Surgeons In Assessment Research Articles

Can MSCT be a useful tool to orthopedic surgeons in assessment of the morphology of the PM (posterior malleolus) fractures using Bartonicek-Rammelt classification?

Can MSCT be a useful tool to orthopedic surgeons in assessment of the morphology of the PM (posterior malleolus) fractures using Bartonicek-Rammelt classification?

Evaluation of the efficacy of wireless sterilizable pulse oximeter in assessment of bowel viability during surgery

Background Intestinal viability is crucial before commencement of any anastomoses or establishment of stomas after resection of the gut for any surgical reason, and depending on the clinical sense and subjective methods alone may result in disastrous results and complications affecting the outcomes of the surgical procedures. There are many techniques available nowadays for assessing bowel viability, but most of them are technically demanding and not usually available in the operating theater, besides the cost of many of them, which may represent another added burden. For all the aforementioned reasons, the wireless pulse oximeter (PO) has emerged as a possible new method which can aid in assessment of bowel viability during surgeries with the advantages of availability, low cost, and simple rapid way of gut viability assessment. Purpose The aim of this study was to evaluate the capability of the wireless PO in discrimination between viable and nonviable intestine intraoperatively before establishment of stomas or intestinal anastomoses. Study design This was a prospective study that included 40 patients who were evaluated intraoperatively by the wireless PO to assess the viability of the proximal and distal ends of the intestine. The intestinal viability in the first 10 patients was also evaluated by the fluorescein dye in addition to the PO. Here, fluorescein was used as a well-established method to validate the new technique of the PO. All the readings were recorded, and patients were followed up for 2 weeks postoperatively to detect any complications related to intestinal ischemia. Results Three cases were complicated: two cases of failed anastomosis with leakage and the third case was ischemic end colostomy stoma. The mean values of PO readings in the noncomplicated group (37 cases) were 95.65 and 96.32% in the proximal and distal segments, respectively, whereas in the complicated group (three cases), mean values were 89 and 87% in the proximal and distal segments, respectively. Conclusion The PO device is safe, portable, and nonsophisticated, which can be used easily by surgeons in assessment of bowel viability during surgery. It takes less time to assess the intestinal viability and is very cost-effective, as one device can be used in multiple patients.

Retroperitoneal Sarcoma - A Diagnostic Challenge with Only a Surgical Cure

Sarcomas are solid tumours of mesenchymal cell origin and account for 1% of all adult malignancies. Retroperitoneal sarcomas more commonly affect people in their 50’s who can present to a general surgeon for assessment of non-specific abdominal symptoms. This nature of their presentation and anatomical location provides a diagnostic challenge and initial investigations may be normal. Patients can therefore present late when the tumour is locally advanced. Complete surgical resection with negative macroscopic margins is the treatment of choice and the only proven modality to improve survival and reduce disease recurrence. Extensive resection of multiple organs may be necessary to offer any chance of cure. The benefits of other treatments such as radiotherapy and chemotherapy are less certain. We will present the case of a 63-year-old man who presented with a chronic history of non-specific abdominal symptoms and outline the results of his investigations and subsequent management. We will briefly discuss some of the issue relating to the diagnosis and management of retroperitoneal sarcomas in general.

Patient compliance with a group model of care: the hernia clinic

In February 2006, a hernia clinic was established at the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia. It was based on a group model of care and was established to increase effective use of resources to reduce waiting times. We conducted a survey of patients referred to the hernia clinic to determine compliance. We developed and mailed a questionnaire to all patients who had surgery after assessment at the hernia clinic. Data were analyzed for the entire study group and for 2 subgroups: patients in group I had the same surgeon for assessment and surgery, whereas patients in group II had a different surgeon for assessment and surgery. Differences between subgroups were assessed using the 2-tailed Fisher exact test. Waiting times were recorded. In all, 94 patients responded to the survey. Of these, 67% had the same surgeon for assessment and surgery, and 31% had a different surgeon; 2% were not sure. Two-thirds were comfortable having their surgery performed by a surgeon whom they met the day of surgery. Most patients had confidence in the competence of any surgeon and considered service to be better and faster in a specialized centre. Most felt that a group of surgeons providing hernia care uses resources more effectively. The waiting times from referral to initial consult decreased from 208 (standard deviation [SD] 139) days in 2007 to 59 (SD 70) days in 2009. Patient compliance with a group model of care for hernia surgery is high.

Abdominal aortic aneurysm: still missing the message.

Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.

An integrated nursing and telemedicine approach to vascular care.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

The overprojecting nose: Aesthetics, diagnosis, and management

Recognition of the aesthetic range of acceptability of nasal projection is crucial to sophisticated rhinoplastic surgery. Within this article, various methods are discussed that use measurements of ratios and angles between facial landmarks to assist the surgeon in assessment of nasal projection. Chin projection, skin thickness, and patient age are further considerations when deciding how to best approach an aesthetic ideal for a particular patient's face. This article then discusses preoperative assessment and diagnosis and emphasizes steps taken to correct problems of projection that completely depend on the anatomic etiology of the deformity.