Acute Care General Surgery0 تومان
A 70-year-old woman presents to the emergency department complaining of right lower quadrant pain for 4 days. Her examination shows a palpable mass in the right lower quadrant. A CT scan shows a large distended appendix measuring 4 cm in diameter, without periappendiceal fat stranding (Fig. 1.1). The diagnosis of appendiceal mucocele is made. An open appendectomy is performed without spillage of any contents. Pathology revealed mucosal hyperplasia without signs of atypia. The patient was scheduled for routine post-appendectomy follow up.
Acute Care Surgery Around the World: Future Perspectives0 تومان
Increasing specialization and fragmentation of ‘general surgery’ has reduced the role of surgeons to care for patients with acute surgical emergencies. The need for such services, however, has escalated due to the population living to older age with increasingly complex diseases and co-morbidities. Compounding the problem is the mounting number of severely injured patients in the emergency departments which are already filled to capacity by non-emergency patients. Other factors have also contributed to the emergence of the new specialty of ‘acute care surgery’. These include the dissatisfaction of surgeons with trauma as a career in the current era of non-operative management of many traumatic injuries; the loss of traditional general surgery cases to ‘organ-specific practices’ (e.g. colon and rectal surgery, upper GI surgery, endocrines) and highly specialized techniques (minimally invasive surgery, organ transplantation, and robotic surgery). Even nonsurgical specialties, for example interventional radiology and gastrointestinal endoscopy have eroded the modern surgical practice. The time was ripe for the creation of a new specialty, acute care surgery, created and developed by the American Association of Surgery for Trauma (AAST).
Advanced Colonoscopy and Endoluminal Surgery0 تومان
Philipp Bozzini is considered by many the father of endoscopy. Born in Mainz, Germany, in 1773, Bozzini’s goal was to examine the inner cavities of the human body in designing the Lichtleiter, or “light conductor.” He recognized the importance of direct observation in the ability to understand the physiology and function of human organs . With his design, he also foresaw the ability to perform new procedures and to make existing procedures safer by allowing, for instance, the removal of rectal polyps or cervical tumors to be done under direct visualization rather than to depend on luck. The original Lichtleiter consisted of a vase-shaped lantern made of tin and covered with leather . Within this housed the light source, a wax candle, on a spring device designed to keep the ﬂame at a constant height. A concave mirror was placed to project light through an aperture, onto which various tubular specula could be attached. The mirror directed light toward the hollow organ and avoided reﬂection toward the observer’s eye . On the opposite side was another fenestration onto which an eyepiece was attached for the observer . The tubular specula were made of brass or silver and modifed based of the organ they were meant for: urethra, vagina, rectum, and so on . His conductors were straight to avoid deviating from the straight lines on which light rays travel. In order to observe objects at an angle, for instance behind the nasopharynx, he used a mirror to bend the light. He did note, however, that bending the light compromised the clarity of the image
Atlas of Implant Dentistry and ToothPreserving Surgery0 تومان
A complication in its broadest sense can be defined as an infrequent and unfavourable evolution of a medical/dental treatment or as a circumstance/difficulty that complicates the outcome in implant dentistry (ID)/tooth-preserving surgery (TPS). With regard to ID/TPS, the dental surgeon as well as his/her assistant or personnel can be associated with complications of variable severity that reflect insufficient knowledge, inexperience, lack of surgical skills, disregard of established protocols as well as surgeon’s mistakes. Knowledge in general can be described as a familiarity with someone or something, which can include facts, information, description or skills acquired through experience or education. It can refer to theoretical or practical understanding of a subject. As far as ID/TPS are concerned, it is unlikely that a dental surgeon would consider these surgical procedures without overall knowledge about them. Insufficient knowledge as causative factor of complications and failures, however, mostly refers to the lack of information on the behaviour of certain materials applied and the reaction of host tissues to them or to specific manoeuvres within the surgical procedure. This factor can play a role both in novice and very experienced surgeons.
