Textbook Of Surgery Research Articles

The first English textbook of plastic surgery—William (Jerry) Moore

The nineteenth century bore witness to a remarkable proliferation of reconstructive literature in Europe, based on procedures originally described in India and Italy. Despite the publication of a successful forehead flap in England in 1816, texts exclusively dedicated to the field of plastic surgery were relatively scarce in the English-speaking world. The authors sought to identify the first English textbook entirely devoted to plastic surgery. A comprehensive examination was undertaken, spanning various databases encompassing medical, medical humanities and historical domains (PubMed, MEDLINE, Web of Science, Anthropology, JSTOR, Encyclopedia of Ancient History), as well as an extensive perusal of materials housed in the State Library of Victoria, the University of Melbourne and the HathiTrust Digital Library. The scope of this search was confined to publications predating Harold Gillies' influential 1920 textbook. Within this vast literary landscape, an Australian surgeon named William Moore emerged as a figure of notable significance, authoring the first textbook of plastic surgery in English in 1899. Moore's legacy as a pioneering surgeon ahead of his era is undeniable. Yet, various factors conspired to obscure his rightful place in the annals of surgical history.

Visual Misrepresentations: The Lack of Skin Tone and Sex Equity in General Surgical Textbooks

Lack of racial and ethnic diversity in educational material contributes to health disparities. This study sought to determine if images of skin color and sex in general surgery textbooks were reflective of the U.S. All human figures with discernable sex characteristics and/or skin tone were evaluated independently by 4 coders. Each image was categorized as male or female. Skin tone in each image was categorized using the Massey- Martin skin color scale. This data was compared to 2020 U.S. Census Data. U.S. Medical School. Not applicable. A total of 1179 images were evaluated for skin tone alone; 293 images for sex alone. 650 images depicted characteristics of both sex and skin tone. Interrater reliability was 0.78 for skin tone and 0.91 for sex. While the U.S. population is 59.3% white, 29.5% non-black persons of color and 13.6% black, in surgical textbooks, 90.7% of images were white, 6.5% were non-black persons of color, and 2.8% were black. Distribution of skin tone for all textbooks were significantly different. (p < 0.001) compared to the U.S. The U.S. population is 49.5% male and 50.5% female. When images of sex specific genitalia and breasts are excluded, surgical textbook images are 62.9% male and 37.1% female. Only 1 textbook had a distribution of sex that was similar to the U.S. Despite increasing diversity in the U.S. population there is a lack of skin tone and sex diversity in traditional surgical textbooks.

H04 The sign of Leser–Trélat: an eponymous misnomer?

Abstract The sign of Leser–Trélat is a paraneoplastic phenomenon consisting of a sudden eruption of seborrhoeic keratoses. It is credited to two surgeons, Edmund Leser (1853–1918) and Ulysse Trélat (1827–1890), who described cutaneous lesions associated with internal malignancies. Edmund Leser, the author of the Textbook of Special Surgery in 50 Lectures, initially studied law in Bonn before qualifying in medicine in Leipzig in 1880. He became Richard von Volkmann’s assistant at Martin Luther University. He was awarded his chair of surgery in 1894, 10 years after becoming a surgeon, and he practised in Goethe University, Frankfurt. Ulysse Trélat was born in Paris in 1827. His father was a republican political activist, Minister of Public Works and known as the founder of public hygiene in France. Ulysse Trélat was employed as an assistant anatomist in surgery at the ‘École Pratique’ 1 year before graduating high school in 1844. He finished his medical studies in 1854 and became a surgeon in 1857. In 1858, he was running the anatomy course in ‘École Pratique’. He replaced Paul Broca, well known for his research on Broca’s area in the frontal lobe, at Hospital Necker in 1880. In 1884, he was awarded a chair of surgery at ‘Hospital de la Charite’, replacing Leon Athanase Gosselin. Notable among his works is the description of the ‘Baizeau and Trélat method’ of surgical repair of cleft palate, and his book Clinique Chirurgicale. Leser and Trélat independently published papers describing skin lesions associated with mammary carcinoma and visceral malignancies. However, their description of cutaneous lesions was more in keeping with the appearance of senile angiomata or Campbell de Morgan spots. Therefore, the credit should go to Eugen Von Hollander (1867–1932), another German surgeon who accurately described the lesions in a paper published in 1900 titled ‘Contributions to the early diagnosis of intestinal carcinomas’. He observed skin changes associated with internal malignancies consisting of an eruption of flat, shiny, pigmented, glandular, epithelial growths similar to seborrhoeic warts or verrucae seniles in young patients with cancer. He hypothesized that there might be a link between abnormal epithelial proliferation in internal organs and skin keratinocyte proliferation. He is remembered for performing the first facelift, on a Polish aristocrat in 1912. The sign of Leser–Trélat is so deeply embedded in medical literature and the minds of modern practitioners that it is unlikely to ever be erased. However, the contribution of Eugen Von Hollander should not be forgotten.

