure was followed with liposuction 3-6 months later if required.

  7. GENERAL SURGERY

    African Journals Online (AJOL)

    Summary: The multidisciplinary management of Breast Cancer (BC) has evolved over the past 50 years: the patient is offered a choice of .... Choice of procedure. – For women with early BC, there is essentially a choice between 2 procedures: mastectomy or breast conserving surgery with radiation (BCT). The standard.

  8. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  9. GENERAL SURGERY

    African Journals Online (AJOL)

    We plan to protocolise earlier surgery and blood conservation strategies intraoperatively in addition to a restrictive strategy in ..... Marshall JC. Review Transfusion trigger: when to transfuse? Crit Care. 2004;8(Suppl 2):S31-3. 11. Hofmann A, Farmer S, Towler SC. Strategies to preempt and reduce the use of blood products: ...

  10. Cosmetic Surgery

    Science.gov (United States)

    ... http://www.mayoclinic.com/health/cosmetic-surgery/SN00006 Medical Tourism (Copyright © American Society of Plastic Surgeons) — People considering ... in exotic vacation spots. This publication talks about "medical tourism" and whether it's safe. http://www.plasticsurgery.org/ ...

  11. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  12. GENERAL SURGERY

    African Journals Online (AJOL)

    after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188-193. http:// dx.doi.org/10.1002/jso.24125. 2. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An international study group of pancreatic surgery (ISGPS) definition. Surg. 2007;142(1):20-25. http://.

  13. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity...

  14. TRAUMA SURGERY

    African Journals Online (AJOL)

    deaths due to other trauma types (gunshot wounds, road traffic fatalities and assault) ... the axillary artery was ligated during surgery. Type of ... Left axillary artery. Ischaemic left upper limb. 3. Fifth intercostal space on the left. Bilateral pneumothorax and haemothorax still present at autopsy. (intercostal drain only inserted on ...

  15. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  18. Tennis elbow surgery - discharge

    Science.gov (United States)

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

  20. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were......The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform...

  1. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....

  2. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee...... a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach...

  3. Heart failure - surgeries and devices

    Science.gov (United States)

    CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Other Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons ...

  7. Hip Replacement Surgery

    Science.gov (United States)

    ... Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or diseased ...

  8. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  9. Laser surgery - skin

    Science.gov (United States)

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  10. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Surgery Dental Implant Surgery Facial Cosmetic Surgery Head, Neck and Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures ...

  12. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and ... Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries ...

  14. What Is Refractive Surgery?

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  15. LASIK - Laser Eye Surgery

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on ... without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) Your dentist, orthodontist and ...

  17. Gastric Bypass Surgery

    Science.gov (United States)

    ... gastrointestinal system Death (rare) Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They ... room, where medical staff monitors you for any complications. Your hospital stay may ... of bariatric surgery Each type of bariatric surgery has pros and ...

  18. Facial Cosmetic Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  20. Corrective Jaw Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We Are Find a Surgeon News Videos Contact Anesthesia Cleft Lip/Palate and Craniofacial Surgery Corrective Jaw Surgery Dental Implant Surgery Extractions and Other Oral Surgeries Facial Cosmetic ...

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ...

  3. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery Life ... Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...

  5. Limited-Access Heart Surgery

    Science.gov (United States)

    ... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...

  6. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid Christine; Neumann, Gudrun

    2014-01-01

    in postmenopausal women was associated with surgery including hysterectomy and bilateral oophorectomy (pcarcinoma was found 138 times (95% CI: 48, 275) more prevalent than the expected rate. CONCLUSION......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  7. Surgery for Stress Urinary Incontinence

    Science.gov (United States)

    ... Surgery for Stress Urinary Incontinence Page Navigation ▼ ACOG Pregnancy Book Surgery for Stress Urinary Incontinence Patient Education FAQs Surgery for Stress Urinary Incontinence Patient Education ...

  8. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  9. Weight Loss Surgery

    Science.gov (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you ... caused by obesity. There are different types of weight loss surgery. They often limit the amount of food ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... administer local anesthesia, all forms of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  12. Preparing for Surgery

    Science.gov (United States)

    ... FAQs Preparing for Surgery Page Navigation ▼ ACOG Pregnancy Book Preparing for Surgery Patient Education FAQs Preparing for ... the person who is in charge of giving anesthesia and checking its effects. What can I do ...

  13. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you ...

  14. Heart valve surgery

    Science.gov (United States)

    ... techniques are used: Percutaneous surgery (through the skin) Robot-assisted surgery If your surgeon can repair your ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, bone and ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  17. Cosmetic ear surgery

    Science.gov (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the ... are not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, ...

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ...

  2. Abdominal wall surgery

    Science.gov (United States)

    Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty ... Most of the time, this surgery is an elective or cosmetic procedure because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair ...

  3. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  5. Refractive corneal surgery - discharge

    Science.gov (United States)

    ... after surgery, it should be OK to use artificial tears. Check with your provider. DO NOT wear contact lenses on the eye that had surgery, even if you have blurry vision. DO NOT use any makeup, creams, or lotions ...

  6. Smoking and surgery

    Science.gov (United States)

    Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

  7. Robotic liver surgery

    Science.gov (United States)

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  8. RADIATION AND SURGERY

    African Journals Online (AJOL)

    Dr. S.A. Adewuyi

    of radical surgical procedures, surgery remains the only potential curative treatment for many cancer patients ... catheter, 'Toilet' procedure, e.g. simple mastectomy or amputation of a limb, for fungating tumours. Debulking .... that tumour is irradiated prior to surgery and post- operative implies after surgery. 10. Pre-operative.

  9. Cavus Foot Surgery

    Science.gov (United States)

    ... Toes All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A cavus or high-arched foot may have ... related problems. What are the goals of cavus foot surgery? The main goal of surgery is to ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  11. Breast Cancer Surgery

    Science.gov (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  12. DEVELOPMENT OF PLASTIC SURGERY.

    Science.gov (United States)

    Pećanac, Marija Đ

    2015-01-01

    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  13. [Breast cancer surgery].

    Science.gov (United States)

    Vlastos, Georges; Berclaz, Gilles; Langer, Igor; Pittet-Cuenod, Brigitte; Delaloye, Jean-François

    2007-10-24

    Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

  14. Gastric and intestinal surgery.

    Science.gov (United States)

    Fossum, Theresa W; Hedlund, Cheryl S

    2003-09-01

    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  15. Annals of surgery

    National Research Council Canada - National Science Library

    1885-01-01

    Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...

  16. [Surgery of adrenal tumors].

    Science.gov (United States)

    Bondarenko, V O; Ermolov, A S; Kovalenko, T I; Kondratiev, A V

    2004-01-01

    From 1983 to 2003 examination and surgical treatment were performed in 463 patients with different adrenal tumors. Hormone-active tumors were revealed in 249 of them, non-active - in 214. Combination of CT or MRT with study of adrenal hormones is the basis of the diagnosis. In different cases multispiral computed tomography, angiography, selected taking of blood from inferior caval vein, US- or CT-guided biopsy were used. Open surgery through thoracofrenolumbotomy was performed in 392 patients, videolaparoscopic surgery - in 71. Expediency of laparoscopic surgery in line with open surgery is demonstrated.

  17. Hyperoxaluria and Bariatric Surgery

    Science.gov (United States)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  18. Oncoplastic breast surgery.

    Science.gov (United States)

    Pillarisetti, Raghu Ram; Querci Della Rovere, Guidubaldo

    2012-06-01

    Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.

  19. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  20. Annals of surgery

    National Research Council Canada - National Science Library

    Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...

  1. [Crohn's disease surgery].

    Science.gov (United States)

    Kala, Zdeněk; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel

    2014-01-01

    Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries.

  2. Contemporary endodontic surgery.

    Science.gov (United States)

    Rubinstein, Richard; Torabinejad, Mahmoud

    2004-06-01

    During the past decade, endodontics has seen a dramatic shift in the application of periradicular surgery and the role it plays in endodontic treatment. With the introduction of enhanced magnification, periradicular ultrasonics and other associative technologies, teeth that might otherwise be extracted now have a chance for retention. This article describes the role of these advances in contemporary endodontic surgery.

  3. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  4. Robust surgery loading

    NARCIS (Netherlands)

    Hans, Elias W.; Wullink, Gerhard; van Houdenhoven, Mark; Kazemier, Geert

    2008-01-01

    We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This

  5. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  6. Prehabilitation Before Major Surgery

    OpenAIRE

    Johnson Francis

    2018-01-01

    Prehabilitation is a new term for preoperative rehabilitation before major surgery. Some authors use the short form 'Prehab', though it is not so widely used. Prehabilitation involves measures to improve the physical, physiological, metabolic and psychosocial reserves in preparation for an elective surgery. This involves exercise, nutrition, education and psychosocial interventions.

  7. Annals of African Surgery

    African Journals Online (AJOL)

    The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...

  8. Economics of epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Venkatraman Sadanand

    2014-01-01

    Full Text Available Objective: Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery. Materials and Methods: A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making. Results: Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients. Conclusions: A process to collect data to quantify the parameters used in the decision analysis is hereby proposed.

  9. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this ... Editorial team. Related MedlinePlus Health Topics Plastic and Cosmetic Surgery Browse the Encyclopedia A.D.A.M., Inc. ...

  10. [Cognitive deterioration after surgery

    DEFF Research Database (Denmark)

    Steinmetz, J.; Rasmussen, L.S.

    2008-01-01

    Delirium and postoperative cognitive dysfunction are important and common complications after surgery. Risk factors are first of all increasing age and type of surgery, whereas the type of anaesthesia does not seem to play an important role. Mortality is higher among patients with cognitive...

  11. Bariatric surgery and fertility.

    Science.gov (United States)

    Shah, Divya K; Ginsburg, Elizabeth S

    2010-06-01

    Bariatric surgery is the most reliable way to sustain weight loss in the morbidly obese. Reproductive age women comprise the majority of bariatric patients, and many may be interested in conceiving after surgery. The purpose of this review is to synthesize the recent literature on bariatric surgery and fertility to assist providers in patient counseling. Obesity adversely impacts fecundability and IVF outcomes through a variety of mechanisms. The body of literature on reproductive outcome after bariatric surgery is sparse and of mixed quality. Bariatric surgery has been shown to improve menstrual cyclicity in anovulatory women, but little is published on the impact of surgical weight loss on spontaneous or IVF-treatment-related pregnancy rates. The increased risk of miscarriage in obese women may decline after bariatric surgery. There are currently insufficient data to support recommendations regarding the ideal timing for pregnancy after bariatric surgery. Obesity has been shown to adversely impact fertility, and weight loss is associated with significant improvement in many parameters of reproductive function. Further research is required as to the specific impact of surgical weight loss on pregnancy and miscarriage rates, as well as the optimal timing of pregnancy after bariatric surgery.

  12. Sinus surgery: optimal surgery, optimal outcome?

    NARCIS (Netherlands)

    Fokkens, Wytske J.

    2016-01-01

    Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness

  13. Revision endoscopic sinonasal surgery.

    Science.gov (United States)

    Cantillano, Pablo; Rubio, Fabián; Naser, Alfredo; Nazar, Rodolfo

    Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  14. Aortic valve surgery - minimally invasive

    Science.gov (United States)

    ... valve surgery. Techniques include min-thoracotomy, min-sternotomy, robot-assisted surgery, and percutaneous surgery. To perform the ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  15. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  16. Tests and visits before surgery

    Science.gov (United States)

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  17. Gamma knife surgery for craniopharyngioma

    International Nuclear Information System (INIS)

    Prasad, D.; Steiner, M.; Steiner, L.

    1995-01-01

    We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)

  18. Getting yourself healthy before surgery

    Science.gov (United States)

    ... 3 months after certain surgeries (joint replacement or heart valve surgery). So be sure to schedule your dental ... Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice . 20th ed. Philadelphia, ...

  19. Anesthesia for bariatric surgery.

    Science.gov (United States)

    Nishiyama, Tomoki; Kohno, Yumiko; Koishi, Keiko

    2012-02-01

    Bariatric surgery has a lot of problems in anesthesia. We retrospectively compared anesthesia for bariatric surgery in yellow race with that in normal weight patients. Twenty patients who received bariatric surgery and 20 normal body weight patients who received abdominal surgery in Japan were enrolled. Induction condition, depth of epidural space, dose of anesthetics, duration of the effects of muscle relaxants, ventilation, and fluid management in bariatric surgery were analyzed and compared with those in normal body weight patients. An epidural catheterization was successful under ultrasound guide in the bariatric group. The depth epidural space was significantly larger in the bariatric group. Cormack and Lehane classification and the number of intubation attempt were not different between the two groups, while one bariatric case was once awakened to intubate blindly. Pressure-controlled ventilation was used in the bariatric group. Four bariatric patients were continuously ventilated after surgery. The doses of anesthetics and fluid infusion rate were not different between the two groups when calculated by ideal body weight in the bariatric group. The duration of the effects of rocuronium and pancuronium were shorter in the bariatric group. For anesthesia of yellow race patients undergoing bariatric surgery, intravenous anesthetics and acetate Ringer's solution with 1% glucose could be administered per ideal body weight, the effects of muscle relaxants lasted shorter, pressure-controlled ventilation could keep oxygenation with adequate carbon dioxide, and ultrasound assist was useful in epidural catheterization in the bariatric patients.

  20. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. There have been some extraordinary accomplishments in that time, which have led to enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source that surveys surgery theory and its applications. Indeed, no one person could write such a survey. The sixtieth birthday of C. T. C. Wall, one of the leaders of the founding generation of surgery theory, provided an opportunity to rectify the situation and produce a

  1. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask

  2. Keratomycosis after cataract surgery.

    Science.gov (United States)

    Mendicute, J; Orbegozo, J; Ruiz, M; Sáiz, A; Eder, F; Aramberri, J

    2000-11-01

    To evaluate cases and results of keratomycosis that developed after cataract surgery. Hospital de Guipúzcoa, San Sebastián, Spain. This retrospective study comprised 8 patients who developed keratomycosis soon after cataract surgery. Culture analysis revealed 7 cases of Aspergillus fumigatus and 1 of Aspergillus flavus. After medical treatment with antifungal agents, 6 cases resolved and 2 required evisceration. The presence of fungi in corneal ulcers that develop after cataract surgery should be considered. Initiation of early treatment determines the prognosis. Among the therapeutic options, collagen shields soaked in amphotericin B may be effective.

  3. Single port laparoscopic surgery

    DEFF Research Database (Denmark)

    Springborg, Henrik; Istre, Olav

    2012-01-01

    potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...

  4. [Cosmetic surgery among Norwegian women].

    Science.gov (United States)

    von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar; Skolleborg, Knut Chr

    2004-07-01

    There are few data on the frequency of cosmetic surgery among Norwegian women. A random sample of 2000 Norwegian women aged 22 to 55 received a questionnaire on cosmetic surgery, demographic data, self-esteem, and to what extent people around them accepted cosmetic surgery. The response rate was 46% (907 women). Of these, 7.7% indicated that they had undergone cosmetic surgery, while 22.6% wished to do so. Other people's degree of acceptance predicted both the wish to undergo cosmetic surgery and already conducted surgery. Low self-esteem was correlated with a wish to undergo surgery, though women who had done surgery had no lower self-esteem than non-patients. Although the response rate was relatively low, this study gives the first reliable data on the frequency of cosmetic surgery in Norway. The results indicate that other people's degree of acceptance of cosmetic surgery is a predictor of such surgery being chosen.

  5. Repetitive endoscopic sinus surgery failure: a role for radical surgery?

    NARCIS (Netherlands)

    Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

    2006-01-01

    OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

  6. Cosmetic surgery: medicolegal considerations.

    Science.gov (United States)

    Piras, Mauro; Delbon, Paola; Conti, Adelaide; Graziano, Vincenzo; Capasso, Emanuele; Niola, Massimo; Bin, Paola

    2016-01-01

    Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB) was also analyzed. The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  7. [Pregnancy after bariatric surgery].

    Science.gov (United States)

    Tzur, Tamar; Sheiner, Eyal

    2011-06-01

    Recent research has put the spotlight on two different aspects of pregnancy after bariatric surgery: safety of the mother and fetus, and the procedure's effectiveness in preventing the complications surrounding reproduction and pregnancy often seen in the obese woman. To evaluate the pregnancy outcome foLlowing bariatric surgery. Although there are severaL reports documenting poor perinatal outcomes and late surgical complications during pregnancies subsequent to bariatric surgery, systematic studies have generaLLy not proven such an association. Pregnancy after bariatric surgery appears to be safe, and in general perinatal outcome is better when compared to pregnancies of obese women. Providers should be familiar with potential complications related to postoperative pregnancies and be prepared to provide appropriate interventions such as nutritional supplementation and band adjustment when necessary.

  8. Gastric Sleeve Surgery

    Science.gov (United States)

    ... regular exercise has family members who will provide emotional and practical support (like driving to every doctor's visit or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this ...

  9. Breast augmentation surgery

    Science.gov (United States)

    ... care - open Images Breast lift (mastopexy) - series Breast reduction (mammoplasty) - series Breast augmentation - series References Maxwell GP, Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013: ...

  10. Oophorectomy (Ovary Removal Surgery)

    Science.gov (United States)

    ... symptoms, such as hot flashes and vaginal dryness Depression or anxiety Heart disease Memory problems Decreased sex drive Osteoporosis Premature death Taking low doses of hormone replacement drugs after surgery and until about age ...

  11. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 1 (2014) >. Log in or Register to get access to full text downloads.

  12. [Pregnancy after bariatric surgery].

    Science.gov (United States)

    Pepe, Franco; DE Luca, Francesco; Stracquadanio, Mariagrazia; Garraffo, Claudia; Santonocito, Veronica C; Privitera, Agata

    2017-04-01

    Pregnancy after bariatric surgery has some peculiarities related to obesity, type of surgery, amount of weight loss, time elapsed from the surgery and adherence to medical prescriptions. Pregnant woman is at risk of nutritional deficiencies and it is unclear whether there is an increased incidence of intestinal complications during pregnancy after bariatric surgery and whether this kind of complications are more frequent during cesarean section. The fetus is at high risk of prematurity and fetal growth restriction, but they seem not at increased risk of birth defects (DTN) except in individual cases of folic acid deficiency (DTN) or vitamin K defect (similar abnormalities in patients receiving oral anticoagulants). In addition, the incidence of gestational diabetes and hypertension results to be decreased. Other postnatal outcomes from possible epigenetic modifications need to be evaluated in the long-term postnatal follow-up.

  13. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well- ... affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance ...

  14. Deep breathing after surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000440.htm Deep breathing after surgery To use the sharing features on ... way to do so is by doing deep breathing exercises. Deep breathing keeps your lungs well-inflated ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced ... make the lips meet without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) ...

  16. Art and Plastic Surgery.

    Science.gov (United States)

    Fernandes, Julio Wilson; Metka, Susanne

    2016-04-01

    The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  17. Blood donation before surgery

    Science.gov (United States)

    ... very safe, some people choose to use a method called autologous blood donation. Autologous blood is blood donated by you, which you later receive if you need a transfusion during or after surgery. You can have blood ...

  18. Nigerian Journal of Surgery

    African Journals Online (AJOL)

    Comparative efficacy of amoxicillin/clavulanic acid and levofloxacin in the reduction of postsurgical sequelae after third molar surgery: A randomized, double blind, clinical trial in a Nigerian University Teaching Hospital.

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and orthodontist understand that this is a long-term commitment for you and your family, and will ... face, mouth and jaw surgery Contact Us Sitemap Terms of Use Privacy Policy © Copyright AAOMS 2008-2018 ...

  20. Retrosternal thyroid surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007558.htm Retrosternal thyroid surgery To use the sharing features on this page, please enable JavaScript. The thyroid gland is normally located at the front of ...

  1. Surgery - Multiple Languages

    Science.gov (United States)

    ... 简体中文) Expand Section Biopsy - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Getting Your Skin Ready for Surgery - 简体中文 (Chinese, ...

  2. Heart Surgery - Multiple Languages

    Science.gov (United States)

    ... Coronary Artery Bypass Surgery - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Pacemaker - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF ...

  3. After Surgery - Multiple Languages

    Science.gov (United States)

    ... After Total Joint Replacement - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Home Care Instructions After Surgery - 简体中文 (Chinese, Simplified ( ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ ...

  5. Robotics in Colorectal Surgery.

    Science.gov (United States)

    Weaver, Allison; Steele, Scott

    2016-01-01

    Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.

  6. Blepharoplasty (Eyelid Surgery)

    Science.gov (United States)

    ... lid blepharoplasty is almost always done just for cosmetic reasons. Risks Possible risks of eyelid surgery include: Infection and bleeding Dry, irritated eyes Difficulty closing your eyes or other eyelid problems Noticeable scarring Injury to eye muscles Skin discoloration ...

  7. Alternative Refractive Surgery Procedures

    Science.gov (United States)

    ... the epithelial cells. Once the epithelial flap is created and moved aside, the procedure is the same ... Sites EyeWiki International Society of Refractive Surgery * Required * First Name: * Last Name: Member ID: * Phone Number: * Email: * ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do ... out more. Who We Are Find a Surgeon News Videos Contact Administration of Anesthesia Cleft Lip/Palate ...

  9. LASIK Eye Surgery

    Science.gov (United States)

    ... your eye. Overcorrections may be more difficult to fix than undercorrections. Astigmatism. Astigmatism can be caused by ... back into place. The flap usually heals without stitches. During the surgery, you'll be asked to ...

  10. Orthopaedics in day surgery

    African Journals Online (AJOL)

    emergency patients for a surgical procedure, returning home the same day (1). Ambulatory orthopaedics happens to have double meaning, so in this communication day surgery will be the preferred term. In Kenya the three models of day.

  11. Cosmetic surgery: medicolegal considerations

    Directory of Open Access Journals (Sweden)

    Piras Mauro

    2016-01-01

    Full Text Available Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  12. Breast Reduction Surgery

    Science.gov (United States)

    ... Breast reduction surgery might also help improve your self-image and your ability to participate in physical activities. ... under the breasts Nerve pain Restricted activity Poor self-image related to large breasts Difficulty fitting into bras ...

  13. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 1 (2011) >. Log in or Register to get access to full text downloads.

  14. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2018) >. Log in or Register to get access to full text downloads.

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  16. Expectations of Sinus Surgery

    Science.gov (United States)

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... reduce the pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...

  18. Shoulder surgery - discharge

    Science.gov (United States)

    ... repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder ... by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

  19. Endoscopic Sinus Surgery

    Science.gov (United States)

    ... vitamins, herbal remedies, and spices including vitamin E, garlic, ginger, gingko, and ginseng may increase the risk of bleeding. Some patients may be asked to take antibiotics and/or steroids prior to sinus surgery. This ...

  20. Bariatric Surgery for Obesity.

    Science.gov (United States)

    le Roux, Carel W; Heneghan, Helen M

    2018-01-01

    In this review, the authors discuss the indications for and the published outcomes of commonly performed bariatric procedures, including weight loss, perioperative morbidity and mortality, late complications, as well as the impact of bariatric surgery on comorbidities, cardiovascular risk, and mortality. They also briefly discuss the mechanisms by which bariatric/metabolic surgery causes such significant weight loss and health gain. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Is day surgery safe?

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Engbæk, J; Bartholdy, Jens

    2012-01-01

    Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....

  2. Robotics in General Surgery

    OpenAIRE

    Wall, James; Chandra, Venita; Krummel, Thomas

    2008-01-01

    In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

  3. Plastic surgery pitfalls.

    Science.gov (United States)

    Gorney, M

    1999-01-01

    As a founding member of the physician-owned insurance carrier The Doctors' Company, the author has reviewed many plastic surgery policy claims. In this article, he presents an overview of the plastic surgery procedures that produce the most severe losses. He then offers suggestions on how to proceed with these "medical malpractice favorites." The author discusses potential antitrust traps and legal recourse for plastic surgeons.

  4. Minimally Invasive Abdominal Surgery

    OpenAIRE

    Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C.

    2000-01-01

    In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have dem...

  5. Surgery for Acute Pancreatitis

    OpenAIRE

    Navadgi, Suresh; Pandanaboyana, Sanjay; Windsor, John A.

    2015-01-01

    Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the ...

  6. Day surgery in Bristol.

    Science.gov (United States)

    Carrington, S

    1993-02-01

    As in the rest of the United Kingdom, day surgery in Bristol is on the increase. In the Bristol Royal Infirmary day surgery unit (DSU) we treat approximately 3,500 patients a year. We have recently opened a second operating theatre. This has shifted the proportion of cases from our general theatres. This has also improved our case mix, less minor surgery under local anaesthetics, to more of the recommended 'basket type' surgery ie hernia repair, varicose vein surgery, excision of breast lumps etc. We have recently introduced an appointment booking system that is progressing. Such changes have to be introduced with good preparation, communication and a lot of diplomacy. I would like to outline the management aspects that help to expand and improve on the service we give, including patient selection and the appointment booking system we have introduced. I will describe how we drew up a policy involving the organisation of operation lists and staff involvement in day surgery management and accountability for patient care from admission through to discharge including our latest care plan. Finally I will outline the methods we have developed for evaluating the care we give.

  7. Innovations in robotic surgery.

    Science.gov (United States)

    Gettman, Matthew; Rivera, Marcelino

    2016-05-01

    Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.

  8. Metabolic surgery: quo vadis?

    Science.gov (United States)

    Ramos-Leví, Ana M; Rubio Herrera, Miguel A

    2014-01-01

    The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  9. Understanding Antegrade Colonic Enema (ACE) Surgery

    Science.gov (United States)

    ... Colonic Enema (ACE) Surgery Antegrade Colonic Enema (ACE) Surgery Antegrade colonic enema surgery (ACE) is a procedure ... Risks / Benefits What is antegrade colonic enema (ACE) surgery? Antegrade colonic enema surgery (ACE) or Malone antegrade ...

  10. Robotic Surgery for Thyroid Disease

    OpenAIRE

    Lee, Jandee; Chung, Woong Youn

    2013-01-01

    Robotic surgery is an innovation in thyroid surgery that may compensate for the drawbacks of conventional endoscopic surgery. A surgical robot provides strong advantages, including three-dimensional imaging, motion scaling, tremor elimination, and additional degrees of freedom. We review here recent adaptations, experience and applications of robotics in thyroid surgery. Robotic thyroid surgeries include thyroid lobectomy, total thyroidectomy, central compartment neck dissection, and radical ...

  11. Innovations in Bariatric Surgery.

    Science.gov (United States)

    Zhu, Catherine; Pryor, Aurora D

    2015-11-01

    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  12. Robotic surgery in gynecology.

    Science.gov (United States)

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  13. SURGERY AND CARDIOVASCULAR SURGERY JOURNALS ANALYSIS.

    Science.gov (United States)

    Schanaider, Alberto

    2015-01-01

    To analyze critically the effectiveness and value of bibliometric indicators in journals of Surgery or Cardiovacular Surgery in the context of the postgraduate programs of CAPES Medicine III. A sampling with 16 academic programs and one professional master of Medicine III, encompassing the General and Digestive System Surgery, Cardiovascular Surgery and Multidisciplinary courses with such contents, was evaluated. Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), and also Scielo databases were used. Only in seven programs, the teachers had an average of Qualis A1 articles greater than the others strata. Eleven journals in the surgical area are in stratum A1 (5%) and it reaches 25% in Cardiovascular Surgery. Among the six journals with the largest number of publications Qualis A1 in area Medicine III, five are from non-specific areas. The Acta Cirúrgica Brasileira represented 58% of the publications in the stratum A2. There are some obstacles in the Qualis classification with little uniformity among the Medicine areas I, II and III. A permanent committee should be set to update the Qualis, composed by the three medical areas. It should be considered using other index databases and the unification of the Qualis criteria for journals in medicine. Rating criteria of multi and transdisciplinary journals need to be reviewed. It is essential an institutional financial support for national journals chosen by peers aiming to provide a full computerization process and a professional reviewer of the English language, in order to increase the impact factor. Analisar criticamente a eficácia e valor de indicadores bibliométricos dos periódicos da Cirurgia e Cirurgia Cardiovascular no contexto dos Programas de Pós-Graduação da área Medicina III da CAPES. Foi avaliada uma amostragem com 16 programas acadêmicos e um mestrado profissional da área de Medicina III, compreendendo a Cirurgia Geral e do Aparelho Digestivo, a Cirurgia Cardiovascular e Cursos Multidisciplinares

  14. Viscoless microincision cataract surgery

    Directory of Open Access Journals (Sweden)

    Guy Sallet

    2008-06-01

    Full Text Available Guy SalletDepartment of Opthamology, Aalsters Stedelijk Ziekenhuis, BelgiumAbstract: A cataract surgery technique is described in which incisions, continuous circular capsulorhexis and hydrodissection are made without the use of any viscoelastics. Two small incisions are created through which the different parts of the procedure can take place, maintaining a stable anterior chamber under continuous irrigation. Subsequent bimanual phacoemulsification can be done through these microincisions. At the end of the procedure, an intraocular lens can be inserted through the self-sealing incision under continuous irrigation. 50 consecutive cataract patients were operated on without the use of viscoelastics and then compared with a group of 50 patients who had been helped with viscoelastics. No difference in outcome, endothelial cell count or pachymetry was noted between the two groups. No intraoperative complication was encountered. Viscoless cataract surgery was a safe procedure with potential advantages.Keywords: ophthalmic visco-surgical device, viscoless cataract surgery, microincision

  15. Recent advances in laparoscopic surgery.

    Science.gov (United States)

    Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen

    2013-02-01

    Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  16. Surgery in Amphibians.

