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Standards for General Surgery

Rama Raghavan, Stephen Hyter, Harsh B Pathak, Andrew K Godwin, Gottfried Konecny, Chen Wang, Ellen L Goode, Brooke L Fridley
BACKGROUND: Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer death among women in the United States (5 % of cancer deaths). The standard treatment for patients with advanced EOC is initial debulking surgery followed by carboplatin-paclitaxel combination chemotherapy. Unfortunately, with chemotherapy most patients relapse and die resulting in a five-year overall survival around 45 %. Thus, finding novel therapeutics for treating EOC is essential. Connectivity Mapping (CMAP) has been used widely in cancer drug discovery and generally has relied on cancer cell line gene expression and drug phenotype data...
October 19, 2016: BMC Genomics
Anthony G Messina, Michael Wang, Marshall J Ward, Chase C Wilker, Brett B Smith, Daniel P Vezina, Nathan Leon Pace
BACKGROUND: General anaesthesia is usually associated with unconsciousness. 'Awareness' is when patients have postoperative recall of events or experiences during surgery. 'Wakefulness' is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness. OBJECTIVES: To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors...
October 18, 2016: Cochrane Database of Systematic Reviews
Peter Szasz, Esther M Bonrath, Marisa Louridas, Andras B Fecso, Brett Howe, Adam Fehr, Michael Ott, Lloyd A Mack, Kenneth A Harris, Teodor P Grantcharov
OBJECTIVES: The objectives of this study were to (1) create a technical and nontechnical performance standard for the laparoscopic cholecystectomy, (2) assess the classification accuracy and (3) credibility of these standards, (4) determine a trainees' ability to meet both standards concurrently, and (5) delineate factors that predict standard acquisition. BACKGROUND: Scores on performance assessments are difficult to interpret in the absence of established standards...
July 28, 2016: Annals of Surgery
Hans Kristian Pilegaard
BACKGROUND: Pectus excavatum (PE) is the most frequent anomaly of the anterior chest wall. Before 2001, all patients in Denmark were referred to the plastic and reconstructive surgeon for implantation of a subcutaneous silicone prosthesis, because the modified Ravitch procedure was not used. Since 2001, all patients have been treated with a modified Nuss procedure, which today has become the gold standard for correction of PE. METHODS: From September 2001 to March 2016, 1,713 patients have been operated by a modified Nuss procedure using the short bar at Aarhus University Hospital with a male-female ratio 6:1...
September 2016: Annals of Cardiothoracic Surgery
Ashutosh Sahu, Rajnish Kumar, Mumtaz Hussain, Ajit Gupta, K H Raghwendra
BACKGROUND: Regional anesthesia using paravertebral block has been suggested as an ideal adjunct to general anesthesia for modified radical mastectomy. Paravertebral block is an effective management of peri-operative pain for Modified radical mastectomy, however, there are no established guidelines regarding what is the most suitable strategy when varying drugs and dosages between different groups. AIM: To evaluate the effectiveness of paravertebral block comparing the most frequently employed drugs in this procedure (bupivacaine vs ropivacaine)...
September 2016: Anesthesia, Essays and Researches
Vijeta Maheshwari, Mohd Asim Rasheed, Raj Bahadur Singh, Sanjay Choubey, Arindam Sarkar
CONTEXT: Epidural anesthesia is nowadays considered as the gold standard anesthetic technique for lower limb orthopedic surgeries, and the present study was conducted to evaluate the efficacy of levobupivacaine and ropivacaine in terms of onset, duration of sensory and motor block with duration of postoperative analgesia in patients undergoing lower limb orthopedic surgeries under epidural anesthesia. AIMS: To compare the efficacy of 15 mL of levobupivacaine 0.5% with that of 15 mL of ropivacaine 0...
September 2016: Anesthesia, Essays and Researches
P Rani, V R Hemanth Kumar, M Ravishankar, T Sivashanmugam, R Sripriya, M Trilogasundary
BACKGROUND: Fentanyl and dexmedetomidine have been tried to attenuate airway and circulatory reflexes during emergence and extubation individually but have not been compared with respect to the level of sedation to evolve a reliable technique for rapid and smooth extubation. AIM: To compare the effects of fentanyl and dexmedetomidine in attenuating airway and circulatory reflexes during emergence and extubation of the endotracheal tube. SETTING AND DESIGN: This double-blind, randomized, controlled study was done in patients undergoing surgery under general anesthesia belonging to the American Society of Anesthesiologists physical status 1 or 2...
September 2016: Anesthesia, Essays and Researches
N Pratheeba, G S Ramya, R V Ranjan, R Remadevi
CONTEXT: Laryngeal mask airway (LMA) Classic™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. AIMS: To compare ease of insertion, number, and duration of insertion attempts among the two device. Secondary objectives were to evaluate the hemodynamic response and SpO2 during device insertion and during maintenance of general anesthesia. SETTINGS AND DESIGN: This study was conducted as randomized observational study in a teaching hospital...
September 2016: Anesthesia, Essays and Researches
Haramritpal Kaur, Gurpreet Singh, Amandeep Singh, Gagandeep Sharda, Shobha Aggarwal
BACKGROUND AND AIMS: Perioperative stress is an often ignored commonly occurring phenomenon. Little or no prior knowledge of anesthesia techniques can increase this significantly. Patients awaiting surgery may experience high level of anxiety. Preoperative visit is an ideal time to educate patients about anesthesia and address these fears. The present study evaluates two different approaches, i.e., standard interview versus informative audiovisual presentation with standard interview on information gain (IG) and its impact on patient anxiety during preoperative visit...