The Isabel Differential Diagnosis Generator for Orbital Diagnosis.

The Isabel differential diagnosis generator is one of the most widely known electronic diagnosis decision support tools. The authors prospectively evaluated the utility of Isabel for orbital disease differential diagnosis. The terms "proptosis," "lid retraction," "orbit inflammation," "orbit tumour," "orbit tumor, infiltrative" and "orbital tumor, well-circumscribed" were separately input into Isabel and the results were tabulated. Then the clinical details (patient age, gender, signs, symptoms, and imaging findings) of 25 orbital cases from a textbook of orbital surgery were entered into Isabel. The top 10 differential diagnoses generated by Isabel were compared with the correct diagnosis. Isabel identified hyperthyroidism and Graves ophthalmopathy as the leading causes of lid retraction, but many common causes of proptosis and orbital tumors were not correctly elucidated. Of the textbook cases, Isabel correctly identified 4/25 (16%) of orbital cases as one of its top 10 differential diagnoses, and the median rank of the correct diagnosis was 6/10. Thirty-two percent of the output diagnoses were unlikely to cause orbital disease. Isabel is currently of limited value in the mainstream orbital differential diagnosis. The incorporation of anatomic localizations and imaging findings may help increase the accuracy of orbital diagnosis.

What do Trauma Surgery Textbooks Teach About Racial Disparities and the Roots of Violence?

This study presents a formal text analysis of trauma surgery textbooks. We examine passages that describe disparities or mechanisms of injury, and we report types of underlying causes and preventative interventions discussed. Trauma textbooks were drawn from an industry-standard list used by medical libraries. Chi-square testing was used to determine whether different types of underlying causes or preventative interventions were discussed by disparity type (those affecting racial minorities vs rural populations) and injury mechanism (accidental injuries vs intentional interpersonal injury). 146 passages were extracted from 7 textbooks, totaling 5576 pages of text. Passages discussing rural disadvantages or unintentional injury were substantially more likely to describe structural risk factors or governmental interventions than those discussing racial disadvantages or intentional injury, respectively. Textbook authors should consider enriching discussion of violence prevention or racial disparities to emphasize structural causes and interventions.

An Anatomical Dissection Method for Observation of Fibrous Facial Structures.

In recent years, structures including the superficial musculoaponeurotic system and retaining ligaments that support the facial soft tissue have been clarified. However, these structures are very difficult to observe in their entirety by the standard gross anatomical procedure (ie, dissection from superficial to deep layers). Furthermore, accurate descriptions of these structures are rare in both anatomical and plastic surgery textbooks. The aim of this study was to clarify the facial fibrous structures in a gross anatomical view. The authors' novel method used soft facial tissue and bone. The tissue was fixed in gelatin and sectioned at a thickness of 5 to 10 mm. Each section was placed on a wooden board; the bone was then pinned, and the skin was pulled outward with sutures to hyperextend the soft tissue. Subsequently, the loose connective tissue was torn and fat tissue was removed under a surgical microscope. After the removal of fat tissue, the fibrous facial structures (eg, the superficial musculoaponeurotic system and retaining ligaments) could be observed clearly. The thickness of the sections allowed three-dimensional observation, such that a structure located deep within a section could be clearly observed. The expansion of soft tissue facilitated observation of the facial layer and fibrous structures, and the locations of nerves and vessels. Therefore, the facial layer structure was readily discerned. This method is likely to be very useful in the field of plastic surgery because it enabled intuitive identification of facial layers and their characteristics. The dissection method developed by the authors reveals the connected morphology of each tissue of the face, thus providing basic data for analyzing soft tissue changes due to aging and gravity. This will be useful for the development of anti-aging medicine.

Give Me a Shot of Holy Water: Critical Elements in Myocardial Protection during Cardiac Surgery.