    Science.gov (United States)

    Chai, Norin

    2016-01-01

    Amphibian surgery has been especially described in research. Since the last decade, interest for captive amphibians has increased, so have the indications for surgical intervention. Clinicians should not hesitate to advocate such manipulations. Amphibian surgeries have no overwhelming obstacles. These patients heal well and tolerate blood loss more than higher vertebrates. Most procedures described in reptiles (mostly lizards) can be undertaken in most amphibians if equipment can be matched to the patients' size. In general, the most difficult aspect would be the provision of adequate anesthesia. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. [Simulation in pediatric surgery].

    Science.gov (United States)

    Becmeur, François; Lacreuse, Isabelle; Soler, Luc

    2011-11-01

    Simulation in paediatric surgery is essential for educational, ethical, medicolegal and economic reasons, and is particularly important for rare procedures. There are three different levels of simulation:--simulation of basic techniques in order to learn or improve surgical skills (dissection, intracorporeal knots, etc.);--preparation for surgery using virtual reality, to perfect and test various procedures on a virtual patient, and to determine the best approaches for individual cases;--behavioral simulation underlines the importance of the preoperative check-list and facilitates crisis management (complications, conversion, etc.).

  18. Surgery in Spain.

    Science.gov (United States)

    Trias, M; Targarona, E M; Moral, A; Pera, C

    1998-02-01

    The Iberian Peninsula-the southwestern point of Europe, between the Mediterranean Sea and the Atlantic Ocean-was visited and settled in ancient times by a variety of peoples. Phoenicians, Carthaginians, Celts, Greeks, Romans, Visigoths, and Arabs all left their mark on the peninsula, and their cultures blended together to found, among other things, a rich tradition in medicine and surgery. During the Renaissance, the fluid exchange of technical skills and knowledge with the rest of Europe and the emergence of universities ensured the development of a high level of medical expertise. Today, surgery in Spain is at the forefront of innovations in the field.

  19. Standing equine dental surgery.

    Science.gov (United States)

    Menzies, Robert A; Easley, Jack

    2014-04-01

    Dental surgeries refer to procedures that affect the dental tissues or their supporting structures. With the development of specific, efficacious, and conservative treatments, morbidity risks have been lowered and chances of benefiting the health of equids improved. Advances in quality of sedation, analgesia, and locoregional anesthesia allow a majority of dental surgeries to be performed in the standing patient. This update focuses on an orthograde endodontic technique, a minimally invasive buccotomy technique, with the potential to combine it with a transbuccal screw extraction technique, and revisits the AO pinless external fixator for fractures of the body of the mandible. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    INTRODUCTION: In 2005 the National Board of Health (NBH) published guidelines on bariatric surgery in Denmark. The aim of the present study was to shed light on the national bariatric effort in relation to these guidelines. MATERIAL AND METHODS: The analysis is based on extraction of the following......, a tendency which was attributable to the activities of one of the private clinics. CONCLUSION: The frequency with which bariatric surgery is performed follows a strongly increasing trend and the procedures are only performed at the public departments selected by the National Board of Health...

  1. Female genital cosmetic surgery.

    Science.gov (United States)

    Shaw, Dorothy; Lefebvre, Guylaine; Bouchard, Celine; Shapiro, Jodi; Blake, Jennifer; Allen, Lisa; Cassell, Krista

    2013-12-01

    To provide Canadian gynaecologists with evidence-based direction for female genital cosmetic surgery in response to increasing requests for, and availability of, vaginal and vulvar surgeries that fall well outside the traditional realm of medically-indicated reconstructions. Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2011 and 2012 using appropriate controlled vocabulary and key words (female genital cosmetic surgery). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Recommendations 1. The obstetrician and gynaecologist should play an important role in helping women to understand their anatomy and to respect individual variations. (III-A) 2. For women who present with requests for vaginal cosmetic procedures, a complete medical, sexual, and gynaecologic history should be obtained and the absence of any major sexual or psychological dysfunction should be ascertained. Any possibility of coercion or exploitation should be ruled out. (III-B) 3. Counselling should be a priority for women requesting female genital cosmetic surgery. Topics should include normal variation and physiological changes over the lifespan, as well as the possibility of unintended consequences of cosmetic surgery to the genital area. The lack of evidence regarding outcomes and the lack of data on the

  2. Epiretinal membrane surgery

    DEFF Research Database (Denmark)

    Hamoudi, Hassan; Correll Christensen, Ulrik; La Cour, Morten

    2017-01-01

    and subsequent pars plana vitrectomy (PPV) (CAT group), (2) PPV and subsequent cataract surgery (VIT group) or (3) phaco-vitrectomy (COMBI group). Examinations were at baseline, one month after each surgery, and at 3 months and 12 months of follow-up. Primary outcome was the RE (the difference between predicted...... and achieved spherical equivalent); secondary outcomes were best-corrected visual acuity (BCVA), and incidence of cystoid macular oedema (CME) defined as >10% increment of central subfield macular thickness (CSMT). Results: Sixty-two eyes were enrolled. The mean RE showed a small myopic shift of -0.36D in all...

  3. Cosmetic Surgery Training in Plastic Surgery Residency Programs

    Directory of Open Access Journals (Sweden)

    Colton H. L. McNichols, MD

    2017-09-01

    Conclusions:. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find ... Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to appropriately administer local ...

  5. Aortic valve surgery - open

    Science.gov (United States)

    ... while you are connected to this machine. This machine does the work of your heart while your heart is stopped. If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve ...

  6. Plastic Surgery: Tackling Misconceptions

    African Journals Online (AJOL)

    will succeed. First impressions tend to last, and if young people's first impression of plastic surgeons is that they spend much of their time doing cosmetic surgery then this is a first impression that might be long ... Res 2014;4 Suppl S3:169‑70. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI:.

  7. Plastic Surgery: Tackling Misconceptions

    African Journals Online (AJOL)

    Misconceptions. Dear Sir,. Denadai and Raposo-Amaral have presented an interesting account of undergraduate plastic surgery education and the challenges associated with it.[1] They have outlined a comprehensive program to ensure that medical students get a much deeper understanding of the activities of plastic ...

  8. Gastric bypass surgery

    Science.gov (United States)

    ... Buchwald H, ed. Buchwald's Atlas of Metabolic and Bariatric Surgical Techniques and Procedures . Philadelphia, PA: Elsevier Saunders; 2012:chap 5. Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients ...

  9. Heart bypass surgery

    Science.gov (United States)

    ... from the hospital. The day before your surgery: Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. Make sure that you dry ...

  10. Mitral valve surgery - open

    Science.gov (United States)

    ... return. The day before your surgery, take a shower and wash your hair. You may need to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may need to ...

  11. Ghrelin and Metabolic Surgery

    Directory of Open Access Journals (Sweden)

    Dimitrios J. Pournaras

    2010-01-01

    Full Text Available Metabolic surgery is the most effective treatment for morbid obesity. Ghrelin has been implicated to play a role in the success of these procedures. Furthermore, these operations have been used to study the gut-brain axis. This article explores this interaction, reviewing the available data on changes in ghrelin levels after different surgical procedures.

  12. Bariatric Surgery and Hypertension.

    Science.gov (United States)

    Owen, Jonathan G; Yazdi, Farshid; Reisin, Efrain

    2017-12-08

    Obesity continues to increase in prevalence worldwide. Hypertension has long been associated with obesity, and weight loss continues to be a first-line therapy in the treatment of hypertension. Lifestyle modification and pharmacologic therapy, however, often meet with treatment failure. Bariatric surgery continues to be the most successful approach to sustained weight loss. This review focuses on the underlying physiologic mechanisms of obesity-hypertension, and the impact of bariatric surgery on the treatment of hypertension. Current available literature on the physiologic mechanisms of obesity-hypertension, and the major trials, meta-analyses and systematic reviews of the impact of bariatric surgery procedures on hypertension are reviewed. Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures. Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric Banding. Though long-term control of hypertension following surgery remains a concern, available follow-up post-operative data of up to 10 years suggests a sustained, if lessened, effect on hypertension control over time. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Robotics in gynecologic surgery.

    Science.gov (United States)

    Frick, A C; Falcone, T

    2009-06-01

    Robotic surgery has evolved from an investigational surgical approach to a clinically useful adjunct in multiple surgical specialties over the past decade. Advocates of robotic-assisted gynecologic surgery revere the system's wristed instrumentation, ergonomic positioning, and three-dimensional high-definition vision system as significant improvements over laparoscopic equipment's four degrees of freedom and two-dimensional laparoscope that demand the surgeon stand throughout a procedure. The cost, lack of haptic feedback, and the bulky size of the equipment make robotics less attractive to others. Studies evaluating outcomes in robotic-assisted gynecologic surgery are limited. Multiple small retrospective studies demonstrate the safety and feasibility of robotic hysterectomy. With increased surgeon experience, operative times are similar to, or shorter than, laparoscopic cases. Robotic assistance can facilitate suturing in laparoscopic myomectomies, and is associated with decreased blood loss and a shorter hospital stay, although may require longer operative times. Robotic assistance has also been applied to multiple procedures in the subspecialties of infertility, urogynecology and gynecologic oncology with good success and relatively low morbidity. However, further research is warranted to better evaluate the relative benefits and costs of robotic assisted gynecologic surgery.

  14. Scoliosis surgery - child

    Science.gov (United States)

    ... from getting worse. But, when they no longer work, the child's health care provider will recommend surgery. There are ... urinate. Your child's stomach and bowels may not work for a few days ... Your child may need to receive fluids and nutrition through ...

  15. Nigerian Journal of Surgery

    African Journals Online (AJOL)

    The Nigerian Journal of Surgery publishes original articles, special articles (by invitation), reviews, case reports, correspondences and notes. Materials cited for publication will include scientific research papers read at the meetings of the Nigerian Surgical Research Society, and of the Association of Surgeons of Nigeria and ...

  16. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. ... Nonconventionalmesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant · EMAIL FREE FULL TEXT EMAIL FREE FULL ...

  17. Surgery for adrenal tumors

    International Nuclear Information System (INIS)

    Salamah, S.M.

    2002-01-01

    Objective: To analyze the presentation, localization, pathology, surgical management and outcome of surgery for adrenal gland tumors. Design: Prospective clinico epidemiological study. Place and Duration of Study: The study was conducted at the Department of General Surgery, University Unit, Riyadh medical Complex Kingdom of Saudi Rabia from June, 1991 to may, 2001. Subjects and Methods: A total of 21 cases with adrenal tumors were studied for demographic data, clinical presentation, diagnostic workup, localization, surgical management, pathology and outcome. The outcome of these patients was followed prospectively. Results: The study included 12 female and 9 male patients. The mean age at surgery was 36.7 years. Hypertension (69.%) was the commonest presentation in hypersecretory functional tumors. The localization accuracy for ultrasonography, computerized tomography, MRI and MIBG scan was 95.2%, 98.3% 87.8% and 83.6% respectively. Pheochromocytoma was the most common adrenal pathology observed in 14 (66.6%) cases. The overall morbidity was 19% with no hospital mortality. Complete follow-up of available 19 patients (90.5 %) revealed no tumor recurrence and persistent hypertension in 14.3% cases. Conclusion: surgery on adrenal glands is safe in experienced hands and is recommended in institutes with all backup facilities. (author)

  18. COMPUTERS IN SURGERY

    African Journals Online (AJOL)

    BODE

    to keep abreast of the rapidly changing trends in surgical fields. What are the legal implications of on- line referrals, treatment via telemedicine, surgical decisions following video-conferencing? In robot- assisted remote surgery and telemedicine, is the consulted or remote doctor bound by the licensing regulations of the ...

  19. Robotic endovascular surgery.

    Science.gov (United States)

    Au, Stephanie; Ko, Koel; Tsang, Josephine; Chan, Yiu Che

    2014-01-01

    The purpose of this review is to compare conventional endovascular procedures and the robotic endovascular approach in aortic aneurysm repair. Despite advantages over open surgery, conventional endovascular surgery has limitations. To develop an alternative, efforts have been focused on robotic endovascular systems. Two of the 3 studies comparing procedure times demonstrated reduced procedure time in the robotic group, by 6 times (p robotic procedures reduced fluoroscopic exposure time by 12 minute (p robotic surgery was reduced up to 10 times (p robotic performance score showed a better performance score in the robotic endovascular group (p = 0.007). These results demonstrate that the robotic technique has multiple advantages over the conventional procedure, including improved catheter stability, a shorter learning curve, reduced procedure time, and better performance in cannulating tortuous vessels. However, robotic endovascular technology may be limited by the cost of the system, the size of the catheter, and the setup time required preoperatively. Further comparative studies between conventional and robotic approaches regarding cost-effectiveness, safety, and performance in cases involving complex anatomy and fenestrated stent grafts are essential. Nevertheless, this revolutionary technology is increasingly popular and may be the next milestone in endovascular surgery.

  20. Advances in trauma surgery

    African Journals Online (AJOL)

    2007-07-19

    Jul 19, 2007 ... to be fully conscious within 48 hours, then a CT of the whole cervical spine is required to exclude any cervical spine injury. Surgical management of penetrating neck injuries. The patient presenting to the emergency room with massive bleeding from a penetrating neck injury requires haemostatic surgery.

  1. [DRG and gastrointestinal surgery].

    Science.gov (United States)

    Leardi, S; Altilia, F; Pietroletti, R; Risetti, A; Schietroma, M; Simi, M

    1999-01-01

    The diagnosis-related-groups (DRG) is the cost-based system for hospital reimbursement. However, the proceeds does not coincide with the costs. Aim of the study was to identify the profit, which we could gained with 147, 155, 158, 162, 165, 198 gastrointestinal surgery DRG. 30 consecutive patients, undergone to surgery in Clinica Chirurgica of L'Aquila University, had been studied. We had calculated the daily costs of medical and nursing practice, diagnostic tests, drugs, hospitalization, surgical instruments for every patient's therapy. The DRG-proceeds had been correlated with the DRG-costs. The "major gastrointestinal surgery" had not profit (147 DRG: anterior resection of rectum = -354428 Pounds, Miles = -94020 Pounds; 155 DRG: total gastrectomy = -1920641 Pounds). On the contrary, "minimal surgery" had good profits (158 DRG: hemorroidectomy with local anestesia = 1469605 Pounds;162 DRG: sutureless groin hernioplasty = 1561200 Pounds; 198 DRG: videolaparochole-cystectomy: 1208807 Pounds). The study seems to demonstrate the disparity of the reimbursement system related to DRG. However, the surgeons, as managers, must employ warily the resources for producing DRG.

  2. [Health education. Heart surgery].

    Science.gov (United States)

    Iriarte Roteta, Andrea; Wilson-Barnett, Jenifer; Narvaiza, M Jesús

    2003-06-01

    By means of a literature review of nursing articles, the authors aim to evaluate the importance of educational programmes before and after cardiac surgery, to assess the advantages and drawbacks of these programmes and to evaluate the need for following-up patients and their carers after being discharged from hospital. Health Education and cardiac surgery: Delivering information following cardiac surgery is an essential task, not only to achieve a behavioural change and the development of patients' self-care attitudes but also to reduce their anxiety. It is also essential to educate family members as they are the most importance source of physical and emotional support following surgery. Issues about in-hospital teaching programmes: Despite the numerous benefits of in-hospital teaching programmes, the actual tendency to shorten hospitalisation length in association with the high levels of anxiety, impede patients and carers' learning. Some studies suggest that these educational programmes have not completely achieved the task of preparing patients and their families to face the early recovery. Education during the early recovery: The authors highlight those studies that have focused on patients and their carers' needs for information following discharge from hospital. Results from these studies show the need for following-up patients and their carers at this period. Educational programmes can extent and reinforce the information provided at hospital.

  3. Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

    Science.gov (United States)

    Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

    Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. ROBOTIC SURGERY: BIOETHICAL ASPECTS.

    Science.gov (United States)

    Siqueira-Batista, Rodrigo; Souza, Camila Ribeiro; Maia, Polyana Mendes; Siqueira, Sávio Lana

    2016-01-01

    The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. To present review of the ethical aspects of robot use in surgery. Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients. A utilização de robôs em procedimentos cirúrgicos tem sido cada vez mais frequente na atualidade, o que permite a emergência de inúmeras questões bioéticas nesse âmbito. Apresentar revisão sobre os aspectos éticos dos usos de robôs em cirurgia. Realizou-se revisão nas bases de dados Pubmed, SciELO e Lilacs cruzando-se os descritores "bioética", "cirurgia", "ética", "laparoscopia" e "robótica". Do total de citações obtidas, selecionou-se 17 artigos, os quais foram utilizados para a elaboração do artigo. Ele contém breve apresentação sobre a robótica, sua inserção na saúde e os aspectos bioéticos da utilização dos robôs em procedimentos cirúrgicos. A cirurgia robótica é uma realidade, hoje, em muitas unidades hospitalares, o que torna essencial a reflexão bioética sobre as relações entre profissionais da saúde, autômatos e pacientes.

  5. Nanotechnology in plastic surgery.

    Science.gov (United States)

    Ibrahim, Ahmed M S; Gerstle, Theodore L; Rabie, Amr N; Song, Yong-Ak; Melik, Rohat; Han, Jongyoon; Lin, Samuel J

    2012-12-01

    Nanotechnology has made inroads over time within surgery and medicine. Translational medical devices and therapies based on nanotechnology are being developed and put into practice. In plastic surgery, it is anticipated that this new technology may be instrumental in the future. Microelectromechanical systems are one form of nanotechnology that offers the ability to develop miniaturized implants for use in the treatment of numerous clinical conditions. The authors summarize their published preliminary findings regarding a microelectromechanical systems-based electrochemical stimulation method through modulation of ions around the nerve that is potentially implantable and clinically efficacious, and expand upon current and potential usages of nanotechnology in plastic surgery. Sciatic nerves (n = 100) of 50 American bullfrogs were placed on a microfabricated planar gold electrode array and stimulated electrically. Using Ca(2+)-selective membranes, ion concentrations were modulated around the nerve environment in situ. In addition, a comprehensive review of the literature was performed to identify all available data pertaining to the use of nanotechnology in medicine. A 40 percent reduction of the electrical threshold value was observed using the Ca(2+) ion-selective membrane. The uses of nanotechnology specifically applicable to plastic surgery are detailed. Nanotechnology may likely lead to advancements in the art and science of plastic surgery. Using microelectromechanical systems nanotechnology, the authors have demonstrated a novel means of modulating the activation of nerve impulses. These findings have potentially significant implications for the design of special nano-enhanced materials that can be used to promote healing, control infection, restore function, and aid nerve regeneration and rehabilitation.

  6. Congenital heart defect - corrective surgery

    Science.gov (United States)

    ... up and over time, cause medical problems and arrhythmias. Sometimes, an ASD can be closed without open- ... surgery. The surgery may be done in the newborn period if the infant has severe symptoms. If ...

  7. Cancer Surgery: Physically Removing Cancer

    Science.gov (United States)

    ... 30, 2017. Townsend CM Jr, et al. Emerging technology in surgery: Informatics, robotics, electronics. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, Pa.: Elsevier; 2017. ...

  8. Infant open heart surgery (image)

    Science.gov (United States)

    During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia. ... During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia.

  9. Preventing Wrong-Site Surgery in Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Assael, Leon A

    2017-05-01

    This article discusses the risk for wrong-site surgery in oral and maxillofacial surgery and the development and utility of checklists. The intent of checklists and the specific applicability of each of them to ambulatory oral and maxillofacial surgery are presented. Checklists and other considerations to mitigate the risk of wrong-site surgery are evaluated. The role of interprofessional teams in improving patient care outcomes with the checklist as a vehicle is evaluated. Recommendations for the use of checklists and related methods in the ambulatory oral and maxillofacial surgery setting are made. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Nigerian Journal of Plastic Surgery

    African Journals Online (AJOL)

    The Nigerian Journal of Plastic Surgery has its objectives in publishing original articles about developments in all areas related to plastic and reconstructive surgery as well as to trauma surgery. It also serves as a means of providing a forum for correspondence, information and discussion. It also accepts review articles that ...

  11. Visual Outcome of Cataract Surgery

    African Journals Online (AJOL)

    non-governmental organization (Amen Foundation) to commence a free cataract surgery programme in January. 2008. Since its inception, the patient turnout for cataract surgery has increased. The World Health Organization (WHO) categorizes the outcome of cataract surgeries into 3 groups: good (visual acuity of 6/ 6-6/ ...

  12. Robot-assisted endoscopic surgery

    NARCIS (Netherlands)

    Ruurda, J.P.

    2003-01-01

    During the last three years, robot-assisted surgery systems are increasingly being applied in endoscopic surgery. They were introduced with the objective to overcome the challenges of standard endoscopic surgery. With the improvements in manipulation and visualisation that robotic-assistance offers,

  13. HYPOTHYROIDISM FOLLOWING THYROID SURGERY

    Directory of Open Access Journals (Sweden)

    M. Lankarani

    2008-06-01

    Full Text Available Postsurgical hypothyroidism and its incidence has not been fully investigated. In this study, the incidence of hypothyroidism and its possible risk factors at Shariati Hospital was assessed. One hundred and two patients with benign thyroid diseases, who had undergone thyroidectomy, were investigated with regards to thyroid function profile during period of one year after the operation every three months with post-operative sample as the baseline. Hypothyroidism was developed in 36 patients (35.2% on average 5 ± 3.2 months after surgery. Factors such as increased age, operation type, histopathologic type, underlying disease, lymphocytic infiltration and use of levothyroxine before surgery were associated with the increased incidence of hypothyroidism. It seems that use of indicators such as Graves' disease and lymphocytic infiltration in pathologic specimens should be helpful in projecting the potential occurrence of hypothyroidism in patients undergoing thyroidectomy.

  14. Robotic mitral valve surgery.

    Science.gov (United States)

    Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2003-12-01

    A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for

  15. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    INTRODUCTION: In 2005 the National Board of Health (NBH) published guidelines on bariatric surgery in Denmark. The aim of the present study was to shed light on the national bariatric effort in relation to these guidelines. MATERIAL AND METHODS: The analysis is based on extraction of the following......, a tendency which was attributable to the activities of one of the private clinics. CONCLUSION: The frequency with which bariatric surgery is performed follows a strongly increasing trend and the procedures are only performed at the public departments selected by the National Board of Health...... data from the National Patient Registry in the period from 2005 through 2007: annual number of operations, type of operation, laparoscopic versus open procedure. Furthermore, the centres were compared. RESULTS: A total of 2,098 bariatric procedures were performed in the years 2005 to 2007. Apart from...

  16. [Cataract surgery in children].

    Science.gov (United States)

    Pavlović, S

    2000-01-01

    Cataract extraction in children has improved and became more popular over the past few decades but, due to particular features of children's eyes, still remains controversial--especially regarding the intraocular lens implantation. In contrast to adults, indications for cataract surgery in children are much more difficult to determine. Since subjective visual acuity cannot be obtained, greater reliance must be placed on the morphology and location of the lens opacity, and the behavior of the child. Forced preferential looking and visual evoked potentials can be helpful, but they should not be the only criteria. In management of pediatric cataract, correction of postoperative aphakia is still an incompletely resolved problem. Conventionally, optical correction is achieved by spectacles or contact lenses. The power of both spectacles and contact lenses can be readily adjusted to compensate for ocular growth. The success of both depends significantly on parental compliance and the child's acceptance. Hutchinson reported that 44% children with aphakia stopped wearing glasses or contact lenses 2 months after surgery. Contact lens wearing can also result in a number of corneal complications, including infectious keratitis, corneal vascularization and hypoxic corneal ulceration. IOL implantation is theoretically superior to glasses and contact lenses since it provides almost immediate optical correction which is much more reliable because it does not depend on parental or child's compliance. Still, there are many controversies about IOL implantation in infants and young children like IOL-size, material, IOL power calculation, prevention and management of secondary cataract, as well as long term safety of IOLs in children's eyes. Although short-term anatomic results after cataract extraction and primary IOL implantation in children are excellent and stable, long-term follow-up is necessary to answer questions about the long-term safety of implants in children's eyes. A

  17. Surgery of the Trachea

    Directory of Open Access Journals (Sweden)

    Mark S. Allen

    2015-08-01

    Full Text Available Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique.

  18. Pregnancy and bariatric surgery.

    Science.gov (United States)

    Mahawar, Kamal K

    2017-12-01

    A large number of women experience pregnancy after bariatric surgery. The purpose of this review was to understand the evidence base in this area to come up with practical, evidence-based recommendations. We examined PubMed for all published articles on pregnancy in patients who have previously undergone a bariatric surgery. There is an increasing body of evidence pointing towards a beneficial effect of weight loss induced by bariatric surgery on female and male fertility prompting calls for recognition of infertility as a qualifying co-morbidity for patients between the Body Mass Index of 35.0 kg/m2 and 40.0 kg/m2. Women in childbearing age group should be routinely offered contraceptive advice after bariatric surgery and advised to avoid pregnancy until their weight has stabilized. Until more focused studies are available, the advice to wait for 12 months or 2 months after the weight loss has stabilized, whichever is latter, seems reasonable. Patients should be advised to seek clearance from their bariatric teams prior to conception and looked after by a multi-disciplinary team of women health professionals, bariatric surgeons, and dietitians during pregnancy. The main objective of care is to ensure adequate nutritional state to allow for a satisfactory weight gain and fetal growth. There is a relative lack of studies and complete lack of Level 1 evidence to inform practice in this area. This review summarizes current literature and makes a number of practical suggestions for routine care of these women while we develop evidence to better inform future practice.

  19. Nanotechnology in Thoracic Surgery*

    Science.gov (United States)

    Schulz, Morgan D.; Khullar, Onkar; Frangioni, John V.; Grinstaff, Mark W.; Colson, Yolonda L.

    2011-01-01

    Nanotechnology is an exciting and rapidly progressive field offering potential solutions to multiple challenges in the diagnosis and treatment of lung cancer, with the potential for improving imaging and mapping techniques, drug delivery and ablative therapy. With promising preclinical results in many applications directly applicable to thoracic oncology, it is possible that the frontiers of minimally invasive thoracic surgery will eventually be explored on a nanoscale. PMID:20494008

  20. Cell response to surgery.

    LENUS (Irish Health Repository)

    Ni Choileain, Niamh

    2012-02-03

    OBJECTIVES: To describe the profound alterations in host immunity that are produced by major surgery as demonstrated by experimental and clinical studies, and to evaluate the benefits of therapeutic strategies aimed at attenuating perioperative immune dysfunction. DATA SOURCES: A review of the English-language literature was conducted, incorporating searches of the MEDLINE, EMBASE, and Cochrane collaboration databases to identify laboratory and clinical studies investigating the cellular response to surgery. STUDY SELECTION: Original articles and case reports describing immune dysfunction secondary to surgical trauma were included. DATA EXTRACTION: The results were compiled to show outcomes of different studies and were compared. DATA SYNTHESIS: Current evidence indicates that the early systemic inflammatory response syndrome observed after major surgery that is characterized by proinflammatory cytokine release, microcirculatory disturbance, and cell-mediated immune dysfunction is followed by a compensatory anti-inflammatory response syndrome, which predisposes the patient to opportunistic infection, multiple organ dysfunction syndrome, and death. Because there are currently no effective treatment options for multiple organ dysfunction syndrome, measures to prevent its onset should be initiated at an early stage. Accumulating experimental evidence suggests that targeted therapeutic strategies involving immunomodulatory agents such as interferon gamma, granulocyte colony-stimulating factor, the prostaglandin E(2) antagonist, indomethacin, and pentoxifylline may be used for the treatment of systemic inflammatory response syndrome to prevent the onset of multiple organ dysfunction syndrome. CONCLUSIONS: Surgical trauma produces profound immunological dysfunction. Therapeutic strategies directed at restoring immune homeostasis should aim to redress the physiological proinflammatory-anti-inflammatory cell imbalance associated with major surgery.

