Branch Of Surgery Research Articles

Consent taking in neurosurgery: Education and tips for safe practice.

Neurosurgery is the most difficult branch of surgery and interventions may occasionally lead to a poor prognosis. Most of the times, one would assume that the likely outcome of a surgery is going to be good; however, not so uncommonly, the results may be devastating. Poor outcomes are further compounded by litigations, which are rising. The safety for neurosurgeon is the consent signed by the patient that ensures some defense. There are no guidelines given by the society and the controlling authorities on what constitutes a real consent. Some judgments by Supreme Court have given us some lead; however, a large part of the complexities involved in the consent process remain unresolved. We, therefore, have to frame our own guidelines and standards that shall be uniformly adapted by all of us. We can even set a precedent for other disciplines of surgery to follow regarding consent-taking for neurosurgery. This shall also serve as a foundation for the wider benefit and safety of surgeons from other disciplines. This paper is an attempt to simplify the complexities of the consent taking process and aims to provide adequate education and information about the nuances of informed consent.

The role of the department of surgical diseases №2 in the formation of cardiovascular surgery service in the Republic of Tatarstan (to the 80th anniversary of the department)

The main stages of development and formation of the cardiovascular surgery in the Republic of Tatarstan and the role of the department of surgical diseases №2, on the basis of which this branch of surgery engendered in the 60s of XX century, are represented. The first demonstrational cardiac surgeries (closed mitral commissurotomy) were performed in Kazan at the premises of the 3d city hospital by academician A.A. Vishnevsky in 1958. In 1963 the 6th city hospital became the main base of the department of surgical diseases №2 in Kazan, and the first cardiac surgery intervention was performed on April 15, 1963 on 26 years old patient with mitral stenosis of rheumatic etiology. In the 70s of XX century cardiac surgery service at the premises of 6th city clinical hospital got the status of Interregional cardiac surgery center. From the beginning of the 1990s, cardiopulmonary bypass surgery became leading in the department of cardiac surgery. In 1992 the cardiac surgery department of the 6th city clinical hospital was reorganized and became the Kazan Center of Cardiovascular Surgery with 75 beds, since 1995 bearing the name of professor N.P. Medvedev. In 2000 the department was headed by associate professor R.K. Dzhordzhikiya (doctoral thesis «Minimally invasive surgery of acquired heart valve disease», 2004). In 2005 more than 300 cardiopulmonary bypass surgeries has been performed in the clinic. In 2006 employees of the center in almost full strength moved to the Interregional clinical diagnostic center, the first cardiac surgery at the center was performed in September 2006. Annually the number of high-tech operations increases. At the same time scientific research work is carrying out. The generalizing research studing the results of the preservation of annulo-papillary continuity when replacing valve in the mitral position with mechanical prosthesis in patients with rheumatic disease conducted at the center was one of the first in Russia. The past 80 years of the history of the Department of Cardiovascular Surgery and the stable foundation laid by previous generations of researchers and clinicians, the glorious representatives of the Kazan school of cardiovascular surgery, serve as a guarantee of successive development of scientific and clinical work of the department and the whole cardiac surgery service in the Republic of Tatarstan.

Le Fort I osteotomy anatomo-tomographic referrings in a sample of the Colombian population

Introduction: The orthognathic surgery is considered one of the most important branches of maxillofacial surgery, to correct dentofacial anomalies through different surgical procedures such as Le Fort I osteotomy; which is to mobilize the maxilla in three dimensions. The primary objective is the repositioning of dental skull and skeletal components to maintain an appropriate relationship between maxilla and mandible.

Emergency general surgery, malnutrition and outcomes in critical illness

Emergency General Surgery (EGS) is a rapidly evolving but understudied branch of Acute Care Surgery. Limited information exists regarding the contribution of malnutrition to the outcome of critically ill patients who undergo EGS.

Lipofilling, an efficient solution for breast sequelae after cardiothoracic surgery

Evolutions in pediatric cardiovascular surgery have allowed the treatment of a various range of cardiovascular malformations in infants. It is a difficult branch of surgery, with vital impact, which can also leave residual thoracic scars, possible sources for thoracomammary deformities in adults. Most thoracomammary deformities after thoracotomy are observed at puberty, when they appear as breast asymmetries. The main cause is the breast bud injured during thoracotomy. Several techniques have been suggested for breast reconstruction, but none give satisfying results. We have been practicing lipofilling since 1998 for breast reconstruction. Since 2001, we have started applying it to breast deformities. The final result is constant in time, natural, and has a good volume filler effect. We describe the fat grafting technique, an original technique, as a solution for this kind of deformities. The technique is illustrated by two clinical cases. In conclusion, fat grafting has really improved breast asymmetry due to iatrogenic deformation. Even if those cases are rare, surgeons have to know this kind of procedure. It is indeed a simple and efficient solution for those patients after childhood, with natural and long standing results.