There is a surprising paucity of information on myocardial protection during cardiac surgery in the popular techniques books on cardiac surgery. For instance, Khonsari's otherwise superb book, Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, has only three of its 300 pages that address myocardial protection, while Cooley's book, Techniques in Cardiac Surgery, has none at all. Similarly, the major textbooks of cardiothoracic surgery (Kirklin & Barrett-Boyes, Sabiston & Spencer, and Cohn & Edmunds) all tend to dwell on basic science and pharmacology, while barely addressing the actual techniques and strategies of myocardial protection during cardiac surgical operations. [Khonsari, Cooley, Kouchoukos, Selke, Cohn].

The Plastic Surgery In-service Training Examination: An In-depth Reference Analysis

INTRODUCTION: The “core surgical principles” section was added to the Plastic Surgery In-Service Training Exam (PSITE) in 2016. To our knowledge, assessment of the “core surgical principles” references has not been performed previously. The main objective is to characterize the references provided as supporting evidence of the PSITE syllabi, including those on the novel “core surgical principles” section. In addition to analyzing the newly instituted “core principle section,” the secondary aims of this study are to determine (1) the most frequently referenced journal and textbooks, (2) the publication lag of journal and textbook references, and (3) the impact factors for referenced journal articles in five consecutive PSITE syllabi. It is our hope that such an analysis will allow for better preparation for the examination and more relevant focus of educational efforts on the part of residents, fellows, and program directors. METHODS: We analyzed the references from five consecutive PSITE syllabi (2016–2020). We collected the following information from each question: year of the examination, question section, the total number of references per question, source of publication of each reference, and year of publication of each reference. We assessed the top journals and textbooks that provided supporting references for the questions. Mean and median were used to summarize continuous variables, while percentages and proportions were used to present categorical data. To compare the JIF and publication lag among the sections and examination years, we used the Kruskal–Wallis one-way analysis of variance test. A P value of <0.05 was considered statistically significant. RESULTS: We analyzed 1250 questions and 3436 references. Plastic and Reconstruction Surgery (PRS) was overall the most frequently referenced journal followed by Journal of Hand Surgery (American Volume) and Annals of Plastic Surgery. The most commonly referenced textbooks were Plastic Surgery (by Neligan), Green’s Operative Hand Surgery, and Grabb and Smith’s Plastic Surgery. Regarding the “core surgical principles” section, PRS remained the most frequently cited journal, followed by the Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM), Annals, and Aesthetic Surgery Journal. “Core surgical principles” contained the largest number of unique journals (n = 209) among all test sections. Within the “core” section, Statistics in Medicine was the most frequently referenced textbook followed by Grabb and Smith’s Plastic Surgery, Guyton and Hall Textbook of Medical Physiology, Plastic Surgery (by Neligan), Principles and Practice of Pediatric Plastic Surgery, and Essential Medical Statistics. There were significant differences in JIF between the sections (P < 0.0001) with references in “core surgical principles” having the highest mean JIF (9.6 ± 19.5). The median journal publication lag for the all references was 6 years (IQR, 3–10). CONCLUSIONS: The main plastic surgery texts and literature were used to support approximately half of the answers within the “core surgical principles” section. The references within this section originated from the largest number of different journals, thus highlighting the breadth and variety of this content and the challenges in preparing for this section.

Is the education of human and animal healthcare professionals about antimicrobial resistance and stewardship adequate during their pre-service training?

PurposeThis paper explores inclusion of topics on antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in pre-service human and animal healthcare professional curricula as mandated in the first strategic objective of National Action Plan on Antimicrobial Resistance. MethodsOnline versions of pre-service medical [Bachelor of Medicine, Bachelor of Surgery (MBBS)], dental [Bachelor of dental sciences (BDS)], pharmacy [Bachelor of Pharmacy (B Pharm)], veterinary [Bachelor of veterinary science and animal husbandry (B.V.Sc. & A.H.)] and post graduate medical [Doctor of medicine (MD), Master of surgery (MS) and post graduate (PG) medical diploma courses] curricula and hardcopy of nursing (Bachelor of science (BSc) Nursing-Basic) curricula were assessed. Validated search terms were used for identifying individual learning topics, domains of learning and number of hours of learning related to AMS and AMR. Recent edition of commonly referred medical textbooks were manually checked for inclusion of chapters or separate sections on AMR and AMS. ResultsLow coverage and poor depth with no mention of required duration of learning for AMR and AMS was observed across the majority of curricula. MS, BDS, B Pharm and BSc nursing curricula did not include AMR and AMS. Out of twenty-three textbooks assessed, only six textbooks included AMS. Gynecology, Obstetrics, Orthopedic and Surgery textbooks did not include separate section on AMR or AMS. ConclusionsOur study documented inadequate inclusion of AMR and AMS in pre-service medical, dental, nursing, pharmacy and veterinary curricula and post graduate medical curriculum. Standardized education regarding AMR and AMS in multi-professional curricula by educational councils across sectors and updating of medical textbooks of all the subjects by authors/publishers for adequate emphasis on these topics is urgently needed for success of ‘One health’ in combating AMR.

