Current Operative Management Research Articles

Animal Hygiene and Animal Health in Dairy Cattle Operations

This paper addresses the economic and strategic position of animal health in the dairy operations and the way that animal health care should be properly designed. Examples of biosecurity plans and quality risk management are fur- ther elaborated. Disease risk identification and disease risk management as primary preventive issues are pivotal in mod- ern animal health care on both the small and larger dairy farms. Biosecurity and quality risk management can both be in- tegrated into current operational veterinary herd health and production management programs.

Hepatic Resection in the Management of Complex Injury to the Liver

Nonoperative management has become the standard for >80% of the blunt liver injuries. In the cases where operation is required, current operative management emphasizes packing, damage control, and early utilization of interventional radiology for angiography and embolization. Liver resection is thought to have minimal role in the management of hepatic injury because of the high morbidity and mortality in many reports. The objective of this study was to show that the management of complex liver injuries with anatomic or nonanatomic resection can be accomplished by experienced trauma surgeons, in conjunction with liver surgeons in some cases, with low morbidity and mortality related to the procedure. Delayed, planned anatomic resection was also applied. This is a retrospective, observational study, on patients admitted to the University of Pittsburgh Medical Center (UPMC)-Presbyterian from December 1986 through March 2001. The patients included in this report underwent hepatic resection for complex liver injuries (grade 3, 4, and 5) according to the American for Association the Surgery of Trauma-Organ Injury Scale. Age, sex, mechanism of trauma, type of resection (nonanatomic, segmentectomy, lobectomy, and hepatectomy), surgical complications, hospital length of stay, and mortality were the variables analyzed. Two hundred sixteen adult patients were admitted with complex liver injury, during the period of December 1986 to March 2001. Fifty-six patients of this series underwent liver resection: 21 anatomic segmentectomies, 23 nonanatomic resections, 3 left lobectomies, 8 right lobectomies, and 1 hepatectomy with orthotopic liver transplant. The median age was 31 years (range, 15-83 years). The Injury severity Score average was 34 +/- 10 (range, 16-59). Mechanism was blunt in 62.5% and penetrating in 37.5%. The grades of hepatic injury were 9 grade III, 32 grade IV, and 15 grade V. A total of 28.5% (16 of 56) of patients had concomitant hepatic venous injury. The overall morbidity was 62.5%. The morbidity related to liver resection was 30%. The overall mortality of the series was 17.8%. Mortality from liver injury was 9% in this series of patients undergoing liver resection for complex hepatic injury. This study demonstrates that liver resection should be considered as a surgical option in patients with complex injury, as initial or delayed management, and can be accomplished with low mortality and liver related morbidity.

Percutaneous Nephrolithotomy Success in the Transplant Kidney

Treatment for symptomatic calculi in the transplanted kidney can be problematic. Percutaneous nephrolithotomy has routinely been used but concerns exist about potential injury to adjacent organs using a percutaneous access technique. We report our experience with percutaneous nephrolithotomy in the transplant kidney. A retrospective chart review from 1988 to the present was performed of all cases of a renal transplant and subsequent renal calculi treated with percutaneous nephrolithotomy. We identified 13 patients with a renal transplant who underwent percutaneous nephrolithotomy. Presenting symptoms included renal failure in 46.1% of cases, hematuria in 23.1%, urinary tract infection/pyelonephritis in 23.1%, pain in 15.4%, fever in 7.7% and hydronephrosis in 7.7%. Average calculus size was 1.36 cm (range 0.2 to partial staghorn). A single access tract was used in 12 cases and 2 access tracts were used in 1. Ultrasonic lithotripsy was performed in 10 cases, basket extraction was performed in 3 and the 2 techniques were performed in 1. No intraoperative complications occurred. Nephrostogram 24 hours after the procedure demonstrated no residual fragments in 10 patients (76.9%). Repeat endoscopy was required in 3 patients to achieve subsequent stone-free status. Postoperative complications developed in 3 patients, including sepsis, gastrointestinal bleeding and herpes esophagitis, respectively. Mean followup was 5.3 years (range 0.6 to 9). The single stone recurrence was treated with shock wave lithotripsy. Mean creatinine was stable at 2.0 mg/dl (range 0.9 to 3.9) preoperatively to 1.7 mg/dl (range 0.9 to 2.6) at the last visit (p = 0.311). Percutaneous nephrolithotomy is safe and effective in the transplanted kidney. Minimal postoperative complications were noted and stone-free status was achieved in all cases. At long-term followup there were few stone recurrences with stable graft function after the procedure.

