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Surgery
Kinds of Surgery Terms modified by Surgery Selected AbstractsESSENTIALS OF PLASTIC SURGERYDERMATOLOGIC SURGERY, Issue 9 2007R. EDWARD NEWSOME MD No abstract is available for this article. [source] CONTROVERSIES IN DERMATOLOGIC SURGERYDERMATOLOGIC SURGERY, Issue 3 2000Article first published online: 6 OCT 200 No abstract is available for this article. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] MORBIDITY AND OUTCOMES OF UROGYNECOLOGICAL SURGERY IN ELDERLY WOMENJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010Patrick F. Vetere MD No abstract is available for this article. [source] BILATERAL FOOT DROP AFTER INTESTINAL SURGERY: PERONEAL NEUROPATHY UNABATED IN ELDERLY PATIENTSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007Erkan K No abstract is available for this article. [source] HYPOSPADIAS SURGERY: AN ILLUSTRATED GUIDEJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2005Professor S Beasley No abstract is available for this article. [source] ORIGINAL RESEARCH,SURGERY: A Large Multicenter Outcome Study of Female Genital Plastic SurgeryTHE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010Michael P. Goodman MD ABSTRACT Introduction., Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim., This study was designed to produce objective, utilizable outcome data regarding FGPS. Main Outcome Measures., 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods., This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results., Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6,42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions., While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent. Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7:1565,1577. [source] ORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical DysplasiaTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Namfon Inna MD ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source] ORIGINAL RESEARCH,SURGERY: Short Term Impact on Female Sexual Function of Pelvic Floor Reconstruction with the Prolift ProcedureTHE JOURNAL OF SEXUAL MEDICINE, Issue 11 2009Tsung-Hsien Su MD ABSTRACT Introduction., The Prolift system is an effective and safe procedure using mesh reinforcement for vaginal reconstruction of pelvic organ prolapse (POP), but its effect on sexual function is unclear. Aim., To evaluate the impact of transvaginal pelvic reconstruction with Prolift on female sexual function at 6 months post-operatively. Methods., Thirty-three sexually active women who underwent Prolift mesh pelvic floor reconstruction for symptomatic POP were evaluated before and 6 months after surgery. Their sexual function was assessed by using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and after surgery. The quality of life was also evaluated with the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) as a control for efficacy of the procedure. The Pelvic Organ Prolapse Quantification system was used to evaluate the degree of prolapse. Main Outcome Measures., PISQ-12 scores at 6 months post-operatively. Results., The total PISQ-12 score decreased from 29.5 ± 9.0 to 19.3 ± 14.7 (P < 0.001), indicating worsening of sexual function 6 months post-operatively. The behavioral, physical, and partner-related domains of PISQ-12 were each significantly reduced (5.2 ± 3.7 vs. 2.9 ± 3.7, P = 0.016; 15.4 ± 4.7 vs. 10.4 ± 8.6, P = 0.001; 8.9 ± 3.8 vs. 6.4 ± 5.5, P = 0.01, respectively). UDI-6 and IIQ-7 scores were significantly improved at the 6-month follow-up, as was anatomic recovery. Of the 33 subjects, 24 (73%) had worse sexual function 6 months after the procedure. Conclusion., The Prolift procedure provided an effective anatomic cure of POP, but it had an adverse effect on sexual function at 6 months after surgery. Su TH, Lau HH, Huang WC, Chen SS, Lin TY, Hsieh CH, and Yeh CY. Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure. J Sex Med 2009;6:3201,3207. [source] ORIGINAL RESEARCH,SURGERY: Torsion of the Penis in Adults: Prevalence and Surgical CorrectionTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2008Osama Shaeer MD ABSTRACT Introduction., Torsion of the penis is a condition where the penis rotates around its longitudinal axis, whether congenital or acquired. Extreme degrees may provoke a cosmetic complaint. Aim., We describe surgical correction of congenital torsion of the penis in adults, and its prevalence among a special patient group. Main Outcome Measures., Success and ease of surgical repair. Methods., Sixteen cases with congenital torsion were operated upon, by counter-rotation, using a dartos