  1. Epilepsy surgery in children

    OpenAIRE

    Sita Jayalakshmi; Sudhindra Vooturi; Swapan Gupta; Manas Panigrahi

    2017-01-01

    Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In approximately 15% of these patients, the seizures are not adequately controlled with anticonvulsive drugs, and such patients are potential candidates for surgical treatment and majority are children. Epilepsy surgery in children, who have been carefully chosen, can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-third of children with intractable seizures. In...

  2. Ambulatory paediatric surgery

    African Journals Online (AJOL)

    Urology: Dental surgery: 1. Please be in ... Ward/Clinic at *7.00 a.m.r9.30 a.m.. 2. If you cannot bring your child, please telephone to make a new appointment. 3. If your child has a cold, ... Please do not give your child medicines containing aspirin for 2 weeks before ... Extraction/filling of teeth under general .. anaesthetic in ...

  3. Pregnancy following bariatric surgery.

    Science.gov (United States)

    Woodard, Carla B

    2004-01-01

    Gastric bypass surgery for morbid obesity is considered an appropriate intervention when other weight-loss measures have proven unsuccessful. Weight loss often brings about improvement in overall health by lessening the effects of obesity-related comorbidities such as chronic hypertension and diabetes. In fact, the ability to become pregnant is enhanced, as weight loss often allows for a normalization of sex hormones. However, the nutrition challenges brought about by the surgery may have a profound impact on maternal health and pregnancy outcome. Surgical procedures for morbid obesity may be classified according to the digestive aftereffects brought about by the particular procedure. These categories include the "restrictive" procedures, "restrictive-malabsorptive" procedures, and the less common "malabsorptive" procedures. Deficiencies in iron, vitamin B12, folate, and calcium can result in maternal complications, such as severe anemia, and in fetal complications, such as neural tube defect, intrauterine growth restriction, and failure to thrive. Nutrient supplementation following bariatric surgery and close supervision before, during, and after pregnancy can help prevent nutrition-related complications and improve maternal and fetal health.

  4. Robotic assisted andrological surgery

    Science.gov (United States)

    Parekattil, Sijo J; Gudeloglu, Ahmet

    2013-01-01

    The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE). PMID:23241637

  5. Art and epilepsy surgery.

    Science.gov (United States)

    Ladino, Lady Diana; Hunter, Gary; Téllez-Zenteno, José Francisco

    2013-10-01

    The impact of health and disease has led many artists to depict these themes for thousands of years. Specifically, epilepsy has been the subject of many famous works, likely because of the dramatic and misunderstood nature of the clinical presentation. It often evokes religious and even mythical processes. Epilepsy surgical treatment has revolutionized the care of selected patients and is a relatively recent advance. Epilepsy surgery has been depicted in very few artistic works. The first portrait showing a potential surgical treatment for patients with epilepsy was painted in the 12th century. During the Renaissance, Bosch famously provided artistic commentary on traditional beliefs in "The stone of madness". Several of these works demonstrate a surgeon extracting a stone from a patient's head, at one time believed to be the source of all "folly", including epileptic seizures, psychosis, intellectual disability, depression, and a variety of other illnesses. There are some contemporary art pieces including themes around epilepsy surgery, all of them depicting ancient Inca Empire procedures such as trepanning. This article reviews the most relevant artistic works related with epilepsy surgery and also its historical context at the time the work was produced. We also present a painting from the Mexican artist Eduardo Urbano Merino that represents the patient's journey through refractory epilepsy, investigations, and ultimately recovery. Through this work, the artist intends to communicate hope and reassurance to patients going through this difficult process. © 2013.

  6. Robotic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Jean eBouquet De Jolinière

    2016-05-01

    Full Text Available Abstract Minimally invasive surgery (MIS can be considered as the greatest surgical innovation over the past thirty years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D monitor reduction in-depth perception, camera instability, limited range of motion and steep learning curves. The surgeon has a low force feedback which allows simple gestures, respect for tissues and more effective treatment of complications.Since 1980s several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon's skills, achieve accuracy and high precision during complex surgery and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three- dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

  7. Gamma surgery for hemangiopericytomas

    International Nuclear Information System (INIS)

    Payne, B.R.; Prasad, D.; Steiner, M.; Steiner, L.

    2000-01-01

    A retrospective analysis of a consecutive series of 12 patients with 15 intracranial hemangiopericytomas treated at the University of Virginia using gamma surgery is presented. Clinical and radiographic follow up of 3 to 56 months is available for 10 patients with 12 tumors. There was one tumor present at the time of initial gamma surgery in each patient. Two new tumors occurred in patients previously treated. Nine of the tumors decreased in volume and three remained stable. Four of the nine tumors that shrank later progressed at an average of 22 months after treatment. Of the tumors that decreased in volume and have not progressed, the response has been for an average of 11 months. The follow-up for two tumors that remained unchanged was 10 and 34 months (average 22 months). A third tumor was unchanged at 42 months but the patient died of new disease adjacent to the treated area in the anterior skull base. There were no complications and the quality of life following the procedure was maintained or improved in every case. Gamma surgery is effective in palliating the patients by decreasing tumor volume and delaying recurrence. (author)

  8. Nutritional considerations after bariatric surgery.

    Science.gov (United States)

    Elliot, Kelly

    2003-01-01

    Malnutrition is a risk that is associated with all bariatric surgeries. Malnutrition is largely preventable after these surgeries if proper patient selection, thorough preoperative nutrition education, and postoperative nutritional follow-up take place along with patient compliance. Bariatric surgery is divided into 2 major categories: restrictive or malabsorptive (with or without the restrictive aspect). The more dramatic weight loss is generally associated with procedures that are malabsorptive in nature. There is an increased risk of specific nutritional deficiencies associated with these surgeries. With proper supplementation these deficiencies are largely avoidable. This article reviews the more common bariatric surgeries and the nutritional considerations associated specifically with each surgery. The article then summarizes the typical diet advancement schedule and reviews critical care nutrition in regards to total parenteral nutrition administration for the morbidly obese individual, following bariatric surgery.

  9. Bariatric surgery insurance requirements independently predict surgery dropout.

    Science.gov (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

    2017-05-01

    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  10. SEBACEOUS CYSTS MINOR SURGERY

    Directory of Open Access Journals (Sweden)

    I Gusti Ayu Agung Laksemi

    2013-12-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Minor surgery is small surgery or localized example cut ulcers and boils, cyst excision, and suturing. Somethings that need to be considered in the preparation of the surgery is minor tools, operating rooms and operating tables, lighting, maintenance of tools and equipment, sterilization and desinfection equipment, preparation of patients and anesthesia. In general cysts is walled chamber that consist of fluid, cells and the remaining cells. Cysts are formed not due to inflammation although then be inflamed. Lining of the cysts wall is composed of fibrous tissue and usually coated epithelial cells or endothelial. Cysts formed by dilated glands and closed channels, glands, blood vessels, lymph channels or layers of the epidermis. Contents of the cysts wall consists of the results is serum, lymph, sweat sebum, epithelial cells, the stratum corneum, and hair. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  11. Military surgery in Rwanda.

    Science.gov (United States)

    Farrow, G B; Rosenfeld, J V; Crozier, J A; Wheatley, P; Warfe, P

    1997-10-01

    In April of 1994, a vicious civil was erupted in Rwanda, with more than 500,000 people massacred by extremist militias. The second United Nations Assistance Mission in Rwanda (UNAMIR II) deployed in August 1994 to monitor the ceasefire, with an Australian Defence Force Contingent of Health Service Support consisting of staff for the UNAMIR Head-quarters, and the Australian Medical Support Force (AS MSF). A retrospective audit was conducted of all operative surgery performed during the year-long deployment, in the AS MSF operating theatres. Twenty surgeons rotated through in 6-week intervals. A total of 750 operations were performed on 547 patients, of which 636 (84.8%) involved civilians. A total of 558 (74.4%) cases were the result of trauma both accidental (38.4%) and war related (36%). The mean age of patients was 21.7 years. The age distribution was skewed, with 289 (38.5%) cases being performed on children. General surgeons performed a wide range of surgery, covering the majority of surgical specialties. These included cardiothoracic, neurosurgical, vascular and paediatric cases. Orthopaedic surgeons dealt with amputations, debridements and skin grafting in addition to bony injuries and infections. Children formed a substantial number of those treated, and required surgery for war-related injuries significantly more often than adults. Surgeons involved in future peacekeeping missions should be aware of the broad variety of clinical problems encountered, and undertake refresher training in the sub-specialties. Children are at great risk of violence in war, and if a civilization can be judged by the protection it affords its helpless, the Rwandan genocide and ensuing civil war represents a horrific example of the opposite extreme.

  12. Antifibrinolytics in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Achal Dhir

    2013-01-01

    Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

  13. Workplace Bullying in Surgery.

    Science.gov (United States)

    Ling, Mary; Young, Christopher J; Shepherd, Heather L; Mak, Cindy; Saw, Robyn P M

    2016-11-01

    The aim of this study was to determine the extent and nature of workplace bullying among General Surgery trainees and consultants in Australia. An online questionnaire survey of General Surgery trainees and consultant surgeons in Australia was conducted between March and May 2012. Prevalence of bullying was measured using both a definition of workplace bullying and the revised Negative Acts Questionnaire (NAQ-R). Sources of bullying were also examined, as well as the barriers and outcomes of formal reporting of bullying. The response rate was 34 % (370/1084) with 41 % (n = 152) of respondents being trainees. Overall, 47 % (n = 173) of respondents reported having been bullied to some degree and 68 % (n = 250) reported having witnessed bullying of surgical colleagues in the last 12 months. The prevalence of bullying was significantly higher in trainees and females, with 64 % of trainees and 57 % of females experiencing some degree of bullying. The majority of respondents (83 %) had experienced at least one negative behavior in the last 12 months, but 38 % experienced at least one negative behavior on a weekly or daily basis. The persistent negative behaviors that represent work-related bullying most commonly experienced were 'having opinions ignored' and 'being exposed to an unmanageable workload.' Consultant surgeons were the most common source of bullying for both trainees and consultants, with administration the next common source. Of those who reported being bullied, only 18 % (n = 32) made a formal complaint. Despite increased awareness and interventions, workplace bullying remains a significant problem within General Surgery in Australia. The findings in this study serve as a baseline for future questionnaires to monitor the effectiveness of implemented anti-bullying interventions.

  14. Cosmetic Surgery Training in Plastic Surgery Residency Programs.

    Science.gov (United States)

    McNichols, Colton H L; Diaconu, Silviu; Alfadil, Sara; Woodall, Jhade; Grant, Michael; Lifchez, Scott; Nam, Arthur; Rasko, Yvonne

    2017-09-01

    Over the past decade, plastic surgery programs have continued to evolve with the addition of 1 year of training, increase in the minimum number of required aesthetic cases, and the gradual replacement of independent positions with integrated ones. To evaluate the impact of these changes on aesthetic training, a survey was sent to residents and program directors. A 37 question survey was sent to plastic surgery residents at all Accreditation Council for Graduate Medical Education-approved plastic surgery training programs in the United States. A 13 question survey was sent to the program directors at the same institutions. Both surveys were analyzed to determine the duration of training and comfort level with cosmetic procedures. Eighty-three residents (10%) and 11 program directors (11%) completed the survey. Ninety-four percentage of residents had a dedicated cosmetic surgery rotation (an increase from 68% in 2015) in addition to a resident cosmetic clinic. Twenty percentage of senior residents felt they would need an aesthetic surgery fellowship to practice cosmetic surgery compared with 31% in 2015. Integrated chief residents were more comfortable performing cosmetic surgery cases compared with independent chief residents. Senior residents continue to have poor confidence with facial aesthetic and body contouring procedures. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.

  15. [Robotics in pediatric surgery].

    Science.gov (United States)

    Camps, J I

    2011-10-01

    Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.

  16. [Temporomandibular joint disc surgery].

    Science.gov (United States)

    Potier, J; Maes, J-M; Nicot, R; Dumousseau, T; Cotelle, M; Ferri, J

    2016-09-01

    Temporomandibular joint (TMJ) disorders are a common disease and may be responsible for major functional and painful repercussions. Treatment is not consensual. The literature highlights the role of conservative treatments (physiotherapy, analgesics, splints) in a first attempt. Minimally invasive surgical techniques (arthroscopy, arthrocentesis) have developed rapidly in recent decades. They have proven effective and reliable, especially in patients suffering from irreducible or reducible anterior disc dislocation or presenting with arthopathies. The goal of our work was to make an update about disk surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Revisional Bariatric Surgery.

    Science.gov (United States)

    Switzer, Noah J; Karmali, Shahzeer; Gill, Richdeep S; Sherman, Vadim

    2016-08-01

    Revisional bariatric procedures are increasingly common. With more primary procedures being performed to manage severe obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  19. Surgery and transfusion

    Directory of Open Access Journals (Sweden)

    C.O. Ramos-Peñafiel

    2016-04-01

    Full Text Available Even though blood transfusion saves thousands of lives worldwide, it causes complications in some patients, and must therefore be correctly administered. As there is no universally accepted consensus on blood transfusion in surgical patients, we have reviewed the latest studies and gathered the best available evidence on blood management strategies. In this study, we discuss indicators for transfusion of erythrocytes and other blood products, haemostatic agents for cardiothoracic and orthopaedic interventions where it is imperative to regulate blood loss, and alternatives in specific situations such as Jehovah's Witnesses patients. Finally, we put forward an algorithm for the preoperative management of surgery patients with low haemoglobin levels.

  20. Oncoplastic breast surgery in Asia

    Directory of Open Access Journals (Sweden)

    Ava Kwong

    2017-02-01

    Full Text Available Oncoplastic breast conservation surgery has given a new light to the options of performing breast conserving surgery by combining oncological principles of breast cancer surgery with plastic surgery techniques. The ultimate oncoplastic achievement would be the conversion of what normally would be considered as an oncologic and/or cosmetic failure when using standard techniques of breast conserving surgery into both oncological and cosmetic success and to avoid mastectomy where possible. Most Techniques are fairly well established. However surgical techniques may also need to be adjusted based on the cohorts that the treatment is offered to. For example, for larger breasts, the technique is more forgiving. However for smaller breast, there is still a limitation of the cosmetic outcome when a high percentage of breast volume has been excised no matter how good the technique or the surgeon is. Various aspects of oncoplastic breast surgery technique will be discussed and its applicability to Asian Cohorts.

  1. Laparoscopic surgery in colorectal cancer

    International Nuclear Information System (INIS)

    Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro

    2011-01-01

    In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen

  2. Robotic Surgery in Gynecologic Oncology

    Science.gov (United States)

    DeBernardo, Robert; Starks, David; Barker, Nichole; Armstrong, Amy; Kunos, Charles A.

    2011-01-01

    Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management. PMID:22190946

  3. Surgery-first accelerated orthognathic surgery: orthodontic guidelines and setup for model surgery.

    Science.gov (United States)

    Liou, Eric J W; Chen, Po-Hsung; Wang, Yu-Chih; Yu, Chung-Chih; Huang, C S; Chen, Yu-Ray

    2011-03-01

    The surgery-first approach indicates that the orthognathic surgery precedes the orthodontic treatment, whereas the orthodontics-first approach indicates that the orthodontic treatment precedes the orthognathic surgery. The conventional approach is an orthodontics-first approach. The purposes of this article are to introduce the concept of the surgery-first approach and to report the guidelines for orthodontic management and model surgery without presurgical orthodontic decompensation. The surgery-first approach treats facial esthetics first and then occlusion, whereas the conventional approach treats occlusion first and then facial esthetics. The surgery-first approach uses osteotomy to solve both skeletal problems and dental compensation, and a "transitional" occlusion is set up postoperatively. Orthodontics in the surgery-first approach is a postoperatively adjunctive treatment to transfigure the transitional occlusion into the solid final occlusion. The advantages of the surgery-first approach are that 1) the patient's chief complaint, dental function, and facial esthetics are achieved and improved in the beginning of the treatment; 2) the entire treatment period is shortened to 1 to 1.5 years or fewer depending on the complexity of orthodontic treatment; and 3) the phenomenon of postoperatively accelerated orthodontic tooth movement reduces the difficulty and treatment time of orthodontic management in the surgery-first approach. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Oncoplastic breast surgery in Denmark

    DEFF Research Database (Denmark)

    Klit, Anders; Henriksen, Trine Foged; Siersen, Hans Erik

    2014-01-01

    With improved survival rates after breast cancer treatment, more attention is drawn to improve the cosmetic outcome after surgical treatment of breast cancer. In this process the oncoplastic breast surgery was conceived. It supplements the traditional surgical treatments (mastectomy and breast...... conserving surgery) with increased focus on individualized therapy. The ambition is to obtain the best possible cosmetic outcome without compromising recurrence rates and survival. This article provides an overview of the current oncoplastic breast surgery treatment offered in Denmark....

  5. Computed tomography, after abdominal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Vogel, H.; Toedt, H.C.

    1985-09-01

    The CT-examinations of 131 patients were analyzed after abdominal surgery. After nephrectomy, splenectomy, partial hepatectomy and pancreatectomy a displacement of the neighbouring intraabdominal and retroperitoneal organs was seen. Scar-tissue was observed containing fat, which faciltated the differential diagnosis to tumor recurrency. The changes of the roentgenmorphology were not so obvious after gastrointestinal surgery. After vascular surgery the permeability of an anastomosis or an operated artery could be demonstrated by bolus injection. (orig.).

  6. Computed tomography, after abdominal surgery

    International Nuclear Information System (INIS)

    Vogel, H.; Toedt, H.C.; Hamburg Univ.

    1985-01-01

    The CT-examinations of 131 patients were analyzed after abdominal surgery. After nephrectomy, splenectomy, partial hepatectomy and pancreatectomy a displacement of the neighbouring intraabdominal and retroperitoneal organs was seen. Scar-tissue was observed containing fat, which fascilated the differentialdiagnosis to tumorrecurrency. The changes of the roentgenmorphology were not so abvious after gastro-intestinal surgery. After vascular surgery the permeability of an anastomosis or an operated artery could be demonstrated by bolusinjection. (orig.) [de

  7. New Trends in General Surgery

    OpenAIRE

    Bautista Iturrizaga, Juan

    2014-01-01

    Currently, with the advance of science, more and more basic disciplines are associated with surgery exerting some influence and giving rise to the concept of Medical-Surgical Science. Besides that, surgery has evolved in paralel with immunology (in the field of transplants), interventional radiology and diagnostic-therapeutic endoscopy. Indeed, many of changes in surgery, such as the use of new diagnostic tools, approaches with shorter incisions, and the colaboration -still in an evaluative p...

  8. Parathyroid transplantation in thyroid surgery

    OpenAIRE

    Barczyński, Marcin; Gołkowski, Filip; Nawrot, Ireneusz

    2017-01-01

    Permanent hypoparathyroidism following thyroid surgery is rare. Its prevalence is reported to be below 1–2% if surgery is performed by experienced thyroid surgeons. Parathyroid identification and preservation in situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands are damaged, autotransplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: (I) fresh ...

  9. Surgery for psychiatric disorders.

    Science.gov (United States)

    Cosgrove, G R

    2000-10-01

    The modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.

  10. Eye Surgery Light

    Science.gov (United States)

    1978-01-01

    During eye surgery, the surgeon uses an illuminating instrument called an opthalmoscope for close examination of the retina or the interior of the eye. Ordinarily, electric power for the head-mounted light is supplied through a cord from an overhead swivel arm or a floor pedestal. Within limits of cord length and swivel arm movement, the surgeon has considerable freedom of motion. But when more than one opthalmoscope is involved, tangling and interference of the power cords becomes a problem. St. Luke's Hospital, Cleveland, Ohio asked Lewis Research Center for assistance in finding a solution. Lewis responded with a battery-powered system that totally frees the surgeon of attached cords and swivels. Borrowing from space technology, Lewis used small, lightweight nickel-cadmium batteries that can deliver high intensity light for an hour and can be recharged overnight. The Opthalmoscope Powerpack consists of eight batteries in three containers affixed to a webbed belt, and a novel on-off switch equipped with a springloaded plexiglass "flapper." The belt pack is worn underneath the surgical gown and the flapper permits the doctor to activate the switch by elbow pressure. Lewis built five units and they have been in service at St. Luke's Hospital for a year. Used for routine examinations as well as for surgery, they have demonstrated excellent reliability.

  11. [Cosmetic eyelid surgery].

    Science.gov (United States)

    Ruban, J-M; Barbier, J; Malet, T; Baggio, E

    2014-01-01

    Cosmetic eyelid surgery is becoming increasingly popular. It can rejuvenate the patient's appearance with relatively minor side effects. Its risk/benefit ratio is one of the best in facial cosmetic surgery. However, the patient does not always accurately assess the aesthetic appearance of his or her eyelids. This underscores the importance of clinical examination in order to determine the patient's wishes, and then make an accurate diagnosis and potential surgical plan. We currently oppose, in general, surgical techniques involving tissue removal (skin-muscle and/or fat) in favor of those involving tissue repositioning and grafting (autologous fat pearl transposition, obtained by liposuction, and lipostructure). Furthermore, the place of adjuvant therapies to blepharoplasty is steadily increasing. They mainly include surface treatments (peels and lasers), dermal fillers and anti-wrinkle botulinum toxin injections. They are also increasingly used in isolation in novel ways. In all cases, a perfect knowledge of anatomy and relevant skills and experience remain necessary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Female cosmetic genital surgery.

    Science.gov (United States)

    Goodman, Michael P

    2009-01-01

    Genital plastic surgery for women has come under scrutiny and has been the topic of discussion in the news media, online, and in medical editorials. In the absence of measurable standards of care, lack of evidence-based outcome norms, and little standardization either in nomenclature or training requirements, concern has been raised by both ethicists and specialty organizations.Some women request alteration of their vulvas and vaginas for reasons of cosmesis, increasing self-esteem, and improving sexual function. Patients must be assured their surgeon is properly trained and should understand that few validated long-term safety or outcome data are presently available in this relatively new field. Women also should be made aware that, although they may wish to cosmetically or physically alter their external genitalia, this does not mean that they are developmentally or structurally "abnormal." It is important that training guidelines for practitioners be established and that long-term outcome, psychosexual, and safety data be published. The genital plastic surgeon must have sufficient training in sexual medicine to withhold these procedures from women with sexual dysfunction, mental impairment, or body dysmorphic disorder. In an atmosphere in which trademarked marketing terms are becoming part of the lexicon, a more descriptive terminology is suggested, incorporating the terms "labiaplasty," "reduction of clitoral hood," "perineoplasty," "hymenoplasty," and "vaginoplasty." The term "female cosmetic genital surgery" is presented as a descriptive umbrella encompassing these genital plastic procedures.

  13. Bariatric metabolic surgery.

    Science.gov (United States)

    Scopinaro, N

    2014-08-01

    According to the WHO, the worldwide prevalence of obesity body mass index (BMI) 30 kg/m² nearly doubled between 1980 and 2008, with 10% of men and 14% of women and a total of more than half a billion adults (aged >20 years old) being classed as obese. At least 2.8 million people die each year worldwide as a result of being overweight or obese, usually from the inevitable related comorbidities. It has been reported that approximately 65% of the worlds population inhabits countries where overweight and obesity are responsible for higher mortality than underweight. The recently published Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery note that despite the WHO stating that excess weight is considered the fifth leading risk for deaths worldwide, it has not yet been possible to successfully curb the obesity epidemic. Moreover, severe obesity (BMI>35 kg/m²) represents a rapidly growing segment of the epidemic in which the negative effects on health and disability are especially marked. Excess weight drastically elevates a persons risk of developing a number of non-communicable diseases, such as diabetes, hypertension, stroke, dyslipidaemia, sleep apnoea, cancer, non-alcoholic steatohepatitis, and other serious comorbidities. The WHO emphasises that 44% of type 2 diabetes mellitus, 23% of ischaemic heart disease and around 741% of certain cancers are attributable to overweight and obesity. In the majority of European countries, overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of cases of ischaemic heart disease and 55% of cases of hypertensive disease among adults. Additionally, a range of debilitating conditions such as osteoarthritis, respiratory difficulties, gallbladder disease, infertility, and psychosocial problems, among others, which lead to reduced life expectancy, quality of life and disability, are extremely costly in terms of both absence from work and use of health resources. Noteworthy, the

  14. How Is Adrenal Surgery Performed?

    Science.gov (United States)

    ... Frequently Asked Questions Office visit worksheet ALSO SEE: NEUROENDOCRINE SYSTEM PARATHYROID GLANDS THYROID GLANDS How is adrenal surgery performed? This document is available in ... Parathyroid Glands | Thyroid Gland

  15. Surgery Risk Assessment (SRA) Database

    Data.gov (United States)

    Department of Veterans Affairs — The Surgery Risk Assessment (SRA) database is part of the VA Surgical Quality Improvement Program (VASQIP). This database contains assessments of selected surgical...

  16. Additional Surgery after Breast-Conserving Surgery Varies Widely

    Science.gov (United States)

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  17. Clinical trials in Surgery | Mwachaka | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 11, No 2 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Clinical trials in Surgery. P Mwachaka, JWM Kigera. Abstract.

  18. Oncoplastic surgery: pushing the limits of breast-conserving surgery.

    Science.gov (United States)

    Clough, Krishna B; Benyahi, Djazia; Nos, Claude; Charles, Caroline; Sarfati, Isabelle

    2015-01-01

    In recent decades, the surgical management of breast cancer has steadily and considerably improved. Mutilating procedures have given way to more individualized surgical approaches aiming to preserve the breast as much as possible. For large tumors, preoperative chemotherapy is a major tool, but emerging oncoplastic surgery techniques are also a new approach in the armamentarium of breast cancer surgery, as a third option between conventional breast-conserving surgery and mastectomy. As this new treatment modality allows wider margin excision, it reduces the need for re-excision procedures and possibly increases breast conservation rates by extending the indications of breast-conserving surgery. This review will provide an overview of current practices and clinical data available to date on oncoplastic surgery. © 2015 Wiley Periodicals, Inc.