Samotność pacjenta i lekarza wobec decyzji o leczeniu inwazyjnym w chirurgii

What we usually call loneliness is surely something experienced by: Palamedes and Ajax at Troy – the victims of Odysseus’s envy, Antygone – after meeting her sister Ismene, Prince Hamlet – after speeking to his mother. The author added to K. Jaspers b order situations his own loneliness research model: about invasive modality in surgery. It consists of two obligatory components parts: 1. Surgeon’s decision given to the patient in the form of proposal – suggestion. 2. Patient’s approval – consent. Without surgeon’s proposal – patient consent is meaningless. Without the patient’s approval, the operation cannot usually take place. Patient’s approval, or refuse, is this part of the surgical decision, were we can distinguish: 1. Man’s sovereignty in disposing of his health and life. 2. Existence of a distinct self – individuality of existence “I”. The research model reveals, perhaps even more clearly than the another ones, the ontic dimension of loneliness. Loneliness is the price of identity – oneselfness. In conclusions the author stressed: Necessity of discussing patient’s consent in conjunction with surgeon’s decision. Attempts to isolate the issue of patient’s approval lead to aporia, in particular cases to unhappiness. Whilst describing, by the surgeon, diagnosis and treatment plan, the patient does not gain any competence in the branch of surgery; he is preoccupied with examining the doctor. The most important thing is whether he can trust him. Even the best functioning institutions and community customs cannot remove loneliness completely, especially in border situation s. Therefore they may not be blamed for the fact that the loneliness exists. Time is a strong generator of tensions connected with loneliness. Agreeing with N. Hartmann, that the man exists in his achievements, the author adds: and in decisions made in solitude. There is also creativity here.

Radiology’sLegacy: Rummaging through the Attic

Early articles in Radiology are based on conventional radiography and provide the foundation for both the way we think about extracting diagnostically important information from images and the spectacular technologic achievements in the decades that followed; therefore, we decided to include in this issue of Radiology a pictorial essay of select figures and our thoughts on the articles themselves to give a taste of the beginnings of so many of our current imaging and research activities.

Robotic Versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: a Meta-analysis of Eight Studies

BackgroundRobotic surgery has been used successfully in many branches of surgery, but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis of randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) to evaluate whether the safety and efficacy of robotic total mesorectal excision (RTME) in patients with RC are equivalent to those of laparoscopic TME (LTME). MethodsPubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. ResultsEight studies were identified that included 1229 patients in total, 554 (45.08 %) in the RTME group and 675 (54.92 %) in the LTME group. Compared with LTME, RTME was associated with lower conversion rate (OR 0.23, 95 % CI [0.10, 0.52]; P = 0.0004), lower positive rate of circumferential resection margins (CRM) (2.74 % vs 5.78 %, OR 0.44, 95 % CI [0.20, 0.96], P = 0.04), and lesser incidence of erectile dysfunction (ED) (OR 0.09, 95 % CI [0.02, 0.41]; P = 0.002). Operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, number of lymph nodes harvested, distal resection margin (DRM), proximal resection margin (PRM), and local recurrence had no significant differences between the two groups. ConclusionsRTME is safe and feasible and may be an alternative treatment for RC. More international multicenter prospective large sample RCTs investigating the long-term oncological and functional outcomes are needed to determine the advantages of RTME over LTME in RC.

Aetiological agents of surgical site infection in a specialist hospital in Kano, north-western Nigeria.

Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infections (SSI) continue to be a major problem in all branches of surgery in the hospitals. The objective of this study was to establish the incidence of SSI, the type and frequency of various pathogens and their antibiotic susceptibility pattern in Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria. A total of 2,920 consecutive patients who underwent different surgical procedures between January 2009 and December 2010 at Murtala Mohammed Specialist Hospital were enrolled in this study. Samples of pus were collected from infected cases and screened for bacterial and fungal pathogens by standard microbiological methods. Antibiotic susceptibility tests were done by disc diffusion technique. A total 878 patients were found to be clinically infected and 919 isolates were obtained in all. This gave an incidence of 30.1% infection rate. While 783 (89.2%) cultures yielded single organism, 77 (9.8%) yielded mixed growth and 18(8.1%) cultures yielded no growth. The most frequently isolated organism was E. coli (25.5%) followed by Staphylococcus aureus 20.6%. The incidence of Methicillin resistant Staphylococcus aureus was 35.7%. Ceftriaxone, ceftazidime and ofloxacin showed good results against most isolates while ampicillin and cotrimoxazole which are commonly used drugs were ineffective. An understanding of the various types of pathogen involved in SSI and their antibiotic susceptibility pattern will reduce indiscriminate prescription of antibiotics and help in infection control.