September 2016: Anesthesia, Essays and Researches
Uri Elbaz, Kamiar Mireskandari, Nasrin Tehrani, Carl Shen, Saad Khan, Sara Luck, Asim Ali
PURPOSE: To establish a normative database of endothelial cell density (ECD) using in-vivo specular microscopy in children under 5 years old. DESIGN: Cross sectional study. METHODS: Specular microscopy was performed during a clinic visit in cooperative children in the standard upright position. In uncooperative children, specular microscopy was performed in the lateral decubitus position under general anesthesia, prior to surgery for other reasons...
October 13, 2016: American Journal of Ophthalmology
Thomas H Hartranft, Kurt Yandle, Tim Graham, Charles Holden, Lowell W Chambers
OBJECTIVE: This study was conducted to assess the effectiveness of a newly implemented electronic web-based review system created at our institution for evaluating resident performance relative to established milestones. DESIGN: Retrospective review of data collected from a survey of general surgery faculty and residents. SETTING: Tertiary care teaching hospital system and independent academic medical center. PARTICIPANTS: A total of 12 general surgery faculty and 17 general surgery residents participated in this study...
October 13, 2016: Journal of Surgical Education
Everton Cazzo, José Carlos Pareja, Bruno Geloneze, Elinton Adami Chaim, Maria Rita Lazzarini Barreto, Daniéla Oliveira Magro
BACKGROUND: Bariatric surgery usually leads to improvement on the general lipid profile, but its role in the levels of apolipoprotein A-IV (Apo-AIV) is not completely understood. Apo-AIV is a gut-released lipoprotein which is enrolled in satiety regulation and presents anti-inflammatory, anti-atherogenic, and anti-oxidative properties. The objective of this study was to determine the influence of biliopancreatic diversion (BPD) in the levels of Apo-AIV. METHODS: This is a prospective exploratory study which evaluated eight obese individuals with type 2 diabetes mellitus (T2DM) who underwent BPD (Scopinaro operation) and were followed-up for 12 months...
October 15, 2016: Obesity Surgery
Daniel S Olsson, Ing-Liss Bryngelsson, Oskar Ragnarsson
PURPOSE: Patients with non-functioning pituitary adenomas (NFPA), especially women, have increased mortality. The aim of this study was to investigate whether mortality in NFPA patients has changed during the last two decades. METHODS: This was a nationwide population-based study including 2795 patients (1502 men, 1293 women) diagnosed with NFPA between 1997 and 2011. Patients were identified and followed in Swedish National Health Registries. Standardized mortality ratios (SMRs) with 95 % confidence intervals were calculated for three time periods at first NFPA diagnosis using the general population as reference...
October 14, 2016: Pituitary
Polpun Boonmak, Suhattaya Boonmak, Malinee Laopaiboon
BACKGROUND: Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative visibility and result in destruction of surrounding structures. Deliberate hypotension (lowering the mean arterial blood pressure to between 50 and 65 mm Hg in normotensive patients) using a range of pharmacological agents during general anaesthesia reduces blood loss in many operations. This review was originally published in 2013 and updated in February 2016...
October 12, 2016: Cochrane Database of Systematic Reviews
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Mohamed A Zayed, Emily A Lilo, Jason T Lee
OBJECTIVE: The surgical council on resident education developed an online competency-based self-study curriculum for general surgery residency trainees. Vascular surgery trainees are yet to have a similarly validated and readily accessible self-study curriculum. We sought to determine the effect of an interactive online vascular surgery curriculum on trainee knowledge and interest in vascular surgery. METHODS: Over 15 months, 53 trainees (36 medical students and 16 surgical residents) performing a vascular surgery rotation were enrolled in a prospective, randomized, 2-cohort study...
October 7, 2016: Journal of Surgical Education
Jessica M Kelly, Allison Bradbury, Douglas R Martin, Mark E Byrne
Approximately 1 in 5000-8000 children are born annually with a lysosomal storage disease (LSD), which affects their cells' ability to break down naturally occurring substrates. Accumulation, or "storage," of undegraded substrates leads to a wide variety of clinical symptoms, and early mortality. Currently, for LSDs with central nervous system (CNS) involvement, there is no available treatment. Four methods of treatment are being explored in clinical trials and preclinical settings: enzyme replacement therapy, ex vivo gene therapy, in vivo gene therapy, and nanoparticle-based therapy...
October 7, 2016: Progress in Neurobiology
Pascal Cyrill Haefeli, Christoph Emanuel Albers, Simon Damian Steppacher, Moritz Tannast, Lorenz Büchler
BACKGROUND: In recent years, surgical treatment of symptomatic femoroacetabular impingement (FAI) has been increasingly performed using arthroscopy. Bony pathomorphologies and damage to the labrum as well as cartilage defects can be addressed with comparable results to open surgery with overall less surgery-related complications. Despite the increasing importance of hip arthroscopy, however, reports on midterm clinical and radiographic outcomes and comparison to open surgical hip dislocation are scarce...
October 7, 2016: Clinical Orthopaedics and related Research
Meredith Degnan, Jessica Brodt, Yiliam Rodriguez-Blanco
AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality...
October 2016: Annals of Cardiac Anaesthesia
Jerrold H Levy
Patients taking direct oral anticoagulants (DOACs) who then need an emergency invasive procedure require specialized management strategies. Appropriate patient evaluation includes assessment of the current anticoagulation state, including timing of the last dose. DOACs require particular coagulation assays to measure anticoagulation levels accurately, although standard coagulation screening tests may provide qualitative guidance. Specialty societies have endorsed general recommendations for patient management to promote hemostasis in anticoagulated patients requiring surgery or other invasive procedures...
September 29, 2016: American Journal of Emergency Medicine
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