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Surgical ethics

X Serra-Aracil, A Zárate, L Mora, S Serra-Pla, A Pallisera, J Bonfill, J Bargalló, A Pando, S Delgado, E Balleteros, C Pericay
PURPOSE: Compared with the open approach, laparoscopic total mesorectal excision (TME) achieves faster patient recovery, reduces morbidity rates, and shortens hospital stay. However, in laparoscopic low anterior resection (L-LAR), conversion to open surgery is required in almost 20% of cases. Transanal TME (Ta-TME) combined with laparoscopy, also called hybrid natural orifice transluminal endoscopic surgery (NOTES), is a less invasive procedure that can overcome some of the limitations of laparoscopic rectal surgery...
March 16, 2018: International Journal of Colorectal Disease
Saksham Gupta, Ivo S Muskens, Luis Bradley Fandino, Alexander F C Hulsbergen, Marike L D Broekman
BACKGROUND: Surgical innovation has advanced outcomes in the field, but carries inherent risk for surgeons and patients alike. Oversight mechanisms exist to support surgeon-innovators through difficulties associated with the innovation process. METHODS: A literature review of ethical risks and oversight mechanisms was conducted. RESULTS: Oversight mechanisms range from the historical concept of surgical exceptionalism to departmental, hospital, and centralized committees...
March 13, 2018: World Journal of Surgery
Nur Altınörs, Mehmet Haberal
To determine the cost effectiveness of transplantation, we analyzed the financial economics of the organ and tissue transplant process. We compared the cost of this process with traditional modalities for treating endstage liver and kidney disease. Medical, surgical, legal, social, ethical, and religious issues are important in organ transplant procedures. Government, health insurance companies, and uninsured individuals are affected by the financial economics of organ transplantation. The distribution of financial burden differs among countries and is dependent on the unique circumstances of each country...
March 2018: Experimental and Clinical Transplantation
A Carmona-Bayonas, F Gordo, C Beato, J Castaño Pérez, P Jiménez-Fonseca, J Virizuela Echaburu, J Garnacho-Montero
Cancer patients are a vulnerable group exposed to numerous and serious risks beyond cancer itself. In recent years, the prognosis of these individuals has improved substantially thanks to several advances such as immunotherapy, targeted molecular therapies, surgical techniques, or developments in support treatment. This coincides with the prolonged survival of oncological patients admitted to the ICU due to critical complications, and under the supervision of intensivists. The time has therefore come to revisit the intensive care support of these patients, which poses new professional as well as organizational challenges...
March 5, 2018: Medicina Intensiva
Jordana da Silva Freitas, Maria Cristina de Almeida Freitas Cardoso
PURPOSE: Determine the occurrence of dysphagia symptoms in children with cleft lip and/or palate (CLP) pre- and post-surgical correction. METHODS: Quantitative observational cross-sectional study. Existence of clef lip and/or palate without association with other syndromes was the study inclusion and/or exclusion criterion. Parents and/or legal guardians responded to a recall questionnaire on the identification of occurrence of coughing, choking, vomiting, and nasal escape pre- and postoperatively and whether these symptoms disappeared after surgical correction...
March 5, 2018: CoDAS
Axel Rand, Peter K Zahn, Thomas A Schildhauer, Christian Waydhas, Uwe Hamsen
BACKGROUND: Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure. METHODS: After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015...
March 5, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Paresh K Doshi
It has been three decades since the first application of deep brain stimulation (DBS) for tremors was described by Benabid. Over the years, the indications for the performance of DBS have been expanding. There are now more than 1,50,000 patients around the world who have undergone DBS for various disorders. The main appeal of DBS is in its reversibility and titratability. Though the initial interest in DBS was for pain, the main indications for DBS have been movement disorders. Despite its wide appeal and "perceived" advantage, United States Food and Drug Administration, the nodal agency for approving therapies, has been cautious and guarded in providing approvals...
March 2018: Neurology India
Nelly Reynaud, Frédérique Courtois, Pierre Mouriquand, Nicolas Morel-Journel, Kathleen Charvier, Marina Gérard, Alain Ruffion, Jean-Etienne Terrier
BACKGROUND: The bladder exstrophy-epispadias complex is a rare congenital malformation associated with severe dysfunction of the genital and urinary tracts and requiring a staged surgical reconstruction. AIM: The primary aims of this study were to report the sexuality, infertility, and urinary incontinence outcomes in a cohort of men born with bladder exstrophy-epispadias complex. The secondary aim was to highlight some predictive factors of infertility in this population...
March 2018: Journal of Sexual Medicine
M Cosson, H Fernandez
No abstract text is available yet for this article.
March 2018: Journal of Gynecology Obstetrics and Human Reproduction
Pietro Bortoletto, Eduardo Hariton, Leslie V Farland, Randi H Goldman, Antonio R Gargiulo
OBJECTIVE: To determine whether reproductive endocrinologists and minimally invasive surgeons support uterine transplantation as a treatment option for absolute uterine factor infertility (AUFI). DESIGN: Cross-sectional study (Canadian Task Force Classification II-2) SETTING: Web-based survey. PATIENTS(S): Physician members of the American Society of Reproductive Medicine (ASRM) and the American Association of Gynecologic Laparoscopists (AAGL)...
March 1, 2018: Journal of Minimally Invasive Gynecology
Mohammed Ashi, Rehab Assur, Basim Awan, Hattan Aljaaly
INTRODUCTION: Split Hand-Foot malformation (SHFM) is a congenital limb defect that affects the central rays of the hands and/or feet. It is a rare condition that has genetic and environmental etiologies. It ranges in severity depending on the extent of the malformation. We report on two siblings with severe SHFM affecting all limbs. METHODS: We described two cases of siblings with SHFM and discuss the possible causes of the condition. This research did not require ethical approval due to the institute not requiring it for this type of study...
