Current surgery最新文献_第10页

Ischemic Steal Syndrome: A Case Series and Review of Current Management 缺血性窃血综合征:一个病例系列和当前管理的回顾

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.04.017

B.P. Mwipatayi MMed (FCS) , T. Bowles (FRACS) , S. Balakrishnan MBBS , J. Callaghan RN, BN , Elvie Haluszkiewicz DMU, AMS , K. Sieunarine DDU (FRACS)

{"title":"Ischemic Steal Syndrome: A Case Series and Review of Current Management","authors":"B.P. Mwipatayi MMed (FCS) , T. Bowles (FRACS) , S. Balakrishnan MBBS , J. Callaghan RN, BN , Elvie Haluszkiewicz DMU, AMS , K. Sieunarine DDU (FRACS)","doi":"10.1016/j.cursur.2005.04.017","DOIUrl":"10.1016/j.cursur.2005.04.017","url":null,"abstract":"<div><h3>Background</h3><p>Currently over 5000 patients are receiving hemodialysis in Australia, which is an increase by approximately 7% each year. Distal ischemia secondary to the steal syndrome (ISS) is an uncommon but recognized complication. Several methods are now available to manage this problem including ligation, banding, and distal revascularization with interval ligation (DRIL). The aim of this report is to review the experience of the authors on this complication and its management at Royal Perth Hospital.</p></div><div><h3>Methods</h3><p>The Vascular Physiology Laboratory Database was used to identify those patients referred for investigation of ISS. Data were collected retrospectively from these patients’ files concerning their demographics, graft particulars, and type of interventional procedure. Patients were then recalled to assess long-term patency and current venous access and for postoperative vascular studies.</p></div><div><h3>Results</h3><p>Eighteen people were identified with ischemic symptoms. The mean age was 66 (range, 44 to 82). Fourteen (77.8%) were men, and 15 (83.3%) were diabetic. Renal failure was secondary to diabetes in 8 patients, hypertension in 3, and a combination of both in 7 patients. Intervention was via the DRIL procedure in 12, ligation in 5, and banding in 1. One patient underwent angioplasty of the ulnar artery before DRIL. At follow-up (between 1 and 12 months), all DRIL bypass were patents. The 5 ligated patients all improved, and the patient who underwent banding thrombosed their graft.</p></div><div><h3>Conclusion</h3><p>The DRIL procedure should be considered the standard operation to manage ISS in that it manages the ischemia while maintaining the functional fistula. It is, however, still necessary to ligate some fistulae and seek alternative access. There are still no preoperative indicators as to who will suffer ISS.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 2","pages":"Pages 130-135"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.04.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25891594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 45

Intramammary Lymph Node Presenting as the Primary Breast Mass in Infiltrating Lobular Carcinoma 浸润性小叶癌的乳腺内淋巴结表现为原发性肿块

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.12.010

Andreana L. Rivera MD , Amna Diwan BA , Stephanie Muylaert BA , Anthony Lucci MD

引用次数: 4

Scheduling the Resident 80-Hour Work Week: An Operations Research Algorithm 居民每周80小时工作制:一个运筹学算法

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.12.001

T. Eugene Day DSc , Joseph T. Napoli DSc , Paul C. Kuo MD

{"title":"Scheduling the Resident 80-Hour Work Week: An Operations Research Algorithm","authors":"T. Eugene Day DSc , Joseph T. Napoli DSc , Paul C. Kuo MD","doi":"10.1016/j.cursur.2005.12.001","DOIUrl":"10.1016/j.cursur.2005.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>The resident 80-hour work week requires that programs now schedule duty hours. Typically, scheduling is performed in an empirical “trial-and-error” fashion. However, this is a classic “scheduling” problem from the field of operations research (OR). It is similar to scheduling issues that airlines must face with pilots and planes routing through various airports at various times. The authors hypothesized that an OR approach using iterative computer algorithms could provide a rational scheduling solution.</p></div><div><h3>Methods</h3><p>Institution-specific constraints of the residency problem were formulated. A total of 56 residents are rotating through 4 hospitals. Additional constraints were dictated by the Residency Review Committee (RRC) rules or the specific surgical service. For example, at Hospital 1, during the weekday hours between 6 <span>am</span> and 6 <span>pm</span>, there will be a PGY4 or PGY5 and a PGY2 or PGY3 on-duty to cover Service “A.” A series of equations and logic statements was generated to satisfy all constraints and requirements. These were restated in the Optimization Programming Language used by the ILOG software suite for solving mixed integer programming problems.</p></div><div><h3>Results</h3><p>An integer programming solution was generated to this resource-constrained assignment problem. A total of 30,900 variables and 12,443 constraints were required. A total of man-hours of programming were used; computer run-time was 25.9 hours. A weekly schedule was generated for each resident that satisfied the RRC regulations while fulfilling all stated surgical service requirements. Each required between 64 and 80 weekly resident duty hours.</p></div><div><h3>Conclusions</h3><p>The authors conclude that OR is a viable approach to schedule resident work hours. This technique is sufficiently robust to accommodate changes in resident numbers, service requirements, and service and hospital rotations.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 2","pages":"Pages 136-141"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25891688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 31

Vascular Diagnosis 血管诊断

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.10.002

Wade Kang MD

引用次数: 0

Intrathoracic Aneurysm of Right Subclavian Artery: A Surgical Approach 右锁骨下动脉胸内动脉瘤:外科入路

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.04.014

Siamak Barkhordarian MD, Shoaib Sheikh MD, Albert Weyman MD

引用次数: 3

Intraabdominal Pulmonary Sequestration 腹内肺隔离

Current surgery Pub Date : 2006-01-01 DOI: 10.1016/j.cursur.2005.04.004

Jan Franko MD , Karen Bell MD , Christopher M. Pezzi MD

引用次数: 26

Ongoing Faculty Evaluations: Developmental Gain or Just More Pain? 持续的教师评估:发展的收获还是更多的痛苦?