Laparoscopic hepatobiliary and pancreatic surgery: my trials and current status in Korea.

There has been a dramatic change in surgical care over the past 30 years with the introduction of laparoscopic surgery. It was my great fortune that I could experience laparoscopic surgery during my resident training period. After beginning to work for my hospital in 1995, I tried laparoscopic surgery in many surgical fields, including hepatobiliary and pancreatic (HBP), colon, stomach, and vascular surgery (endoscopic saphenous vein harvesting, endoscopic subfascial perforating vein interruption to treat skin complications in patients with deep vein insufficiency in the lower leg). In Sabiston, Textbook of Surgery, published in 1997, laparoscopic Whipple and major liver resection were not accepted at the time but now are. There are three possible reasons that may explain this shift. The first one is the 30 years of experience using advanced techniques; all of us know that “Seeing is believing,” and “A thousand hearings are not worth one seeing.” Next is the availability of three-dimensional imaging with magnification which enables us to perform difficult surgeries. The last one is the use of good instruments and an advanced surgical platform. In this paper, I would like to share my past and recent trials with advanced HBP laparoscopic surgery, as well as its current status in Korea and future directions.

Advancing the Specialty of Plastic Surgery While Helping and Supporting Other Surgical Services at an Academic Medical Center.

While helping and supporting other surgical services at our academic medical center, we noticed that many clinical problems presented to our plastic surgery team are truly unique and challenging. Many of the necessary reconstructive procedures, performed by the senior author, had never been published in plastic surgery textbooks or the literature before. Because of the plastic surgeon's creative problem-solving ability, we use reconstructive treatment plans that also innovate and advance the field of plastic surgery. In this case series, we share our experience with creative solutions for the management of novel and challenging clinical problems faced by our plastic surgery service. The resultant and effective solutions for each challenging case have all been published in reputable plastic surgery journals by the senior author. Once published, our inventive reconstructive solutions can be harnessed by other plastic surgeons and trainees and new standardized techniques or solutions for these unique and challenging clinical problems can be established. Ultimately, plastic surgeons can evolve their specialty through helping and supporting other surgical services at an academic medical center by establishing innovative solutions for ever arising challenging clinical problems. Once again, the plastic surgery team in a tertiary hospital supports many surgical services so that more complex surgical procedures can be performed safely and complications from other surgical services can be managed successfully. Therefore, adequate support for a plastic surgery service, by the hospital or department, is critical in developing a strong plastic surgery program at an academic medical center.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Didier A. MandelbrotDidier A. MandelbrotDr Mandelbrot is currently Medical Director of Kidney and Pancreas Transplantation at UW Health and Professor of Medicine at the University of Wisconsin School of Medicine. He was an undergraduate at Harvard College, medical student at the University of Pennsylvania, resident in Medicine at the Hospital of the University of Pennsylvania, and renal fellow at Brigham and Women's Hospital. He has a background in basic transplant immunology and a longstanding interest in the diagnosis and treatment of solid organ rejection. He has participated in numerous single and multi-center clinical trials in kidney transplantation, and has published almost 200 papers and chapters. He has made important contributions on the role of donor-specific antibodies in the context of kidney transplantation, pancreas transplantation and simultaneous liver-kidney transplantation. He also has a particular interest in living kidney donation, and has been active in describing and improving practices in the US. He was co-PI of the NIH-funded Kidney Donor Outcomes Cohort study and recently finished serving as Chair of the American Society of Transplantation's Living Donor Community of Practice. He is currently a member of the United Network of Organ Sharing Medical and Professional Standards Committee, the American Transplant Congress Program Planning Committee, and the Medical Board of the National Kidney Registry. He is an Associate Editor of Clinical Transplantation. Maria SiemionowMaria SiemionowDr Siemionow, a world-renowned scientist and microsurgeon, is Professor of Orthopedics and Director of Microsurgery Research at The University of Illinois at Chicago. She specializes in microsurgery, hand surgery, peripheral nerve surgery, transplantation, and microsurgery research. She is pioneering development of new technology for minimal immunosuppression in transplantation and enhancement of nerve and muscle regeneration. She served as a President of the American Society for Reconstructive Transplantation, President of the International Hand and Composite Tissue