flap in eight cases, and skin realignment in the other eight. The prevalence of congenital torsion was examined in 12,307 patients attending two andrology clinics. Results., Full correction was achieved in all cases. Skin realignment was easier and faster than dartos flap, and was equally effective. Congenital torsion was present in 11.993% of the epidemiologic study group, mild in 80%, moderate in 15%, and severe in 5%. Only 2.2% was bothered by the condition. Conclusion., Torsion of the penis is not uncommon but rarely provokes a complaint. Surgical repair by degloving and skin realignment is effective and easy. Dartos flap technique may be utilized if the former is inadequate. Shaeer O. Torsion of the penis in adults: Prevalence and surgical correction. J Sex Med 2008;5:735,739. [source] ORIGINAL RESEARCH,SURGERY: Penile Prosthesis Implantation in Cases of Fibrosis: Ultrasound-Guided Cavernotomy and Sheathed Trochar ExcavationTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2007Osama Shaeer MD ABSTRACT Introduction., Implantation of a penile prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra. Aim., This work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue. Main Outcome Measures., Clinical outcome data were examined. Methods., Surgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, penile prosthesis was implanted. Results., All implants survived adequately. No complications occurred following implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation. Conclusion., Ultrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue. Shaeer O. Penile prosthesis implantation in cases of fibrosis: Ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med 2007;4:809,814. [source] ORIGINAL RESEARCH,SURGERY: Surgical Treatment of Vulvar Vestibulitis Syndrome: Outcome Assessment Derived from a Postoperative QuestionnaireTHE JOURNAL OF SEXUAL MEDICINE, Issue 5 2006Andrew T. Goldstein MD ABSTRACT Introduction., Vulvar vestibulitis syndrome (VVS) is the most common pathology in women with sexual pain. Surgery for VVS was first described in 1981. Despite apparently high surgical success rates, most review articles suggest that surgery should be used only "as a last resort." Risks of complications such as bleeding, scarring, and recurrence of symptoms are often used to justify these cautionary statements. However, there are little data in the peer-reviewed literature to justify this cautionary statement. Aims., To determine patient satisfaction with vulvar vestibulectomy for VVS and the rate of complications with this procedure. Methods., Women who underwent a complete vulvar vestibulectomy with vaginal advancement by one of three different surgeons were contacted via telephone by an independent researcher between 12 and 72 months after surgery. Main Outcome Measures., The primary outcome measurement of surgical success was overall patient satisfaction with surgery. Additional secondary outcome measurements included improvement in dyspareunia, changes in coital frequency, and occurrence of surgical complications. Results., In total, 134 women underwent surgery in a 5-year period. An independent research assistant was able to contact 106 women, and 104 agreed to participate in the study. Mean duration since surgery was 26 months. A total of 97 women (93%) were satisfied, or very satisfied, with the outcome of their surgery. Only three patients (3%) reported persistently worse symptoms after surgery and only seven (7%) reported permanent recurrence of any symptoms after surgery. Prior to surgery, 72% of the women were completely apareunic; however, after surgery, only 11% were unable to have intercourse. Discussion., In this cohort of patients, there was a high degree of satisfaction with surgery for VVS. In addition, the risks of complications with this procedure were low, and most complications were transient and the risk of recurrence after surgery was also found to be low. Goldstein AT, Klingman D, Christopher K, Johnson C, and Marinoff SC. Surgical treatment of vulvar vestibulitis syndrome: Outcome assessment derived from a postoperative questionnaire. J Sex Med 2006;3:923,931. [source] BT04 LAPAROSCOPIC REVISION OF GASTRIC BAND SURGERYANZ JOURNAL OF SURGERY, Issue 2009S. Bardsley Aim: , To identify the outcome of laparoscopic revision of gastric band surgery with respect to percentage of excess weight lost (%EWL). Methods: , Analysis of a prospective database was performed and %EWL was plotted with respect to time from initial procedure and also time from revision procedure. Results: , All revision operations were performed laparoscopically. There were no