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Surgical ethics

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https://www.readbyqxmd.com/read/29788106/microsurgical-resection-of-a-solitary-spinal-epidural-cavernous-angioma-3-dimensional-operative-video
#1
Guilherme H W Ceccato, Lucélio Henning, Julyana L Prado, Marcio S Rassi, Luis A B Borba
Solitary spinal epidural cavernous angiomas are rare vascular malformations. Surgical excision is the treatment of choice, as these lesions tend to grow or bleed at some point. In this 3-dimensional, narrated video, we present the case of a 61-year-old male who presented with progressive pain in the right paravertebral region secondary to an epidural cavernous angioma located at the T6/T7 level. Under intraoperative neurophysiological monitoring, a laminectomy between T5 and T7 was performed. A reddish, well delimited, and highly vascularized epidural mass was identified and dissected from the adjacent dura and nerve root, and an en bloc total resection was achieved...
May 21, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29786819/evaluation-of-pterygoid-plate-fractures-unrelated-to-le-fort-fractures-using-maxillofacial-computed-tomography
#2
Serra Özbal Güneş, Yeliz Aktürk, Esra Soyer Güldoğan
BACKGROUND: This study aims to describe the major pterygoid plate fractures (PPFs) patterns unrelated to Le Fort fractures (LFFs) using maxillofacial computed tomography (CT). METHODS: After obtaining our hospital ethics committee approval (37-05), data for PPF were acquired from the medical records of all the trauma patients who were diagnosed using CT at our hospital from April 2014 to April 2017. RESULTS: Of the 178 patients, 135 (male/female = 86/49; mean age = 37...
May 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29784583/medical-techniques-of-fertility-preservation-in-the-male-and-female
#3
C Vinolas, J Raad, C Sonigo, C Sifer, N Sermondade, M Grynberg
Therapeutic advances in many medical fields have led to the need to consider patient quality of life after curative medico-surgical treatments for malignancy. Thus, it has become a major issue for young patients to preserve the ability to become "genetic" parents, with their own gametes. While the preservation of male fertility has been an established technique for more than 30 years, it is only in the last decade that progress in cryopreservation techniques has allowed surgeons to offer successful oocyte and ovarian tissue cryobanking...
May 18, 2018: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29781783/clinical-and-radiological-outcome-of-non-surgical-management-of-thoracic-and-lumbar-spinal-fracture-dislocations-a-historical-analysis-in-the-era-of-modern-spinal-surgery
#4
Andrei Fernandes Joaquim, Gregory D Schroeder, Alpesh A Patel, Alexander R Vaccaro
CONTEXT: It is well established that traumatic spinal dislocations (AO Type C injuries) should be surgically treated. However, no recent comparative study of surgical versus non-surgical management of type C injuries was found attesting the superiority of surgical treatment. OBJECTIVE: Due to the lack of information about the natural history of non-surgical management of type C injuries, we evaluated the outcome of historical conservative treatment of type C injuries...
May 21, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29774166/hemostatic-state-augmented-with-platelet-indices-among-sudanese-diabetic-septic-foot
#5
Bashir Abdrhman Bashir, Mohamed Salih Ali
Background: Diabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot. Methods: A case-control study was conducted during the period from July to September 2017 at Dr...
2018: BMC Hematology
https://www.readbyqxmd.com/read/29770586/surgical-infection-after-posterolateral-lumbar-spine-arthrodesis-ct-analysis-of-spinal-fusion
#6
Pablo Andrés-Cano, Ana Cerván, Miguel Rodríguez-Solera, Jose Antonio Ortega, Natividad Rebollo, Enrique Guerado
OBJECTIVE: To determine the incidence of infection after instrumented lumbar spine surgery, the demographic and surgical variables associated with acute infection, and the influence of infection and debridement on the consolidation of spinal fusion. METHODS: After obtaining approval from the hospital ethics committee, an observational study was made on a prospective cohort of consecutive patients surgically treated by posterolateral lumbar spine arthrodesis (n = 139, 2005-2011)...
May 16, 2018: Orthopaedic Surgery
https://www.readbyqxmd.com/read/29766353/how-ethical-is-our-current-delivery-of-care-to-patients-with-severe-and-complicated-obesity
#7
REVIEW
Hilary Craig, Carel le Roux, Fiona Keogh, Francis M Finucane
Despite overwhelming evidence that bariatric interventions reduce morbidity and mortality and are cost-effective, access for affected patients is limited. We sought to describe the extent to which health policy makers and publically funded health services have an ethical obligation to provide bariatric care. We conducted a narrative review of the literature pertaining to the efficacy, safety, and cost-effectiveness of bariatric surgical interventions, in the context of the core principles of medical ethics...