Allotransplantation Society and President of the American Society for Peripheral Nerve. She is a member of the academic-industry team, Warrior Restoration Consortium, focusing on development of clinical therapies and new technologies for wounded soldiers as part of the second phase of the Armed Forces Institute for Regenerative Medicine (AFIRM II). She has received numerous honors, including high praise as Principal Investigator for the world's first IRB approval for Facial Allograft Transplantation protocol; in 2008, she led the team that performed the first near-total face transplantation in the United States. Dr Siemionow has over 330 scientific publications. She has edited three plastic surgery textbooks, two popular science books, and has contributed to over 120 published book chapters. Dr Siemionow received numerous awards including the Polish Order of Merit (2009), the Commander's Cross Polonia Restituta Award from the President of Poland (2009), the Outstanding Achievement in Clinical Research Award from the Plastic Surgery Educational Foundation (2010); the 2011 American Society of Plastic Surgeons’ Board of Trustees Special Achievement Award and Casimir Funk National Science Award (2013). In 2014 she received the Great Immigrants Award from the Carnegie Foundation of New York. In 2016 Dr Siemionow was awarded the Heritage Award granted by the Polish American Congress. In 2019 she received Golden Otis Award. Prior to her UIC appointment, she was Director of Plastic Surgery Research and Head of Microsurgical Training for Cleveland Clinic's Department of Plastic Surgery. Jeffery A. KahnJeffery A. KahnDr Jeffrey A. Kahn completed his undergraduate training at the University at Albany, State University of New York, medical school training at the State University of New York, Upstate Medical University and internal medicine residency at Emory University. He then went on to fellowship training in gastroenterology at the University of Southern California and transplant hepatology training at Cedars Sinai-Sinai Medical Center. He has been the medical director of the Keck School of Medicine of USC Liver Transplant Program since 2011, with a special interest in living donor liver transplantation and transfusion-free liver transplantation. His research interests include liver transplant waitlist disparities, liver transplant outcomes and has ongoing translational research related to occult hepatitis C infection.

A modern appraisal of current vascular surgery education

ObjectiveAlthough general program requirements and curriculum content outlines are provided by the Accreditation Council for Graduate Medical Education, Association for Program Directors in Vascular Surgery, and Vascular Surgery Board of the American Board of Surgery, there is no single format for delivery of this content. The delivery of these defined educational components is, thus, likely to differ from site to site. The curriculum committee of the Association of Program Directors in Vascular Surgery was tasked with formalizing the content of the Vascular Surgery Surgical Council on Resident Education curriculum modules, and, therefore, we sought to appraise the current status of vascular educational programs in U.S. training programs before its implementation. MethodsProgram directors (PDs) of 112 U.S. vascular surgery residency and fellowship training programs were contacted via email and asked to participate in an anonymous electronic survey. This survey evaluated the educational components of individual programs, including vascular specific conferences, use of other training modalities, and determination of who was involved in the creation of these programs. ResultsOf the 112 PDs offered the survey, 80 (71%) responded. Most (42 of 80; 53%) have both an integrated vascular residency and a fellowship with the remaining being solely fellowship (31 of 80; 39%) or integrated residencies (7 of 80; 9%). The majority (79 of 81; 98%) of programs hold at least one vascular conference per week, with 75% (60 of 81) holding more than one each week. The total time spent in conference averaged 2.6 hours/wk, and the most common educational components of the weekly conferences were review of upcoming (48 of 79, 61%) or recently completed surgical cases (30 of 79; 38%), lectures on vascular disease processes (40 of 79; 51%), and review of book chapters from vascular surgery textbooks (27 of 78; 35%). PDs are responsible for creating the schedule at 50% (39 of 78) of the programs with most remaining programs relying on trainees (18 of 78; 23%) and assistant PDs (17 of 78; 22%). Vascular trainees present the majority of material at most programs' conferences (64 of 77; 83%). The majority of PDs feel that trainees should independently study 4 hours or more per week (51 of 79; 65%), but only 25% (20 of 79) believe that trainees actually spend this amount of time studying (P = .0001). Only 13 of 80 (16%) programs currently use a preformatted standardized vascular curriculum, but 64 of 80 (80%) believe that there is a need for the creation of this product and 72 of 80 (90%) would most likely use it. ConclusionsThere is a significant variation in vascular surgery educational programs with considerable dependence on trainees to create the curriculum. The majority of PDs in vascular surgery support the creation of a standardized vascular curriculum and would use it if made.

