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Surgical Problem (surgical + problem)
Selected AbstractsSkin cancer in liver transplant recipientsLIVER TRANSPLANTATION, Issue 3 2000Clark C. Otley Skin cancer is the most common malignancy arising in the posttransplantation setting. Multiple factors contribute to the high risk for cutaneous carcinoma in immunosuppressed organ-transplant recipients. We review the phenomenon of skin cancer in solid-organ transplant recipients and further delineate the problem in the context of liver transplantation. Skin cancer is a significant medical and surgical problem for organ-transplant recipients. With prolonged allograft function and patient survival, the majority of solid-organ transplant recipients will eventually develop skin cancer. Although squamous cell carcinoma is the most common cutaneous malignancy in this population, basal cell carcinoma, melanoma, and Kaposi's sarcoma, as well as uncommon skin malignancies, may occur. Highly susceptible patients may develop hundreds of squamous cell carcinomas, which may be life threatening. Management strategies focus on regular full-skin and nodal examination, aggressive treatment of established malignancies, and prophylactic measures to reduce the risk for additional photodamage and malignant transformation. Skin cancer is a substantial cause of morbidity and even mortality among solid-organ transplant recipients. As a byproduct of immunosuppression, liver transplant recipients experience a high incidence of skin cancer and should be educated and managed accordingly. [source] Medication errors: another important surgical problemANZ JOURNAL OF SURGERY, Issue 9 2009David G Bruce MD No abstract is available for this article. [source] DAMAGE CONTROL SURGERY AND ANGIOGRAPHY IN CASES OF ACUTE MESENTERIC ISCHAEMIAANZ JOURNAL OF SURGERY, Issue 5 2005Anthony J. Freeman Background: Acute mesenteric arterial occlusion typically presents late and has an estimated mortality of 60,80%. This report examines the evolution of a novel management approach to this difficult surgical problem at a teaching hospital in rural Australia. Methods: A retrospective review of 20 consecutive cases that presented to Lismore Base Hospital, Lismore, New South Wales, between 1995 and 2003 was performed. Results: Of the 16 patients who were actively treated, 10 survived. Mortality was associated with attempting an emergency operative revascularisation and not performing a second-look laparotomy. All three patients who had a damage control approach at the initial operation survived and in four cases endovascular intervention successfully achieved reperfusion of acutely ischaemic bowel. Conclusions: Evidence from the series of patients described suggests that damage control surgery and early angiography improve survival in patients suffering acute mesenteric ischaemia. A damage control approach involves emergency resection of ischaemic bowel with no attempt to restore gastrointestinal continuity and formation of a laparostomy. Patients are stabilised in the intensive care unit (ICU) and angiography can be arranged to either plan a definitive bypass procedure or alternatively endovascular therapies can be carried out in an attempt to arrest gastrointestinal infarction. Definitive surgery is then considered after 2,3 days. This approach is particularly attractive if immediate specialist vascular expertise is not available. [source] Do We Need to Create Geriatric Hospitals?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2002Muriel R. Gillick MD During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients. [source] Unplanned anesthesia-related admissions to pediatric intensive care , a 6-year auditPEDIATRIC ANESTHESIA, Issue 6 2007IRINA KUROWSKI MBBS FANZCA Summary Background:, Unplanned admissions to the intensive care unit may result from unexpected events related to anesthesia, and are recommended by some healthcare organizations as a clinical indicator. The rate of anesthesia-related unplanned admissions in adults ranges between 0.04% and 0.45% of procedures. However, there is a paucity of data relating to the rate in children. Methods:, Admissions to the pediatric intensive care unit (PICU) occurring within 24 h of anesthesia were identified through retrospective chart review. Only those admissions from a complication of anesthesia were included and not those from communication errors or surgical problems. The aim was to determine the rate of unplanned admissions, as well as the causes and management of this group of unplanned admissions. Results:, Seventy-six children requiring admission to the PICU were identified from 55196 procedures during the 6-year study period. The rate of unplanned admission was 0.14% of procedures. A total of 47% of these admissions were related to airway problems and 68% of children requiring admission were aged less than 5 years. Most children required only observation after their admission. Conclusions:, We found the unplanned admission rate to the PICU in our hospital population to be similar to that reported for adults, and is a relatively rare event in pediatric anesthesia. Most admissions were for children aged less than 5 years and were as a result of airway problems. Most cases were deemed potentially predictable. [source] The internet: From basics to telesurgeryANZ JOURNAL OF SURGERY, Issue 1 2002John C. Hall The exponential growth in information technology is resulting in a rapid increase in the ability to develop useful applications on the Internet. The purpose of the present article is to provide a brief review of the Internet with a consideration of its relevance to surgeons. This review is intended to indicate a range of relevant issues, rather than to discuss any specific topic in depth. It is becoming difficult for surgeons to reach their full potential unless they exploit Internet-based activities. This is because the ability to rapidly capture information of quality is an essential ingredient in a reflective approach to surgical problems. More futuristic is the prospect of using computer-based technology to operate upon patients from a distance (telesurgery). [source] | ||||||||||