patient deaths, but two serious complications. Percentage Excess Weight Loss after replacement of the band because of prosthetic failure or dysphagia was 57% at an average follow up of 19 months. For repositioning of the band due to slippage, the %EWL was 72% at an average of 15 months follow up for those who had the existing band repositioned, and 42% at an average of 23 months follow up for those who had a new band repositioned. Conclusion: , Revision laparoscopic gastric band surgery is a safe option for patients, and results in good %EWL at an average follow up period of 19 months. [source] ANAESTHESIA AND ANALGESIA: CONTRIBUTION TO SURGERY, PRESENT AND FUTUREANZ JOURNAL OF SURGERY, Issue 7 2008Edward Shipton Anaesthetists provide comprehensive perioperative medical care to patients undergoing surgical and diagnostic procedures, including postoperative intensive care when needed. They are involved in the management of perioperative acute pain as well as chronic pain. This manuscript considers some of the recent advances in modern anaesthesia and their contribution to surgery, from the basic mechanisms of action, to the delivery systems for general and regional anaesthesia, to the use of new drugs and new methods of monitoring. It assesses the resulting progress in acute and chronic pain services and looks at patient safety and risk management. It speculates on directions that may shape its future contributions to the management of the patient undergoing surgery. [source] ACADEMIC SURGERY IN NORTH AMERICAANZ JOURNAL OF SURGERY, Issue 5 2008Murray F. Brennan MD No abstract is available for this article. [source] ACADEMIC SURGERY IN THE UNITED KINGDOMANZ JOURNAL OF SURGERY, Issue 5 2008FRACS Nuffield Professor of Surgery Emeritus(University of Oxford)Honorary Professor(University of London), Peter J. Morris AC No abstract is available for this article. [source] PANCREATIC SURGERY CONTINUES TO CHALLENGEANZ JOURNAL OF SURGERY, Issue 4 2008John A. Windsor No abstract is available for this article. [source] THE 75TH ANNIVERSARY OF THE ANZ JOURNAL OF SURGERYANZ JOURNAL OF SURGERY, Issue 12 2007John C Hall No abstract is available for this article. [source] RURAL SURGERY AND RURAL SURGEONS: MEETING THE NEEDANZ JOURNAL OF SURGERY, Issue 11 2007John C. Graham FRACS No abstract is available for this article. [source] CORRECT PATIENT, CORRECT SIDE AND CORRECT SITE SURGERYANZ JOURNAL OF SURGERY, Issue 10 2007FAOrthA, MRACMA, Rob Atkinson FRACS No abstract is available for this article. [source] IS INFORMED CONSENT IN CARDIAC SURGERY AND PERCUTANEOUS CORONARY INTERVENTION ACHIEVABLE?ANZ JOURNAL OF SURGERY, Issue 7 2007Marco E. Larobina Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. Methods: Patients undergoing CABG or PCI at a tertiary hospital were interviewed with questionnaires focusing on the consent process, the patient's understanding of CABG or PCI and associated risks and understanding of medical concepts. Medical staff were questioned on the process of obtaining consent and understanding of medicolegal concepts. Results: Fifty CABG patients, 40 PCI patients and 40 medical staff were interviewed over a 6-month period. No patient identified any of the explained risks as a reason to reconsider having CABG or PCI, but 80% of patients wanted to be informed of all risks of surgery. 80% of patients considered doctors obligated to discuss all risks of surgery. One patient (2%) expressed concern at the prospect of a trainee surgeon carrying out the operation. Stroke (40%) rather than mortality (10%) were the important concerns in patients undergoing CABG and PCI. The purpose of interventions was only partially understood by both groups; PCI patients clearly underestimated the subsequent need for repeat PCI or CABG. Knowledge of medical concepts was poor in both groups: less than 50% of patients understood the cause or consequence of an AMI or stroke and less than 20% of patients correctly identified the ratio equal to 0.5%. One doctor (2.5%) correctly identified the four elements of negligence, eight (20%) the meaning of material risk and four (10%) the meaning of causation. Thirty doctors (75%) believed that all complications of a procedure needed to be explained for informed consent. Less than 10% could recognize landmark legal cases. Conclusion: Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists. [source] SINOTOMY VERSUS EXCISIONAL SURGERY FOR PILONIDAL SINUSANZ JOURNAL OF SURGERY, Issue 7 2007Dietrich Doll MD, LtCOL No abstract is available for this article. [source] METHYLENE BLUE IN PILONIDAL SINUS SURGERYANZ JOURNAL OF SURGERY, Issue 7 2007FRCSEd, FRCSI, Mohamed