A CLINICAL STUDY ON THE EFFICACY OF NIMBAPATRAADI LEPA IN THE MANAGEMENT OF DUSHTA VRANA

The science Ayurveda is one of the most promising branches of health care system. Sushruta Samhita is the pioneer textbook of ancient Indian surgery, which is also known as Vranapradhana Tantra2 (Textbook of traumatology). According to Acharya Sushruta Vrana is a condition which causes break in the continui-ty of epithelium, consumes the tissue and exposes the underlining structures resulting in a lifelong scar of the affected part even after healing. Ayurveda has a vast scope of research in this field to revalidate the efficacy of Ayurvedic management for chronic non-healing wound for the benefit of mankind. Chronic wound or non-healing ulcers are the most common problem in surgery which leads to considerable disabil-ity and are associated with increased mortality and morbidity. An ulcer is breaking in the continuity of the covering epithelium, either following molecular death of the surface epithelium or its traumatic removal. Therefore, a clinical study on the efficacy of Nimbapatradi Lepa in the management of Dushta Vrana is an approach to re-evaluate an effective, cost effective and minimally invasive Ayurvedic dressing material.

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

The objective of this review is to describe the normal and variant anatomy of the inferior mesenteric artery (IMA), including a brief overview of the relevant embryology, as well as proposing a classification system of the IMA vasculature, and clinical significance. A systematic review of articles published in Google Scholar and PubMed database using search terms: inferior mesenteric artery anatomy, inferior mesenteric artery variation, inferior mesenteric artery development, mesenteric circulation anatomy and variation, inferior mesenteric artery angiography. This was followed by review of the reference list of relevant publications to reveal publications missed during the initial search. Several standard anatomy and surgery text books were also referred for normal anatomy. The anatomy of the inferior mesenteric system is highly variant, with only a small proportion of anatomical, angiographic or surgical studies providing support for what is traditionally taught to be normal anatomy. Whilst the origin of the inferior mesenteric artery is less variant, the branching into left colic, sigmoidal and superior rectal arteries is variable between individuals in terms of origin of branches, number of branches and the presence or absence of certain branches. Whilst there did not appear to be a common classification system, similarities included three main variants of branching with a colo-sigmoid trunk, recto-sigmoid trunk or common trifurcation. There is a disparity between what is described in anatomical texts as the ‘normal’ IMA, and what is seen in anatomical, radiological and surgical research studies. The variable anatomy of the inferior mesenteric artery and its branches is significant in radiological interpretation and colorectal surgery from both an oncological perspective when considering resection, as well as in colonic ischaemia. A classification system has been introduced with a step-wise approach to the assessment of the IMA anatomy to avoid misleading nomenclature and provide a framework for surgeons to assess the vasculature.

N.L. Bidloo, director of the Moscow hospital school. to the 310&lt;sup&gt;th&lt;/sup&gt; anniversary of the first russian textbook of surgery (military field surgery)

The article presents data on the first handwritten textbook on surgery (military field surgery) for training military doctors in the Russian Empire in the early 18th century at the Moscow Hospital (Moscow Medical and Surgical) School. The author of the textbook was the Chief Doctor of the Moscow Hospital and the Director of the School Nicholas Bidloo. The textbook consists of 4 parts (129 chapters and 8 signs) in the main areas of medicine. The article provides a summary of Leib-medic Peter I Nicholas Bidloo.

Wikipedia in Vascular Surgery Medical Education: Comparative Study.