  19. Surgery in India.

    Science.gov (United States)

    Mukerjee, S; Gupta, T

    1997-06-01

    Surgical practice in India is mostly managed by the central and state governments and is totally government financed, offering free medical aid. However, with the economic growth and affluence of the middle-class population in urban areas, more and more hospitals, nursing homes, and clinics managed by the private sector are arising in cities and towns. Privately owned hospitals are built and managed by large industrial houses and trusts. It is essential, according to government directives, for these hospitals to have certain numbers of general beds that will provide for the economically weaker sections of the population. Medical insurance is popular amongst the urban population; in addition to well-established insurance companies, many new medical service reimbursement organizations are forming. Surgical care standards are uniformly high in the larger teaching institutions and hospitals run by the private sector in major cities in India, in which superspecialty surgical care that meets worldwide standards is available in addition to general surgical care. These hospitals are manned by surgeons holding master's degrees in general surgery, superspecialties, and subspecialties. In the hospitals and dispensaries in rural areas, only basic surgical facilities are available; for major surgical procedures, the patients are referred to the closest urban hospitals. Therefore, the government of India is placing more and more emphasis on building hospitals that offer better surgical facilities away from the cities and towns. A diploma course in surgery is run by the National Board of Surgery, and these diplomates are encouraged to practice more in rural areas and small hospitals. Economic constraints and the population explosion are the biggest hurdles to progress in surgical care, teaching, and research activities. With the advancement in education and growth of the economy, more and more multinationals are walking into the field of medical care, which is proving to be a

  20. Bariatric surgery patients: reasons to visit emergency department after surgery.

    Science.gov (United States)

    Gonzalez-Sánchez, Juan A; Corujo-Vázquez, Omar; Sahai-Hernández, Mrisa

    2007-01-01

    Morbid obesity prevalence is reaching epidemic proportions in Western society. Long-term weight loss can be achieved by bariatric surgery. This surgery also has a positive impact in the reduction of obesity related co-morbid conditions. The purpose of this study is to determine the reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery. A retrospective chart review study was performed at the UPR Hospital in Carolina. Patients with the diagnosis of morbid obesity who had bariatric surgery were identified. Of the 283 patients who met the criteria, the following information was obtained: gender, age, height, weight, pre-operative BMI, obesity-related comorbid conditions, post operative length of stay (LOS), and reasons and length of stay of Emergency Department (ED) visits within a 3 month period after surgery. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) Program. The same profile of gender and BMI was obtained between the population that had the surgery and the sample that visited the ED, the group of patients between 20-29 years old was more likely to visit the ED. No correlation was found between a longer post operative length of stay and an increased probability of visiting the ED. Of the population, 5% had to visit ED within a three month period. The most common post operative complications were: Abdominal Pain (46.2%), Emesis (38.5%), and Dehydration (30.8%). Other less frequent complications were nausea, DVT, pneumonia, dizziness, gastritis, infected wound and upper GI bleeding. The most common reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery were: abdominal pain, emesis, dehydration and nausea. These complications could most likely be attributed to patient poor compliance with diet, resulting in the classical symptoms of the dumping syndrome which is common in patients that have undergone

  1. Urogenital Reconstructive Surgery

    DEFF Research Database (Denmark)

    Jakobsen, Lotte Kaasgaard

    Urogenital reconstructive surgery Lotte Kaasgaard Jakobsen1 Professor Henning Olsen1 Overlæge Gitte Hvistendahl1 Professor Karl-Erik Andersson2 1 – Dept. of Urology, Aarhus University Hospital 2 – Dept. of Gynecology and Obstetrics, Aarhus University hospital Background: Congenital obstruction...... 3, and intermittent unloading by urethrostomy in group 4. Group 2 will not be unloaded and serve as continously obstructed controls, whilst group 1 serves as sham-operated, non-obstructed controls. Urodynamic assessment will be performed and samples of urine, blood and bladder tissue...... or intermittent means, we hope to make it easier to choose which treatment to offer the patients. By establishing a solid animal model of congenital infravesical obstruction, we expect to make way for development of better treatments of a rare, but serious condition....

  2. Smartphones in Surgery

    Directory of Open Access Journals (Sweden)

    Ara A. Salibian

    2011-01-01

    Full Text Available Smartphones have the capability of enhancing many aspects of the continuum of surgical care by providing an efficient means of multimedia communication among surgeons and healthcare personnel. The ability for mobile Internet and email access, along with features such as built-in cameras and video calling, allow surgeons to rapidly access, send and receive patient information without being restricted by issues of connectivity. Smartphones create an unrestricted network of data sharing, improving the flexibility of patient consultation, timeliness of preoperative preparation, efficiency of post-operative care and the effectiveness of a surgical team. Furthermore, smartphones provide mobile access to a multitude of surgical resources to bolster continued surgical education. This article presents a review of the current literature on the utilizations of smartphones in surgery, discusses their benefits and limitations, and addresses the possibility of incorporating smartphones into the protocol of surgical care.

  3. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail: raulmorelli@hotmail.com

    2005-01-01

    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  4. Apparatus for stereotactic surgery

    International Nuclear Information System (INIS)

    Koslow, M.A.M.

    1982-01-01

    Apparatus for stereotactic surgery consisting of a probe and a computerized tomographic scanning system is described. The scanning system comprises a display and means for reconstructing cross-sectional images on the display using data from partial circumferential scans of source and detectors. It operates on the data with an algorithm that provides the difference between the local values of the linear attenuation coefficient and average of these values within a circle centered at each reconstruction point. The scanning system includes a means of maintaining the frames of reference of the probe and scanning system rigid with respect to one another. The position of the probe, which may be a cryogenic probe, with respect to the actual anatomical structure of the body, particularly a human head, may thus be viewed by the surgeon. (author)

  5. [Functional endoscopic sinus surgery].

    Science.gov (United States)

    Han, D M

    1992-01-01

    Eighty-two cases of functional endoscopic sinus surgery were analyzed. It include 62 males and 20 females; the oldest was 72 years of age and the youngest eight years of age. A hard endoscope with a diameter of 4mm and the CCD micro-videorecorder produced by Circon and Olympus Company were used. Operations were done under general anesthesia in all cases. Twenty-three cases (28.1%) recovered in one stage and recovery was delayed in 28 cases (34.2%); late inflammation occurred in 23 cases (28.1%); 8 cases failed (9.8%). The cure rate was 62.2%. Two cases (2.4%) had operative complications namely injury to the lamina papyracea and anterior ethmoidal artery, all recovered uneventfully.

  6. [Andreas Vesalius and surgery].

    Science.gov (United States)

    Van Hee, R

    1993-01-01

    By publishing De Humani Corporis Fabrica Libri Septem in 1543, Andries van Wesel (1514-1564) gave surgical science an immense impulse. The revolutionary renovation in the knowledge of man's anatomical structure changed slowly and progressively into topographical and physiological understanding of surgical diseases. At the same time, this made better aimed and more secure operations possible. Apart from the importance of this anatomical publication, Andreas Vesalius also won his spurs as a surgeon. He taught surgery in Padua for many years. He was appointed court physician and surgeon at the Habsburg Court of Charles V and Philip II. He personally performed lots of operations known at the time as major ones. He not only quickly adopted the surgical innovations of his fellow-surgeon Ambroise Paré, but he even performed operations that had been forgotten during several centuries, among which thoracocentesis for pleural empyema. His clinical perspicacity in discovering the indication for some operations was staggering and was appreciated by all great monarchs of Europe in the 16th century. In his several consilia, numerous pieces of advice were given for the treatment of surgical patients. The surgical practice which Vesalius had in Brussels for many years, consequently became most successful. Many publications by Vesalius about surgery and blood-letting are well-known. His Chirurgia magna in septem Libros digesta still remains controversial; these books were published by Prospero Borgarruccio (1560) in 1568 by the Venetian editor Valgrisi. This book gives an excellent survey of surgical pathology as it was taught and treated in the 16th century. The scientific method that Vesalius used, not only in his anatomical studies but also in his surgical practice, deserves not only our full appraisal but should still be studied in our own time.

  7. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T

    2012-01-01

    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  8. Endoscopy and surgery for obesity

    International Nuclear Information System (INIS)

    Mejia, Andres Felipe; Unigarro, Ivan; Bolanos, Eduardo; Chaux, Carlos Felipe

    2006-01-01

    Actually bariatric surgery appears to be a secure, feasible and durable option for patients with morbid obesity. Most of the complications that arise from bariatric surgery can be solved with the use of endoscopy avoiding the morbidity and mortality of a surgical intervention. This group of patients has become a challenge for the endoscopist and favours the development of interventional endoscopy

  9. Robotic Surgery by G Watanabe

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    Robotic Surgery is the next big innovation after Minimally Invasive. Surgery. Emerging within a generation of each other, the two have synergized to show the way to the future, where soft advantages like patient comfort and convenience and surgeon ergonomics meld seamlessly with hard considerations like safety,.

  10. Nursing Care in Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Emine Aydin

    2014-02-01

    Full Text Available Obesity is caused by increased amounts of fatty tissue in the body and increasingly common serious health problem. The prevalence of obesity is increasing in all age groups throughout the world. This increase in the rate of obesity increases the incidence of obesity-related chronic diseases. In this respect, obesity is considered a risk factor for the chronic diseases. People who are more than 30 Body Mass Index called as obese and people who are over 40 called morbidly obese. Bariatric surgery is an effective treatment providing in permanent weight loosing for obesity. Bariatric surgery techniques are applied as three different types. These techniques include; limit food intake, reduce nutrient absorption (malabsorption, and restricting food intake and malabsorption surgeries. In bariatric surgery, patient care is becoming increasingly important at before and after surgery due to the presence of concomitant diseases in obese patients. During this period, there are special nursing practices which include reducing the risks in the care of patients who are candidates for bariatric surgery, preventing the development of complications and supplying the recovery from illness as soon as possible. In this article nursing care of obese patients before and after surgery is to be discussed. In addition, bariatric surgery, complications and difficulties in live patients are to be examined [TAF Prev Med Bull 2014; 13(1.000: 77-82

  11. Archives: Nigerian Journal of Surgery

    African Journals Online (AJOL)

    Items 1 - 16 of 16 ... Archives: Nigerian Journal of Surgery. Journal Home > Archives: Nigerian Journal of Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 16 of 16 Items ...

  12. Archives: Annals of African Surgery

    African Journals Online (AJOL)

    Items 1 - 19 of 19 ... Archives: Annals of African Surgery. Journal Home > Archives: Annals of African Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 19 of 19 Items. 2017 ...

  13. Socioeconomic outcome of epilepsy surgery

    DEFF Research Database (Denmark)

    Jennum, Poul; Sabers, Anne; Christensen, Jakob

    2016-01-01

    after surgery. The surgical intervention had no significant effects on social status in terms of occupation and educational level. CONCLUSION: Although epilepsy surgery was followed by a reduction in inpatient and outpatient health care use, medication and use of accident and emergency facilities...

  14. Archives: Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Items 1 - 32 of 32 ... Archives: Annals of Pediatric Surgery. Journal Home > Archives: Annals of Pediatric Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 32 of 32 Items ...

  15. Gastrointestinal Surgery of Neuroendocrine Neoplasms

    DEFF Research Database (Denmark)

    Hansen, Carsten Palnæs; Olsen, Ingrid Marie Holst; Knigge, Ulrich

    2015-01-01

    Surgery is the only treatment that may cure the patient with gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) and should always be considered as the first-line treatment if radical resection can be achieved. Even in cases where radical surgery is not possible, palliative resection may...

  16. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

    Full Text Available The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom′s Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK, FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc. redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System ® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist ® . It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.

  17. Virtual reality and laparoscopic surgery.

    Science.gov (United States)

    Coleman, J; Nduka, C C; Darzi, A

    1994-12-01

    The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.

  18. South African Journal of Surgery

    African Journals Online (AJOL)

    The South African Journal of Surgery is published by the South African Medical Association and publishes papers related to surgery. Other websites related to this journal: http://www.sajs.org.za/index.php/sajs. Vol 56, No 1 (2018). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access ...

  19. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  20. Neurological Complications of Bariatric Surgery.

    Science.gov (United States)

    Goodman, Jerry Clay

    2015-12-01

    Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke's encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential.

  1. The future of glaucoma surgery

    Directory of Open Access Journals (Sweden)

    Arsham Sheybani

    2015-01-01

    Full Text Available Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

  2. Oncoplastic breast surgery: comprehensive review.

    Science.gov (United States)

    Bertozzi, N; Pesce, M; Santi, P L; Raposio, E

    2017-06-01

    Breast cancer is the most common female cancer in Western populations, affecting 12.5% of women, with 1.38 million patients per year. Breast-conserving surgery followed by postoperative radiotherapy replaced the radical and modified-radical procedures of Halsted and Patey as the standard of care for early-stage breast cancer once the overall and disease-free survival rates of breast-conserving surgery were demonstrated to be equivalent to those of mastectomy. However, excision of >20% of breast tissue, low or centrally located cancer, and large-sized breasts with various grades of breast ptosis, result a in unacceptable cosmetic outcomes. Oncoplastic breast surgery evolved from the breast-conserving surgery by broadening its general indication to achieve wider excision margins without compromising on the cosmetic outcomes. Thus, oncoplastic breast surgery can be defined as a tumor-specific immediate breast reconstruction method that applies aesthetically derived breast reduction techniques to the field of breast cancer surgery and allows for higher volume excision with no aesthetic compromise. However, contralateral breast symmetrization should be regarded as an intrinsic component of the oncoplastic surgery. The main procedures involved are volume-displacement or volume-replacement techniques, which depend on breast size and cancer size/location. Volume-displacement or reshaping procedures apply the plastic surgery principles to transpose a dermo-glandular flap of breast tissue into the defect site, while volume-replacement techniques use autologous tissues to replace the volume loss that follows tumor resection. Furthermore, these procedures are more complex and time-consuming than those involved in breast-conserving surgery. Based on current literature, the authors analyze the different techniques and indications of the oncoplastic breast surgery, determining its complication rate, in order to help both surgeons and their patients in the decision-making stage of

  3. Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift.

    Science.gov (United States)

    Bartlett, Erica L; Zavlin, Dmitry; Friedman, Jeffrey D; Abdollahi, Aariane; Rappaport, Norman H

    2017-12-14

    With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P reduction in fatigue/drowsiness on POD 0 and 1 (P plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  4. Weight Loss Surgery: An Option for Teens?

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Weight Loss Surgery: An Option for Teens? Page Content Article ... operation should not be made hastily. Candidates for Weight Loss Surgery Weight loss surgery is advisable only for ...

  5. What's It Like to Have Surgery?

    Science.gov (United States)

    ... Search English Español What's It Like to Have Surgery? KidsHealth / For Teens / What's It Like to Have ... and blood tests, before your surgery begins. Before Surgery Before your operation takes place, you and your ...

  6. Chapter 12: Surgery for sinonasal disease.

    Science.gov (United States)

    Higgins, Thomas S; Lane, Andrew P

    2013-01-01

    Surgery for chronic rhinosinusitis is an effective complement to a well-designed medical regimen. Functional endoscopic sinus surgery is among the most common surgeries performed for sinonasal disease refractory to maximal medical therapy. Nasal surgery techniques, such as septoplasty and inferior turbinate surgery, may assist in both relieving the symptom of nasal obstruction and providing access for sinus surgery. Although rare, open sinus techniques are occasionally required.

  7. Bariatric Surgery and Precision Nutrition

    Directory of Open Access Journals (Sweden)

    Carolina F. Nicoletti

    2017-09-01

    Full Text Available This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient’s genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance.

  8. Approach to Rectal Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Terence C. Chua

    2012-01-01

    Full Text Available Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

  9. Bariatric Surgery and Precision Nutrition.

    Science.gov (United States)

    Nicoletti, Carolina F; Cortes-Oliveira, Cristiana; Pinhel, Marcela A S; Nonino, Carla B

    2017-09-06

    This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient's genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance.

  10. Depression, Obesity and Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Andreia Lopes

    2018-01-01

    Full Text Available Background:  Overweight is an increasing problem worldwide. Data from  2008 show that, in Portugal, 60% of the adult population was overweight and 25% was obese. The relation between mood disorders and obesity is well known and about 2/3 of those who search for bariatric surgery have a psychiatric diagnosis, being depression the most common. Aims: We reviewed the relation between depression and obesity before and after bariatric surgery and evaluated its impact in the pharmacokinetics of antidepressant medication and nutrients that influence depressive symptomatology. Methods: We conducted a non-systematic review of the literature published in English between 1988 and 2015, through research in MEDLINE with the keywords absorption, bioavailability, bariatric surgery, obesity, depression, antidepressants. Results: Depression and obesity potentiates each other in a bidirectional way and the strength of this association is modulated by gender, physical activity, diet and antidepressant medication usage. Bariatric surgery leads to changes in the pharmacokinetics of antidepressant medication and nutrients that have a regulatory role on mood symptomatology. Discussion and Conclusions: Available data show we need to pay special attention to obese depressive patients proposed for bariatric surgery. The existence of depressive symptoms leads to a greater risk of not losing weight after a bariatric surgery but, in the opposite direction, bariatric surgery leads to a lower bioavailability of antidepressant medication.

  11. Robotic surgery in pediatric urology

    Directory of Open Access Journals (Sweden)

    Adam Howe

    2017-01-01

    Full Text Available While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.

  12. Robotic surgery in pediatric urology.

    Science.gov (United States)

    Howe, Adam; Kozel, Zachary; Palmer, Lane

    2017-01-01

    While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.

  13. Strabismus Following Scleral Buckling Surgery.

    Science.gov (United States)

    Ganekal, Sunil; Nagarajappa, Ashwini

    2016-01-01

    To assess the incidence of strabismus, relationship of strabismus with type and width of scleral buckle after scleral buckling surgery for retinal detachment. Retrospective analysis was done of 360 eyes of 344 patients treated for rhegmatogenous retinal detachment with scleral buckling surgery between January 2008 and January 2013. The mean age of patients was 38.45 ± 18.12 years (range: 7 to 89 years). Strabismus was detected in 48 out of 344 (13.95%) patients at 6 weeks after scleral buckling surgery. Horizontal deviation was the commonest type. Incidence of strabismus was higher after repeat scleral buckling surgery (4/9, 44.4%) compared to patients who had single scleral buckling surgery (44/335, 13.1%) (P=0.02). Strabismus was observed in 18.5% of patients with implants, compared to 11.3% of patients who received explants (P=0.02). Strabismus surgery was performed on 2 (4.1%) cases. Horizontal strabismus is common after scleral buckling surgery for repair of retinal detachment. Repeat scleral buckling and use of implants resulted in a higher incidence of strabismus in the postoperative period. Majority of these cases resolve with conservative management.

  14. Augmented reality in surgery.

    Science.gov (United States)

    Shuhaiber, Jeffrey H

    2004-02-01

    To evaluate the history and current knowledge of computer-augmented reality in the field of surgery and its potential goals in education, surgeon training, and patient treatment. National Library of Medicine's database and additional library searches. Only articles suited to surgical sciences with a well-defined aim of study, methodology, and precise description of outcome were included. Augmented reality is an effective tool in executing surgical procedures requiring low-performance surgical dexterity; it remains a science determined mainly by stereotactic registration and ergonomics. Strong evidence was found that it is an effective teaching tool for training residents. Weaker evidence was found to suggest a significant influence on surgical outcome, both morbidity and mortality. No evidence of cost-effectiveness was found. Augmented reality is a new approach in executing detailed surgical operations. Although its application is in a preliminary stage, further research is needed to evaluate its long-term clinical impact on patients, surgeons, and hospital administrators. Its widespread use and the universal transfer of such technology remains limited until there is a better understanding of registration and ergonomics.

  15. Lateral canthal surgery.

    Science.gov (United States)

    Chong, Kelvin Kam-Lung; Goldberg, Robert A

    2010-08-01

    The lateral canthus is a delicate and complicated three-dimensional structure with function relevant to the health of the ocular surface. Dysfunction of the lateral canthus, due to aging changes or iatrogenic trauma, results in ocular morbidity ranging from chronic irritation to tearing to recalcitrant keratopathy. From an aesthetic standpoint, symmetric, normally positioned lateral canthi are cornerstones of youthful periorbital appearance, disruption of which leads to cosmetically significant deformity or asymmetry. Reconstruction of the lateral canthus is important in the rehabilitation of the aging eyelid and an unfortunate necessity after failed lateral canthal surgery. The common methods for improving or maintaining position, tone, and shape of the lower eyelid and lateral canthus use tightening or shortening the lower eyelid horizontally, keeping the canthal angle in an appropriate vertical level, and hugging the ocular surface. Many techniques have been described for the reconstruction of the lateral canthus in functional conditions or for aesthetic purposes. These methods have met with varying success. In this article, we begin with a discussion of the anatomy and physiology of the lateral canthus, followed by clinical examples of lateral canthal abnormalities and underlying pathophysiologies. A review of surgical options for the lateral canthus is presented with concluding remarks on postoperative complications.

  16. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  17. Neurologic complications of bariatric surgery.

    Science.gov (United States)

    Kumar, Neeraj

    2014-06-01

    The increasing utilization of bariatric surgery has been accompanied by an increased incidence and awareness of related neurologic complications. The purpose of this review is to provide up-to-date information on the neurologic complications related to bariatric surgery. Neurologic complications related to bariatric surgery are predominantly due to nutrient deficiencies. Common early complications include Wernicke encephalopathy due to thiamine deficiency, and late complications include myelopathy or myeloneuropathy due to vitamin B12 or copper deficiency. Early recognition and prompt institution of treatment is essential to prevent long-term disability. Often, life-long supplementation may be required.

  18. Intracraneal complications after raquis surgery.

    Science.gov (United States)

    Sierra, J J; Malillos, M

    Intracraneal bleeding is a rare complication after raquis surgery. It is believed to occur as a drop in the intracraneal pressure after a loss of CSF secondary to an iatrogenic dural tear. We report a patient who after surgery for lumbar stenosis presented a subarachnoid haemorrhage, an intraparenchymal haematoma, and a subdural haematoma. To our knowledge, this is the first report in the literature with such complications after this type of surgery. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. OSAS Surgery and Postoperative Discomfort: Phase I Surgery versus Phase II Surgery

    Directory of Open Access Journals (Sweden)

    Giulio Gasparini

    2015-01-01

    Full Text Available Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery and phase II (orthognathic surgery procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP and those who accepted phase II (IIP. To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

  20. The Ethics of Breast Surgery.

    Science.gov (United States)

    Throckmorton, Alyssa; VanderWalde, Lindi; Brackett, Craig; Dominici, Laura; Eisenhauer, Thomas; Johnson, Nathalie; Kong, Amanda; Ludwig, Kandice; O'Neill, Jennifer; Pugliese, Matthew; Teller, Paige; Sarantou, Terry

    2015-10-01

    Breast surgery has evolved as a subspecialty of general surgery and requires a working knowledge of benign and malignant diseases, surgical techniques, shared decision-making with patients, collaboration with a multi-disciplinary team, and a basic foundation in surgical ethics. Ethics is defined as the practice of analyzing, evaluating, and promoting best conduct based upon available standards. As new information is obtained or as cultural values change, best conduct may be re-defined. In 2014, the Ethics Committee of the ASBrS acknowledged numerous ethical issues, specific to the practice of breast surgery. This independent review of ethical concerns was created by the Ethics Committee to provide a resource for ASBrS members as well as other surgeons who perform breast surgery. In this review, the professional, clinical, research and technology considerations that breast surgeons face are reviewed with guidelines for ethical physician behavior.

  1. Antibiotic prophylaxis in genitourinary surgery.

    Science.gov (United States)

    Childs, S J; Wood, P D; Kosola, J W

    1981-01-01

    Antibiotic prophylaxis in surgery, particularly genitourinary surgery, has been controversial for years. At best, the results have been more testimonial than scientific because of the failure to observe proper experimental design. A survey of the literature indicates that antibiotic prophylaxis in genitourinary surgery probably has little influence on postoperative fever; it appears to favorably affect the incidence of postoperative bacteriuria and bacteremia in the short term without encouraging nosocomial or resistant infections. The regimen for prophylaxis must be perioperative and continued for no longer than 24 hours postoperatively. Given that antibiotic prophylaxis in elective genitourinary surgery has merit, a comparison between cefazolin and cefotaxime was undertaken. Of 160 evaluable cases, a total of 23 patients had positive cultures within the first nine days; only two occurred within the first five days. When cefazolin and cefotaxime were administered in the same dosage regimen, the infection rate for cefazolin was 19% compared with 10% for cefotaxime.

  2. Preparing Children for Heart Surgery

    Science.gov (United States)

    ... hospital or in the neighborhood. Learn more about: Feeding Tips Children's Special Needs Learn more about your child and ... Cardiac Catheterizations Heart Transplants Preparing Children for Surgery - Feeding Tips - Children's Special Needs Physical Activity Recommendations for Heart Health • ...

  3. Social media in vascular surgery.

    Science.gov (United States)

    Indes, Jeffrey E; Gates, Lindsay; Mitchell, Erica L; Muhs, Bart E

    2013-04-01

    There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  4. Basics of LASIK Eye Surgery

    Science.gov (United States)

    ... poorer quality vision and a decrease in depth perception. These effects are most noticeable in low lighting ... that: you may experience a mild burning or sensation for a few hours after surgery. Don’t ...

  5. Excimer lasers for refractive surgery

    Science.gov (United States)

    Vartapetov, Serge K.

    2003-10-01

    Over the last decade excimer lasers have been broadly used for technological and medical processes. One of the most widespread applications of excimer laser is the clinical use for refractive surgery. Refractive surgery with excimer lasers is the prevalent method for the eye acuity correction. Operation at 193 nanometers, the excimer laser is able to precisely sculpt the corneal surface to correct refractive errors. Both the increase in the accuracy of sculpturing and the predictability of procedures are the key elements of the excimer laser designed for refractive surgery. The novel excimer laser for refractive surgery is offered for small aberration treatment. The excimer laser with both a full aperture Gaussian beam and fly spot system is described. The comparison of different systems of laser correction is reviewed.

  6. Urinary incontinence surgery - female - discharge

    Science.gov (United States)

    ... or doing other exercise, lifting, coughing, sneezing, and laughing can all cause stress incontinence. You had surgery ... sure you have enough dressing supplies at home. Nothing should go into the vagina for at least ...

  7. Immediate Sequential Bilateral Cataract Surgery

    DEFF Research Database (Denmark)

    Kessel, Line; Andresen, Jens; Erngaard, Ditte

    2015-01-01

    The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...

  8. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance...

  9. Animal Surgery and Resources Core

    Data.gov (United States)

    Federal Laboratory Consortium — The ASR services for NHLBI research animals include: animal model development, surgery, surgical support, post-operative care as well as technical services such as...

  10. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  11. Rheumatoid arthritis and hand surgery

    DEFF Research Database (Denmark)

    Peretz, Anne Sofie Rosenborg; Madsen, Ole Rintek; Brogren, Elisabeth

    2017-01-01

    Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery...

  12. Bariatric Surgery and Stone Disease

    Science.gov (United States)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  13. Parathyroid transplantation in thyroid surgery

    Science.gov (United States)

    Gołkowski, Filip; Nawrot, Ireneusz

    2017-01-01

    Permanent hypoparathyroidism following thyroid surgery is rare. Its prevalence is reported to be below 1–2% if surgery is performed by experienced thyroid surgeons. Parathyroid identification and preservation in situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands are damaged, autotransplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: (I) fresh parathyroid tissue autotransplantation during thyroidectomy in order to reduce the risk of permanent hypoparathyroidism; (II) cryopreserved parathyroid tissue autotransplantation in patients with permanent hypoparathyroidism; (III) parathyroid allotransplantation in patients with permanent hypoparathyroidism when cryopreserved parathyroid tissue is not available for grafting. Nowadays, allotransplantation of cultured parathyroid cells without immunosuppression should be taken into consideration in selected patients as an alternative to calcium and vitamin D3 supplementation in management of permanent hypoparathyroidism. This paper is aimed to provide a review of current status of various parathyroid transplantation techniques in thyroid surgery. PMID:29142845

  14. American Society for Dermatologic Surgery

    Science.gov (United States)

    ... better results. Join today! Explore Quest, the ASDS digital knowledge network Through Qu est, ASDS members can ... exceptional visibility, outreach and value. Learn More » 2017 Advertising Opportunities Reach key decision-makers in dermatologic surgery ...

  15. Surgery for pancreatic cancer -- discharge

    Science.gov (United States)

    ... in the bathroom and prevent falls at home. Wound care Your health care provider will explain how ... Kennedy EP, Yeo CJ. Pancreatic cancer: Clinical aspects, assessment, and management. In: Jarnagin WR, ed. Blumgart's Surgery ...

  16. Stereotactic surgery for eating disorders.

    Science.gov (United States)

    Sun, Bomin; Liu, Wei

    2013-01-01

    EATING DISORDERS (EDS) ARE A GROUP OF SEVERELY IMPAIRED EATING BEHAVIORS, WHICH INCLUDE THREE SUBGROUPS: anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS). The precise mechanism of EDs is still unclear and the disorders cause remarkable agony for the patients and their families. Although there are many available treatment methods for EDs today, such as family therapy, cognitive behavioral therapy, medication, psychotherapy, and so on, almost half of the patients are refractory to all current medical treatment and never fully recover. For treatment-refractory EDs, stereotactic surgery may be an alternative therapy. This review discusses the history of stereotactic surgery, the modern procedures, and the mostly used targets of stereotactic surgery in EDs. In spite of the limited application of stereotactic surgery in ED nowadays, stereotactic lesion and deep brain stimulation (DBS) are promising treatments with the development of modern functional imaging techniques and the increasing understanding of its mechanism in the future.