BIOMEDICAL ENGINEERING IN GASTROINTESTINAL SURGERY0 تومان
It goes without saying that surgery cannot be performed with bare hands. Accordingly, surgeons were always compelled to use more or less dedicated instruments. Descriptions of specialized tools of the surgeons are found early in the history of mankind. The papyri of ancient Egypt deal in detail with surgical instruments, as do many manuscripts of Greek and Roman antiquity. Often ignored, ancient India had also a profound surgical legacy. In a classical Sanskrit text of Sushruta written in the 6th century BC, more than 100 instruments are described, including saws, needles, scalpels, etc. They certainly reflected the spearhead of contemporary technological innovation. The obviously high level of surgical care as related to general development was not maintained in the following centuries. Conservative medicine always remained the reserve of academics. However, this only meant drug oriented noninvasive medicine. Diagnosis and therapy were based upon the humoral pathology of Galenos. Accordingly, the only “invasive” procedure was phlebotomy (bloodletting). Human diseases were treated with drugs, ointments, diets, or similar conservative measures. Surgical tasks, such as the treatment of fractures, open wounds, and hernia, were completely left over to the surgeons.
Brain and Spine Surgery in the Elderly0 تومان
Before information about and a discussion of the elderly segment of the global population is presented, it is important to consider what is meant by the terms elderly, old age, aging, and the like. The term elderly has no precise meaning, and past and current researchers throughout the globe have viewed the elderly population many different ways. Aging as a process has both biological and social components and must be seen from the perspectives of upward shifts in life expectancy, the growth of the older population, as well as how societies view old age. From a biological perspective, for a number of years, demographers and others
have been interested in both life expectancy at various ages and lifespan, the hypothetical length of life that would be realized if disease was eliminated. Life expectancy calculations rely on death rates specifc to various ages, and often there is interest in examining death rates by cause of death or in calculating life expectancy if death due to one or more causes was eliminated (e.g., cancer). During the twentieth century, researchers from many scientifc and social science felds focused on understanding why life expectancy was increasing as well as identifying the implications of increasing life expectancy on population size, population composition, and the changing social structure of populations. The cause-of-death transition during the nineteenth and twentieth centuries was comprised of falling death rates due to infectious and parasitic diseases along with increased death rates due to cancer and heartrelated causes. These studies continue today, particularly as the age structures of the world and individual nations show that relatively rapid aging is ubiquitous.
Clinical Reproductive Medicine and Surgery0 تومان
Te menstrual cycle is the result of an orchestra of hormones. It involves the interaction of many endocrine glands as well as a responsive uterus. Te menstrual cycle remains a complex process where many aspects are still not well understood. In this chapter we will examine the control of the menstrual cycle through the interaction of the central nervous system, namely, the hypothalamus and pituitary, and the ovaries, resulting in the cyclic and ordered sloughing of the uterine endometrial lining. Te frst section of this chapter, Te Menstrual Cycle, will review the phases of the menstrual cycle. In the second section, Anatomy of the Menstrual Cycle, the hypothalamic, pituitary, ovarian, and uterine activities will be reviewed. Te key hormones that play a role in the control of the menstrual cycle include gonadotropin-releasing hormone (GnRH), follicle- stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone (. Table 1.1). In addition to these key hormones, there are other peptide and non-peptide hormones that play a role in the menstrual cycle that will also be discussed. Tese hormones will be discussed in the third section, Endocrinology of the Menstrual Cycle.