BackgroundMedical students commonly refer to Wikipedia as their preferred online resource for medical information. The quality and readability of articles about common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery.ObjectiveThe aims of this study were to (1) compare the quality of Wikipedia articles to that of equivalent chapters in a standard undergraduate medical textbook of surgery, (2) identify any errors of omission in either resource, and (3) compare the readability of both resources using validated ease-of-reading and grade-level tools.MethodsUsing the Medical Council of Canada Objectives for the Qualifying Examination, 8 fundamental topics of vascular surgery were chosen. The articles were found on Wikipedia using Wikipedia’s native search engine. The equivalent chapters were identified in Schwartz Principles of Surgery (ninth edition). Medical learners (n=2) assessed each of the texts on their original platforms to independently evaluate readability, quality, and errors of omission. Readability was evaluated with Flesch Reading Ease scores and 5 grade-level scores (Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index), quality was evaluated using the DISCERN instrument, and errors of omission were evaluated using a standardized scoring system that was designed by the authors.ResultsFlesch Reading Ease scores suggested that Wikipedia (mean 30.5; SD 8.4) was significantly easier to read (P=.03) than Schwartz (mean 20.2; SD 9.0). The mean grade level (calculated using all grade-level indices) of the Wikipedia articles (mean 14.2; SD 1.3) was significantly different (P=.02) than the mean grade level of Schwartz (mean 15.9; SD 1.4). The quality of the text was also assessed using the DISCERN instrument and suggested that Schwartz (mean 71.4; SD 3.1) had a significantly higher quality (P=.002) compared to that of Wikipedia (mean 52.9; SD 11.4). Finally, the Wikipedia error of omission rate (mean 12.5; SD 6.8) was higher than that of Schwartz (mean 21.3; SD 1.9) indicating that there were significantly fewer errors of omission in the surgical textbook (P=.008).ConclusionsOnline resources are increasingly easier to access but can vary in quality. Based on this comparison, the authors of this study recommend the use of vascular surgery textbooks as a primary source of learning material because the information within is more consistent in quality and has fewer errors of omission. Wikipedia can be a useful resource for quick reference, particularly because of its ease of reading, but its vascular surgery articles require further development.

Anatomy, Physiology and Pathophysiology of Haemorrhoids.

Haemorrhoidal Disease (HD) is a frequent anal disorder and one of the most common findings identified at the colorectal clinic. This article aims to provide an overview of the anatomy, physiology and pathophysiology of haemorrhoids and haemorrhoidal disease. Internal haemorrhoids are vascular cushions located in the anal canal, above the dentate line and covered by columnar epithelium. They contribute to the faecal continence and the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce symptoms and complications, the so-called haemorrhoidal disease. A systematic research was realized, looking at the best evidence in literature, searching PubMed, Embase, Cochrane library and the most renowed textbooks of colorectal surgery from January 1980 to January 2020. Aetiology and pathophysiology of HD are still controversial, but multifactorial. Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and rectal redundancy represent key events in the development and complications of the disease. Local inflammation may also play a role. Goligher's classification remains the most widely used. Thorough patient history and examination are paramount to diagnose HD, excluding other anal or colonic pathologies. Several aspects of etiopathogenesis and pathophysiology remain controversial. Further studies are needed to obtain a better understanding of the disease.

Pyoderma gangrenosum underrepresentation in non-dermatological literature.

Pyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI). We reviewed four major textbooks each in general surgery, plastic surgery, trauma surgery, vascular surgery, emergency medicine, and dermatology. We also performed a search of review articles addressing NSTI and necrotizing fasciitis (NF). Ten out of the 20 non-dermatology textbooks did not list PG anywhere, and only two listed a differential diagnosis for PG. None of the non-dermatology textbooks indicated PG in the NSTI differential diagnosis, while three of the dermatology textbooks included PG in the NSTI differential diagnosis. PG was listed in all of the dermatology textbooks. Only one of the NSTI and NF articles mentioned PG in the differential diagnosis. There is an underrepresentation in major textbooks of surgery and emergency medicine and in NSTI and NF review articles when it comes to diagnosing PG. This might be leading to trainees and advanced providers in these fields being uninstructed on PG, and likely contributes to PG misdiagnosis and mismanagement. We recommend PG be included in the differential diagnosis of chronic ulcers and NSTI in non-dermatology textbooks. We also suggest adding identification and diagnosis of inflammatory mimickers of NSTI (e.g. PG) in teaching modules in surgical and emergency specialties to address this knowledge gap.

IAPS textbook of pediatric surgery

IAPS textbook of pediatric surgery