Diagnosis Of Surgical Diseases Research Articles

P136: Artificial Intelligence (AI) and its role in the diagnosis of surgical disease: panacea or potentially dangerous?

Abstract Background AI algorithms are used in many healthcare settings, though concerns about underlying bias and accuracy exist. This study assessed accuracy of AI in investigation and diagnosis of acute surgical patients, when compared with clinicians’ performance. Methods Consecutive patients who attended a surgical SDEC unit over a two-week period in October 2023 were identified. The documented clerking history was inputted into ChatGPT (v3.5) and the algorithm was asked to give the most likely diagnosis and a list of recommended investigations. Clinical records were compared to the AI recommendations. Primary outcome measures were the investigative and diagnostic accuracy of the AI. Results 88 patients were identified. The most common presenting complaints were abdominal pain (57 patients, 64.8%), abdominal swelling (10 patients, 11.4%) or abscess (8 patients, 9.1%). AI correctly diagnosed 32 patients (36%). AI accuracy was greatest for patients with an abscess (6 patients, 75%), and less accurate for abdominal masses (4 patients, 40%) and abdominal pain (12 patients, 21%). AI recommended fewer investigations that doctors (6 versus 7 tests, median). AI recommended fewer blood tests (3 versus 5 tests, median) yet was more likely to recommend cross-sectional imaging and microbiological investigations. Conclusions At present, ChatGPT lacks sufficient diagnostic and investigative maturity to confidently replace a formal surgical clerking and misdiagnosed almost 80% of patients with abdominal pain as well as under-investigating most acute general surgical patients. Development of a bespoke machine-learning algorithm may improve accuracy and enhance the role of AI in triage and initial investigation.

Artificial intelligence in screening and diagnosis of surgical diseases: A narrative review.

Artificial intelligence (AI) is playing an increasing role in several fields of medicine. It is also gaining popularity among surgeons as a valuable screening and diagnostic tool for many conditions such as benign and malignant colorectal, gastric, thyroid, parathyroid, and breast disorders. In the literature, there is no review that groups together the various application domains of AI when it comes to the screening and diagnosis of main surgical diseases. The aim of this review is to describe the use of AI in these settings. We performed a literature review by searching PubMed, Web of Science, Scopus, and Embase for all studies investigating the role of AI in the surgical setting, published between January 01, 2000, and June 30, 2023. Our focus was on randomized controlled trials (RCTs), meta-analysis, systematic reviews, and observational studies, dealing with large cohorts of patients. We then gathered further relevant studies from the reference list of the selected publications. Based on the studies reviewed, it emerges that AI could strongly enhance the screening efficiency, clinical ability, and diagnostic accuracy for several surgical conditions. Some of the future advantages of this technology include implementing, speeding up, and improving the automaticity with which AI recognizes, differentiates, and classifies the various conditions.

Application prospect of nanomaterials mediated magnetic technology in the diagnosis and treatment of surgical diseases

As an important part of modern medical science, surgery is a discipline, focused mainly on the treatment of trauma, infection, tumor, malformation and dysfunction. Excision and repair are the main surgical treatment method. Therefore, the predictive diagnose and evaluation, the proper selection of operation ways and the absolute exposure of the operating area are crucial in the surgical operation. However, due to the special physiological structure of some tissues and organs, traditional surgical operation cannot treat some disease effectively. Novel surgical techniques are in urgent need now. With the development of surgical technology, the surgical operating area is greatly increased. Many refractory diseases can be treated effectively with the new technology now. Among these new surgical techniques, nanomaterials and nanotechnology, developing rapidly and playing an increasingly important role, provide novel tools and methods for surgery. According to the needs of clinical application, materials scientists have designed and developed all kinds of nanomaterials with special functions and structure. These functions are difficult for traditional materials to achieve. These novel nanomaterials have been applied in many field of the diagnose and treatment of surgical diseases, including the accurate diagnose of surgical lesions, treatment of tissue infection, fast haemostasis, bone reconstruction, repair of decayed teeth, treatment of tumor and pain etc. Among these nanomaterials, magnetic nanomaterials, with unique magnetic properties, specific biological effects, therapeutic functions and the ability of remote control through non-contact magnetic field, show great potential in the biomedical application and surgical application. This feature article mainly focused on the application prospect of nanomaterials mediated magnetic technology in the diagnosis and treatment of surgical diseases. The following sections were included in this feature article: Overview of medical magnetic nanomaterials; advances in nanomaterials mediated magnetic technology in the diagnosis of surgical diseases; advances in nanomaterials mediated magnetic technology in the treatment of surgical diseases. Magnetic nanomaterials used in clinical application mainly include hard magnetic materials (NdFeB materials, representatively) and soft magnetic materials (iron oxide nanomaterials and their compounds, representatively). NdFeB materials, based on their magnetic force or magnetic field, are used mainly as medical devices or for magnetic therapy; iron oxide nanomaterials, as the only inorganic nanomaterials approved by FDA, are widely used in clinical application as contrast agent, new iron-enriched agent and heat source for tumor thermal therapy. Based on iron oxide nanomaterials, there are more than 10 products in different clinical stages and many commercial products have been launched. However, there are still lots of problems during the use of magnetic nanomaterials. Lack of magnetic force, metabolism of the materials in human body, biocompatibility, toxicity, material design and synthesis, are the mainly aspects limiting the application of magnetic materials. With the development of nanotechnology, in the future, we should firstly further investigate the synthesis of medical magnetic nanomaterials of high performance and expand the clinical applicability in surgery. What’s more, the new clinical magnetic nanodrugs, nanodevices and novel contrast agent should be developed for surgery. Meanwhile, the biological effects of magnetic nanomaterials in the presence of magnetic field should be explored deeply. Recent years, more and more engineering scientists are cooperate with clinician, more and more techniques and strategies based on magnetic nanomaterials are tested for diagnosis and treatment in surgical application. We believe that the magnetic nanomaterials hold great promise for future surgical applications.