Qualidade de vida em pacientes submetidos à cirurgia ortognática: saúde bucal e autoestima

A cirurgia ortognática é o ramo da cirurgia bucomaxilofacial que trata das deformidades dentofaciais, buscando a correção da oclusão e melhora articular, respiratória e fonética, que geram benefícios funcionais e harmonizam a face, o que acarreta aspectos positivos em relação à estética e ao fator psicossocial do paciente. Objetivou-se avaliar a qualidade de vida desses pacientes, através dos aspectos funcionais, estéticos e psicossociais. O presente estudo foi realizado em clínica odontológica particular, na cidade de Taubaté. Foram avaliados 33 pacientes, 12 do gênero masculino e 21 do gênero feminino, com idades entre 18 a 45 anos, com tratamento ortocirúrgico indicado ou já realizado, utilizando-se os questionários Escala de Autoestima de Rosenberg/UNIFESP-EPM, Oral Health Impact Profile-14 - OHIP14 e PIDAQ-Brasil/UNIFESP e o Teste não Paramétrico de Mann-Whitney. Os resultados evidenciaram que a cirurgia ortognática é um procedimento capaz de oferecer melhora da qualidade de vida para pacientes portadores de deformidades dentofaciais, por meio dos aspectos funcionais, estéticos e psicossociais.

Core Specialty Collaboration and Integrated Subject Formation of Cosmetic Medicine

In her January 2013 article in Aesthetic Surgery Journal entitled, “Why Should We Foster Core Specialty Collaboration in Cosmetic Medicine?” Dr Laurie Casas stated, “To better understand the scope of current research and clinical evidence, it is necessary to familiarize myself with the work coming from 4 distinct specialty groups: plastic surgery, dermatology, facial plastic surgery, and oculoplastic surgery.”1 Later, she remarked, “I remain frustrated by the lack of widespread collaboration among the specialties to achieve standardized outcome measures that are both safety- and patient-centric driven.”1 This particular viewpoint is scientific acknowledgment, based on Dr Casas's specialty practice, that several areas of cosmetic medicine should be integrated. We believe this represents an ongoing need not only in Dr Casas's own practice but also in cosmetic medicine throughout the United States. In this Letter to the Editor, we discuss trends of Chinese cosmetic medicine compared with American methods in terms of integrated care. In 1988, the Tianjin Technology Publishing House in China published research by Qiu Linzhi and Peng Qingxing proposing the concept of integrated care in cosmetic medicine. Branches of cosmetic surgery include plastic surgery, cosmetic dermatology, cosmetic dentistry, and traditional Chinese physical cosmetic techniques, among others, the approaches of which must all be integrated for the most efficacious and safe outcomes.2–14 Because of this integrated approach begun 25 years ago, China is becoming one …

Computer assisted navigation in orthopaedics and trauma surgery

Abstract Computer assisted navigation was initially introduced into neurosurgical practice, and then orthopaedic spinal surgery, in the 1990's. It has gained momentum in recent years, finding applications in multiple branches of orthopaedic surgery including hip and knee arthroplasty, sports injuries, trauma, spinal surgery and bone tumour surgery. The technology provides the surgeon with real-time information regarding the position of surgical instruments and implants in relation to the skeleton and has the potential to improve surgical accuracy and outcome. Computer assisted navigation systems can be active, employing robotic surgeons, or passive where the surgeon remains in total control but computer software aids in the procedure. Computer assisted navigation has the potential to help surgeons perform procedures more accurately, with a view to improving outcome. This article reviews the multiple applications, limitations, and advantages of computer assisted navigation in orthopaedics in the operating theatre and beyond.

Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis

BackgroundRobotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME. Materials and methodsPubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. ResultsEight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME. ConclusionsRTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.

