Invasiveness Of Surgery Research Articles

RECONSTRUCTION OF MANDIBULAR DEFECTS USING INDIVIDUAL VASCULARIZED AUTOGRAFTS COMBINED WITH MACROPOROUSTITANIUM FIBER MA

— The choice of donor material poses a problem for surgeons handling reconstruction of large combined bone defects or limited maxillofacial bone defects. Restoration methods, applicable in reconstructive microsurgery are based on materials of non-biological origin and musculoskeletal autogenous transplants which have complications and may inhibit the processes of osseointegration. Our study aimed to improve the efficiency of surgical treatment and rehabilitation of patients with mandibular defects using vascularized autograft in combination with macroporous titanium fiber material. The reconstruction of the defective mandible caused by chronic osteomyelitis, trauma, benign tumors was performed in 107 patients either by means of conventional methods (titanium plates, free and vascularized bone autografts), or by a novel engineered bone substitute. Our novel vascularized bone autotransplant combines a macroporous fiber titanium material and spiral bone autochips. For its fabrication we applied digital 3D technologies and methods of rapid prototyping, whereas its vascularization was harvested in iliac crest. Unlike the standard methods of reconstruction, the use of the engineered vascularized implant showed a significant reduction in stages, volume and invasiveness of surgical procedures and an improvement of esthetic and functional outcomes in patients with mandibular defects.

Microbiological assessment of cleanliness of surfaces and equipment in a children's operating theatre on the example of a selected hospital.

The operating theatre is one of the most important places in a hospital. Due to the presence of numerous reservoirs of microorganisms and the invasiveness of surgical procedures it is necessary to ensure high hygiene standards in these locations. The aim of the study was to carry out a qualitative assessment of the microbiological cleanliness of the surfaces and equipment in an operating theatre. The results of microbiological tests of the surfaces and equipment of the Children's Operating Theatre in Clinical Provincial Hospital No. 2 in Rzeszów, southeast Poland, during 2007-2012 were reviewed retrospectively. For the analysis, a total of 1,819 swabs were collected, of which 1.05% were positive. Positive results were obtained mainly from samples taken from moist places (57.9%). Among the microorganisms isolated, Gram-negative bacteria constituted the majority (57.9%), Pseudomonas bacteria were found most frequently (31,6%). Isolated microbes can be the etiological agent of nosocomial infections.

Minimal Invasive Fixation Can Decrease Infection Rates in Diabetic and Obese Patients With Severe Ankle Fracture and Syndesmotic Injury.

Ankle fractures involving syndesmosis disruption cause severely unstable joint conditions. Traditional invasive operations put certain patient groups at an increased risk of infection. There is limited literature discussing the outcomes of minimally invasive fixation of severe ankle fractures including syndesmotic injury, as clinicians may be tempted to treat these difficult cases with open reduction internal fixation (ORIF). A retrospective case-control study was conducted on patients treated at a level one trauma center. Patients were divided into 2 groups based on presence of diabetes and/or obesity (body mass index ≥30.0 kg/m2). Those with either comorbidity were defined as high infection risk patients and placed in a comorbidity group. Patients were further divided into subgroups based on the operation's invasiveness; either traditional ORIF or percutaneous cannulated screw fixation. Comorbid patients (N = 67) were more likely to sustain Weber C fractures compared to noncomorbid patients (N = 43) (59.70% to 37.21%, P = .019). Additionally, patients receiving minimally invasive fixation procedures experienced fewer infections than those receiving ORIF (0 vs 11 incidences, P = .01), without effect on union rates, fracture reduction, pain, need for revision surgery, or time to full weightbearing. Diabetic and obese patients are at an increased risk of experiencing severe ankle fractures. The use of minimally invasive fixation methods can reduce the risk of postoperative infection without sacrificing other surgical outcomes, even with fractures involving syndesmotic injury. Therapeutic, Level III: Retrospective comparative study.

Enumeration of circulating endothelial cell frequency as a diagnostic marker in aortic valve surgery - a flow cytometric approach

BackgroundThe frequency of circulating endothelial cells (CEC) in patients’ peripheral blood can be assessed as a direct marker of endothelial damage. However, conventional enumeration methods are extremely challenging. We developed a novel, automated approach to determine CEC frequencies and tested this method on two groups of patients undergoing conventional (CAVR) versus trans-catheter aortic valve implantation (TAVI).MethodsCEC frequencies were assessed by a flow cytometric approach, including automated pre-enrichment of CD34 positive blood cell subpopulation and isotype controls. The efficacy and reproducibility of the CEC enumeration method was validated by spiking blood samples of healthy control donors with defined numbers of endothelial cells.ResultsCEC frequencies were significantly higher in the TAVI group before (9.8 ± 4.1 vs. 5.5 ± 2.2, p = 0.019) and 1 h after surgery (13.4 ± 5.1 vs. 8.2 ± 4.1, p = 0.030) corresponding to higher Euroscore, STS score in higher risk patients from the TAVI group. Five days after surgery, CEC frequencies became significantly higher in the more invasive CAVR group (39.0 ± 13.0 vs. 14.3 ± 4.4, p < 0.001) compared to minimally invasive TAVI approach.ConclusionsThe new flow cytometric approach might be a robust and reliable method for CEC enumeration. Initial results show that CEC frequency is a valid clinical marker for the assessment of pre-operative risk, invasiveness of surgical procedure and clinical outcome. Further studies are necessary to validate the practical clinical usefulness and the potential superiority compared to conventional markers.