Laparoscopic cholecystectomy in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare congenital anomaly, in which both the thoracic and the abdominal viscera are transposed to the opposite side of the body. The diagnosis of surgical diseases in patients with SIT is often delayed, leading to complications. Surgery in these patients has been reported to be more challenging for right-handed surgeons. We herein present a case of a 30-year-old woman, not known to have SIT, with a history of intermittent left upper quadrant pain related to food for more than a year. After clinical examination, chest X-ray, and abdominal ultrasound, she was diagnosed with SIT and chronic cholecystitis, and underwent laparoscopic cholecystectomy performed by a right-handed surgeon. We believe that this case report will be informative for surgeons in managing chronic cholecystitis in patients with SIT, and for physicians to always look for clues for SIT in patients presenting with abdominal pain.

The Pediatric Surgeon’s Role in Prenatal Counseling

The purpose of this article is to provide an overview of surgical disease for which the pediatric surgeon may be called upon to provide prenatal counseling to parents. Many surgical diseases are detected prenatally and benefit from pediatric surgical consultation. Moreover, there are increasing numbers of fetal interventions that can be performed for certain diseases in select cases. For example, investigation of fetal tracheal occlusion for congenital diaphragmatic hernia (TOTAL trial) is underway, and therapy for congenital bilateral renal agenesis (RAFT trial) is in the planning phase. For these reasons, many pediatric surgical diseases should be referred to a fetal center. Prenatal diagnosis of surgical disease will continue to increase, and the pediatric surgeon will have an important role in prenatal counseling and management. Pediatric surgeons should have a working knowledge of these diseases and know which ones will benefit from a referral to a fetal center.

Study on pictures in Waike Xinfa Yaojue

Collecting 265 pictures, Waike Xinfa Yaojue (written in Qing Dynasty) is the extant ancient surgical book with most pictures. Pictures could be divided into four kinds, i.e. disease and symptoms, meridians, pulse taking and taboos. Pictures on disease and symptoms account for the largest number and appeared most often and those pictures are also with special subject characteristics and of great importance to the diagnosis of surgical diseases. Pictures in ancient medical books played an important role in academic heritage.

Practical Cystoscopy and Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder. By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Large 8vo. Pp. 398, with 233 illustrations, and 29 in colours. Second edition. Philadelphia and London W B. Saunders Co. 25s. net

Practical Cystoscopy and Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder. By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Large 8vo. Pp. 398, with 233 illustrations, and 29 in colours. Second edition. Philadelphia and London W B. Saunders Co. 25s. net

Diagnosis of surgical disease. Edited by Richard T. Shackelford, M.D. Vol. I. Pp. 1–780. Illustrated. Vol. 2. Pp. 781–1510. Illustrated. Vol. 3. Pp. 1511–2131. Illustrated. 10 × 7 in. 1968. London: W. B. Saunders Company Ltd. Three-volume set, £30 16s