  17. Thrombosis and Hemostasis in Surgery

    DEFF Research Database (Denmark)

    Hvas, Anne-Mette; Larsen, Julie Brogaard; Pasalic, Leonardo

    2017-01-01

    .g., bleeding disorders, cancer, or developmental hemostatic changes in pediatric patients), to anticoagulant medication or complications such as heparin-induced thrombocytopenia (HIT), or to inherent risks of a particular surgical procedure or affected organ (e.g., hepatobiliary surgery or renal......The present issue of Seminars in Thrombosis & Hemostasis focuses on challenges related to hemostatic and thromboembolic complications in surgery or trauma. Multiple factors contribute to perioperative bleeding or thromboembolic risk. These factors might be related to the individual patient (e...

  18. Bariatric Surgery and Precision Nutrition

    OpenAIRE

    Carolina F. Nicoletti; Cristiana Cortes-Oliveira; Marcela A. S. Pinhel; Carla B. Nonino

    2017-01-01

    This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient’s genetic and epigenetic variables on the response t...

  19. Iron Deficiency and Bariatric Surgery

    OpenAIRE

    J?uregui-Lobera, Ignacio

    2013-01-01

    It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia) may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life aft...

  20. Public perception of Plastic Surgery.

    Science.gov (United States)

    de Blacam, Catherine; Kilmartin, Darren; Mc Dermott, Clodagh; Kelly, Jack

    2015-02-01

    Public perception of Plastic Surgery is strongly influenced by the media and may not reflect the broad scope of work within the speciality. The aim of this study was to provide an assessment of the general public's perception of plastic surgical practice and to report the perceived importance of Plastic Surgery relative to other specialities working within a large tertiary referral centre. 899 members of the public who attended our Emergency Department completed a questionnaire where they matched eight surgical specialities with 30 operative procedures and ranked the importance of 30 different hospital specialities using a Likert scale. The majority of respondents correctly identified plastic surgeons as performing each of the cosmetic procedures listed (abdominoplasty 63.7%; breast augmentation 59.1%; facelift 61.35%; liposuction 59.7%). Plastic Surgery was identified as the primary speciality involved in breast reconstruction (49.3%) and burns surgery (43.0%). There was poor understanding of the role of plastic surgeons in hand surgery, with only 4.7% of respondents attributing tendon repair to plastic surgeons. Plastic Surgery ranked lowest of 30 specialities in terms of importance in providing care for patients within the hospital. Plastic Surgery is often misunderstood within the wider community and misconceptions reflect the influence of the media in highlighting certain aspects of the speciality. It behoves our professional organisations to highlight the importance of Plastic and Reconstructive Surgery within major tertiary referral centres. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Laparoscopic revolution in bariatric surgery

    OpenAIRE

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techn...

  2. Gastrointestinal Complications After Bariatric Surgery

    OpenAIRE

    Ma, Irene T.; Madura, James A.

    2015-01-01

    Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the 4 most common bariatric surgical proc...

  3. Ophthalmic Complications of Bariatric Surgery

    OpenAIRE

    Azevedo Guerreiro, R; Ribeiro, R

    2014-01-01

    Obesity is increasing vastly in the world, and the number of bariatric surgeries being performed is also increasing. Patients being submitted to bariatric surgeries, especially malabsorptive procedures, have an increased risk of developing nutrient deficiencies, which can culminate in symptomatic hypovitaminosis, if supplementation is not done correctly. The eye and the optic system need an adequate level of several vitamins and minerals to perform properly, especially vitamin A, and this art...

  4. Neurological Complications of Cardiac Surgery

    OpenAIRE

    Gottesman, Rebecca F.; McKhann, Guy M.; Hogue, Charles W.

    2008-01-01

    Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be...

  5. Robotic Surgery for Oropharyngeal Cancer

    Directory of Open Access Journals (Sweden)

    Shivani Shah

    2014-04-01

    Full Text Available Oropharyngeal cancer represents a growing proportion of head and neck malignancies. This has been associated with the increase in infection of the oropharynx by oncogenic strains of human papillomavirus (HPV. Transoral robotic surgery (TORS has opened the door for minimally invasive surgery for HPV-related and non-HPV-related oropharyngeal cancer. Compared to traditional open surgical approaches, TORS has been shown to improve functional outcomes in speech and swallowing, while maintaining good oncologic outcomes.

  6. Controversies in Facial Cosmetic Surgery.

    Science.gov (United States)

    Retana, Armando

    2017-11-01

    Facial cosmetic surgery techniques are constantly updated to meet the expectations of patients who demand less invasive procedures and less recovery time. Current trends in lower eyelid surgery call for periorbital fat repositioning instead of excision of fat. Controversies still exist in chin augmentations regarding osseous genioplasty versus alloplastic chin implant. The benefits, disadvantages, and considerations of these procedures are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Improving Quality in Colorectal Surgery

    OpenAIRE

    Slieker, Juliette

    2014-01-01

    markdownabstract__Abstract__ Colorectal surgery is an important aspect of our current health system, due to the high incidence of colorectal cancer combined with an ageing population, improved long-term outcomes after colorectal surgery, and the perfectioning of the operative and postoperative aspects through laparoscopy and enhanced recovery programs. However, postoperative complications painfully remain, despite efforts of amelioration of perioperative care. Research for molecular pathways ...

  8. Litigation After Nasal Plastic Surgery

    OpenAIRE

    Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan

    2011-01-01

    Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading ...

  9. Refractive Surgery: Malpractice Litigation Outcomes.

    Science.gov (United States)

    Custer, Benjamin L; Ballard, Steven R; Carroll, Robert B; Barnes, Scott D; Justin, Grant A

    2017-10-01

    To review data on malpractice claims related to refractive surgery to identify common allegations and injuries and financial outcomes. The WestlawNext database was reviewed for all malpractice lawsuits/settlements related to refractive eye surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. A total of 167 cases met the inclusion criteria, of which 108 cases (64.7%) were found to be favorable and 59 cases (35.3%) unfavorable to the defendant. A total of 141 cases were tried by a jury with 108 cases (76.4%) favorable and 33 cases (23.6%) unfavorable to the defendant. Laser in situ keratomileusis was performed in 127 cases (76%). The most common allegations were negligence in treatment or surgery in 127 cases (76%) and lack of informed consent in 83 cases (49.7%). For all cases, the need for future surgery (P = 0.0001) and surgery resulting in keratoconus (P = 0.05) were more likely to favor the plaintiff. In jury verdict decisions, cases in which failure to diagnose a preoperative condition was alleged favored the defendant (P = 0.03), whereas machine malfunction (P = 0.05) favored the plaintiff. After adjustment for inflation, the overall mean award was $1,287,872. Jury verdicts and settlements led to mean awards of $1,604,801 and $826,883, respectively. Malpractice litigation in refractive surgery tends to favor the defendant. However, large awards and settlements were given in cases that were favorable to the plaintiff. The need for future surgery and surgery leading to keratoconus increased the chance of an unfavorable outcome.

  10. Cardiovascular effects of bariatric surgery.

    Science.gov (United States)

    Beamish, Andrew J; Olbers, Torsten; Kelly, Aaron S; Inge, Thomas H

    2016-12-01

    Obesity is a major global health problem, and its multisystem effects are inextricably linked with elevated cardiovascular risk and adverse outcomes. The cardiovascular benefits of reversing obesity in adults are well-established. Compared with other weight-loss strategies, programmes that incorporate bariatric surgery for weight loss are beneficial for sustained BMI reduction. A marked improvement in cardiovascular risk factors, including hypertension, dyslipidaemia, inflammation, and type 2 diabetes mellitus, has been observed after bariatric surgery. This broad improvement in cardiovascular risk profile has led to substantial reductions in the risk of myocardial infarction, stroke, and death. As with all procedures, the benefits of bariatric surgery must be weighed against its potential risks. Modern bariatric surgery has an excellent safety profile, but important limitations remain, including the potential for surgical complications and nutritional deficiencies, and the lifelong requirement for nutritional supplementation. Surgery should be considered in patients with severe obesity, especially those with cardiovascular comorbidities. In this Review, we summarize the current management options for patients with obesity, and discuss the effects of bariatric surgery on cardiovascular risk factors and outcomes.

  11. Bone Metabolism after Bariatric Surgery

    Science.gov (United States)

    Yu, Elaine W.

    2014-01-01

    Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery. PMID:24677277

  12. Endocrine Function after Bariatric Surgery.

    Science.gov (United States)

    Kim, Ki-Suk; Sandoval, Darleen A

    2017-06-18

    Obesity increases the risks of metabolic disorders including type 2 diabetes mellitus (T2DM). Bariatric surgery is the most successful therapeutic option that causes sustained weight loss and improvements in obesity comorbidities. Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are two of the most frequently performed bariatric surgeries. Despite their different anatomical rearrangement, they have remarkably similar success in both weight loss and T2DM remission. Interestingly, they also both cause a wide range of endocrine changes. Many of these endocrine changes are reflected specifically within the intestine and are implicated as mechanisms for the metabolic success of surgery. However, while most of the work shows that these hormonal changes are associated with the metabolic changes after surgery, causation has been difficult to ascertain. Here, we review the endocrine changes after RYGB and VSG and explore their mechanistic role in the success of bariatric surgery. Further, we explore important changes in gastrointestinal function and the role of these changes in the increase in postprandial endocrine responses after bariatric surgery. © 2017 American Physiological Society. Compr Physiol 7:783-798, 2017. Copyright © 2017 John Wiley & Sons, Inc.

  13. Neurological complications of cardiac surgery.

    Science.gov (United States)

    Gottesman, Rebecca F; McKhann, Guy M; Hogue, Charles W

    2008-11-01

    Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be determined by the type of procedure, by patient-specific characteristics, and by the extent of cerebral embolization and hypoperfusion during and after surgery. Changes in surgical techniques, including the use of off-pump surgery, have not decreased rates of brain injury from cardiac surgery. When appropriate, modern neuroimaging techniques should be used in postoperative patients to confirm diagnosis, to provide information on potential etiology, to direct appropriate therapy, and to help in prognostication. Management of postoperative medications and early use of rehabilitation services is a recommended strategy to optimize the recovery for individuals with neurological injury after cardiac surgery.

  14. The day of your surgery - adult

    Science.gov (United States)

    Same-day surgery - adult; Ambulatory surgery - adult; Surgical procedure - adult; Preoperative care - day of surgery ... You should expect to: Have a responsible adult with you to get ... yourself home after surgery. You can take a bus or cab if there ...

  15. Knowledge and Perception of Laparoscopic Surgery among ...

    African Journals Online (AJOL)

    user

    Conclusion: There is a need for public health education in the region to drive this relatively new frontier of surgery to improve our practice and encourage indigenous innovations. INTRODUCTION. Minimal access surgery (Laparoscopic surgery) is prospected as the future of surgery. It offers the benefits of reduced morbidity, ...

  16. Training in Trauma Surgery

    Science.gov (United States)

    Reilly, Patrick M.; Schwab, C William; Haut, Elliott R.; Gracias, Vicente H.; Dabrowski, G Paul; Gupta, Rajan; Pryor, John P.; Kauder, Donald R.

    2003-01-01

    Objective: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. Summary Background Data: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. Methods: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. Results: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P FIE year; P FIE educational experience “great -5” or “exceptional– 6.” Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. Conclusion: The educational

  17. Metabolic Surgery in Korea: What to Consider before Surgery

    Directory of Open Access Journals (Sweden)

    Mi-Kyung Kim

    2017-09-01

    Full Text Available Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m2, regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m2 and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.

  18. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  19. [Treatments around surgery of prostate cancer and surgery of recurrence].

    Science.gov (United States)

    Salomon, L; Ploussard, G; Hennequin, C; Richaud, P; Soulié, M

    2015-11-01

    To describe neoadjuvant and adjuvant treatments to surgery and the place of surgery in the recurrence after primary treatments. Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed), selected according to the scientific relevance. The research was focused on treatments before and after surgery, biological recurrence and surgery as the procedure in case of failure of other treatments of non-metastatic prostate cancer. Main oncological objectif of surgery is to decrease positive surgical margins by good adequation between technics and tumor and patient status. Neoadjuvant treatments are today disappointing; however, adjuvant radiotherapy and hormonotherapy demonstrated their interest in case of extracapsular extension, positive margins or invasion of lymph nodes. Nevertheless, superiority of adjuvant treatment to salvage treatment is still debated. Radical prostatectomy is still the only curative treatment in case of failure of another localized treatment. Radical prostatectomy has to be one of the main references of localized prostate cancer treatments especially in case of multimodal approach. Pathological exam of specimen and postoperative PSA value should precise the optimal management of prostate cancer. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Sexuality in Aesthetic Breast Surgery.

    Science.gov (United States)

    Guimarães, Paulo Afonso Monteiro Pacheco; Resende, Vanessa Contato Lopes; Sabino Neto, Miguel; Seito, Caroline Lumy; de Brito, Maria José Azevedo; Abla, Luiz Eduardo Felipe; Veiga, Daniela Francescato; Ferreira, Lydia Masako

    2015-12-01

    The breasts are important for a woman's psychological well-being, which may be negatively affected by distortions of breast size and shape. Improvements in self-esteem and sexuality are important psychological factors associated with motivation for cosmetic surgery. Mammaplasty is among the most sought-after and performed cosmetic procedures. The aim of this study was to evaluate the impact of aesthetic breast surgery on a woman's sexuality. This study was conducted in a plastic surgery clinic of a hospital university in Brazil, between 2009 and 2012. Forty-six patients with hypomastia and 30 patients with breast hypertrophy, who expressed the desire for aesthetic breast surgery, were selected for the study. The patients were assessed preoperatively and 6 months postoperatively using the sexual quotient-Female version scale (QS-F). The QS-F is a validated Brazilian questionnaire to assess sexual function. It contains ten items covering five domains of female sexual function: desire and interest, foreplay, excitement and harmony, comfort, and orgasm and satisfaction. Higher QS-F scores indicate better sexual functioning. There was a significant increase in the mean total QS-F score after surgery in both groups (p surgery was observed in both groups, which is consistent with the literature. Aesthetic breast surgery has a positive impact on the sexuality of patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  1. Nucleus accumbens surgery for addiction.

    Science.gov (United States)

    Li, Nan; Wang, Jing; Wang, Xue-lian; Chang, Chong-wang; Ge, Shun-nan; Gao, Li; Wu, He-ming; Zhao, Hai-kang; Geng, Ning; Gao, Guo-dong

    2013-01-01

    Opiate addiction remains intractable in a large percentage of patients, and relapse is the biggest hurdle to recovery because of psychological dependence. Multiple studies identify a central role of the nucleus accumbens (NAc) in addiction; several studies note decreased addictive behavior after interventions in this area. Based on animal experiments, our institute started the clinical trial for the treatment of drug addicts' psychological dependence by making lesions in the bilateral NAc with stereotactic surgery from July 2000. The short-term outcomes were encouraging and triggered rapid application of this treatment in China from 2003 to 2004. However, lack of long-term outcomes and controversy eventually led to halting the surgery for addiction by the Ministry of Health of China in November 2004 and a nationwide survey about it later. Our institute had performed this surgery in 272 patients with severe heroin addiction. The follow-up study showed that the 5-year nonrelapse rate was 58% and the quality of life was significantly improved. Patients had several kinds of side effects, but the incidence rate was relatively low. The patients gradually recovered more than 5 years after the surgery. The side effects did not severely influence an individual's life or work. Nationwide surgery showed that the nonrelapse rate was 50% in the sample of 150 cases, from 1167 patients overall who underwent stereotactic surgery in China. Although sometimes accompanied by neuropsychological adverse events, stereotactic ablation of NAc may effectively treat opiate addiction. Lesion location has a significant impact on treatment efficacy and requires further study. Because ablation is irreversible, the NAc surgery for addiction should be performed with cautiousness, and deep brain stimulation (DBS) is an ideal alternative. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Bariatric surgery in hypothalamic obesity

    Directory of Open Access Journals (Sweden)

    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  3. Lean and Green Hand Surgery.

    Science.gov (United States)

    Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

    2018-02-01

    Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Nutritional Status of Bariatric Surgery Candidates

    OpenAIRE

    Aliaa Al-Mutawa; Alfred Kojo Anderson; Salman Alsabah; Mohammad Al-Mutawa

    2018-01-01

    Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseli...

  5. Metabolic surgery and nutritional deficiencies.

    Science.gov (United States)

    Stroh, Christine; Manger, Thomas; Benedix, Frank

    2017-10-01

    The increasing prevalence of morbid obesity in Germany is associated with an increasing number of metabolic surgical interventions. Short-term surgical and long-term metabolic complications such as nutrient deficiencies can be considered as the main risks of metabolic surgery with its malabsorptive but also restrictive procedures. The aim of this review was to characterize the most relevant metabolic complications specific for the various bariatric procedures, which, subsequently, require a permanent surveillance and supplementation, respectively. Furthermore, we aimed to identify if there are diagnostic and therapeutic measures that can prevent those complications. Restrictive bariatric surgery such as "gastric banding" and "sleeve gastrectomy" can be associated with deficiencies related to B-vitamins whereas iron, folate, vitamin B1, B12 and D deficiencies are associated with the malabsorptive procedure such as "biliopancreatic diversion," "duodenal switch" and "Roux-en-Y gastric bypass". Due to possible metabolic and surgical complications after bariatric surgery, patients need to undergo life-long medical and dietetic surveillance. The recently published guidelines of the "American Association of Bariatric and Metabolic Surgery" are the basis for recommendations on supplementation and treatment following weight loss surgery.

  6. Robotic systems in spine surgery.

    Science.gov (United States)

    Onen, Mehmet Resid; Naderi, Sait

    2014-01-01

    Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

  7. Oral Contraceptives after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Joël Schlatter

    2017-04-01

    Full Text Available Objective: Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. Methods: We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. Results: The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters. Bariatric surgery could potentially result in a transient change in the absorption of drugs such as analgesics, antibiotics, antiarrhythmics, anticoagulants, psychotropic, and oral contraceptive drugs. Effective contraception is especially critical in the postoperative period, and implants might be representing a safe contraceptive method in women undergoing bariatric surgery. Conclusion: Each drug will have to be evaluated with respect to its site of absorption and its mechanism of absorption, with special attention on parameters influencing the effectiveness of the absorption processes.

  8. Nutritional deficiencies after bariatric surgery.

    Science.gov (United States)

    Bal, Bikram S; Finelli, Frederick C; Shope, Timothy R; Koch, Timothy R

    2012-09-01

    Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.

  9. Hardware complications in scoliosis surgery

    Energy Technology Data Exchange (ETDEWEB)

    Bagchi, Kaushik; Mohaideen, Ahamed [Department of Orthopaedic Surgery and Musculoskeletal Services, Maimonides Medical Center, Brooklyn, NY (United States); Thomson, Jeffrey D. [Connecticut Children' s Medical Center, Department of Orthopaedics, Hartford, CT (United States); Foley, Christopher L. [Department of Radiology, Connecticut Children' s Medical Center, Hartford, Connecticut (United States)

    2002-07-01

    Background: Scoliosis surgery has undergone a dramatic evolution over the past 20 years with the advent of new surgical techniques and sophisticated instrumentation. Surgeons have realized scoliosis is a complex multiplanar deformity that requires thorough knowledge of spinal anatomy and pathophysiology in order to manage patients afflicted by it. Nonoperative modalities such as bracing and casting still play roles in the treatment of scoliosis; however, it is the operative treatment that has revolutionized the treatment of this deformity that affects millions worldwide. As part of the evolution of scoliosis surgery, newer implants have resulted in improved outcomes with respect to deformity correction, reliability of fixation, and paucity of complications. Each technique and implant has its own set of unique complications, and the surgeon must appreciate these when planning surgery. Materials and methods: Various surgical techniques and types of instrumentation typically used in scoliosis surgery are briefly discussed. Though scoliosis surgery is associated with a wide variety of complications, only those that directly involve the hardware are discussed. The current literature is reviewed and several illustrative cases of patients treated for scoliosis at the Connecticut Children's Medical Center and the Newington Children's Hospital in Connecticut are briefly presented. Conclusion: Spine surgeons and radiologists should be familiar with the different types of instrumentation in the treatment of scoliosis. Furthermore, they should recognize the clinical and roentgenographic signs of hardware failure as part of prompt and effective treatment of such complications. (orig.)

  10. Changing trends in bariatric surgery.

    Science.gov (United States)

    Lo Menzo, E; Szomstein, S; Rosenthal, R J

    2015-03-01

    Bariatric surgery is considered the only long-lasting treatment for morbid obesity. Techniques and procedures have changed dramatically. We report on some of the major changes in the field. We reviewed some of the major changes in trends in bariatric surgery based on some landmark paper published in the literature. We identified three major phases in the evolution of bariatric surgery. The pioneer phase was mostly characterized by discovery of weight loss procedures serendipitously from procedures done for other purposes. The second phase can be identified with the advent of laparoscopic techniques. This is considered the phase of greatest expansion of bariatric surgery. The metabolic phase derives from the improved understanding of the mechanisms of actions of the bariatric operations at the hormonal and molecular level. Bariatric surgery has changed significantly over the years. The safety of the laparoscopic approach, along with the better understanding of the metabolic changes obtained postoperatively, has led to a more individualized approach and also an attempt to expand the indications for these procedures. © The Finnish Surgical Society 2014.

  11. Laparoscopic revolution in bariatric surgery.

    Science.gov (United States)

    Sundbom, Magnus

    2014-11-07

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21(st) century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

  12. Computational Planning in Facial Surgery.

    Science.gov (United States)

    Zachow, Stefan

    2015-10-01

    This article reflects the research of the last two decades in computational planning for cranio-maxillofacial surgery. Model-guided and computer-assisted surgery planning has tremendously developed due to ever increasing computational capabilities. Simulators for education, planning, and training of surgery are often compared with flight simulators, where maneuvers are also trained to reduce a possible risk of failure. Meanwhile, digital patient models can be derived from medical image data with astonishing accuracy and thus can serve for model surgery to derive a surgical template model that represents the envisaged result. Computerized surgical planning approaches, however, are often still explorative, meaning that a surgeon tries to find a therapeutic concept based on his or her expertise using computational tools that are mimicking real procedures. Future perspectives of an improved computerized planning may be that surgical objectives will be generated algorithmically by employing mathematical modeling, simulation, and optimization techniques. Planning systems thus act as intelligent decision support systems. However, surgeons can still use the existing tools to vary the proposed approach, but they mainly focus on how to transfer objectives into reality. Such a development may result in a paradigm shift for future surgery planning. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Direct surgery for brainstem lesions

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru [Gifu Univ. (Japan). School of Medicine

    1997-09-01

    Direct surgery for intrinsic lesions of the brainstem has been considered a hazardous procedure. During the past 10 years, 32 cases of symptomatic lesions involving the brainstem were operated on. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indications. Almost all cases were treated by radical extirpation. Namely, 9 cavernous angiomas and 2 hemangioblastomas resulted in radical extirpation. The preoperative neurological deficits improved after surgery. Also, 2 ependymomas, 4 medulloblastomas, 4 plexus papillomas, and 1 epidermoid were successfully extirpated, and the surgical treatment for them allowed favorable outcome. Therefore, those brainstem lesions were considered to be more favorable indications for direct surgery. On the other hand, 4 astrocytomas and 6 glioblastomas were either subtotally or partially resected, in which a small incision in the fourth ventricle floor and the surface of the brainstem was made when the lesion was intramedullary. Consequently, there were neither mortality in surgery nor aggravation of the focal neurological symptoms. High-grade glioma in 6 cases was removed as much as possible, but almost all of the cases nevertheless expired due to prompt recurrence under 2 years after onset of symptoms and surgery. (author)

  14. Redefining surgery for gastric cancer.

    Science.gov (United States)

    Whiting, J. L.; Hallissey, M. T.; Rowlands, D. C.; Fielding, J. W. L.

    1999-12-01

    BACKGROUND: Despite encouraging retrospective and non-randomized trials, two large prospective, randomized trials of D1 vs D2 resections show double the mortality in the D2 group, with no increase in long-term survival. However, the D2 resection still offers the only hope of cure when N2 nodes are involved. We propose a reclassification of the International Union Against Cancer TNM "N" staging to a system with an anatomical basis that is useful in defining the surgery performed. Junctional nodes lying between the N1 and N2 tiers will act as a guide to surgery. Where these nodes are uninvolved, the probability of gastric bed (N2) involvement is low and the radical D2 dissection with its higher mortality and morbidity can be avoided.CONCLUSION: Such "stage-appropriate" surgery will reduce the number of D2 resections while ensuring that patients with N2 disease are not denied curative surgery. A prospective, randomized, controlled trial of targeted surgery is required.

  15. Levothyroxine Dosing Following Bariatric Surgery.

    Science.gov (United States)

    Gadiraju, Silpa; Lee, Clare J; Cooper, David S

    2016-10-01

    Based on the mechanisms of drug absorption, increased levothyroxine requirements are expected after bariatric surgery. However, there are conflicting data on this topic. This review evaluates the effects of bariatric surgery on levothyroxine dosing. Data were obtained from PubMed, Scopus, and review of published bibliographies. Six of 10 studies demonstrated decreased postoperative requirements. Most demonstrated correlations between weight loss and dose. Only 3 case reports and 1 case series demonstrated increased levothyroxine requirements, attributed to malabsorption. The loss of both fat and lean body mass may counteract malabsorptive effects from surgery, resulting in decreased postoperative levothyroxine requirements. In addition, the reversal of impaired levothyroxine pharmacokinetics and an altered set point of thyroid hormone homeostasis may also contribute to postoperative levothyroxine reductions.

  16. Surgery applications of virtual reality

    Science.gov (United States)

    Rosen, Joseph

    1994-01-01

    Virtual reality is a computer-generated technology which allows information to be displayed in a simulated, bus lifelike, environment. In this simulated 'world', users can move and interact as if they were actually a part of that world. This new technology will be useful in many different fields, including the field of surgery. Virtual reality systems can be used to teach surgical anatomy, diagnose surgical problems, plan operations, simulate and perform surgical procedures (telesurgery), and predict the outcomes of surgery. The authors of this paper describe the basic components of a virtual reality surgical system. These components include: the virtual world, the virtual tools, the anatomical model, the software platform, the host computer, the interface, and the head-coupled display. In the chapter they also review the progress towards using virtual reality for surgical training, planning, telesurgery, and predicting outcomes. Finally, the authors present a training system being developed for the practice of new procedures in abdominal surgery.

  17. Oncoplastic breast surgery: current strategies.

    Science.gov (United States)

    Piper, Merisa; Peled, Anne Warren; Sbitany, Hani

    2015-04-01

    The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed.

  18. Massage therapy after cardiac surgery.

    Science.gov (United States)

    Wang, Amy T; Sundt, Thoralf M; Cutshall, Susanne M; Bauer, Brent A

    2010-01-01

    Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. Mounting evidence demonstrates that such challenges can impair immune function and slow wound healing, in addition to causing suffering for the patient. Finding new approaches to mitigate these challenges is necessary if patients are to experience the full benefits of surgery. Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic. Copyright © 2010 Elsevier Inc. All rights reserved.

  19. Cognitive dysfunction after cardiovascular surgery

    DEFF Research Database (Denmark)

    Funder, K S; Steinmetz, J; Rasmussen, L S

    2009-01-01

    This review describes the incidence, risk factors, and long-term consequences of cognitive dysfunction after cardiovascular surgery. Postoperative cognitive dysfunction (POCD) is increasingly being recognized as an important complication, especially in the elderly. A highly sensitive neuropsychol......This review describes the incidence, risk factors, and long-term consequences of cognitive dysfunction after cardiovascular surgery. Postoperative cognitive dysfunction (POCD) is increasingly being recognized as an important complication, especially in the elderly. A highly sensitive...... neuropsychological test battery must be used to detect POCD and a well-matched control group is very useful for the analysis and interpretation of the test RESULTS: Cardiovascular surgery is associated with a high incidence of POCD. Cardiopulmonary bypass was thought to explain this difference, but randomized...