Ezzedien Rabie MSc No abstract is available for this article. [source] SUPPLEMENTARY OXYGEN AND WOUND HEALING IN VASCULAR SURGERY: TOO SIMPLE TO BE TRUE?ANZ JOURNAL OF SURGERY, Issue 6 2007FRACS, John P. Harris AM No abstract is available for this article. [source] PERIOPERATIVE HIGH-DOSE OXYGEN THERAPY IN VASCULAR SURGERYANZ JOURNAL OF SURGERY, Issue 6 2007Phillip J. Puckridge Background: Patients undergoing infrainguinal bypass surgery have reduced baseline tissue oxygen tension and high rates of wound infections. The hypoxaemia worsens during surgery, potentially reducing the ability to combat bacterial lodgement. We investigated whether high-dose perioperative oxygen administration to patients undergoing infrainguinal arterial surgery results in increased tissue oxygenation. Methods: Ten consecutive patients undergoing infrainguinal arterial surgery had transcutaneous partial pressure of oxygen (TcpO2) measured preoperatively, intraoperatively after arterial clamps applied, postoperatively and at discharge. Measurements were taken with inspired oxygen concentration (FiO2) of 30% then 80%. Arterial blood gases were measured at the same times. Results: Tissue oxygenation showed no difference intraoperatively while arterial clamps were in place, but significantly higher tissue oxygenation was seen with use of high-dose oxygen (FiO2 80%) postoperatively (P < 0.05). Carbon dioxide levels in tissue increased while arterial clamps were in place (P < 0.01) and pH fell intraoperatively and following reperfusion (P < 0.05). Conclusion: The administration of high-dose oxygen to vascular surgical patients undergoing lower-limb arterial surgery results in increased tissue oxygen concentrations when perfusion is not reduced by the presence of arterial clamps. These results suggest the administration of high-dose oxygen intraoperatively may be beneficial in reducing wound infections, but further research is required. [source] NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?ANZ JOURNAL OF SURGERY, Issue 5 2007Thorbjorn J Loch-Wilkinson Background: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. Methods: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation. Results: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. Conclusion: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention. [source] CT14 PREDICTING ONE-YEAR SURVIVAL AFTER SURGERY FOR EARLY STAGE NON-SMALL CELL LUNG CANCERANZ JOURNAL OF SURGERY, Issue 2007M. O'keefe Introduction Post-operative survival after surgery for early stage non-small cell lung cancer (NSCLC) is influenced by factors such as stage of disease and co-morbidities. We sought to assess the performance of 2 models in predicting 1 year survival after resected NSCLC. Methods The Colinet Simplified Co-Morbidity Score (SCS) (1) and a prognostic model by Birim (2) were retrospectively applied to a cohort of patients with surgically resected NSCLC. End-point was 1 year survival obtained from clinical follow-up and data-linkage with the Cancer Council of Victoria. Results 216 patients were treated from Feb 1999 to Dec 2005. 52 patients were excluded due to missing data, leaving 164 patients for analysis. Mean patient age was 66.4 ± 10.3. Pathological stage was 1 in 61%, 2 in19% and 3 in 17%. Observed 1 year survival was 78.7%. SCS was predictive of 1 year survival: mean SCS 9.24 for survivors and 11.03 for non-survivors (p = 0.001 by t-test). Patient's with low SCS (0-9) had a higher 1-year survival than those with high SCS (>9); 87.2% vs 69.2% (p = 0.005 by chi-square test). SCS discriminated fairly for 1 year survival (area under ROC curve 0.66). The predicted survival using the Birim model (74.2%) was similar to the observed survival (p = 0.43). The model predicted survival well in both low (predicted 83% vs observed 88%, p = 0.51) and high (66 vs 70%, p = 0.74) risk groups. Birim model discriminated well for 1 year survival (area under ROC curve 0.70). Conclusion SCS and the Birim model can both be used to estimate 1-year survival. They may aid the clinician in deciding who should be considered for surgical resection. [source] CT15 RISK STRATIFICATION MODELS FOR HEART VALVE SURGERYANZ JOURNAL OF SURGERY, Issue 2007C. H. Yap Purpose Risk stratification models may be useful in aiding surgical decision-making, preoperative informed consent, quality assurance and healthcare management. While several overseas models exist, no model has been well-validated for use in Australia. We aimed to assess the performance of two valve surgery risk stratification models in an Australian patient cohort. Method The Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) and