December 27, 2017: International Journal of Surgery Case Reports
Jason M Weissler, Brian L Chang, Martin J Carney, David Rengifo, Charles A Messa, David B Sarwer, Ivona Percec
The landscape of gender dysphoria has changed dramatically in recent years secondary to increased societal acceptance, legislative changes, and medical providers' increased awareness of the associated psychosocial burden associated with the diagnosis. National and global advocacy efforts, in conjunction with expanded third-party insurance coverage, have resulted in new health care opportunities for patients suffering from gender dysphoria. Delivering quality, streamlined health care to these patients requires a complex multidisciplinary approach, involving multiple medical and mental health disciplines, including plastic surgeons...
March 2018: Plastic and Reconstructive Surgery
Franziska Eckert, Paul Weindling, Astrid Ley, Hans-Joachim Lang, Sascha Lang, Gabriele Moser
Whereas the scientific community is aware of atrocities committed by medical doctors like Mengele, the specifics of radiology and radiation oncology during National Socialism remain largely unknown. Starting in 2010, the German Radiology Association and the German Association of Radiation Oncology coordinated a national project looking into original archival material. A national committee convened in 2013 to discuss the project's findings, which were also the subject of a symposium at the University of Tuebingen in 2016 on radiology under National Socialism...
February 21, 2018: Journal of the American College of Radiology: JACR
L Lewis Wall
OBJECTIVES: To review the historical background surrounding the early work of Dr. J. Marion Sims, who developed the first consistently successful surgical technique for the repair of obstetric vesicovaginal fistulas by operating on a group of young, enslaved, African American women who had this condition between 1846 and 1849. METHODS: Review of primary source documents on Sims and his operations, early 19th century clinical literature on the treatment of vesicovaginal fistula, the introduction of ether and chloroform anesthesia into surgical practice, and the literature on the early 19th century medical ethics pertaining to surgical innovation...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Deena Harji, Helen Marshall, Katie Gordon, Hannah Crow, Victoria Hiley, Dermot Burke, Ben Griffiths, Catherine Moriarty, Maureen Twiddy, John L O'Dwyer, Azmina Verjee, Julia Brown, Peter Sagar
INTRODUCTION: Acute colorectal surgery forms a significant proportion of emergency admissions within the National Health Service. There is limited evidence to suggest minimally invasive surgery may be associated with improved clinical outcomes in this cohort of patients. Consequently, there is a need to assess the clinical effectiveness and cost-effectiveness of laparoscopic surgery in the acute colorectal setting. However,emergency colorectal surgical trials have previously been difficult to conduct due to issues surrounding recruitment and equipoise...
February 22, 2018: BMJ Open
Mohamed S Al Riyami, Sulaiman Al Saidi, Badria Al Ghaithi, Anisa Al Maskari, Sadiq Lala, Nabil Mohsin, Lekha Hirshikesan, Naifain Al Kalbani
Objectives: This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods: Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up...
January 2018: Oman Medical Journal
Christopher A Adin, Callie A Fogle, Steven L Marks
To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors...
February 19, 2018: Veterinary Surgery: VS
Ignacio J Amat-Santos, Pablo Catalá, Felipe Diez Del Hoyo, Jose A Fernandez-Diaz, Juan H Alonso-Briales, María Del Trigo, Ander Regueiro, Pablo Juan-Salvadores, Vicenç Serra, Enrique Gutierrez-Ibanes, Antonio J Muñoz-García, Luis Nombela-Franco, Manel Sabate, Victor A Jimenez-Diaz, Bruno García Del Blanco, Javier López, Luis H Varela-Falcón, Teresa Sevilla, Roman Arnold, Ana Revilla, J Alberto San Roman
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) as a treatment in severe aortic stenosis (AS) is an excellent alternative to conventional surgical replacement. However, long-term outcomes are not benign. Renin-angiotensin system (RAS) blockade has shown benefit in terms of adverse remodelling in severe AS and after surgical replacement. METHODS AND ANALYSIS: The RAS blockade after TAVI (RASTAVI) trial aims to detect if there is a benefit in clinical outcomes and ventricular remodelling with this therapeutic strategy following the TAVI procedure...
February 13, 2018: BMJ Open
Francesco Onorati, Riccardo Gherli, Giovanni Mariscalco, Evaldas Girdauskas, Eduardo Quintana, Francesco Santini, Marisa De Feo, Sandro Sponga, Piergiorgio Tozzi, Mohamad Bashir, Andrea Perrotti, Aniello Pappalardo, Vito Ruggieri, Giuseppe Santarpino, Mauro Rinaldi, Silva Ronaldo, Francesco Nicolini
INTRODUCTION: Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size...
February 10, 2018: BMJ Open
Kezhong Chen, Heng Zhao, Fan Yang, Bengang Hui, Tianyang Wang, Lieu Tu Wang, Yanbin Shi, Jun Wang
INTRODUCTION: Circulating tumour DNA (ctDNA) has potential applications in cancer management. Most previous studies about ctDNA focused on advanced stage cancer patients. We have completed a clinical prospective study (NCT02645318) and showed the feasibility and clinical application of ctDNA detection in early stage non-small cell lung cancer (NSCLC) patients. The aim of this study is to investigate the elimination rate of ctDNA level after surgery. This is the first prospective study to evaluate the perioperative dynamic changes of ctDNA in surgical lung cancer patients...
February 6, 2018: BMJ Open
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