  20. Complications After Cosmetic Surgery Tourism.

    Science.gov (United States)

    Klein, Holger J; Simic, Dario; Fuchs, Nina; Schweizer, Riccardo; Mehra, Tarun; Giovanoli, Pietro; Plock, Jan A

    2017-04-01

    Cosmetic surgery tourism characterizes a phenomenon of people traveling abroad for aesthetic surgery treatment. Problems arise when patients return with complications or need of follow-up care. To investigate the complications of cosmetic surgery tourism treated at our hospital as well as to analyze arising costs for the health system. Between 2010 and 2014, we retrospectively included all patients presenting with complications arising from cosmetic surgery abroad. We reviewed medical records for patients' characteristics including performed operations, complications, and treatment. Associated cost expenditure and Diagnose Related Groups (DRG)-related reimbursement were analyzed. In total 109 patients were identified. All patients were female with a mean age of 38.5 ± 11.3 years. Most procedures were performed in South America (43%) and Southeast (29.4%) or central Europe (24.8%), respectively. Favored procedures were breast augmentation (39.4%), abdominoplasty (11%), and breast reduction (7.3%). Median time between the initial procedure abroad and presentation was 15 days (interquartile range [IQR], 9) for early, 81.5 days (IQR, 69.5) for midterm, and 4.9 years (IQR, 9.4) for late complications. Main complications were infections (25.7%), wound breakdown (19.3%), and pain/discomfort (14.7%). The majority of patients (63.3%) were treated conservatively; 34.8% became inpatients with a mean hospital stay of 5.2 ± 3.8 days. Overall DRG-related reimbursement premiums approximately covered the total costs. Despite warnings regarding associated risks, cosmetic surgery tourism has become increasingly popular. Efficient patients' referral to secondary/tertiary care centers with standardized evaluation and treatment can limit arising costs without imposing a too large burden on the social healthcare system. 4. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  1. Current status of robot-assisted surgery.

    Science.gov (United States)

    Ng, Ada T L; Tam, P C

    2014-06-01

    The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.

  2. Gastrointestinal Complications After Bariatric Surgery.

    Science.gov (United States)

    Ma, Irene T; Madura, James A

    2015-08-01

    Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the 4 most common bariatric surgical procedures: laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

  3. Ophthalmic complications of bariatric surgery.

    Science.gov (United States)

    Guerreiro, Rui Azevedo; Ribeiro, Rui

    2015-01-01

    Obesity is increasing vastly in the world, and the number of bariatric surgeries being performed is also increasing. Patients being submitted to bariatric surgeries, especially malabsorptive procedures, have an increased risk of developing nutrient deficiencies, which can culminate in symptomatic hypovitaminosis, if supplementation is not done correctly. The eye and the optic system need an adequate level of several vitamins and minerals to perform properly, especially vitamin A, and this article wants to cover the main nutrients involved, the possible ophthalmic complications that can arise by their deficiency, and the management of those complications.

  4. Gastrointestinal Complications After Bariatric Surgery

    Science.gov (United States)

    Ma, Irene T.

    2015-01-01

    Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the 4 most common bariatric surgical procedures: laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. PMID:27118949

  5. [Bronchoplastic surgery in bronchial cancer].

    Science.gov (United States)

    Baros, B; Djuric, B

    1990-02-01

    Conservative resection is applied in cases with central localisation of the tumour in the surrounding lymph nodes are not affected by the malignant process. This surgery is of great importance for patients with restricted respiratory function if pneumonectomy is contraindicated or is performed under enhanced risk. A total of 29 surgeries were performed on the bronchial system. Blood vessel resection was simultaneously done in two of the cases. Frozen section biopsy was obligatorily performed. In one case atelectasis was an early complication that was resolved by bronchoaspiration. In a thirty-day long postoperative period one (3.4%) of the patients died because of profound intrathoracic bleeding.

  6. [The profile surgery. Mandibular osteotomies].

    Science.gov (United States)

    Sancho, M A; Grande, C; Parri, F J; Rivera, A; Sarget, R; Morales, L

    1996-04-01

    During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.

  7. Glaucoma Surgery Outcome in Rwanda.

    Science.gov (United States)

    De Smedt, Stefan K; Fonteyne, Yannick S; Muragijimana, Felicienne; Palmer, Katie; Murdoch, Ian

    2016-08-01

    To assess long-term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Central Africa. All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow-up visit. Surgical and clinical data were collected from medical records. At the study visit, best-corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an IOPglaucoma management in Africa. However, the IOP control reduced at a follow-up duration beyond 2 years, highlighting the importance of regular long-term follow-up.

  8. Breast conserving surgery versus mastectomy

    DEFF Research Database (Denmark)

    Christiansen, Peer; Carstensen, Stina Lyck; Ejlertsen, Bent

    2018-01-01

    Background: Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. Methods: The cohort...... included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995–2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients...

  9. The economics of pancreas surgery.

    Science.gov (United States)

    Vollmer, Charles M

    2013-06-01

    Pancreas surgery is a paradigm for high-acuity surgical specialization. Given the current intrigue over containing health care expenditures, pancreas surgery provides an ideal model to investigate the cost of care. This article explores the economics of this field from literature accrued over the last 2 decades. The cost of performing a pancreatic resection is established and then embellished with a discussion of the effects of clinical care paths. Then the influence of complications on costs is explored. Next, cost is investigated as an emerging outcome metric regarding variations in pancreatic surgical care. Finally, the societal-level fiscal impact is considered. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Back surgery: Modern medical pitfall.

    Science.gov (United States)

    Smith, Jc

    2002-01-01

    Medical iatrogenesis is at an all-time high with increasing deaths, disability, and costs compounded by unnecessary and ineffective surgeries despite the warnings from WHO, the US Public Health Service, and the Institute of Medicine. One area in particular, failed back surgeries, has drawn increasing attention by researchers due to disproved medical theories and surgical treatments. Paradoxically, while spinal manipulative therapy has been shown to achieve better results for this epidemic of low back pain in particular, medical and insurance programs often limit or boycott this inexpensive and effective treatment, indicating the solution to lowering medical costs and iatrogenesis now rests with political and economic factors primarily.

  11. Hernia surgery, South Africa 2015

    African Journals Online (AJOL)

    Abdominal hernia repair is one of the most common operations in general surgery. Abdominal wall hernias include inguinal, incisional, ventral and femoral hernias. The repair rate ranges from 10 per. 100 000 population in the UK to 28 per 100 000 in the US.[1,2] More than one million hernia repairs are performed.

  12. Outpatient Surgery In Day Clinics*

    African Journals Online (AJOL)

    1971-12-18

    Dec 18, 1971 ... arrange for mastectomy within 48 hours on the rare occasion where an unsuspected carcinoma is found, rather than subject all patients to the mental trauma of knowing that they might wake up having had their breast removed. Arden and Lunn' add the following procedures to out- patient surgery: carpal ...

  13. Iron deficiency and bariatric surgery.

    Science.gov (United States)

    Jáuregui-Lobera, Ignacio

    2013-05-15

    It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia) may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life after bariatric surgery. The treatment of perioperative anaemia and nutrient deficiencies has been shown to improve patients' outcomes and quality of life. All patients should undergo an appropriate nutritional evaluation, including selective micronutrient measurements (e.g., iron), before any bariatric surgical procedure. In comparison with purely restrictive procedures, more extensive perioperative nutritional evaluations are required for malabsorptive procedures due to their nutritional consequences. The aim of this study was to review the current knowledge of nutritional deficits in obese patients and those that commonly appear after bariatric surgery, specifically iron deficiencies and their consequences. As a result, some recommendations for screening and supplementation are presented.

  14. Iron Deficiency and Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Ignacio Jáuregui-Lobera

    2013-05-01

    Full Text Available It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life after bariatric surgery. The treatment of perioperative anaemia and nutrient deficiencies has been shown to improve patients’ outcomes and quality of life. All patients should undergo an appropriate nutritional evaluation, including selective micronutrient measurements (e.g., iron, before any bariatric surgical procedure. In comparison with purely restrictive procedures, more extensive perioperative nutritional evaluations are required for malabsorptive procedures due to their nutritional consequences. The aim of this study was to review the current knowledge of nutritional deficits in obese patients and those that commonly appear after bariatric surgery, specifically iron deficiencies and their consequences. As a result, some recommendations for screening and supplementation are presented.

  15. Nutritional consequences of bariatric surgery.

    Science.gov (United States)

    Xanthakos, Stavra A; Inge, Thomas H

    2006-07-01

    Bariatric surgery is being increasingly used to help treat morbidly obese adults and adolescents. As a greater percentage of this population faces a lifetime of living with surgically altered gastrointestinal anatomy and physiology, increased awareness of the nutritional consequences is critical for all health care practitioners, as many of these patients may be lost to follow-up and can present with significant nutritional complications years after surgery. Nutritional deficiencies can occur after bariatric surgery, although to a lesser degree after restrictive procedures. Risk may increase over time, perhaps due to poor compliance with supplementation, continued inadequate intake and/or ongoing malabsorption. Adolescent patients may be at greater risk due to poor compliance and longer life span. Nutritional monitoring and supplementation among bariatric programs has been widely variable and few prospective studies of outcomes exist. Bariatric surgery can carry significant risk of nutritional complications. Compliance with dietary recommendations should be monitored and encouraged, with annual screening for selected deficiencies. Prospective longitudinal research is needed to identify the true prevalence and significance of nutritional deficiency in these patients and to determine optimum dietary recommendations.

  16. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

    Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.

  17. Surgery, public health, and Pakistan.

    Science.gov (United States)

    Zafar, Syed Nabeel; McQueen, K A Kelly

    2011-12-01

    Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

  18. Physiotherapy after subacromial decompression surgery

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Falla, Deborah; Frost, Poul

    2015-01-01

    This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop...... is currently being evaluated within the framework of the Shoulder Intervention Project (ISRCTN55768749)....

  19. Architecture of European Plastic Surgery

    NARCIS (Netherlands)

    Nicolai, J. -P. A.; Banic, A.; Molea, G.; Mazzola, R.; Poell, J. G.

    2006-01-01

    The architecture of European Plastic Surgery was published in 1996 [Nicolai JPA, Scuderi N. Plastic surgical Europe in an organogram. Eur J Plast Surg 1996; 19: 253-6.] It is the objective of this paper to update information of that article. Continuing medical education (CME), science, training,

  20. Tensor surgery and tensor rank

    NARCIS (Netherlands)

    M. Christandl (Matthias); J. Zuiddam (Jeroen)

    2018-01-01

    textabstractWe introduce a method for transforming low-order tensors into higher-order tensors and apply it to tensors defined by graphs and hypergraphs. The transformation proceeds according to a surgery-like procedure that splits vertices, creates and absorbs virtual edges and inserts new vertices

  1. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit

    2009-01-01

    Full Text Available The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery.

  2. Mitral valve surgery - minimally invasive

    Science.gov (United States)

    ... for when you get home from the hospital. Shower and wash your hair the day before surgery. You may need to wash your body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked ...

  3. Surgery for GEP-NETs

    DEFF Research Database (Denmark)

    Knigge, Ulrich; Hansen, Carsten Palnæs

    2012-01-01

    Surgery is the only treatment that may cure the patient with gastroentero-pancreatic (GEP) neuroendocrine tumours (NET) and neuroendocrine carcinomas (NEC) and should always be considered as first line treatment if R0/R1 resection can be achieved. The surgical and interventional procedures for GEP...

  4. Day case surgery in Nigeria

    African Journals Online (AJOL)

    Therefore, it is important to introduce and popularize the concept of day case surgery, as this may help hospitals and healthcare ... practised in developed countries. DSUs are the best way to achieve results and so it is important for all to embrace this ..... There should be teamwork between groups. • Liaison with community ...

  5. Chest complication after abdominal surgery

    International Nuclear Information System (INIS)

    Koh, B. H.; Choi, J. Y.; Hahm, C. K.; Kang, S. R.

    1981-01-01

    In spite of many advances in medicine, anesthetic technique and surgical managements, pulmonary problems are the most frequent postoperative complications, particularly after abdominal surgery. As postoperative pulmonary complications, atelectasis, pleural effusion, pneumonia, chronic bronchitis and lung abscess can be occurred. This study include evaluation of chest films of 2006 patients (927 male, 1079 female), who had been operated abdominal surgery from Jan. 1979 to June, 1980 in the Hanyang university hospital. The results were as follows: 1. 70 cases out of total 2006 cases (3.5%) developed postoperative chest complications, 51 cases (5.5%) in male, 19 cases (1.8%) in female. 2. The complication rate was increased according to the increase of age. The incidence of the postoperative complications over 40 years of age was higher than the overall average complications rate. 3. The most common postoperative pulmonary complication was pleural effusion, next pneumonia, atelectasis and pulmonary edema respectively. 4. The complication rate of the group of upper abdominal surgery is much higher than the group of lower abdominal surgery. 5. Complication rate was increased according to increase of the duration of operation. 6. There were significant correlations between the operation site and side of the complicated hemithorax

  6. Experience with day stay surgery.

    Science.gov (United States)

    Cohen, D; Keneally, J; Black, A; Gaffney, S; Johnson, A

    1980-02-01

    Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

  7. Controlled hypotension for spinal surgery

    OpenAIRE

    Dutton, Richard P.

    2004-01-01

    Controlled, deliberate hypotension during anesthesia for major spinal surgery reduces intraoperative blood loss and transfusion requirement. Hypotension may be achieved with increased doses of volatile anesthetic agents or by continuous infusion of vasodilating drugs. Safe application of this technique requires knowledge of the physiology of hemorrhagic shock and close intraoperative monitoring to avoid vasoconstriction and end-organ ischemia.

  8. [Antibiotic prophylaxis in colorectal surgery].

    Science.gov (United States)

    Hrivnák, R; Hanke, I; Hansliánová, M; Kala, Z; Sevcíková, A

    2009-06-01

    Antibiotic (ATB) prophylaxis is generaly recommended in surgery. There is an important role in colorectal surgery especially. Colorectal surgery is associated with a particularly high risk of post-operative infection because of contamination of the wound with faecal bacteria. ATB prophylaxis decreases surgical wound infection, morbidity and mortality as well. Morbidity and mortality are associated with longer hospital stays and increased costs of care. At surgical department of Faculty hospital Brno, during March-June 2008 an 88 patients were operated because of different diagnoses in colorectum. Both an emergent and schedule operations were made. Type of ATBs, time of application before operation, reapplication after operation and surgical site infection (SSI), in - hospital stay were followed up prospectively. SSI were divided into superficial, deep and intraabdominal. Data were analyse statistically. The most used combination of ATBs, almost in 91%, were Cefazoline and Metronidazole. In 50% were time of application till 20 minutes before incision. Only in 17% were time of application in interval 20-30 minutes before incision, which is recommended. We noticed 25 SSI. We prove that patients with SSI has almost two-times longer in-hospital stay. Enterococcus and enterobacterias were the most common etiological agents. ATB prophylaxis is indicated in colorectal surgery. It has to be applied in correct dose and right time before operation to decrease SSI.

  9. Annals of African Surgery: Submissions

    African Journals Online (AJOL)

    must be applied to the entire image and may not result in misrepresentation of the original image. Conflict of Interest. All editors at the ... The Annals of African Surgery does not knowingly permit advertising for a specific product in physical proximity to a specific article mentioning that product. Editorial decisions are made ...

  10. Conventional surgery in breast cancer

    International Nuclear Information System (INIS)

    Tapia Herrera, Andres

    2013-01-01

    General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es

  11. Functional recovery following vitreoretinal surgery

    NARCIS (Netherlands)

    Scheerlinck, LME

    2016-01-01

    The general aim of this thesis was to evaluate functional outcome following vitreoretinal surgery for idiopathic epiretinal membranes (iERM) and rhegmatogenous retinal detachment (RRD). Idiopathic epiretinal membrane Pars plana vitrectomy with removal of the iERM is considered to be the standard

  12. Gender Confirmation Surgery: Guiding Principles.

    Science.gov (United States)

    Schechter, Loren S; D'Arpa, Salvatore; Cohen, Mimis N; Kocjancic, Ervin; Claes, Karel E Y; Monstrey, Stan

    2017-06-01

    At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. To propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery. We use expert opinion to provide a "first of its kind" framework for training surgeons to care for transgender and gender nonconforming individuals. We describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters. This article represents the first step in the development of a structured educational program for surgical training in gender confirmation procedures. The World Professional Association for Transgender Health Board of Directors unanimously approved this article as the framework for surgical training. This article builds a framework for surgical training. It is designed to provide concepts that will likely be modified over time and based on additional data and evidence gathered through outcome measurements. We present an initial step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures. Schechter LS, D'Arpa S, Cohen MN, et al. Gender Confirmation Surgery: Guiding Principles. J Sex Med 2017;14:852-856. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  13. The scope of plastic surgery

    African Journals Online (AJOL)

    2013-08-03

    Aug 3, 2013 ... Memorial Children's hospitals and University of Cape Town, Cape Town, South Africa ... paediatric congenital conditions, as well as the supplementary .... General surgeons f. Orthopaedic surgeons g. ENT surgeons h. Neurosurgeons. QUESTIONNAIRE. 1. Who do you feel are experts in eyelid surgery? 2.

  14. Planned combined radiotherapy and surgery

    International Nuclear Information System (INIS)

    Silverman, C.L.; Marks, J.E.

    1987-01-01

    Though the planned combined use of surgery and radiation has been shown to be beneficial for other tumors, the authors feel that the present evidence is far from persuasive in demonstrating a definite superiority of combined therapy over surgery or radiation alone for advanced laryngeal tumors. The actuarial or disease-free survival rates for patients treated with combined therapy have not been significantly increased over those obtained with a single modality in any randomized, well-controlled study, although the trend is toward improved local regional control. Many of the retrospective studies are probably flawed by selection bias; the patients selected for combined treatment generally have more advanced cancers and represent a worse prognostic group. It is clear from this review that the positive value of irradiation for advanced transglottic and supraglottic tumors needs to be documented by a controlled study that compares surgery alone with salvage radiation at time of recurrence to surgery plus adjuvant radiation. The authors feel that such a study is needed to put to rest the present controversy before they can advocate a course of treatment that is expensive, time-consuming, and difficult for the patients to tolerate owing to severe acute side effects and potentially morbid late effects (xerostomia, necrosis) that can greatly lessen the quality of life for these patients

  15. Computational Modeling in Liver Surgery

    Directory of Open Access Journals (Sweden)

    Bruno Christ

    2017-11-01

    Full Text Available The need for extended liver resection is increasing due to the growing incidence of liver tumors in aging societies. Individualized surgical planning is the key for identifying the optimal resection strategy and to minimize the risk of postoperative liver failure and tumor recurrence. Current computational tools provide virtual planning of liver resection by taking into account the spatial relationship between the tumor and the hepatic vascular trees, as well as the size of the future liver remnant. However, size and function of the liver are not necessarily equivalent. Hence, determining the future liver volume might misestimate the future liver function, especially in cases of hepatic comorbidities such as hepatic steatosis. A systems medicine approach could be applied, including biological, medical, and surgical aspects, by integrating all available anatomical and functional information of the individual patient. Such an approach holds promise for better prediction of postoperative liver function and hence improved risk assessment. This review provides an overview of mathematical models related to the liver and its function and explores their potential relevance for computational liver surgery. We first summarize key facts of hepatic anatomy, physiology, and pathology relevant for hepatic surgery, followed by a description of the computational tools currently used in liver surgical planning. Then we present selected state-of-the-art computational liver models potentially useful to support liver surgery. Finally, we discuss the main challenges that will need to be addressed when developing advanced computational planning tools in the context of liver surgery.

  16. Controversies in gynaecologic endoscopic surgery

    NARCIS (Netherlands)

    Darwish, A.M.M.

    2009-01-01

    Despite the widespread utilization of assisted reproductive techniques in recent years, hysteroscopic as well as laparoscopic surgery should be firstly offered for patients with adnexal and uterine lesions desiring fertility. Permanent correction of the patient’s problem with frequent chances of

  17. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  18. Mortality after surgery in Europe

    DEFF Research Database (Denmark)

    Pearse, Rupert M; Moreno, Rui P; Bauer, Peter

    2012-01-01

    Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international s...

  19. Gas explosion during colonic surgery.

    Science.gov (United States)

    De Wilt, J H; Borel Rinkes, I H; Brouwer, K J

    1996-12-01

    Explosions of the colon as a result of the use of diathermy in the presence of gas mixtures of oxygen, hydrogen and/or methane have been previously described in the literature. This danger is present during colonoscopic polypectomy as well as during colonic surgery. The following case is presented to alert to the potential hazards of bowel gas during electrosurgery.

  20. Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

    OpenAIRE

    Choi, Seung Woo; Lee, Jae Yeun; Lew, Helen

    2016-01-01

    Purpose To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). Methods Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular m...

  1. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

    Science.gov (United States)

    Huffman, Mark D; Karmali, Kunal N; Berendsen, Mark A; Andrei, Adin-Cristian; Kruse, Jane; McCarthy, Patrick M; Malaisrie, S C

    2016-01-01

    Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random

  2. Cardiac surgery in the parturient.

    Science.gov (United States)

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

    2009-03-01

    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

  3. "Oriental anthropometry" in plastic surgery

    Directory of Open Access Journals (Sweden)

    Senna-Fernandes Vasco

    2008-01-01

    Full Text Available Background : According to Chinese medicine, the acupuncture-points′ (acupoints locations are proportionally and symmetrically distributed in well-defined compartment zones on the human body surface Oriental Anthropometry" (OA. Acupoints, if considered as aesthetic-loci, might be useful as reference guides in plastic surgery (PS. Aim: This study aimed to use aesthetic-loci as anatomical reference in surgical marking of Aesthetic Plastic Surgery. Method: This was an observational study based on aesthetic surgeries performed in private clinic. This study was based on 106 cases, comprising of 102 women and 4 men, with ages varying from 07 to 73 years, and with heights of between 1.34 m and 1.80 m. Patients were submitted to aesthetic surgical planning by relating aesthetic-loci to conventional surgical marking, including breast surgeries, abdominoplasty, rhytidoplasty, blepharoplasty, and hair implant. The aesthetic-surgical-outcome (ASO of the patients was assessed by a team of plastic surgeons (who were not involved in the surgical procedures over a follow-up period of one year by using a numeric-rating-scale in percentage (% terms. A four-point-verbal-rating-scale was used to record the patients′ opinion of therapeutic-satisfaction (TS. Results: ASO was 75.3 ± 9.4% and TS indicated that most patients (58.5% obtained "good" results. Of the remainder, 38.7% found the results "excellent", and 2.8% found them "fair". Discussion and Conclusion : The data suggested that the use of aesthetic-loci may be a useful tool for PS as an anatomical reference for surgical marking. However, further investigation is required to assess the efficacy of the OA by providing the patients more reliable balance and harmony in facial and body contours surgeries.

  4. EARLY COMPLICATIONS IN BARIATRIC SURGERY:

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    Full Text Available ContextBariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.MethodThe medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2.ResultsEarly complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.ConclusionThe incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

  5. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary

  6. Economic and psychological burden of scheduled surgery ...

    African Journals Online (AJOL)

    Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation ... management. High cancellation rates may indicate that rare health resources are being used ineffectively, thereby increasing costs. There are many reasons for surgery cancellation including.

  7. Anesthesia Awareness (Waking Up) During Surgery

    Science.gov (United States)

    ... Resources About Policymakers Media ASA Member Toolkit Risks Anesthesia Awareness (Waking Up) During Surgery Explore this page: ... do you reduce the risk of anesthesia awareness? Anesthesia Awareness (Waking Up) During Surgery If you’re ...

  8. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “ ...

  9. Nigerian Journal of Plastic Surgery: Journal Sponsorship

    African Journals Online (AJOL)

    Nigerian Journal of Plastic Surgery: Journal Sponsorship. Journal Home > About the Journal > Nigerian Journal of Plastic Surgery: Journal Sponsorship. Log in or Register to get access to full text downloads.

  10. Weight-loss surgery and children

    Science.gov (United States)

    ... more likely to have problems such as: Low self-esteem Poor grades in school Depression ... weight-loss surgery should receive care at an adolescent bariatric surgery center. There, a team of experts ...

  11. New DVD supports trachoma surgery training

    Directory of Open Access Journals (Sweden)

    Saul N Rajak

    2011-12-01

    Full Text Available The first part of this article introduces a new comprehensive TT surgery training DVD. The second part presents an extract from the DVD covering using a steam autoclave to sterilise the instruments used in trachoma surgery.

  12. Your diet after gastric bypass surgery

    Science.gov (United States)

    ... and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) . 2009;17 Suppl 1:S1- ...

  13. Management of Antiepileptic Treatment After Epilepsy Surgery

    DEFF Research Database (Denmark)

    Rubboli, Guido; Sabers, Anne; Uldall, Peter

    2017-01-01

    BACKGROUND: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic...

  14. Chemo Before Surgery May Help Stomach Cancer

    Science.gov (United States)

    Chemotherapy given before surgery for cancer of the lower esophagus and stomach increased the number of patients surviving for five years compared to surgery alone, according to findings presented at the 2007 ASCO meeting in Chicago.

  15. American Society for Surgery of the Hand

    Science.gov (United States)

    ... of Hand Surgery ASSH Annual Meeting Registration Program Hotel and Travel Industry and Exhibits Future Annual Meetings Shop our Store ... of Hand Surgery ASSH Annual Meeting Registration Program Hotel and Travel Industry and Exhibits Future Annual Meetings Shop our Store ...

  16. Pregnancy after Bariatric Surgery: A Review

    OpenAIRE

    Hezelgrave, N. L.; Oteng-Ntim, Eugene

    2011-01-01

    Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to ...

  17. Reconstructive Surgery in the Thermally Injured Patient

    Science.gov (United States)

    2012-01-01

    the same or Conflicts of interest: The authors disclose no conflicts. a Division of Oral and Maxillofacial Surgery , Dental and Trauma Research...Reconstructive Surgery in the Thermally Injured Patient Davin Mellus, DMDa,* Rodney K. Chan, MDb KEYWORDS • Microvascular free-tissue transfer...Pedicle flaps • Reconstructive Surgery • Thermal injury • Z-plasties • Skin grafting AN INCREASED NEED FOR RECONSTRUCTIVE SURGERY Reconstruction is a

  18. Errors and complications in laparoscopic surgery

    OpenAIRE

    Liviu Drăghici; Mircea Lițescu; Rubin Munteanu; Constantin Pătru; Carmen L. Gorgan; Radu Mirică; Isabela Drăghici

    2017-01-01

    Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during...

  19. Receptivity to Bariatric Surgery in Qualified Patients

    OpenAIRE

    Fung, Michael; Wharton, Sean; Macpherson, Alison; Kuk, Jennifer L.

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to comple...

  20. Reflection on internationalization of Chinese surgery journals.

    Science.gov (United States)

    Wang, Jin; Lu, Yuan-qiang

    2009-08-01

    Chinese surgery journals are of small international impact which does not measure up to the state of development of surgery in China and they can not adequately publish Chinese researches to the world. To improve the visibility of Chinese surgery journals, this article suggests developing more English surgery journals, extending a co-operation with famous publishers, employing overseas experts as editorial committee and making more use of the Internet.

  1. History of Argentine surgery, abaut general surgery residents

    OpenAIRE

    A. Jankilevich

    2015-01-01

    This work, as its title indicates, is targeted to young general surgery residents, who have been kind enough to open their journal for this collaboration. A gesture that I appreciate and I’ll try to give back narrating some facts of the first century of our independence. The story starts a few decades before 1810, especially with the institution of the Viceroyalty of Rio de la Plata, and ends at 1880, when indigenous peoples are submited, traditional estate, the gaucho gerrillas and ...

  2. Receptivity to Bariatric Surgery in Qualified Patients

    Directory of Open Access Journals (Sweden)

    Michael Fung

    2016-01-01

    Full Text Available Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female completed the questionnaire. Only 87 of 371 (23% participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m2, P=0.03 and believed that they would lose more weight with surgery (51 versus 44 kg, P=0.0069. Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery.

  3. Receptivity to Bariatric Surgery in Qualified Patients.

    Science.gov (United States)

    Fung, Michael; Wharton, Sean; Macpherson, Alison; Kuk, Jennifer L

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m(2), P = 0.03) and believed that they would lose more weight with surgery (51 versus 44 kg, P = 0.0069). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery.

  4. Anticipating urgent surgery in operating room departments

    NARCIS (Netherlands)

    van der Lans, M.; Hans, Elias W.; Hurink, Johann L.; Wullink, Gerhard; van Houdenhoven, M.; Kazemier, G.

    2005-01-01

    Operating Room (OR) departments need to create robust surgical schedules that anticipate urgent surgery, while minimizing urgent surgery waiting time and overtime, and maximizing utilization. We consider two levels of planning and control to anticipate urgent surgery. At the tactical level, we study

  5. Clean room technology in surgery suites

    Science.gov (United States)

    1971-01-01

    The principles of clean room technology and the criteria for their application to surgery are discussed. The basic types of surgical clean rooms are presented along with their advantages and disadvantages. Topics discussed include: microbiology of surgery suites; principles of laminar airflow systems, and their use in surgery; and asepsis and the operating room.