Current surgery Pub Date : 2006-01-01 DOI: 10.1016/j.cursur.2005.08.010

Vijay K. Maker MD , Michael J. Lewis MD , Michael B. Donnelly PhD

{"title":"Ongoing Faculty Evaluations: Developmental Gain or Just More Pain?","authors":"Vijay K. Maker MD , Michael J. Lewis MD , Michael B. Donnelly PhD","doi":"10.1016/j.cursur.2005.08.010","DOIUrl":"10.1016/j.cursur.2005.08.010","url":null,"abstract":"<div><h3>Purpose</h3><p>We continue to increase the amount of evaluations to improve the outcomes of our residency programs. Although ongoing faculty evaluations clearly are an important part of faculty development, their value in terms of improving the program needs to be evaluated. The questions asked were as follows: (1) Do faculty evaluations continue to improve the faculty over the course of successive evaluation periods? (2) Are there groups of faculty who would benefit the most from faculty evaluation feedback? (3) Are there any specific objective categories within the evaluation that carry more value and may help to shorten this form?</p></div><div><h3>Methods</h3><p>Forty-two faculty members were evaluated by 40 surgical residents with an assessment form developed by surgical residents that assessed faculty members by 10 different criteria. The initial set of data was collected, and attending surgeons were given an intervention in the form of a letter detailing how they had been assessed in each of the 10 categories. The attending surgeons were evaluated again 6 months later and were given an intervention in the form of verbal feedback regarding their evaluations. The attending faculty members were then assessed 1 year after that. One way analyses of variance and Fisher Protected Least Significant Difference (PLSD) were used to analyze the resulting data to determine if there were significant differences in the faculty evaluations. A part–whole correlation was performed that correlated the 10 evaluation criteria against the mean score on each evaluation, and partial η-squared analysis was used to determine which criterion had the largest effect on the overall means.</p></div><div><h3>Results</h3><p>The means for the 42 faculty members as a whole continued to improve from the first to the final evaluation period, with 30 faculty members increasing their mean score (18 significantly) and 12 decreasing their mean score (4 significantly). Seven of the 10 evaluation criteria’s means improved sequentially by feedback session. These were (1) Didactic Teaching, (2) Teaching Rounds, (3) Attendance at Didactic Activities, (4) Allows [Resident] Autonomy to Make Independent Decisions, (5) Provides Feedback, (6) Stimulates Critical Thinking with Use of Literature, and (7) Encourages and Maintains an Atmosphere of Professional Mutual Respect for All Members of Health Care Team (Role Model).</p><p>The faculty group with the lowest evaluations improved significantly more than those of both the middle and the role model group, with the middle and the role model groups improving, but not significantly differently from each other.</p><p>Of the criteria that improved, only Provides Feedback improved significantly from the first to second and the second to third evaluation periods. The three criteria with the highest correlation coefficients were Role Model (0.76), Provides Feedback (0.75), and Stimulates Critical Thinking (0.74). The results from the partia","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 1","pages":"Pages 80-84"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.08.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25766028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 25

Surgical Experience and Cosmetic Outcomes in Children with Sacrococcygeal Teratoma 儿童骶尾骨畸胎瘤的手术经验和美容效果

Current surgery Pub Date : 2006-01-01 DOI: 10.1016/j.cursur.2005.04.011

Stefan Bittmann MD, Volker Bittmann MD

{"title":"Surgical Experience and Cosmetic Outcomes in Children with Sacrococcygeal Teratoma","authors":"Stefan Bittmann MD, Volker Bittmann MD","doi":"10.1016/j.cursur.2005.04.011","DOIUrl":"10.1016/j.cursur.2005.04.011","url":null,"abstract":"<div><p>To determine the extent of progress in the treatment of sacrococcygeal teratomas (SCTs), the experience of 25 patients over a period of 30 years between 1972 and 2002 was evaluated. The medical records of the children were reviewed for demographics, histology, clinical course, bladder, anorectal and sexual function, and outcome. In particular, analysis of long-term cosmetic results after surgery for SCT was performed. The follow-up period ranged from 1 day to 396 months (median, 212 months). In more than half of the cases, unsatisfactory cosmetic long-term results after surgery for SCT were found. This study demonstrates that poor cosmetic results in the buttock region were the most common long-term complication after surgery for SCT, possibly leading to further corrective operations in later life. A better surgical procedure for closing the buttock region in the treatment of SCT should be discussed. Early assessment of bladder, anorectal, and sexual function along with long-term cosmetic results should be integrated into the well-established long-term oncology follow-up program. Moreover one has to keep in mind that cesarean section could become necessary as the primary delivery technique in female patients who have had surgery for SCT. More evaluations concerning this aspect are necessary.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 1","pages":"Pages 51-54"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.04.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25766561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 34

Current surgery Pub Date : 2006-01-01 DOI: 10.1016/j.cursur.2005.08.001

Stanislaw Stawicki MD

引用次数: 1

The Why and How of Coordinator Certification 协调员认证的原因和方法

Current surgery Pub Date : 2006-01-01 DOI: 10.1016/j.cursur.2005.09.022

Ruth H. Nawotniak MS

引用次数: 1