Diagnosis of surgical disease. Edited by Richard T. Shackelford, M.D. Vol. I. Pp. 1–780. Illustrated. Vol. 2. Pp. 781–1510. Illustrated. Vol. 3. Pp. 1511–2131. Illustrated. 10 × 7 in. 1968. London: W. B. Saunders Company Ltd. Three-volume set, £30 16s Get access Diagnosis of Surgical Disease. Edited by Richard T Shackelford, M.D. Vol. I. Pp. 1–780. Illustrated. Vol. 2. Pp. 781–1510. Illustrated. Vol. 3. Pp. 1511–2131. Illustrated. 10 × 7 in. 1968. London: W. B. Saunders Company Ltd. Three-volume set, £30 16s. British Journal of Surgery, Volume 56, Issue 6, June 1969, Pages 478–479, https://doi.org/10.1002/bjs.1800560630 Published: 07 December 2005

Reply

Associate Professor of Anesthesia and Surgery, Director, Fellowship in Critical Care Medicine, Department of Anesthesia, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennysylvania 19104–4283.In Reply:-Kempen maintains that “the single most cost effective preoperative evaluation likely occurs when competent surgeons thoroughly evaluate and prepare their patients regarding perioperative needs…” He later bemoans the concern that Stanford's surgeons “never develop necessary skills…” Implicit in these, and other statements, is an assumption that appropriate preparation of patients for the perioperative period is something best performed by either surgeons or primary care physicians. This is simply not true.The goal of surgical training is learning when and how to perform surgery. The emphasis is, as it should be, on the diagnosis of surgical disease, selection of the appropriate operation, and skilled performance of that operation. Similarly, primary care physicians and medical subspecialists are trained to deal with disorders within the context of everyday life at home or recovery from a severe medical problem in the hospital. Neither surgeons, primary care physicians, nor medical subspecialists are trained to understand the interactions between perioperative pathophysiology and intrinsic medical conditions. In contrast, anesthesiologists are specifically and intensively trained in just such issues. Therefore, in a sense, Kempen's statement regarding the need for surgeons to develop “necessary skills” is key. Surgeons, primary care physicians, and medical subspecialists will need to develop additional skills to deal with patients in the perioperative period, just as some anesthesiologists may need to enhance their skills in this area, also. However, an anesthesiologist trained in a modern department that emphasizes perioperative medicine possesses these skills in abundance and is, therefore, the appropriate individual to evaluate and prepare a patient for the perioperative period. An analogy to postoperative pain management can be made; the anesthesiologist understands the physiologic source of pain, is versed in management modalities, and is trained to manage these in the context of the response to surgery. Clearly, the anesthesiologist is best equipped to manage this issue, and the failure of classical methods of postoperative pain management emphasizes this point.Let's put this in completely practical terms. It is the rare anesthesiologist who has not been confronted with a medical consultation for “preoperative clearance,” wherein a well meaning primary care physician, untrained in the implications of perioperative pathophysiology, has neglected an essential component of preoperative management. Similarly, most of us have been faced with a consultation on a significantly ill patient who is “cleared but only for spinal anesthesia,” indicating ignorance of the issues involved. Surgeons tend to treat such consultations as license to proceed and are angered when an unaddressed issue leads to cancellation or postponement. The result is often the ordering of all tests on all patients. Appropriate preoperative evaluation by a competent anesthesiologist, or a physician extender supervised by that anesthesiologist, can avoid these problems. We anesthesiologists are trained to do this, we are better aware than anyone of the issues involved, and anesthesia preoperative evaluation clinics such as that at Stanford will serve to institutionalize this essential role. This may not be the best approach for all places; the private practitioner in a small hospital may accomplish the same thing simply by being available for informal consultation and by developing a professional and personal relationship with his surgical colleagues. The point is, this service is appropriate, and best provided by a well-trained anesthesiologist. Embracing this role is good for anesthesiologists, surgeons, hospitals, and, most importantly, patients.Clifford S. Deutschman, M.S., M.D., Associate Professor of Anesthesia and Surgery, Director, Fellowship in Critical Care Medicine, Department of Anesthesia, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennsylvania 19104–4283.(Accepted for publication September 11, 1996.)

Diagnosis of Surgical Disease, Vol. I

Diagnosis of Surgical Disease, Vol. I

Diagnosis of Surgical Disease

Shackelford's Diagnosis of Surgical Disease appears to be, in a sense, a companion work to his invaluable Surgery of the Alimentary Tract published in 1955. This work discusses in considerable detail the diagnostic features of virtually all conditions which a surgeon might encounter. The richness of the author's personal experience is reflected in many chapters which he himself has prepared, but he has unhesitatingly drawn upon the more specialized knowledge of some 22 colleagues for chapters in their particular areas of interest. Volume 1 includes a most extensive consideration of history taking and physical examination, followed by a section of cytopathology and one on radioisotope scanning. The remainder of this volume is devoted to lesions of the nervous system, head and neck, breast, esophagus, and thorax, including heart and lungs. Heart disease in children and in adults is properly considered in separate chapters, written by cardiologists working in these fields.