Complications in Robotic Urologic Surgery0 تومان
Recent technological advances have made many surgical procedures possible with minimally invasive techniques, including urologic robotic surgeries. These techniques have improved patient satisfaction and recovery times, leading to reduced morbidity. However, it is important to recognize that these procedures are not without risk and require a careful preoperative assessment in order to minimize complications. During the preoperative assessment, the goal is to identify patients at intermediate or high clinical risk for adverse events and whether modifable medical conditions exist. In addition, we evaluate the surgical urgency and assess whether the delay in an untreated underlying urologic disease will pose a greater risk over an untreated non-urological clinical condition. In general, a thorough preoperative evaluation includes a full review of the patient’s medications, in addition to any cardiac, pulmonary, thromboembolic, or bleeding risks. Also, an assessment of delirium and frailty may be benefcial in the prediction of the elderly patients’ outcome. Postoperative complications related to robotic surgeries can include cardiopulmonary events related to insufﬂation and decompression, postoperative ileus, and increased intraocular pressure in the steep Trendelenburg position.
Complications of Female Incontinence and Pelvic Reconstructive Surgery0 تومان
The etymology of the word “taxonomy” is from the Greek taxis, meaning orderly arrangement, and nomos, meaning law. Stedman’s Medical Dictionary defnes “taxonomy” as the systemic classifcation of living things or organisms; however, more recently, the term has come to mean any specialized method of classifying objects or events. The aim of taxonomic classifcation of surgical complications is to permit comparison of adverse outcomes and assist in risk stratifcation. In this chapter, we review the existing broader surgical classifcation systems that may be applicable to female pelvic medicine as well as those systems specifcally developed for female reconstructive procedures.
Endocrine Surgery in Children0 تومان
This chapter reviews the embryology, anatomy, and physiology of the thyroid gland with special emphasis on how these topics relate to surgical conditions and surgical decision-making. First, thyroid development is reviewed since it is the essential foundation to understand thyroid anatomy. Next, the anatomy of the thyroid, its blood supply and its relationship to nearby nerves are reviewed to understand the conduct of thyroid operations and the risks and complications of those operations. Finally, the details of the thyroid gland’s principle function—the synthesis and secretion of thyroid hormones—are considered. Understanding these normal physiologic functions and their control provides insight into the diagnostic evaluation and treatment of thyroid diseases. Parathyroid gland embryology, anatomy, and function are reviewed in Chap. 5.
Evidence-Based Bunion Surgery0 تومان
The common deformity of the frst ray known as a “bunion” is a progressive positional deformity which leads to pain from shoe pressure and biomechanical malfunction of the frst metatarsal phalangeal joint. While the medial bump is idely considered the etiology of pain, malalignment results in progressive joint adaptation and
degeneration. The exact biomechanical fault and the etiology of the progression of the deformity remain unclear. The origin of the terminologies describing this frst ray deformity deserves specifc attention due to the common historical misapplications of terms used to describe disorders of the frst metatarsophalangeal joint (MTPJ) .Bunion is derived from the Latin term bunio, meaning turnip. This term has been applied to describe any enlargement of the frst MTPJ and therefore poorly defnes the deformity . It was not until 1870, when Carl Hueter, a German surgeon, coined the term hallux valgus to more accurately describe the condition . Hueter defned this frst ray deformity as a subluxation of the frst MTPJ in the transverse plane with lateral deviation of the great toe and medial deviation of the frst metatarsal. However, the term hallux valgus raised questions on whether the laterally deviated hallux should be the primary focus of the deformity. Therefore, half a century later, Truslow proposed the term metatarsus primus varus to replace hallux valgus in the belief that the medially deviated frst metatarsal is the primary level of deformity. This is in fact the frst time the primary level of deformity is considered to be located at the frst metatarsal cuneiform joint.