Professional training of the gastrointestinal surgeons

Currently,specialized treatment for diseases is increasingly becoming the mainstream in clinical practice.Gastrointestinal surgery,as an important branch of general surgery,has increasingly developed specialized; however,our present gastrointestinal surgeon training system is not yet perfect.The article summarized the problems and challenges in gastrointestinal surgeon training in China based on the situations at home and abroad,and addressed some available gastrointestinal surgeon training protocols in future.We hope this article can be helpful on our country's gastrointestinal surgeon professional training. Key words: Surgeons ; Gastrointestinal surgery ; Professional training

Laparoscopic liver resection: A review

Laparoscopic liver surgery was slower to develop than other fields of laparoscopic surgery because of a steep learning curve, and fear of uncontrolled bleeding or gas embolism. However, laparoscopic liver resection (LLR) is associated with significant advantages: faster recovery, less post-operative pain, less morbidity, easier subsequent surgery and better cosmetic results. Since the inception of this technique, more than 3000 procedures have been reported. The aim of this update was to review the literature in order to define the indications (malignant tumors, benign tumors, major resections), the advantages and limits of this approach as well as the expected value of new technology, such as intra-operative guidance or robotics, in the development of this branch of surgery.

The History and Evolution of Plastic Surgery

Plastic surgery is a branch coming from the main trunk of medicine and surgery and the origins are in antiquity.Of all branches of medical science plastic surgery is probably the most frequently misunderstood. The word ‘plastic’ is not modern. Today it is used in the main for products of a great modern industry. When one refers to plastic surgery, most people think of cosmetic surgery and unfortunately in some quarters plastic surgery and cosmetic surgery are virtually synonymous. This is far from the case. Again, some persons in ignorance believe that in plastic surgery plastic materials, are used to close wounds and to make scars invisible.

Nail surgery

Nail surgery is a special branch of hand and dermatologic surgery. It is not widely performed, and many physicians do not feel at ease to perform it. The objective of this contribution is to give a short overview of the most important surgical procedures in clinical practice. References from the literature and the author’s own experiences are condensed to describe what a dermatologic practitioner with knowledge of the nail and some surgical skills can perform. Nail surgery is a precise technique that requires careful administration and attention to details. Proper patient preparation starts with a patient history to identify potential contraindications and to prevent unnecessary complications. The author recommends isopropyl alcohol scrub and chlorhexidine for disinfection and ropivacaine 1% for anesthesia. The technique used for anesthesia depends on the type of surgery. Surgical procedures are described for diagnostic biopsies, nail avulsion in general, onychogryposis, paronychia treatment, hematomas and bone fracture due to trauma, removal of subungual foreign bodies, ingrowing nails, pincer nails, warts, ungual fibrokeratomas, digital myxoid pseudocyst, subungual exostoses, and various tumors. If performed correctly with adequate skills, nail surgery will lead to functionally and aesthetically satisfying results in the majority of instances.

Curtis’s Cephaloscope: Deafness and the Making of Surgical Authority in London, 1816–1845

Aural surgery is a branch of nineteenth-century medicine and surgery providing specialized treatment for ear diseases. During the 1830s, faced with a "popular prejudice" against the curability of deafness as well as intraprofessional rivalries and continuous accusations of quackery, aurists found their surgical authority questioned and their field's value threatened. In an attempt to bolster aural surgery's reputation, in 1841, the aurist John Harrison Curtis (1778-1856) introduced his new diagnostic instrument, the cephaloscope, which could not only improve diagnosis but also provide approaches for regulating aural knowledge, thus strengthening aural surgery's authority. This article examines the motives underlying Curtis's introduction of the cephaloscope and the meanings it held for the occupational group at large.

How to nurse the ageing, small animal inpatient part 1 – general nursing considerations

Geriatrics is the branch of medicine and surgery that treats problems peculiar to old age. Ageing is defined as the accumulation of progressive body changes associated with or responsible for disease, decreased physiologic function, and ultimately death. Lifespan and life expectancy differ among species and among individual members of a species, therefore there is no one specific age that can define the term ‘geriatric’ The term is therefore generally used to define those animals that have reached 75–80% of their expected lifespan. Ageing patients do not adapt well to a change in environment or alterations to their daily routine. This first of this two-part article will focus on general nursing considerations for the ageing inpatient.

Assessment of microsurgery competency‐where are we now?

In the last decade surgical training is being revolutionized by two novel concepts that have been introduced to almost all branches of surgery including and most recently to microsurgery. These two concepts are: objective assessments of surgical skills and the nurturing of surgical skills in a simulation laboratory setting. Acquiring surgical skills in the laboratory setting can help move the microsurgical learning curve from the patient to the laboratory and this will in turn improve patient safety. In order to optimize microsurgical training through a competency based training programme, it is imperative for microsurgical educators to understand microsurgical skill acquisition. This requires accurate objective assessment tools that can define and quantify microsurgical competency. This article aims to review the current literature on the various objective assessment tools adapted for microsurgery and attempt to identify the gaps that need to be addressed by research in microsurgical education to establish the ideal objective assessment tool.