  6. Piezosurgery in oral and maxillofacial surgery

    Czech Academy of Sciences Publication Activity Database

    Pavlíková, G.; Foltán, R.; Horká, M.; Hanzelka, T.; Borunská, H.; Šedý, Jiří

    2011-01-01

    Roč. 40, č. 5 (2011), s. 451-457 ISSN 0901-5027 Institutional research plan: CEZ:AV0Z50390703 Keywords : piezosurgery * oral surgery * maxillofacial surgery Subject RIV: FJ - Surgery incl. Transplants; FH - Neurology (UEM-P) Impact factor: 1.506, year: 2011

  7. Value of microvascular surgery in academic oral and maxillofacial surgery.

    Science.gov (United States)

    Fattahi, Tirbod; Fernandes, Rui

    2013-01-01

    The specialty of oral and maxillofacial surgery has witnessed a large trend of inclusion of maxillofacial oncology and microvascular reconstructive surgery within its scope of practice in recent years. The purpose of this report is to describe the authors' experience with a very active oncologic and microvascular reconstructive surgical service within an academic oral and maxillofacial surgical program at a large university teaching hospital. The operative log from July 1, 2010, to June 30, 2011, of 325 operations devoted to head and neck oncology and reconstruction was examined. Thirty-nine patients (group A) received a pedicled flap for head and neck reconstruction. Sixty-three patients (group B) received a microvascular free tissue transfer for head and neck reconstruction. Financial records of 20 consecutive patients who underwent simultaneous ablative and reconstructive procedures in each group were then reviewed for total hospital charges, including direct (surgical fees) and indirect (hospital stay, operating room expenses, and ancillary services) charges, and length of stay. Total hospital charges and direct surgical fees, were higher for the microvascular reconstruction group (group B). Length of hospital stay was not statistically different between the two groups. Microvascular reconstructive surgery performed within an academic oral and maxillofacial surgical program has many financial and intangible benefits within a medical center. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Adjuvant analgesics for spine surgery.

    Science.gov (United States)

    Nielsen, Rikke Vibeke

    2018-03-01

    Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes. More than 6,000 spine surgeries are performed annually in Denmark and spine surgery has been associated with high levels of pain compared to other surgical procedures. Therefore, we considered spine surgery to pose a group of well-defined surgical procedures and we used this model to investigate the efficacy of 3 adjuvant analgesics aiming to improve the multimodal approach in pain management.
 
In study I and II we hypothesized that preoperative IV dexamethasone 16 mg would reduce acute postoperative pain, opioid consumption and persistent pain after lumbar disk surgery. We found that dexamethasone significantly reduced acute pain during mobilization. The clinical relevance is however debatable and we could not demonstrate an opioid sparing effect. Further, we discovered significantly higher pain levels in the dexamethasone group compared to placebo 1 year postoperatively.
 
In study III we explored the effect of 500 mg of oral chlorzoxazone on acute postoperative pain and opioid consumption in patients with moderate to severe pain after spine surgery and found no effect of chlorzoxazone compared to placebo.
 
In study IV we hypothesized that intraoperative ketamine would reduce postoperative opioid consumption and persistent pain after spinal fusion surgery in chronic pain patients with opioid dependency. We found a significantly reduced opioid

  9. [The main aspects of vesical risk in intraperitoneal surgery].

    Science.gov (United States)

    Tode, V; Voinea, F; Marin, O

    2001-01-01

    They are described the main aspects of vezical risk in intraperitoneal surgery: subembilical celiostomy, haernios surgery, rectal surgery, gynecological surgery. It is shown few aspects of our experience in the treatment of haernias, vesicovaginal fistules secondary to total hysterectomy.

  10. Metals used in maxillofacial surgery.

    Science.gov (United States)

    Pacifici, L; DE Angelis, F; Orefici, A; Cielo, A

    2016-01-01

    The goal of maxillofacial surgery is to restore the shape and functionality of maxillofacial region. In the past years, there has been a tremendous progress in this field because of significant advances in biotechnology that provided innovative biomaterials to efficiently reconstruct the maxillofacial injured region. By using appropriate selection of the implant biomaterial, it is possible to reconstruct the native tissue, both in form and function. The ideal biomaterial should mimic native tissues regarding density, strength, and modulus of elasticity. Autografts are currently the gold standard for replacement of missing tissues, but synthetic biomaterials have been widely used because they eliminate the discomfort to take the replacement tissue from the donor site. Among synthetic biomaterials, different metals may be utilized to efficiently reconstruct the maxillofacial injured region. This article makes an effort to summarize the most important metals in use in maxillofacial surgery, and point out advantages and disadvantage of each type.

  11. Prophylactic digitalisation in pulmonary surgery.

    Science.gov (United States)

    Ritchie, A J; Danton, M; Gibbons, J R

    1992-01-01

    Prophylactic digoxin is widely used in patients undergoing pulmonary surgery to prevent or control cardiac arrhythmias, but whether it is helpful or not is uncertain. An open, controlled randomised prospective clinical study of 111 patients was undertaken to compare the incidence of cardiac arrhythmias in the 58 patients who received preoperative digoxin and the 53 who did not. Cardiac arrhythmia occurred in half (29/58) of those given prophylactic digoxin and in 36% (19/53) of those who were not. The overall incidence of arrhythmia was 43%, with no statistically significant difference between the groups. Cardiac arrhythmias remain an important complication of pulmonary surgery and the incidence is not reduced by prophylactic digoxin.

  12. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark....... PARTICIPANTS: Sixty patients for major lung resection. INTERVENTIONS: Postoperative observation of ipsilateral shoulder pain. MEASUREMENTS AND MAIN RESULTS: Postoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...

  13. Arthroscopic surgery for degenerative knee

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, C B; Roos, E M

    2015-01-01

    OBJECTIVE: To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURES: Pain and physical function....... RESULTS: The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

  14. FLUOROSCOPY DURATION IN ORTHOPEDIC SURGERY

    Science.gov (United States)

    Salvia, Joao Caron La; de Moraes, Pablo Reis; Ammar, Tiago Yossef; Schwartsmann, Carlos Roberto

    2015-01-01

    Objective: To ascertain the mean length of radiation emission from fluoroscopic devices during several types of orthopedic surgery and which of these required greater use of radiation. Methods: The times taken to perform sixteen different types of surgery (total of 80 procedures) were measured. At the end of each procedure, the length of time for which fluoroscopy was used directly from the image intensifier was ascertained. Results: The mean time required for fluoroscopy per operation was 61 seconds. The procedures that demanded greatest mean duration of radiation use were bilateral proximal femoral epiphysiodesis (5.1 minutes) and femoral shaft osteosynthesis using a locked intramedullary nail (3.33 min). Conclusion: The mean duration of fluoroscopy use in orthopedic operations was 61 seconds. The procedures using an intramedullary device were the ones that required greatest radiation emission. PMID:27027000

  15. [Outpatient surgery: an unstoppable evolution].

    Science.gov (United States)

    Charbonnet, P; Ott, V; Schiffer, E; Berney, T; Morel, P

    2010-06-23

    The trend is to definitely shorten hospital stays. It follows in the footsteps of a broader range of surgeries that can be managed in an ambulatory care setting. The expected benefits are: a reduction in costs, a shorter preoperative delay, a shorter absence for the work place and a lessened risk of hospital-borne infections. A multidisciplinary approach is essential for the success of such a program. Surgeons, anaesthetists and nursing staff must be prepared to modify and adapt their skills. The criterion of success for such an endeavour is a low level of readmissions and hospitalisations. If day surgery tends to keep the patient away for the hospital settings, it certainly places him in the centre of his medical management.

  16. Infection management following ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Chin AB

    2015-10-01

    Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

  17. Office-Based Plastic Surgery

    OpenAIRE

    Ersek, Robert A.

    2007-01-01

    Office-based plastic surgery began in the 1960s and has expanded exponentially since then. The majority of plastic surgeons now have their own office-based facilities, and every elective aesthetic procedure from hair transplantation to abdominoplasty and breast reduction can be done as an outpatient procedure with tremendous increases in efficiency, safety, and time. We started with a single room and have expanded to three operating rooms, two specific preoperative, postoperative private room...

  18. Outcome measurement in plastic surgery.

    Science.gov (United States)

    Wormald, Justin C R; Rodrigues, Jeremy N

    2018-03-01

    Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patients' perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? And how valid is it? Measurement that combines being patient-centred and aligning with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Performance Indicators in Spine Surgery.

    Science.gov (United States)

    St-Pierre, Godefroy Hardy; Yang, Michael H; Bourget-Murray, Jonathan; Thomas, Ken C; Hurlbert, Robin John; Matthes, Nikolas

    2018-02-15

    Systematic review. To elucidate how performance indicators are currently used in spine surgery. The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. 1.

  20. Nutritional requirements after bariatric surgery.

    Science.gov (United States)

    Bosnic, Gordana

    2014-06-01

    This article presents an overview of postoperative nutritional requirements and goals following bariatric surgery. It summarizes current diet progression and nutrient intake guidelines geared toward optimizing weight loss and maintaining adequate nutritional status, nutrient absorption, as well as hydration. The article further emphasizes the importance of postoperative follow-up with a bariatric multidisciplinary team for appropriate postoperative care, diet management, and nutrient deficiency screenings. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Laser Surgeries - Subverting Potential Hazards

    Directory of Open Access Journals (Sweden)

    S Kiran

    2016-01-01

    Full Text Available Use of lasers in Operation Theatre (OT is a challenge for both the surgeons and anesthesiologists due to its potential hazard of thermal injury to both patients and OT personnel Adequate preparations need to be undertaken prior to surgery to reduce the risks associated with laser beams. Pre-considered contingency plans for airway fires should be in place. Strict implementation of safety precautions is key for safety of patients and staff in naval hospitals.

  2. Sleep surgery and medical malpractice.

    Science.gov (United States)

    Tolisano, Anthony M; Bager, Jennifer M

    2014-06-01

    To describe and analyze the causes and outcomes of lawsuits pertaining to sleep surgery to mitigate future litigation and improve physician education. A retrospective review of a publicly available database containing jury verdicts and settlements. The LexisNexis MEGA Jury Verdicts and Settlements database was reviewed for all lawsuits including settlements and trial verdicts related to sleep surgery. Data including type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed. Fifty-one cases met the inclusion criteria. Of these, 30 were decided by a jury, nine were settled out of court, and 10 were resolved by other means. Overall, 57% of known outcomes favored the defendant. The most common surgery performed was tonsillectomy (57%), followed by uvulopalatopharyngoplasty (45%), adenoidectomy (31%), and septoplasty (31%). No difference was found between outcomes when comparing the most common injuries cited, including wrongful death (P = .572), airway compromise (P = .376), and drug reaction (P = .443). If failure to recognize a complication (P = .034) or delay in diagnosis (P = .026) was a component of the legal allegations, the outcome significantly favored the plaintiff. The median settlement ($545,000) and plaintiff award ($1.45 million) were not significantly different (P = .13). The majority of outcomes favored the defendant. Type of injury did not predict outcome. Failure to recognize complications and delay in diagnosis strongly predicted a verdict in favor of the plaintiff. 2c. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Toward robot guided waterjet surgery

    OpenAIRE

    Bahls, Thomas; Fröhlich, Florian; Albu-Schäffer, Alin

    2013-01-01

    Papachristou and Bartes [1] first used a waterjet in the medical context. By using a waterjet in ablative liver surgery intrahepatic parenchyma could be washed away whereas vessels and ducts stay undamaged and intact which leads to less interoperative loss of blood. The aspect of tissue selectivity is one of the major advantages of using a waterjet to prepare soft tissue. This work first explains the physical basics of this method and differs between relevant properties which are res...

  4. Heterochromia after pediatric cataract surgery.

    Science.gov (United States)

    Lenart, T D; Drack, A V; Tarnuzzer, R W; Fernandes, A; Lambert, S R

    2000-02-01

    Changes in iris color have been noted anecdotally after cataract surgery in infants, but they have not been studied systematically. The mechanism for these iris color changes has not previously been reported in the biomedical literature. Photographs were taken of both eyes of 15 children and 11 rhesus monkeys who had undergone unilateral cataract surgery. Masked examiners reviewed the photographs and compared the iris color of the eyes that were operated on with the eyes that were not operated on. Between 4 and 6 weeks postoperatively, the level of prostaglandin F(2alpha) in the aqueous humor (n = 4) and vitreous humor (n = 2) was measured in both the operated and nonoperated eyes of 4 monkeys that had undergone a neonatal lensectomy during the first 5 days of life. Thirteen of 15 children had a darker iris color in the operated eye in relation to the nonoperated (control) eye. Four of 11 monkeys had a uniformly darker iris in the operated eye; the other 7 monkeys had regional darkening or patches of darker iris in the eye that was operated on. The prostaglandin F(2alpha) levels in neonatal monkeys were higher in the aqueous humor and in the vitreous humor of the operated eye in relation to the nonoperated eye. In some children, cataract surgery is associated with a darkening of the iris color in the operated eye. We speculate that this darkening results from an exuberant prostaglandin release stimulated by the cataract surgery and may occur through the same or a similar mechanism by which latanoprost causes the darkening of iris color.

  5. Obesity surgery: French medico-legal aspects.

    Science.gov (United States)

    Manaouil, Cecile; Gignon, Maxime; Jardé, Olivier

    2011-06-01

    The demand for bariatric surgery is expected to increase. It is a procedure that carries a high surgical risk, and a risk of postoperative complications due to the pathologies associated with obesity. Obesity surgery is not classified as plastic surgery, but may subsequently lead to plastic surgery-type operations. Malpractices in the field of obesity surgery are most frequently at the pre-operative stage. In the absence of any fault, a patient may obtain indemnification by "national solidarity". Physicians and surgeons have an obligation to be able to prove that they informed their patients properly.

  6. "Open" minimally invasive surgery in pediatric urology.

    Science.gov (United States)

    Hidalgo-Tamola, Josephine; Shnorhavorian, Margarett; Koyle, Martin A

    2009-06-01

    Minimally invasive surgery (MIS) offers alternative operative approaches to standard open surgical techniques. However, MIS has been defined primarily as substituting laparoendoscopic alternatives for the traditional open surgical approach. The concept of MIS methodology may also be applied to open surgery in an effort to decrease incision size, potentially reduce morbidity and enhance convalescence, without compromising 'gold standard' outcomes. Pediatric urological applications of open MIS include pediatric renal surgery, ureteral reimplantation, ureteral surgery, inguinal-scrotal and genital surgery. A thorough review of the pediatric urology literature was performed and studies were identified describing open MIS, including outcomes and complications.

  7. Anaesthetic complications in plastic surgery.

    Science.gov (United States)

    Nath, Soumya Sankar; Roy, Debashis; Ansari, Farrukh; Pawar, Sundeep T

    2013-05-01

    Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome.

  8. Anaesthetic complications in plastic surgery

    Directory of Open Access Journals (Sweden)

    Soumya Sankar Nath

    2013-01-01

    Full Text Available Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist′s concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients′ experience and surgical outcome.

  9. On the uniqueness of surgery.

    Science.gov (United States)

    Fischer, Josef E

    2005-03-01

    As the divergence between medicine and surgery increases, the author traces its beginnings not to the recent past, but as far back as the Middle Ages and the Renaissance. Even at that time, physicians rarely came in physical contact with the patients and made their diagnoses from looking at flasks of urine from the patients. Skilled physicians allegedly could make approximately 1000 diagnoses from examining a flask of urine. On the other hand, barber surgeons were relatively unskilled and unrewarded, at a much lower class in society, and laid hands on the patient by draining abscesses, cauterizing, dealing with bladder stones, etc. Despite the Quincentenary of the Royal College of Surgeons of Edinburgh this year and the rendering of the first guild to the barber surgeons, this schism between medical and surgical practice has remained. The author attempts to fit this schism into medicine today by addressing continuity of care and the 80-hour workweek, stating that this schism is not a new development but has existed for many years. The proposal is made that medicine and surgery should work together as much as they can. However, if surgical patients are not well served by the lack of emphasis on continuity of care brought forth by the leadership of medicine in this country, who the author claims of intentionally distancing themselves from patient care, then surgery may need to go its own way. The patient comes first.

  10. Current advances in liver surgery

    Directory of Open Access Journals (Sweden)

    Shannon Melissa Chan

    2015-01-01

    Full Text Available Hepatobiliary surgery has taken a big step forward in recent decades especially in the minimally invasive approach for hepatectomy. From being sceptical at the beginning of the 1990s when laparoscopic surgery had become prevalent, to now, where laparoscopic hepatectomy has been well-established, especially in minor hepatectomies; this new technique has evolved rapidly over the past 20-years demonstrating better short-term outcomes and equivalent oncological outcomes in selected patients and in expert hands. Laparoscopic hepatectomy is indeed, more difficult to master than the open procedure with restrictions in working space, difficulty in haemostasis and the potential risk of gas embolism. However, with better visibility of the operative field around the liver, especially beneath the costal margin, the magnified view and theoretical advantage of pneumoperitoneum acting as haemostatic pressure have made laparoscopic hepatectomy increasingly popular. Another important advancement is the new surgical technique of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS. This procedure induces more rapid liver hypertrophy within a median period of 9-days, allowing resection to be performed in candidates with borderline functional liver remnant and at an earlier date. However, studies have shown that ALPPS is associated with a relatively higher rate of morbidity and mortality. Therefore, it remains a highly controversial treatment option and more studies have to be performed to establish its usefulness and define its role in liver surgery.

  11. VITREORETINAL SURGERY AND ITS INDICATIONS

    Directory of Open Access Journals (Sweden)

    Mojca Globočnik-Petrovič

    2002-11-01

    Full Text Available Background. Vitreoretinal surgery is the second most frequent surgery after cataract extraction. It is indicated in the treatment of various vitreous and retinal disorders such as diabetic retinopathy, proliferative vitreoretinopathy, endophthalmitis, penetrating and perforating injuries of the eye. 400 vitreoretinal operations were done in University Eye Clinic in Ljubljana last year which is three times more like years ago. Almost third of all vitreoretinal operations were done on patients with diabetic retinopathy, 22% on patients with proliferative vitreoretinopathy, 10% on traumatic eyes and 14% were reoperations. Remaining 28% of operations were done on eyes with different diagnoses such as macular diseases, retinal detachment, haematovitreus, endophthalmitis and dropped nucleus.During vitrectomy, vitreous opacities are excised and abnormal structural changes above and beneath the retina can be removed. Depending on the type of retinal disease different types of vitreous cavity tamponade such as silicone oil, gas or intraocular saline are used.Conclusions. Improved knowledge of the pathohistology of abnormal vitreoretinal structural changes and new surgical techniques have resulted in improved anatomical and visual results of vitreoretinal surgery. The list of indications has expanded and some macular diseases which were untreatable a few years ago can now be routinely operated with good results.

  12. Cosmetic procedures in orthognathic surgery.

    Science.gov (United States)

    Nocini, Pier Francesco; Chiarini, Luigi; Bertossi, Dario

    2011-03-01

    Orthognathic surgery produces cosmetic and functional effects, and patients should be evaluated for additional cosmetic improvements beyond those possible with orthognathic surgery. Soft tissue procedures can be performed on an outpatient basis in an office environment and can be combined with orthognathics and delayed in a second stage. Systematic accurate facial evaluation is necessary to focus on cosmetic soft tissue problems. Features that make the patient look unattractive, old, tired, out of shape, weak, or sad must be identified by accurate clinical analysis and 3-dimensional planning. Then it will be possible to select the treatment plan according to the patient's input, prioritizing the additional cosmetic improvements that can be added to primary surgery. It is particularly important to review the results and the patient's satisfaction by clinical examination, a questionnaire, and with 3-dimensional pictures, and to understand if the treatment options have been accurately chosen and their lasting effect on follow-up. The treatment sequence is analyzed, and if there are residual defects, a secondary cosmetic procedure can be planned to complete the result. The surgeon's goal must be the simultaneous treatment of malocclusions and facial esthetic disharmonies, and orthognathic surgical procedures and facial cosmetics must be performed simultaneously, if possible. Residual defects must be treated after at least 6 to 12 months. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Shaping the Future of Surgery

    Science.gov (United States)

    Callcut, Rachael A.; Breslin, Tara M.

    2006-01-01

    Objective: To educate surgeons about the growth of the private regulatory movement and its potential implications for the practice of surgery. Methods: An in-depth analysis and literature review of one of the largest private regulatory groups, the Leapfrog Group, provides a model for understanding the impact of these groups on the practice of surgery. A detailed discussion of the history, mission, structure, and quality initiatives of Leapfrog is included. Results: Private regulatory groups are using quality standards as a method for controlling the rising cost of health care. Traditionally, little financial support, manpower, or incentives have existed for individual surgeons and hospitals to report and maintain their own outcomes data. However, as surgical outcomes have increasingly become the target of quality improvement initiatives, the need to measure performance is gaining importance. Surgical quality has been both a direct target of private regulation, as illustrated by the evidence-based hospital referral guidelines of Leapfrog, and an indirect target with initiatives like computerized physician order entry and ICU staffing guidelines. Conclusions: Private regulation is rapidly reshaping the way we practice and teach surgery. It is almost a certainty that their power, popularity, financial support, and missions will all continue to expand. As surgeons, we must decide soon if we wish to be an active participant in shaping the movement or, rather, if we are going to let it shape us by remaining largely uninvolved. PMID:16495692

  14. Bundled payments in orthopedic surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-02-01

    As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. Recognize the importance of resource utilization management, quality outcome measurement, and combined economic-clinical value in determining the value of bundled payment arrangements. 4. Identify the implications of bundled payments for practicing orthopedists, as well as the legal issues and potential future directions of this increasingly popular alternative payment method. Bundled payments, the idea of paying a single price for a bundle of goods and services, is a financial concept familiar to most American consumers because examples appear in many industries. The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery. Copyright 2015, SLACK Incorporated.

  15. History of shoulder instability surgery.

    Science.gov (United States)

    Randelli, Pietro; Cucchi, Davide; Butt, Usman

    2016-02-01

    The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. IV.

  16. Medical malpractice in hand surgery.

    Science.gov (United States)

    Pappas, Nick D; Moat, Diane; Lee, Donald H

    2014-01-01

    The rise in medical malpractice claims over the past few decades has altered physicians' practice patterns and has had a considerable financial impact on the medical community as a whole. While numerous studies have analyzed the content and effect of these claims, only a handful of articles have addressed specifically the issue of medical malpractice in hand surgery. This article outlines the available literature on malpractice in hand surgery, offers guidance to hand surgeons on managing medical malpractice claims, and discusses preventative measures they might take to limit such claims from being filed in the future. We conclude that the key measures one can take to protecting oneself legally are knowing and abiding by the standard of care, keeping patients informed and developing good relationships with them, and meticulously documenting. Although some malpractice claims are unavoidable, we believe that one can limit his or her exposure to them by incorporating these measures into their respective practices. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Robot-assisted general surgery.

    Science.gov (United States)

    Hazey, Jeffrey W; Melvin, W Scott

    2004-06-01

    With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

  18. Medicolegal pitfalls of cataract surgery.

    Science.gov (United States)

    Lee, Bryan S

    2015-01-01

    To provide a general overview of medicolegal issues that may arise before, during, and after cataract surgery. The Department of Health and Human Services Office of Inspector General has designated ophthalmology as an auditing target, an unusual step to take for an entire specialty. Ongoing False Claims Act litigation may provide greater clarity on billing Medicare for a premium intraocular lens patient's return to the operating room and charging for an intervening exam when performing cataract surgery on both eyes. Ophthalmologists should continue to follow basic principles that help decrease medicolegal risk. These include a thorough informed consent discussion before surgery and accurate and contemporaneous documentation. When complications arise, surgeons should handle them in accordance with best practices and refer patients appropriately. Problems can arise from inattentive postoperative care, so ophthalmologists should train staff members on handling of patient calls. Implementing safety protocols for intraocular lens implantation and asking for legal advice when considering certain types of financial arrangements are also prudent. Cataract surgeons also should follow guidelines for billing noncovered services carefully.

  19. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  20. Pregnancy outcomes after gastric-bypass surgery.

    Science.gov (United States)

    Dao, Tuoc; Kuhn, Joseph; Ehmer, Dale; Fisher, Tammy; McCarty, Todd

    2006-12-01

    The purpose of this study is to compare outcomes of patients who become pregnant within the first year after surgery and those who delayed pregnancy until after 1 year after surgery. A retrospective review was performed to identify patients who became pregnant after their gastric-bypass surgery from 2001 to 2004. Endpoints included pregnancy complications, fetal birth weight and outcome, delivery method, weight change during pregnancy, and nutrition. Of 2,423 patients who had undergone bariatric surgery from 2001 to 2004, 21 patients became pregnant within the first year after surgery and 13 became pregnant after 1 year. Similar outcomes were seen between the 2 groups regarding fetal weight, term pregnancy, and complications. Pregnancy outcomes within the first year after weight-loss surgery revealed no significant episodes of malnutrition, adverse fetal outcomes, or pregnancy complications. Anxiety over poor outcomes of pregnancy during the first year after bariatric surgery can be allayed.

  1. [The history of plastic surgery in Israel].

    Science.gov (United States)

    Wiser, Itay; Scheflan, Michael; Heller, Lior

    2014-09-01

    The medical institutions in the country have advanced together with the development of the state of Israel. Plastic surgery, which has progressed significantly during the 20th century, has also grown rapidly in the new state. The arrival of Jewish plastic surgeons from all over the world with the knowledge and experience gained in their countries of origin, as well as the need for reconstructive surgical treatment for many combat injured soldiers, also contributed to the development of plastic surgery. This review tells the story of plastic surgery in Israel, since its foundation until nowadays. This article reviews the work of the founders of plastic surgery in Israel, indicating significant milestones in its development, and clinical and scientific contribution to the international plastic surgery profession. Moreover, the article describes the current condition of the field of plastic surgery in Israel and presents the trends and the future challenges facing the next generation of plastic surgery in Israel.

  2. Limited Evidence for Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Onsberg Hansen, Iben; Rosenberg, Jacob

    2016-01-01

    -assisted surgery. Open versus robot-assisted surgery was investigated in 3 studies. A lower blood loss and a longer operative time were found after robot-assisted surgery. No other difference was detected. CONCLUSIONS: At this point there is not enough evidence to support the significantly higher costs......PURPOSE: To evaluate available evidence on robot-assisted surgery compared with open and laparoscopic surgery. METHOD: The databases Medline, Embase, and Cochrane Library were systematically searched for randomized controlled trials comparing robot-assisted surgery with open and laparoscopic...... surgery regardless of surgical procedure. Meta-analyses were performed on each outcome with appropriate data material available. Cochrane Collaboration's tool for assessing risk of bias was used to evaluate risk of bias on a study level. The GRADE approach was used to evaluate the quality of evidence...

  3. Cochlear implant revision surgeries in children.

    Science.gov (United States)

    Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo

    2018-02-16

    The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  4. [Surgery as handicraft, surgery as art, surgery as science (author's transl)].

    Science.gov (United States)

    Wolner, E

    1982-03-19

    The reputation of surgery is not only based on manual skill, though in the light of history the surgeon belonged rather to craft-gilds than to hippocratism. Not until the evolution of the whole medical science a new status of the surgeon was created. Today in a high degree he is a devoted servant to science, despite the priority of manual skill. An artist is praised for his brilliant abilities to manage problems by intuition, to improvise successfully, thus the surgeon can be designated as of congenial spirits. Examples describing the activities at the 2nd Surgical Clinic of the University of Vienna, illustrate these three virtues of surgery: manual skill, artistic work, scientific attitude. In this sense students as well as graduates should receive their education. In future the surgeon himself must guarantee by extreme personal engagement that this ideal conception of the surgical professional, criticising the methods of scholastic medicine, is maintained and can bear up against organization obstacles.