Charge balanced control of seizure like activity in a two dimensional cortical model

The invasiveness of surgical procedures and the ineffectiveness of medication in remedying seizures in some epileptic patients have led to investigations into alternative methods such as feedback control. While the methods for applying control are varied, the underlying idea is to use electrical signals to disrupt irregular cortical activity. Experimentally, an adaptively applied radial electric field has been shown to control seizure like activity in a mammalian brain [1]. In previous work, a meso scale model consisting of stochastic partial differential equations was developed [2]. Seizure like activity has been simulated with this model, and successfully suppressed using charge balanced electrical control [3]. The magnitude of control was related to the signal sensed at the cortical surface. This work extends previous research to a two dimensional meso scale cortical model. Cortical waves in a two dimensional spatial domain present more complex dynamics than are seen in the one dimensional model, with a greater variety of instabilities of the basic (healthy) states. This presents greater challenges for successful control.

Questioning the Universality of Medical Ethics: Dilemmas Raised Performing Surgery around the Globe

Performing surgery in the developing world presents unique challenges and dilemmas for the visiting physician from an industrialized country. Language barriers, widespread, profound pathology, and lack of adequate facilities are obvious hurdles. more subtle problem, though every bit as significant, is that the principles and procedures we routinely utilize at home to uphold ethical standards of care and to aid us in decision-making are often poorly applicable in the developing world. Acknowledging that cultural factors play a primary role in every aspect of their interaction with patients, physicians must scrutinize and even modify the tools they employ when attempting to deliver ethical care in foreign environments. Over the past two decades, I have routinely taken time from clinical practice to teach, practice, and perform eye surgery in remote locations. I've enjoyed the privilege of vastly broadening both my professional skills and global perspective while working with some of the most devoted and selfless health care workers I've encountered in my career. From Mongolia to points along the ancient Silk Route, to the deep Himalayas, to Southeast Asia, to sub-Saharan Africa, many of the locations where I've worked lack basic facilities including potable water, reliable electricity, and proper sanitation. Nearly all lack what an ophthalmologist considers requisite for even the most basic intraocular surgery: adequate illumination and magnification. If available at all, the precise instrumentation necessary to manipulate tissue within the eye is usually worn or broken due to overuse and repeated repair. Cutting instruments are blunt; forcep tips no longer meet. Disposable equipment acquired through donation is meticulously cleaned and reused far beyond its intended lifespan, and medications are routinely expired or implicitly understood to be the best available. Surgical gloves and sutures are resterilized and used as long as possible. Dressings are ingeniously fashioned from material of every imaginable sort. Indeed, resourcefulness and ingenuity are the unique and necessary attributes of doctors and their staff throughout the developing world. I am always presented with highly advanced pathology when working abroad, due in part to a chronic shortage of trained medical personnel and resources. Whether their ailments are secondary to trauma or to neglected or indolent disease, indigent patients usually seek care only when there is no alternative. The numbers are shocking: According to the most recent World Health Organization estimates, approximately 87 percent of the 314 million visually impaired live in developing countries; roughly 45 million are completely blind. (1) About 85 percent of all visual impairment and 75 percent of blindness could be prevented or cured. (2) While procedures performed to save or restore sight do not directly save lives, they are nevertheless crucial to survival in subsistence-level societies. blind person often represents an untenable responsibility for both the family and the community. It is believed that 60 percent to 80 percent of children who become blind in the developing world die within two years. (3) Nepalese proverb conveys the economic reality most concisely: A blind person has a mouth but no hands. In all of medicine, there is a unique burden associated with the decision to perform surgery. This arises, I suspect, from the very nature of an operation's invasiveness, and is compounded by the unpredictable perils of intraoperative and postoperative complications. In the industrialized world, a surgeon's decision to operate is not only strongly supported by well-defined ethical principles, but also facilitated by procedural tools that help to ensure the maintenance of these principles in daily practice. The most well-known is perhaps the Hippocratic edict to do no harm. Every graduating medical student is required to recite this commandment and implicitly understands it to be the sine qua non of ethical practice. …

Profiling of resource use variation among six diseases treated at 82 Japanese special functioning hospitals, based on administrative data

Background Profiling treatment in Japanese hospitals has rarely been conducted systematically with an administrative database. The study aims to present descriptive statistics of medical profiling and to examine the sources of variation in resource used for six common diseases. Methods Administrative records for 266,677 patients were analyzed to examine variation in length of stay (LOS) and total charge (TC) by hierarchical multiple linear regression for cases of ischemic stroke, ischemic heart disease (IHD), great vessel disease (GVD), respiratory neoplasm, gastric neoplasm and colonic neoplasm. Results Average LOS and TC increased with disease severity and invasiveness of surgical procedure. The coefficient of determination of the full model was highest for LOS in IHD (0.432), and for TC that was highest in GVD (0.702). Among various variable sets examined, surgical procedures explained largest variance in resource use. Conclusion With a standardized database derived from claims data, wide audience of stakeholders in Japanese healthcare will be able to access the profiling of practice or disease variation concerned.