INTRAOSSEOUS EPIDURAL VENOGRAPHY IN THE DIAGNOSIS OF SURGICAL DISEASES OF THE LUMBAR SPINE.

INTRAOSSEOUS EPIDURAL VENOGRAPHY IN THE DIAGNOSIS OF SURGICAL DISEASES OF THE LUMBAR SPINE.

Intussusception of the vermiform appendix; report of a case.

The first report in the literature on intussusception of the appendix was made by McKidd,1in 1858. His young patient died one month after he was first seen, without benefit of surgical treatment. The tremendous strides in surgery since then have established successful therapeutic measures, but preoperative diagnosis has lagged far behind. Rarely has a correct preoperative diagnosis been arrived at, although certain characteristics of the disease are definite enough to warrant its inclusion in the differential diagnosis of surgical disease of the abdomen. The case reported here is of interest because of the type of intussusception; an invagination of the appendix into itself is rare, and only three previous cases have been reported. The fourth case of this type is reported with a brief discussion of the possible causative factors and a review of the literature. REPORT OF A CASE The patient, a 65-year-old white man, was admitted

Some Observations on the Use of Roentgen Ray in the Diagnosis of Surgical Diseases of the Chest

Some Observations on the Use of Roentgen Ray in the Diagnosis of Surgical Diseases of the Chest

Schinz, Baensch und Friedl. Lehrbuch der Röntgendiagnostik mit besonderer Berücksichtigung der Chirurgie. XVIII +1131 pages, 1722 radiographs and figures, 5 phototables. ed. by G. Thieme, Leipzig. 1928. Price 90 marks

The present, sumptuously published and with rare clear reproductions of radiographs, is a guide to radiology, specifically on the roentgen diagnosis of surgical diseases, which differs from other voluminous German and French textbooks-collections, It is distinguished from other German and French textbooks by the fact that its entire presentation is from the point of view of the specialist surgeon-radiologist (Schninz-Zurich), who spared no expense in ensuring that in each chapter the radiological data is compared with the anatomical and surgical data in each section. Despite the surgical bias, this voluminous work presents all roentgenodiagnostics of internal diseases, by wealth of material it is not inferior to the well-known Assmann's textbook. In particular, skeletal diseases take up 458 pages, internal diseases some 618 pages, and the genitourinary apparatus 100 pages. In doing so, each section reflects all the advances of recent years that modern radiology is proud of.

The Use of the Roentgen Ray for Diagnosis of Surgical Diseases of the Mouth

The Use of the Roentgen Ray for Diagnosis of Surgical Diseases of the Mouth

Book Review Practical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder . By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Second edition, thoroughly revised and enlarged. Octavo of 504 pages, with 299 illustrations, 29 in colors. Philadelphia and London: W. B. Saunders Company. 1915.

Book Review Practical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder . By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Second edition, thoroughly revised and enlarged. Octavo of 504 pages, with 299 illustrations, 29 in colors. Philadelphia and London: W. B. Saunders Company. 1915.

Pratical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Uninary Bladder

Pratical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Uninary Bladder

Book Review Practical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder . By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Octavo of 398 pages, with 233 illustrations, 29 in colors. Philadelphia and London: W. B. Saunders Company. 1911.

Book Review Practical Cystoscopy and the Diagnosis of Surgical Diseases of the Kidneys and Urinary Bladder . By Paul M. Pilcher, M.D., Consulting Surgeon to the Eastern Long Island Hospital. Octavo of 398 pages, with 233 illustrations, 29 in colors. Philadelphia and London: W. B. Saunders Company. 1911.

Recent Literature The Diagnosis of Surgical Diseases . By Dr. E. Albert, late Director and Professor of the First Surgical Clinic at the University of Vienna. Authorized translation from the eighth edition. By Robert T. Frank, A.M., M.D. 419 pages and 53 illustrations. New York: D. Appleton and Co. 1902.

Recent Literature The Diagnosis of Surgical Diseases . By Dr. E. Albert, late Director and Professor of the First Surgical Clinic at the University of Vienna. Authorized translation from the eighth edition. By Robert T. Frank, A.M., M.D. 419 pages and 53 illustrations. New York: D. Appleton and Co. 1902.