Changes In Surgical Technique Research Articles

The Cambridge and King's College Hospital experience of liver transplantation, 1968-1983.

The postoperative course of 138 transplants performed in 137 patients in the Cambridge and King's College Hospital series between May 2, 1968 and April 1, 1983 is presented. During the last 15 years, criteria for selection of transplant candidates has been improved and types of disease categories, both suitable and unsuitable for liver transplantation, have been defined. The acceptance of the concept of brain death and the use of heart-beating donors in the United Kingdom since 1976 has greatly improved the quality of donor organs. Changes in surgical technique, particularly with regard to biliary tract drainage, have reduced morbidity and mortality from biliary tract complications since 1975. The use of partial cardiopulmonary bypass in selected cases and changes in immunosuppressive drug regimens have not significantly improved our overall results. Despite these changes based on our experience, the perioperative mortality in the Cambridge and King's College Hospital series remains disturbingly high.

Comparison of two methods of profile prediction in surgical treatment of mandibular prognathism

Two methods for prediction of the soft tissue profile subsequent to oblique subcondylar osteotomy for correction of mandibular protrusion were evaluated. The first one included distalization of the mandible into an Angle Class I relationship. The amount of distalization and any vertical changes were transferred to the tracing, and the anticipated new profile was drawn. The second method was based on the profile means of a group of "normal" persons and was aimed at correction of both sagittal and vertical discrepancies. Fifty patients were studied. A double set of prediction tracings was made according to both methods; and the results were compared with the actual postoperative results and with a "normal" control group. Both methods were usable, as the predictions were considered satisfactory if they were within one standard deviation from the mean of the control group. The sagittal changes were somewhat exaggerated by both analyses. The vertical changes were much better expressed by the profile prediction. Such changes are difficult to create by the vertical subcondylar osteotomy. Consequently, the model prediction seems most suitable for planning profile changes in surgical techniques that include mobilization of one main mandibular fragment.

Peptic Ulcer in the Royal Navy

AbstractPeptic ulcer disease has been a major problem in the Royal Navy for more than 50 years. During the past decade specialist gastroenterology services have been established in an attempt to conserve and retain manpower skills. Fibreoptic endoscopy now provides rapid and accurate diagnosis while treatment with the new H2 receptor antagonists permits safe and effective therapy for the sailor both outside hospital and often now while still at sea. Changes in surgical techniques and a combined medical/surgical policy towards the peptic ulcer patient have also contributed to a coordinated programme.The result of these changes has been a reduction in hospital admissions for duodenal ulcer, in the number of days of work lost from peptic ulcer disease, and a decline in the number of surgical operations for peptic ulcer at RNH Haslar. Invaliding of patients from the Royal Navy and Royal Marines for peptic ulcer disease has been almost abolished, emphasising the success of our policy of manpower conservation. Further work is required, however, to maintain patients in remission from their ulcer for longer periods and to identify better and earlier those patients who will ultimately require surgery.

STENOTIC CONDITIONS OF THE LUMBAR SPINAL CANAL: CHANGES IN SURGICAL TECHNIQUES IN THE MANAGEMENT OF LOW BACK DISABILITY1

The diagnostic recognition of acquired stenotic conditions in the lumbar spinal canal occurring from the fifth to the eighth decades of life had led to a significant change in surgical techniques during the last ten years. This communication presents a comparison of surgical techniques used by the author in two consecutive series of patients operated for low back, lumbosciatic, and spondylotic caudal disability syndromes during the period 1965 to 1969 inclusive (100 patients) and 1976 and 1977 (105 patients). Interlaminar discectomy was carried out in 88%, and laminectomy with spinal nerve nerolysis in 12%, of the 1965 - 1969 series. Discectomy by interlaminar approach was carried out in only 10% of the 1976 - 1977 series; all other patients had laminectomies with or without discectomies. Early follow-up results in the recent series indicate a significant (20%) increase in the number of patients who resumed their previous occupations as compared with those in the previous series.

Instructional Course Lectures.

This volume presents lectures and symposia given at the 1971 meeting of the American Academy of Orthopaedic Surgeons. Some of the material is new and documented; some is the accumulated experience of the authors; some is a review of the work of others. The book is directed primarily toward orthopedists and will be most useful to students and practitioners of orthopedics. Many changes in surgical techniques are evolutionary rather than revolutionary. The evolutionary changes find expression in this volume when they might not appear in standard journals. Some lectures deal very specifically with technical details (eg, surgery for hallus valgus, slipped femoral capital epiphysis, and the cervical spine) and thus provide important information for those doing such surgery. Most of the lectures are very practical expositions of subjects useful to all orthopedists. Other specialists (psychiatrists, internists, neurosurgeons, anesthesiologists, embryologists) have made valuable contributions to this publication, placing information within reach

Chondrosarcomas of the facial region.

AbstractLess than 100 chondrosarcomas originating in the facial skeleton have been reported. Information regarding chondrosarcomas in the facial region is fragmentary. The largest series collected transcend a long period of time containing changes in surgical technique and philosophy. Precedence for therapy and prognostic information is not readily available. Three patients with facial chondrosarcomas are reported. All were diagnosed within a four‐year time span. The aforementioned adequately depict the protean manifestations of this tumor and the aggressive therapy required. Correlation is made with the existing body of information regarding this entity.

Total Knee Joint Replacement Prosthesis

Summary In summary, we feel that the total replacement knee joint prosthesis deserves a permanent place in the armamentarium of the reconstructive surgeon. Instability due to combined femoral and tibial articular destruction is the indication for the procedure. A predictable result may be anticipated so long as the patient has the required anatomic assets. A proposed change in surgical technique should increase the yield of successful operations. Failure can be retrieved by means of athrodesis. Total replacement of the knee joint utilizing a prosthesis is not a procedure to be utilized instead of joint debridement, femoral prosthetic replacement, or tibial prosthetic replacement. Its place is in reconstruction of the knee whose articular integrity is so compromised that partial replacement cannot solve the problem. The only alternative procedure is therefore arthrodesis.

The management of total xerophthalmia.

It is the purpose of this thesis to present a broad program for the management of total xerophthalmia based on ten years' experience and follow-up of patients. The evolution of this program will be presented with emphasis on the changes in surgical technique and management. The objective of these modifications is to minimize complications and to insure the best possible long-term result. It is hoped that this presentation including surgical techniques, management of complications, and details of the overall program may serve as a basis for the ophthalmologist faced with the problems inherent in the management of total xerophthalmia.

Complications arising during transurethral resection of the prostate

We believe that hemolysis during a transurethral resection of the prostate is one of the factors involved in the production of a lower nephron nephrosis Dostoperatively. The other factors are hemorrhage, shock and previously diseased kidneys. These latter three factors may be mmimized by obvious means and the factor of intravascular hemolysis diminished by the use of an isotonic irrigating fluid, or if water is being used, by the early recognition and treatment of hemolysis. It is true that isotonic solutions, by virtue of their non-hemolyzing properties, do interfere somewhat with vision within the bladder, but it requires very little change in surgical technique to overcome tins obstacle.