Northern New England (NNE) models were applied to all patients undergoing valvular heart surgery at St Vincent's Hospital Melbourne and The Geelong Hospital between June 2001 and November 2006. Observed and predicted early mortalities were compared using the chi-square test. Model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve. Model calibration was tested by applying the chi-square test to risk tertiles. Results SCTS model (n = 1095) performed well. Observed mortality was 4.84%, expected mortality 6.64% (chi-square p = 0.20). Model discrimination (area under ROC curve 0.835) and calibration was good (chi-square p = 0.9). the NNE model (n = 1015) over-predicted mortality. Observed mortality 4.83% and expected 7.54% (chi-square p < 0.02). Model discrimination (area under ROC curve 0.835) and calibration was good (chi-square p = 0.9). Conclusion Both models showed good model discrimination and calibration. The NNE model over-predicted early mortality whilst the SCTS model performed well in our cohort of patients. The SCTS model may be useful for use in Australia for risk stratification. [source] HS09 REPLANTATION SURGERY , THE RECONSTRUCTIVE APPROACHANZ JOURNAL OF SURGERY, Issue 2007L. C. Teoh The function of the replanted parts can be improved if attention to reconstruction techniques is carried out. These reconstructive techniques are: 1) adequate debridement and shortening, 2) stable skeletal fixation, 3) strengthened tendon repairs, 4) quality nerve repair, 5) extensive vascular anastomosis, 6) complete skin coverable, and 7) Early intensive active rehabilitation. 1) The debridement should be generous and the shortening judicious. More than 50% of the skin should be in direct contact, and direct anastomosis of some of vessels should be possible. 2) The skeletal stabilization should be of good very quality that will allow free mobilization of the joints. 3) The repair of the tendons should take advantage of the excess length for a strengthen repair. Some degree of active mobilization should be make possible. 4) Primary nerve grafting or nerve transfer should be considered if there is loss of nerve length. 5) Vascular repair should be on the basis of as many as possible the number of arteries and veins that can be found for anastomosis. 6) Any residual skin defect should be planned for a proper resurfacing within the next 5 to 10 days. 7) Early intensive active rehabilitation should be prescribed. Gradual active ROM for tendon gliding should be instituted with in the first week. The function of the replanted digit and hand has continued to improve with the reconstructive approach. With further experience the reconstructive approach can be done in all cases with confidence. [source] HP23 USE OF ANTI-REFLUX MEDICATION AFTER ANTI-REFLUX SURGERYANZ JOURNAL OF SURGERY, Issue 2007B. P. L. Wijnhoven Purpose It is thought that a substantial number of patients who undergo anti-reflux surgery use anti-reflux medication post operatively, despite no objective evidence of reflux. This study aims to determine the prevalence and underlying reasons for anti-reflux medication usage in patients after anti-reflux surgery. Methodology A questionnaire (13 questions) on the usage of anti-reflux medication was sent to 1016 patients from a prospective database of anti-reflux surgery patients. Results 852 patients (84%), (437 males & 415 females with a mean age 58 yrs) returned the questionnaire. Mean follow up was 5.9 yrs after surgery. A single or combination of medications was being taken by 319 patients (37%): 82% proton pump inhibitors, 9% H2-blockers and 34% antacids. 54 patients (18%) had never stopped taking medication, whereas 261 patients (82%) re-started medication at a mean of 2.4 yrs after surgery. Persistent or return of the same or different symptoms was the reason for taking medication by the vast majority (85%), whereas 15% were asymptomatic or had other reasons for medication use. A response of symptoms to the medication occurred for 30% of the patients, whereas 64% noticed some improvement. Postoperative 24-hour pH studies (while off medication) were abnormal in 17/62 patients (27%) on medication and in 5/73 patients (6%) not taking medication. Conclusions Anti-reflux medication is frequently taken by patients for symptoms after surgery, despite normal pH profiles in the majority. Strategies need to be employed to lower the inappropriate use of medications after surgery and to further evaluate the mechanisms underlying postoperative symptoms, which are non-responsive to anti-reflux medication. [source] | |||||||||||||||||||||||||||||||||||||||||||