Evidence-based Therapy in Vascular Surgery0 تومان
Recommendations for management of asymptomatic carotid artery disease (European Stroke Organisation et al. 2011): • All patients with asymptomatic carotid artery stenosis should be treated with long-term antiplatelet therapy. (Class-I-recommendation/Level of evidence B) • All patients with asymptomatic carotid artery stenosis should be treated with long-term statin therapy. (Class- I-recommendation/Level of evidence C) • In asymptomatic patients with carotid artery stenosis ≥60%, CEA should be considered as long as the perioperative stroke and death rate for procedures performed by the surgical team is <3% and the patient’s life expectancy exceeds 5 years. (Class-IIa-recommendation/Level of evidence A) • In asymptomatic patients with an indication for carotid revascularization, CAS may be considered as an alternative to CEA in high- volume centres with documented death or stroke rate <3%. (Class-IIb-recommendation/Level of evidence B) Recommendations for management of symptomatic carotid artery disease: • All patients with symptomatic carotid stenosis should receive long-term antiplatelet therapy. (Class-I-recommendation/Level of evidence A) • All patients with symptomatic carotid stenosis should receive long-term statin therapy. (Class-I-recommendation/Level of evidence B) • In patients with symptomatic 70–99% stenosis of the internal carotid artery, CEA is recommended for the prevention of recurrent stroke. (Class- Irecommendation/Level of evidence A).
GI Surgery Annual0 تومان
Cancer is constituted by mutated cells that have escaped the normal checks and balances of regulated cell growth. It is initially localized to the organ of origin and thereafter spreads through the body, and ultimately becomes the cause of unnatural death of the patient. In the natural history of any cancer three distinct phases can be described: (i) limited to the organ of origin (localized phase); (ii) limited to the region of origin (regional phase); and (iii) spread to distant organs (metastatic phase) . Regional phase/stage is usually described as spread limited to the regional lymph node basin. The philosophy of surgical lymphadenectomy, along with extirpation of the primary tumour, is meant to treat the regional stage of the disease. It will be obvious to those familiar with this feld, that high quality evidence to evaluate lymphadenectomy in oesophageal carcinoma is diffcult to come by, else there would be no need for reviews like this. To the GI Surgery fellows taking their fnal examinations this represents a treacherous minefeld due to the varying practices followed by surgeons across the world. In this review we attempt to introduce the reader to the concept, guidelines, evidence and practice of lymphadenectomy in the surgical treatment of oesophageal carcinoma.
Hiatal Hernia Surgery0 تومان
A hiatal hernia is a condition involving herniation of abdominal contents into the mediastinum via the diaphragmatic hiatus. Anatomically, there is proximal displacement of the gastroesophageal junction causing the intrinsic sphincter to lie proximal to the esophageal hiatus; this is likely secondary to weakening or disruption of the phrenoesophageal ligament (fascia of Laimer) and widening of the diaphragmatic crura. The true prevalence of hiatal hernias is diffcult to discern because many individuals are asymptomatic and, therefore, never diagnosed and the diagnostic criteria are somewhat subjective. Estimated prevalence in studies range widely from 10% to 80% in the United States , but is generally correlated with obesity and increasing age. Although, hiatal hernias may remain asymptomatic in most patients and diagnosed incidentally, if at all; they are frequently associated with gastroesophageal reﬂux disease as an incompetent lower esophageal sphincter may be a consequence of a hiatal hernia. Other patients, in whom paraesophageal hernias develop, may progress to signifcant symptoms including obstruction, ischemia, bleeding, and volvulus. In the asymptomatic patient, pursuing a diagnosis of hiatal hernia is not indicated, but those experiencing symptoms warrant evaluation and possible surgical intervention. Understanding the risk factors and types of hiatal hernias are vital in managing patients once they are diagnosed.
Imaging in Bariatric Surgery0 تومان
Obesity is defned as an abnormal or excessive accumulation of fat that may impair health, and it is a chronic disease that is increasing in prevalence . Global obesity rates have tripled in many countries of the World Health Organization (WHO) European Region since the 1980s, and the numbers of those affected continue to rise at an alarming rate . Based on the latest estimates in European Union countries, overweight affects 30–70%, and obesity affects 10–30% of adults. In the USA 70% of the population are now affected by excess weight or obesity . It is now no exaggeration to state that obesity is an international epidemic. Moreover, it is no longer a disorder of the adult since obesity prevalence in children has accelerated rapidly affecting 21.1% of girls and 18.6% of European boys (Ahrens et al. 2014).
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