A multi-model approach to the simulation of large scale karst flows

The possible effects of water transfer through a tunnel from Fatnicko Polje to Bileca Reservoir on the hydrologic regime of the Bregava River located in Eastern Herzegovina, in an area characterised by a predominantly karstic terrain, are studied. Three different simulation models of the area were developed and their predictions compared under a range of current and future hydrological and operational management conditions. These are based on a range of modelling approaches from a simplified conceptual approach to a quasi-physically based one. Despite the large complexity of the natural system, the models gave good fits to existing flow data with the most simplified model providing the closest agreement to historical flows. Calibrated models were used to study the possible effects of the intervention under a range of operational scenarios and identify the sources of the associated uncertainties. The results of the work suggest that the system of tunnels in question has a favourable effect in reducing flood hazard in the area, thus liberating scarce land resources for agriculture, and in reducing flows in the Bregava River (especially high flows). It is also suggested that a significant reduction in the uncertainty of modelling the karstic environment can be achieved by an appropriate, complementary combination of modelling approaches viewed as a multi-model ensemble.

Contralateral groin node metastasis following ipsilateral groin node dissection in vulval cancer: a case report

Background The majority of vulval cancers are of the squamous cell type. Current operative management strategies are based on modifications of radical vulvectomy and groin node dissection, enabling a more individualised and conservative approach to surgery. This has led to interesting dilemmas regarding the most appropriate management in certain individuals. Case We describe a case of a contralateral recurrence following unilateral groin node dissection for vulval cancer, with an initial single microscopically positive node. The patient did not receive adjuvant treatment. Evidence regarding the safety of this approach is discussed. Conclusion The subject remains controversial, and further such cases should be recorded in the literature in order to gather more information on this difficult problem.

Analysis of Advantages and Disadvantages of Current Operational Risk Management Models (AS/NZS 4360, AS/NZS ISO 9000, AS/NZS ISO 14000, AS/NZS 4801, AS/NZS 3806, AS/NZS 4444)

This paper will describe about the analysis of advantages and disadvantages of current operational risk management models (AS/NZS 4360: Risk Management, AS/NZS 4801: Occupational Health and Safety Management Systems, AS/NZS ISO 9001: Quality Management System, AS/NZS ISO 14001: Environment Management System, AS/NZS 3806: Compliance Management System, AS/NZS 4444: Information Security Management) based on expert experiences and extracting the literature review. The advantages of most current models are widely adopted by industries of various of sizes as the basis for their operational risk management. In addition, they may help the organizations to improve the operations and competitiveness. However, there are some disadvantages of most current models such as the models are very general (guidance only), not specific to cover particular risks of industries. And they don’t have the specific tools and processes. In addition, they may not be able to integrate all elements of the management systems such as safety, health, environment, quality, security, and compliance.

TRANSPERITONEAL PREPERITONEAL LAPAROSCOPIC LUMBAR INCISIONAL HERNIORRHAPHY

Flank incisions may be associated with flank hernias, which may be complicated by incarceration and strangulation. Furthermore, they may be the cause of significant patient dissatisfaction with the surgical outcome. To avoid an open surgical procedure with its associated morbidity for hernia repair we describe a novel laparoscopic technique for repairing flank hernias with minimal morbidity and an excellent outcome. Three cases of flank hernia were managed by the transperitoneal preperitoneal laparoscopic approach using polypropylene mesh to repair the fascial defect. An initial transperitoneal approach helps to identify the limits of the hernia. A 2 to 3 cm. margin of overlying peritoneum is incised around the hernia margin. It is important not to dissect overlying bowel. The mesh is placed behind the peritoneal envelope and secured with hernia staples. All cases were managed successfully via laparoscopy. There were no intraoperative or postoperative complications. At a mean followup of 12 months cosmesis has been excellent and there have been no recurrences. We describe a minimally invasive, versatile technique for laparoscopic repair of flank incisional hernias with excellent functional and cosmetic results. This approach avoids the significant morbidity associated with open repair of incisional flank hernias.