May 15, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29763389/how-should-complex-communication-responsibilities-be-distributed-in-surgical-education-settings
#8
Bradley M Dennis, Allan B Peetz
Part of any trauma surgeon's job is communicating effectively in difficult, often time-limited, situations. The ability to effectively discuss topics like goals of care in these settings has a direct effect on patient care. Many factors contribute to the complexity of these conversations, including patient, physician, surrogate, and system-specific factors. In responding to the case of Mr. D and Dr. J, we attempt to outline and analyze some of the moral challenges and ethical questions that this professional responsibility poses to trauma surgeons and trainees...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29762444/efficacy-of-autologous-platelet-concentrates-as-adjuvant-therapy-to-surgical-excision-in-the-treatment-of-keloid-scars-refractory-to-conventional-treatments-a-pilot-prospective-study
#9
Barbara Hersant, Mounia SidAhmed-Mezi, Frédéric Picard, Oana Hermeziu, Anne-Marie Rodriguez, Khaled Ezzedine, Jean Paul Meningaud
BACKGROUND: After conventional treatments, keloid scars show varying degrees of recurrence. The aim of this study was to assess the efficacy and safety of platelet-rich plasma in the treatment of postoperative keloid scars refractory to conventional treatments. METHODS: This pilot prospective study was conducted in 17 patients with keloid scars who did not respond to 4 injections of cortisone or radiotherapy after extralesional resection of keloid. Platelet-rich plasma was injected intraoperatively and then 3 times with a 1-month interval...
May 14, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29751598/informed-consent-decision-making-in-deep-brain-stimulation
#10
REVIEW
Gabriele Mandarelli, Germana Moretti, Massimo Pasquini, Giuseppe Nicolò, Stefano Ferracuti
Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity...
May 11, 2018: Brain Sciences
https://www.readbyqxmd.com/read/29742889/intraoperative-neurophysiological-monitoring-a-review-of-techniques-used-for-brain-tumor-surgery-in-children
#11
REVIEW
Keewon Kim, Charles Cho, Moon-Suk Bang, Hyung-Ik Shin, Ji-Hoon Phi, Seung-Ki Kim
Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues...
May 2018: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29741720/nerve-surgeons-assessment-of-the-role-of-eduard-pernkopf-s-atlas-of-topographic-and-applied-human-anatomy-in-surgical-practice
#12
Andrew Yee, Demetrius M Coombs, Sabine Hildebrandt, William E Seidelman, J Henk Coert, Susan E Mackinnon
BACKGROUND: Pernkopf's atlas of Anatomy contains anatomical plates with detailed images of the peripheral nerves. Its use is controversial due to the author's association with the "Third Reich" and the potential depiction of victims of the Holocaust. The ethical implications of using this atlas for informing surgical planning have not been assessed. OBJECTIVE: To (1) assess the role of Pernkopf's atlas in nerve surgeons' current practice and (2) determine whether a proposal for its ethical handling may provide possible guidance for use in surgery and surgical education...
May 8, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29741687/bowel-surgery-as-a-fertility-enhancing-procedure-in-patients-with-colorectal-endometriosis-methodological-pathogenic-and-ethical-issues
#13
Paolo Vercellini, Paola Viganò, Maria Pina Frattaruolo, Alessandra Borghi, Edgardo Somigliana
Bowel surgery for colorectal endometriosis is being promoted to infertile women without severe sub-occlusive symptoms, with the objective of improving the likelihood of conception. Contrary to rectal shaving, bowel surgery involving full-thickness disk excision and segmental resection entails opening of the intestinal lumen thus increasing the risk of postoperative infectious complications. About 1 in 10 patients undergoing colorectal resection for intestinal endometriosis will experience severe sequelae, including anastomotic dehiscence, rectovaginal fistula formation, and bladder and bowel denervation...
May 7, 2018: Human Reproduction
https://www.readbyqxmd.com/read/29739786/using-mobile-health-technology-and-community-health-workers-to-identify-and-refer-caesarean-related-surgical-site-infections-in-rural-rwanda-a-randomised-controlled-trial-protocol
#14
Kristin A Sonderman, Theoneste Nkurunziza, Fredrick Kateera, Magdalena Gruendl, Rachel Koch, Erick Gaju, Caste Habiyakare, Alexi Matousek, Evrard Nahimana, Georges Ntakiyiruta, Robert Riviello, Bethany L Hedt-Gauthier
INTRODUCTION: Surgical site infections (SSIs) are a significant cause of morbidity and mortality in low-income and middle-income countries, where rates of SSIs can reach 30%. Due to limited access, there is minimal follow-up postoperatively. Community health workers (CHWs) have not yet been used for surgical patients in most settings. Advancements in telecommunication create an opportunity for mobile health (mHealth) tools to support CHWs. We aim to evaluate the use of mHealth technology to aid CHWs in identification of SSIs and promote referral of patients back to healthcare facilities...