  5. Cosmetic surgery in Australia: a risky business?

    Science.gov (United States)

    Parker, Rhian

    2007-08-01

    Cosmetic surgery is increasing in popularity in Australia and New Zealand, as it is across other Western countries. However, there is no systematic mechanism for gathering data about cosmetic surgery, nor about the outcomes of that surgery. This column argues that the business of cosmetic surgery in Australia has questionable marketing standards, is conducted with little scrutiny or accountability and offers patients imperfect knowledge about cosmetic procedures. It also argues that while medical practitioners debate among themselves over who should carry out cosmetic procedures, little attention has been paid to questionable advertising in the industry and even less to highlighting the real risks of undergoing cosmetic surgery. While consumers are led to believe that cosmetic surgery is accessible, affordable and safe, they are sheltered from the reality of invasive and risky surgery and from the ability to clearly discern that all cosmetic procedures carry risk. While doctors continue to undertake advertising and engage in a territorial war, they fail to address the really important issues in cosmetic surgery. These are: providing real evidence about what happens in the industry, developing stringent regulations under which the industry should operate and ensuring that all patients considering cosmetic surgery are fully informed as to the risks of that surgery.

  6. Interface Between Cosmetic and Migraine Surgery.

    Science.gov (United States)

    Gfrerer, Lisa; Guyuron, Bahman

    2017-10-01

    This article describes connections between migraine surgery and cosmetic surgery including technical overlap, benefits for patients, and why every plastic surgeon may consider screening cosmetic surgery patients for migraine headache (MH). Contemporary migraine surgery began by an observation made following forehead rejuvenation, and the connection has continued. The prevalence of MH among females in the USA is 26%, and females account for 91% of cosmetic surgery procedures and 81-91% of migraine surgery procedures, which suggests substantial overlap between both patient populations. At the same time, recent reports show an overall increase in cosmetic facial procedures. Surgical techniques between some of the most commonly performed facial surgeries and migraine surgery overlap, creating opportunity for consolidation. In particular, forehead lift, blepharoplasty, septo-rhinoplasty, and rhytidectomy can easily be part of the migraine surgery, depending on the migraine trigger sites. Patients could benefit from simultaneous improvement in MH symptoms and rejuvenation of the face. Simple tools such as the Migraine Headache Index could be used to screen cosmetic surgery patients for MH. Similarity between patient populations, demand for both facial and MH procedures, and technical overlap suggest great incentive for plastic surgeons to combine both. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  7. Photoacoustic monitoring of clot formation during surgery and tumor surgery

    Science.gov (United States)

    Juratli, Mazen A.; Galanzha, Ekaterina I.; Sarimollaoglu, Mustafa; Nedosekin, Dmitry A.; Suen, James Y.; Zharov, Vladimir P.

    2013-03-01

    When a blood vessel is injured, the normal physiological response of the body is to form a clot (thrombus) to prevent blood loss. Alternatively, even without injury to the blood vessel, the pathological condition called thromboembolism may lead to the formation of circulating blood clots (CBCs), also called emboli, which can clog blood vessels throughout the body. Veins of the extremities (venous thromboembolism), lungs (pulmonary embolism ), brain (embolic stroke), heart (myocardial infarction), kidneys, and gastrointestinal tract are often affected. Emboli are also common complications of infection, inflammation, cancer, surgery, radiation and coronary artery bypass grafts. Despite the clear medical significance of CBCs, however, little progress has been made in the development of methods for real-time detection and identification of CBCs. To overcome these limitations, we developed a new modification of in vivo photoacoustic (PA) flow cytometry (PAFC) for real-time detection of white, red, and mixed clots through a transient decrease, increase or fluctuation of PA signal amplitude, respectively. In this work, using PAFC and mouse models, we present for the first time direct evidence that some medical procedures, such as conventional or cancer surgery may initiate the formation of CBCs. In conclusion, the PA diagnostic platform can be used in real-time to define risk factors for cardiovascular diseases, assist in the prognosis and potential prevention of stroke by using a well-timed therapy or as a clot count as a marker of therapy efficacy.

  8. Assessing quality in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Samer A.M. Nashef

    2005-07-01

    Full Text Available There is a the strong temporal, if not causal, link between the intervention and the outcome in cardiac surgery and therefore a link becomes established between operative mortality and the measurement of surgical performance. In Britain the law stipulates that data collected by any public body or using public funds must be made freely available. Tools and mechanisms we devise and develop are likely to form the models on which the quality of care is assessed in other surgical and perhaps medical specialties. Measuring professional performance should be done by the profession. To measure risk there are a number of scores as crude mortality is not enough. A very important benefit of assessing the risk of death is to use this knowledge in the determination of the indication to operate. The second benefit is in the assessment of the quality of care as risk prediction gives a standard against performance of hospitals and surgeons. Peer review and “naming and shaming” are two mechanisms to monitor quality. There are two potentially damaging outcomes from the publication of results in a league-table form: the first is the damage to the hospital; the second is to refuse to operate on high-risk patients. There is a real need for quality monitoring in medicine in general and in cardiac surgery in particular. Good quality surgical work requires robust knowledge of three crucial variables: activity, risk prediction and performance. In Europe, the three major specialist societies have agreed to establish the European Cardiovascular and Thoracic Surgery Institute of Accreditation (ECTSIA. Performance monitoring is soon to become imperative. If we surgeons are not on board, we shall have no control on its final destination, and the consequences may be equally damaging to us and to our patients.

  9. Political issues in endovascular surgery.

    Science.gov (United States)

    Rutherford, R B

    1992-08-01

    "Political issues" may determine the relative progress if not the ultimate success and acceptance of endovascular surgery as much as its intrinsic merits. These issues include turf battles, commercialization of newly developing technologies, unethical advertising, and self-serving reporting practices in presenting clinical results. Acceptable indications, methods of evaluating results, standardized reporting practices, appropriate "gold standards" for comparison, and controlled trials (without premature release) are recommended, as well as an emphasis on the future need for proper training and credentialing and quality assurance programs.

  10. Bronchoplastic and lung preservation surgery

    International Nuclear Information System (INIS)

    Moore, E.H.; Templeton, P.A.; Grillo, H.C.; Shepard, J.A.O.; McLoud, T.C.

    1988-01-01

    Candidates for bronchoplastic surgery include patients previously considered inoperable because of central endobronchial tumors or inability to tolerate pneumonectomy, patients at risk for a second primary neoplasm, and young active patients. The authors reviewed over 50 bronchoplastic procedures, including carinal resections with bronchial reimplantations, carinal pneumonectomies, sleeve resections, and resections of the left interlobar carina. Conventional tomography provided the most accurate assessment of endobronchial anatomy. Computed tomography, unsuitable for intraluminal disease due to volume averaging of obliquely oriented bronchi, provided information about the extraluminal extent of disease, nodes, and the lung parenchyma. Complications including stricture, air leak, atelectasis, pneumonia, and residual tumor

  11. Equivariant surgery theories and their periodicity properties

    CERN Document Server

    Dovermann, Karl Heinz

    1990-01-01

    The theory of surgery on manifolds has been generalized to categories of manifolds with group actions in several different ways. This book discusses some basic properties that such theories have in common. Special emphasis is placed on analogs of the fourfold periodicity theorems in ordinary surgery and the roles of standard general position hypotheses on the strata of manifolds with group actions. The contents of the book presuppose some familiarity with the basic ideas of surgery theory and transformation groups, but no previous knowledge of equivariant surgery is assumed. The book is designed to serve either as an introduction to equivariant surgery theory for advanced graduate students and researchers in related areas, or as an account of the authors' previously unpublished work on periodicity for specialists in surgery theory or transformation groups.

  12. Kerala Pioneering Pediatric Surgery in India

    Directory of Open Access Journals (Sweden)

    TP Joseph

    2014-04-01

    Full Text Available Pediatric surgeons of Kerala are very proud to have led the development of superspeciality in any branch of medicine in Kerala and also superspeciality of Pediatric surgery in whole of India. Late Prof. Raman Nair returned in 1954 after training under Dr. Everett Koop in US. Same year, in his far-sighted vision for future development of the speciality, he moved to SATH, Medical College, Trivandrum and started Pediatric surgery as a speciality attached to Paediatrics department; this was the beginning of Pediatric surgery in India. He opted for Pediatric surgery as a full time job and did not do any general surgery work in adults. He was the first full time Pediatric surgeon of India; during the next few years, 2 surgeons, one in Calcutta, Prof. UC Chakraboty and Prof. D Anjaneyulu in Hyderabad started working as full time Pediatric surgeons. In Mumbai, Delhi and Chennai, Pediatric surgery developed much later and then all over the country.

  13. The evolution of robotic general surgery.

    Science.gov (United States)

    Wilson, E B

    2009-01-01

    Surgical robotics in general surgery has a relatively short but very interesting evolution. Just as minimally invasive and laparoscopic techniques have radically changed general surgery and fractionated it into subspecialization, robotic technology is likely to repeat the process of fractionation even further. Though it appears that robotics is growing more quickly in other specialties, the changes digital platforms are causing in the general surgical arena are likely to permanently alter general surgery. This review examines the evolution of robotics in minimally invasive general surgery looking forward to a time where robotics platforms will be fundamental to elective general surgery. Learning curves and adoption techniques are explored. Foregut, hepatobiliary, endocrine, colorectal, and bariatric surgery will be examined as growth areas for robotics, as well as revealing the current uses of this technology.

  14. Comprehensive review on endonasal endoscopic sinus surgery

    Science.gov (United States)

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  15. General Surgery Resident Satisfaction on Cardiothoracic Rotations.

    Science.gov (United States)

    Lussiez, Alisha; Bevins, Jack; Plaska, Andrew; Rosin, Vadim; Reddy, Rishindra M

    2016-01-01

    General surgery residents' exposure to cardiothoracic (CT) surgery rotations has decreased, which may affect resident satisfaction. We surveyed general surgery graduates to assess the relationships among rotation satisfaction, CT disease exposure, rotation length, mentorship, and mistreatment. A survey assessing CT curriculum, exposure, mentorship, and satisfaction was forwarded to general surgery graduates from 17 residency programs. A Wilcoxon rank-sum test was used to assess statistical significance of ordinal level data. Statistical significance was defined as p surgery residency programs who graduated between the years of 1999 to 2014. A total of 94 responses were completed and received. Receiving adequate exposure to CT procedures and disease management was significantly associated with higher satisfaction ratings for all procedures, particularly thoracotomy incisions (p Surgery. Published by Elsevier Inc. All rights reserved.

  16. [Obesity, bariatric surgery and future fertility].

    Science.gov (United States)

    Tsur, Abraham; Machtinger, Ronit; Segal-Lieberman, Gabriella; Orvieto, R

    2014-08-01

    Obesity is an increasingly widespread health problem. In addition to comorbidities such as diabetes, hypertension, dyslipidemia and cardiovascular disease, obesity has a significant impact on reproductive life, including infertility, miscarriages and high prevalence of pregnancy complications. The present review describes the possible benefits of bariatric surgery regarding fertility and pregnancy outcome. It is well established that bariatric surgery leads to regular ovulatory cycles and improves spontaneous conception rates in obese women. While pregnancy after bariatric surgery is safe and associated with reduced pregnancy complications, pregnant women following bariatric surgery are still at high risk for preterm births and small dimensions of gestational age offsprings. The optimal interval that should be kept between surgery and subsequent pregnancy is controversial, with recent studies emphasizing the importance of nutritional balance rather than the time from surgery to conception as being the most important determinant. Strict peri-conceptional surveillance is mandatory in order to prevent nutritional deficiencies and for the early diagnosis of abnormal fetal growth.

  17. Improving the visual realism of virtual surgery.

    Science.gov (United States)

    Jin, Wei; Lim, Yi-Je; Xu, Xie George; Singh, Tejinder P; De, Suvranu

    2005-01-01

    In this work we focus our attention on improving the visual realism of virtual surgery. A synthetic solution by innovative use of various image-based rendering methods is presented for realistic rendering of virtual surgery scenes. We have, for the first time, developed a methodology for generating virtual surgery scenes with realistic glistening effects by a combination of various image-based rendering techniques, including image mosaicing and view-dependent texture mapping. Realistic examples are presented to showcase the results.

  18. Bariatric Surgery and Urinary Stone Disease

    Directory of Open Access Journals (Sweden)

    Cevahir Ozer

    2016-07-01

    Full Text Available Obesity is a major public health problem and has been suggested to play a role in the etiology of urinary tract stone disease. Furthermore, the increasingly widespread use of surgery in the treatment of obesity also is related with urinary stone disease. In daily practice, patients to whom obesity surgery has been planned or who have undergone obesity surgery are seen more frequently. This review aims to highlight the urological evaluation and management of this patient group.

  19. Present status of bariatric surgery in Poland

    OpenAIRE

    Janik, Micha? R.; Stanowski, Edward; Pa?nik, Krzysztof

    2016-01-01

    Introduction : The first survey of bariatric surgery in Poland was published in 2007. New trends are observed worldwide, and there is a current need to investigate the status of bariatric surgery in Polish institutions. This survey was initiated to gain an overview of Polish bariatric surgery during 2007–2014. Aim : To analyze the number and types of bariatric procedures performed in Polish institutions in 2014 and to perform a trend analysis from 2007 to 2014. Material and methods ...

  20. Bariatric surgery waiting times in Canada.

    Science.gov (United States)

    Christou, Nicolas V; Efthimiou, Evangelos

    2009-06-01

    Severe obesity is reaching epidemic proportions throughout the world, including Canada. The only permanent treatment of severe or morbid obesity is bariatric surgery. Access to bariatric surgery is very limited in Canada. We sought to collect accurate data on waiting times for the procedure. We carried out a survey of members of the Canadian Association of Bariatric Physicians and Surgeons and performed a more detailed analysis within Quebec and at one Canadian bariatric surgery centre where a prospectively collected bariatric surgery registry has been maintained since 1983. The survey response rate was 85%. All centres determined whether patients were eligible for bariatric surgery based on the National Institutes of Health criteria. Patients entered the queue as "office contacts" and moved through the queue, with the exit point being completion of the procedure. In 2007, a total of 6783 patients were waiting for bariatric surgery and 1313 procedures were performed in Canada. Assuming these trends are maintained, the calculated average waiting time for bariatric surgery in Canada is just over 5 years (6783/1313). The Fraser Institute and the Wait Times Alliance benchmarks for reasonable surgical waiting times vary from 8 weeks for cancer surgery to 18 months for cosmetic surgery. At one Canadian centre, 12 patients died while waiting for bariatric surgery. The waiting times for bariatric surgery are the longest of any surgically treated condition. Given the significant reduction in the relative risk of death with bariatric surgery (40%-89% depending on the study), the current waiting times for the procedure in Canada are unacceptable.

  1. [Computer assisted orthognathic surgery: Condyle repositioning.

    Science.gov (United States)

    Bettega, G; Leitner, F

    2013-07-17

    Computer aided surgery has become a standard in many fields. It is rarely used in orthognathic surgery. Twenty years ago, we developed a navigation system adapted to this surgery, especially for mandibular condyle repositioning. The system has been improved along with technological progress. The authors of several clinical studies have validated this system. It is now routinely used in our department, because of its educational virtues among other assets. Copyright © 2013. Published by Elsevier Masson SAS.

  2. Robot-assisted surgery for gastric cancer

    Science.gov (United States)

    Procopiuc, Livia; Tudor, Ştefan; Mănuc, Mircea; Diculescu, Mircea; Vasilescu, Cătălin

    2016-01-01

    Minimally invasive surgery for gastric cancer is a relatively new research field, with convincing results mostly stemming from Asian countries. The use of the robotic surgery platform, thus far assessed as a safe procedure, which is also easier to learn, sets the background for a wider spread of minimally invasive technique in the treatment of gastric cancer. This review will cover the literature published so far, analyzing the pros and cons of robotic surgery and highlighting the remaining study questions. PMID:26798433

  3. Advances in hard nucleus cataract surgery

    Directory of Open Access Journals (Sweden)

    Wei Cui

    2013-11-01

    Full Text Available Security and perfect vision and fewer complications are our goals in cataract surgery, and hard-nucleus cataract surgery is always a difficulty one. Many new studies indicate that micro-incision phacoemulsification in treating hard nucleus cataract is obviously effective. This article reviews the evolution process of hard nuclear cataract surgery, the new progress in the research of artificial intraocular lens for microincision, and analyse advantages and disadvantages of various surgical methods.

  4. [Complications after refractive surgery abroad].

    Science.gov (United States)

    Terzi, E; Kern, T; Kohnen, T

    2008-05-01

    In this article a retrospective analysis of patients presenting at a German university following refractive surgery abroad is presented. A total of 20 cases of patients who had undergone treatment between 1998 and 2006 in China (1 case), Greece (1 case), Iran (1 case), Russia (2 cases), Switzerland (1 case), Slovakia (1 case), Spain (2 cases), South Africa (3 cases), Turkey (6 cases) and the USA (2 cases) were analyzed retrospectively. The following complications were observed: epithelial ingrowth into the interface with or without melting of the flap (6 cases), corneal ectasia (2 cases), dislocation of a phakic posterior chamber intraocular lens and prolapse into the anterior chamber with endothelial cell loss (1 case), secondary increase of intraocular pressure following implantation of a phakic intraocular lens (1 case), flap-related complications following laser-in-situ keratomileusis (LASIK) (2 cases), keratitis (1 case), dislocation of the complete flap (1 case), diffuse lamellar keratitis (DLK) grade IV (1 case), hyperopia as a consequence of radial keratotomy (1 case), and under correction/over correction and poor optical quality following laser epithelial keratomileusis (LASEK) and LASIK for high myopia (5 cases) with possible early corneal ectasia. There are four important problems arising from refractive surgery abroad, often referred to as "LASIK tourism": wrong indications, insufficient management of complications, lack of postoperative care and the health economic aspect.

  5. Breast Reshaping Following Bariatric Surgery.

    Science.gov (United States)

    Vindigni, Vincenzo; Scarpa, Carlotta; Tommasini, Antonio; Toffanin, Maria Cristina; Masetto, Laura; Pavan, Chiara; Bassetto, Franco

    2015-09-01

    Obesity is a worldwide problem that affects millions of people from a medical and psychological point of view. To solve the related complications, patients should lose weight with the consequent need to be subjected to body contouring due to the presence of a loose and redundant skin. We report our experience in the treatment of the post-bariatric breast. We considered all the post-bariatric patients subjected to a breast reshaping, and we viewed the features of the breast, the type of surgery performed, the outcomes, and the complications. All patients filled out BREAST-Q surveys both preoperatively and after 6 months to study the rate of satisfaction. Ninety post-bariatric patients underwent breast reshaping in the last 5 years. The average age was 40 years old. The follow-up period ranged from 6 months to 5 years. The most represented ptosis was second grade; the favorite technique has been mastopexy with parenchymal remodelling and augmentation with autologous tissue. The mean duration of the surgery has been 3 h. The most represented complications have been delayed healing, unfavorable scarring, hematoma, and seroma. Statistically significant improvements were observed in satisfaction with breast appearance, psychological, and physical well-being. Breast reshaping in post-bariatric patients is a big challenge and only a careful analysis of the degree of ptosis of the breast, its volume and shape, and a clear communication with the patients about the real outcomes and complications can make the winning surgeon.

  6. Litigation after nasal plastic surgery.

    Science.gov (United States)

    Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan

    2011-01-01

    Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients' expectations. This article aims to clarify the aspects of causes leading to these legal claims. We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients' demographic data, surgeons' specialty and experience, and method of anesthesia were also collected. One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients' age and sex, and also with the surgeons' experience. There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians' malpractice and some to the patients' social and personal circumstances.

  7. Allograft in bone tumour surgery

    International Nuclear Information System (INIS)

    Sengupta, S.

    1999-01-01

    In the last twenty years, there has been a vast improvement in the prognosis of primary malignant tumours of bone. This is due to many factors including early detection, staging and classification of tumours as a result of better staining and imaging techniques, better surgical technology, e.g. endoprosthesis and most importantly adjuvant treatment with cytotoxic drugs. As a result of long term survival, amputation of limb has more or less been replaced by limb salvage surgery. This procedure consists of two parts. Primary objective is of course complete removal of the tumour by adequate soft tissue cover and secondarily by reconstruction of the locomotor system, If possible with retention of the function of the limb. These procedures include endo-prosthetic replacement or arthroplasty and arthrodesis using autologus grafts, allograft or combination. With the development of bone banks and assured safety of preserved bones, reconstructive limb salvage surgery using massive allograft is gradually replacing prosthetic implants. The advantages include replacement of articular surfaces, incorporation of the graft to the host bone, attachment of bone tissue and increased probably permanent survival. Allograft can be used for intercalary replacement, osteo-articular arthroplasty arthrodesis or filling large cavities. Inherent complication of massive allograft are disease transmission, infection, delayed and non-union, pathological fractures, mechanical failure and joint destruction. Several limb salvage procedures using allografts have been carried out in our institution with one failure due to infection. Paucity of available allograft has restricted more such procedures to be carried out

  8. Litigation After Nasal Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Ebrahim Razmpa

    2011-03-01

    Full Text Available Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61% were female and 49 (39% male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances.

  9. Litigation After Nasal Plastic Surgery

    Science.gov (United States)

    Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan

    2011-01-01

    Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances. PMID:24303371

  10. Day surgery for inguinal hernia.

    Science.gov (United States)

    Gilbert, A I

    1995-01-01

    Historical developments of groin herniorrhaphy date from Bassini's contributions through many present-day simplified tension-free techniques. Availability of sterile-packaged prosthetic mesh has currently given every surgeon an inexhaustible "tissue bank" for hernia repair surgery. The value of using a local anesthetic is unequaled in verifying the completeness of a repair. Same-day surgery has many advantages including lowered rates of infection, quicker ambulation, and more rapid return to regular activities. The sutureless umbrella plug technique is discussed. It is the simplest technique to permanently repair indirect inguinal hernias. Taking advantage of Nature' window through the internal inguinal ring, the properitoneal space can be reached. By dissecting the peritoneal sac high on its neck and shoulders, the retromuscular properitoneal space can be actualized. It allows a permanent repair to be done by simply protecting the internal ring with a swatch of polypropylene mesh shaped as an umbrella. The body's natural forces that created the hernia work to repair it by transversalis fascia. The procedure is easy to perform, done with local anesthesia, inexpensive, safe, and has minimal recurrence and complication rates.

  11. Hearing preservation surgery: current opinions.

    Science.gov (United States)

    Fitzgerald O'Connor, Edmund; O'Connor, Alec Fitzgerald

    2010-01-01

    Although the indications and surgical technique for cochlear implantation are well formalized, the introduction of hearing preservation surgery and electric acoustic stimulation have posed new questions for the cochlear implant clinician. This study was designed to crystallize the contemporary views of the implant community on how best to implement these new strategies. An anonymized questionnaire was made available to members of the Politzer Society and a selected group of implant surgeons via the Internet. Five questions required the respondent to choose a specific answer from the text on technique and 17 questions assessed the relative importance attached to the statements relating to the surgical process. A final question inquired on what basis the opinions were derived. The country of origin was also identified. The questionnaire was sent to 180 clinicians of whom 62 replied (34%). Tacit agreement was obtained in 2 of the specific questions and in 10 of the relative importance inquiries. There were varying degrees of opinions on the remaining questions. It is clear that there is still limited consensus between surgeons when considering ways of maximizing outcomes in hearing preservation surgery and electric acoustic stimulation. More protocol-driven studies are required before an accepted gold standard approach can be achieved. Copyright 2010 S. Karger AG, Basel.

  12. Morphine use in cancer surgery

    Directory of Open Access Journals (Sweden)

    Banafsheh eAfsharimani

    2011-08-01

    Full Text Available Morphine is the core of perioperative pain management. However, when it comes to cancer surgery the possibility that this drug might affect tumor recurrence and metastasis has raised concerns. The results of two recent retrospective clinical trials indicated that regional anesthesia/analgesia might be beneficial in prostate and breast cancer surgery. It was proposed that morphine could be responsible for the higher recurrence and mortality rate observed in the general anesthesia/opioid analgesia groups. Nevertheless, the results of several other retrospective studies and one randomized prospective trial failed to confirm any advantage for regional anesthesia/analgesia over general anesthesia and opioid analgesia. Moreover laboratory data on the effect of morphine on cancer are contradictory, ranging from tumor-promoting to anti-tumor effects. Considering that surgical stress and pain promote the recurrence and spread of cancer, choosing a proper analgesic strategy is of high significance. Although the question of whether morphine causes any harm to cancer patients remains unanswered, alternative analgesic regimens could be used concomitant to or instead of morphine to limit its potential adverse effects.

  13. [Pregnancy and bariatric surgery: Critical points].

    Science.gov (United States)

    Ciangura, C; Nizard, J; Poitou-Bernert, C; Dommergues, M; Oppert, J M; Basdevant, A

    2015-06-01

    More than 200,000 people underwent obesity surgery in France. Most of them are women. Pregnancy after bariatric surgery is becoming a common situation. This surgery results in major nutritional and gastro-intestinal tract modifications that may influence or be influenced by pregnancy, and yields benefits as well as complications. A multidisciplinary management including a nutritionist, an obstetrician, an anesthesiologist, and a bariatric surgeon is required. The aim of this review is to analyze the impact of bariatric surgery on pregnancy and vice versa, and to identify the key points of this management. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Nutritional Status of Bariatric Surgery Candidates

    Science.gov (United States)

    Al-Mutawa, Aliaa; Anderson, Alfred Kojo; Alsabah, Salman; Al-Mutawa, Mohammad

    2018-01-01

    Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B12 (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B6 (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery. PMID:29324643

  15. Surgical Adhesives in Facial Plastic Surgery.

    Science.gov (United States)

    Toriumi, Dean M; Chung, Victor K; Cappelle, Quintin M

    2016-06-01

    In facial plastic surgery, attaining hemostasis may require adjuncts to traditional surgical techniques. Fibrin tissue adhesives have broad applications in surgery and are particularly useful when addressing the soft tissue encountered in facial plastic surgery. Beyond hemostasis, tissue adhesion and enhanced wound healing are reported benefits associated with a decrease in operating time, necessity for drains and pressure dressings, and incidence of wound healing complications. These products are clinically accessible to most physicians who perform facial plastic surgery, including skin grafts, flaps, rhytidectomy, and endoscopic forehead lift. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Nutritional Status of Bariatric Surgery Candidates.

    Science.gov (United States)

    Al-Mutawa, Aliaa; Anderson, Alfred Kojo; Alsabah, Salman; Al-Mutawa, Mohammad

    2018-01-11

    Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B 12 (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B₆ (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.

  17. Bariatric Surgery and Kidney-Related Outcomes.

    Science.gov (United States)

    Chang, Alex R; Grams, Morgan E; Navaneethan, Sankar D

    2017-03-01

    The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of ≥35 kg/m 2 . Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remission. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery population. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.

  18. Extreme oncoplastic breast surgery: A case report

    Directory of Open Access Journals (Sweden)

    Daniele Bordoni

    2016-01-01

    Conclusion: The surgical treatment for multicentric breast cancers remains controversial even though emerging evidences show good oncological and aesthetic outcomes following oncoplastic conserving breast surgery.

  19. Nutritional Status of Bariatric Surgery Candidates

    Directory of Open Access Journals (Sweden)

    Aliaa Al-Mutawa

    2018-01-01

    Full Text Available Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76% and Vitamin B12 (16%. Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B6 (24% was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.

  20. Indications & predisposing factors of crown lengthening surgery

    Directory of Open Access Journals (Sweden)

    Arghavan Amini-Behbahani

    2014-09-01

    Full Text Available Introduction: Since crown lengthening surgery could be accompanied by stress, pain and discomfort, knowledge about its predisposing factors could reduce the demands for such surgery.The aim of this study was to identify the most important indications of crown lengthening surgery in order to present new ideas to clinicians on how to reduce the need for this surgery. Methods: This cross-sectional study was done on 470 patients (aged 12-89 years referred for crown lengthening surgery. The patients' demographic data and their reasons for surgery, the teeth restoration condition and its type, condition of the opposite tooth, type of fractured cusp (posterior teeth, root canal therapy condition and quality, and size of existing intracanal posts were recorded in a data sheet. Data were analyzed by using SPSS software.The chi-square and fisher exact test were used for statistical analysis. The significant difference was p<0.05. Results: The most frequent indication in men and women was dental caries followed by tooth fracture.The second upper premolars and first lower molars needed crown lengthening surgery more often, respectively. Conclusions: Since dental caries and fracture are the most important factors that predispose teeth to crown lengthening surgery, controlling caries with a regular recall sequence can reduce the need for such surgery, especially in the elderly.