Slap lesions: Current operative techniques and management

Lack of definitive findings specific to SLAP lesions in patient history, physical examination, and diagnostic tests make this entity difficult to diagnose. Although magnetic resonance arthrography shows much promise, diagnostic arthroscopy remains the gold standard for identifying this lesion. The type of lesion identified at the time of arthroscopy determines the treatment. Type I and III SLAP lesions are debrided. Type II lesions and many type IV lesions are repaired.

Operations management in Italy

Reports on the current operations management situation in Italy. Includes a brief historical review looking back to the 1950s. Considers the development of research and education in the field since the 1980s. Gives listings of key institutions, personnel and events relating to operations management in Italy.

Multi-disciplinary operative management of vulval metastasis from rectal adenocarcinoma

A 61-year-old female developed vulval metastasis five months after a metastatic rectal carcinoma was treated by abdomino-perineal resection (APR) and pelvic exenteration, chemotherapy and radiotherapy. In view of her previous management and the anticipated defect a joint operative management was performed by the oncological and plastic surgical teams. She had bilateral en bloc inguinal node dissection and posterior vulvo-vaginectomy. Immediate reconstruction using bilateral gracilis myocutaneous flaps was complicated only by minor skin necrosis. The selection of flaps for reconstruction was limited by previous and current operative management.

Surgical technique for talipes equinovarus

The pathoanatomy of the resistant clubfoot is reviewed, the evolution of surgical technique is discussed, and the author's current operative management is described in detail.

Observations and current operative management of congenital lumbar hernias during infancy : S.M. Fakhry and R.G. Azizkhan. Surg Gynecol Obstet 172:475–479, (June), 1991

Observations and current operative management of congenital lumbar hernias during infancy : S.M. Fakhry and R.G. Azizkhan. Surg Gynecol Obstet 172:475–479, (June), 1991

Data‐Base Management System Technology and Geographic Information Systems

Current operational data-base management system technology is restrictive in its capacity to clearly model and efficiently manage complex data objects, in general, and spatial data objects, such as those handled by geographic information system (GIS) software, in particular. This has led to the prevalence of hybrid GIS software architectures, in which the lexical and geometric components of spatial data are managed in a disintegrated fashion. However, recent developments in object-oriented DBMS technology suggest approaches for the unified management of spatial data. The need for distributed management of spatial data poses further technological challenges. Structure transfer protocols must be further developed to support real-time interchanges of subsets of spatial database on a query-by-query basis. Distributed crash recovery, concurrency control, and multiple copy updated capabilities as developed for distributed relational data bases must also be provided for distributed object-oriented data bases. Also, the technology to support physical and semantic integration needs to be further developed to allow distributed GISs to be built from pre-existing single-site components.

A Decision Impact Model

ABSTRACTCurrent and forecasted world economic trends call for an examination of traditional management organizational behavior. Changes in organizational behavior require a downward decision-making responsibility transfer. An examination of human motivational theories and experimental data provides insight into this needed decision transfer.A decision impact model of current operational management trends is presented. The model shows the necessity for streamlining the traditional organization in an effort to accommodate rapidly changing technology and increase organizational competitiveness. An investigation of decision transfer is also presented.

Current Operative Management of Urinary Calculi after Renal Transplantation

We examined the medical records of renal transplantation patients at our institution to determine the incidence and etiology of renal calculi after renal transplantation. Of 7 patients identified calculi formed on the basis of congenital hyperoxaluria in 2, secondary to chronic urinary infection in 1 and from iatrogenic causes in 4. We review the various surgical and radiological procedures used to treat these renal transplant patients. We also discuss the role of the new treatment modalities in managing urolithiasis in transplant recipients.

General Surgery Therapy Update Service

General Surgery Therapy Update Service is a loose-leaf compendium that covers the broad field of general surgery in 15 sections. The work is updated ($65 per year) three times yearly. Each update consists of a complete revision of one section, eliminating the old method of page-by-page replacement. In addition, annotated reviews of current literature are published yearly for each of the 15 sections. Twenty-three authors have combined to present their interpretations of optimal current diagnosis, preoperative preparation, and operative management of the full gamut of general surgical problems. In addition to adult general surgery, pediatric and congenital conditions are also covered, in terse but adequate fashion. The emphasis of this work is on practical management. The individual bias of each chapter's author is strongly reflected. The book is organized by organ system. Good coverage is provided of virtually all problems the practicing general surgeon faces. Technical highlights are appropriately included,