May 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29731402/-how-can-we-explain-the-crimes-of-nazis-doctors-in-auschwitz
#15
Bruno Halioua
The Nazi doctors committed crimes in the camp of Auschwitz which constitute the darkest page in the history of medicine of the twentieth century. They were largely directly involved in the murder of the 1.1 million Jewish majority and about 21,000 gypsies who were transported from all over Europe. How can we explain the intellectual journey of those men who had embraced the medical career to relieve their neighbors? How could these cultivated and refined men, from the most prestigious faculties of medicine, have been able to achieve activities ethically unacceptable? Eight factors help to explain the crimes committed by these educated and cultivated SS doctors: indoctrination fervent to Nazism, adherence to racial hygiene, a false sense of participation in a "public health enterprise", virulent anti-Semitism, unreserved obedience to orders, the opportunity to avoid the danger of fighting areas, the ambition to carry out medical research and the desire to improve surgical knowledge...
May 3, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29724585/urothelial-carcinoma-in-children-a-case-series
#16
Federica Marinoni, Francesca Destro, Giorgio Giuseppe Orlando Selvaggio, Giovanna Riccipetitoni
OBJECTIVE: To report a series of 5 patients with urothelial bladder cancer (UBC) three of them with a history of exposure to amines and only two with gross hematuria. MATERIALS AND METHODS: After obtaining ethical and legal authorization, we performed a restrospective monocentric study. We collected information of patients with UBC over a period of 10 years. We recorded: age, sex, reason for presentation, familial history and risk factors, preoperative assessment, surgical details, histological type and grade, follow-up...
April 30, 2018: Bulletin du Cancer
https://www.readbyqxmd.com/read/29724252/synthetic-versus-autologous-reconstruction-syn-var-of-the-medial-patellofemoral-ligament-a-study-protocol-for-a-randomised-controlled-trial
#17
Adam Tucker, Sam McMahon, Bronwyn McArdle, Bridgeen Rutherford, Danny Acton
BACKGROUND: Recurrent patellar instability incidence is 5.8/100,000 population, and recurrent dislocations are reported in the range of 15-80%. Recurrent instability is multifactorial and can be associated with disorder of limb alignment, osseous development, congruity of the patella in the trochlea and soft tissue static and dynamic constraints. The multifactorial aetiology makes management challenging, and a lack studies in a heterogeneous population with robust clinical outcomes compounds this further...
May 3, 2018: Trials
https://www.readbyqxmd.com/read/29716613/task-shifting-in-health-service-delivery-from-a-decision-and-policy-makers-perspective-a-case-of-uganda
#18
Sebastian Olikira Baine, Arabat Kasangaki, Euzobia Margaret Mugisha Baine
BACKGROUND: Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers' numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers' perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy...
May 2, 2018: Human Resources for Health
https://www.readbyqxmd.com/read/29709330/does-volumetric-measurement-of-cervical-lymph-nodes-serve-as-an-imaging-biomarker-for-locoregional-recurrence-of-oral-squamous-cell-carcinoma
#19
Ali-Farid Safi, Martin Kauke, Hendrik Jung, Marco Timmer, Jan Borggrefe, Thorsten Persigehl, Hans-Joachim Nickenig, Max Zinser, David Maintz, Matthias Kreppel, Joachim Zöller
In consideration of the 3-R-rule (Refine-Replace-Reduce) as a guideline for promoting ethical use of animals for surgical training, we present a novel training model for microvessel anastomosis. At hand of a rat cadaveric study, we evaluated the surgical anatomy of the common carotid artery (CCA), external jugular vein (EJV) and femoral vessels (FV) which were then used as templates for the present investigation. Anatomical dissection of 30 rat cadavers was performed. Two residents without prior microsurgical experience were included in the study and performed 5 CCA, 5 femoral artery, 5 EJV and 5 femoral vein anastomoses...
April 10, 2018: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29703860/thinking-clearly-about-the-first-trial-addressing-ethical-challenges-in-cluster-randomised-trials-of-policy-interventions-involving-health-providers
#20
Austin R Horn, Charles Weijer, Spencer Phillips Hey, Jamie Brehaut, Dean A Fergusson, Cory E Goldstein, Jeremy Grimshaw, Monica Taljaard
The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials (CRTs) of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the relevant ethical issues...
April 27, 2018: Journal of Medical Ethics
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