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<title>Surgeons_and_Clinics RSS : Gourt</title>
<link>http://www.gourt.com/Health/Medicine/Surgery/Surgeons-and-Clinics.html</link>
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<dc:rights>Copyright 2007, Gourt.com</dc:rights>
<dc:date>2010-02-08T10:19+24:00
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<dc:publisher>rtruog@gourt.com</dc:publisher>
<dc:creator>rtruog@gourt.com</dc:creator>
<dc:subject>Surgeons_and_Clinics RSS : Gourt</dc:subject>
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<item rdf:about="http://www.biomedcentral.com/1471-2482/10/5">
<title>Experimental investigation of the elasticity of the human diaphragm</title>
<link>http://www.biomedcentral.com/1471-2482/10/5</link>
<description><![CDATA[Background:
Traumatic diaphragmatic ruptures affect mainly the left side. In an experimental study in human corpses we examined the stretch behaviour of the left and right diaphragmatic halves.MethodIn a total of 8 male and 8 female corpses each diaphragmatic half was divided into 4 different segments. Each segments stretch behaviour was investigated. In steps of 2 N the stretch was increased up to 24 N.
Results:
In the female the left diaphragm showed a stronger elasticity compared to the right. Additionally the left diaphragm in females showed a higher elasticity in comparison to the left in males. Traumatic diaphragmatic ruptures affect mostly the central tendineous part or the junction between tendineous and muscular part of the diaphragmatic muscle. Accordingly we found a lower elasticity in these parts compared with the other diaphragmatic segments.
Conclusion:
In summary it can be said that albeit some restrictions we were able to determine the elasticity of different diaphragmatic segments quantitatively and reproduceably with our presented method. Thereby a comparison of results of different diaphragmatic segments as well as of both diaphragmatic halves and of both genders was possible]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/10/4">
<title>Potential hospital cost-savings attributed to improvements in outcomes for colorectal cancer surgery following self-audit
</title>
<link>http://www.biomedcentral.com/1471-2482/10/4</link>
<description><![CDATA[Background:
One of the potential benefits of surgical audit is improved hospital cost-efficiencies arising from lower resource consumption associated with fewer adverse events.  The aim of this study was to estimate the potential cost-savings for Australian hospitals from improved surgical performance for colorectal surgery attributed to a surgical self-audit program.
Methods:
We used a mathematical decision-model to investigate cost differences in usual practice versus surgical audit and synthesized published hospital cost data with epidemiological evidence of adverse surgical events in Australia and New Zealand. A systematic literature review was undertaken to assess post-operative outcomes from colorectal surgery and effectiveness of surgical audit.  Results were subjected to both one-way and probabilistic sensitivity analyses to address uncertainty in model parameters.
Results:
If surgical self-audit facilitated the reduction of adverse surgical events by half those currently reported for colorectal cancer surgery, the potential cost-savings to hospitals is AU $48,720 (95% CI: $18,080-$89,260) for each surgeon treating 20 cases per year.  A smaller 25% reduction in adverse events produced cost-savings of $24,960 per surgeon (95%CI: $1,980-$62,980).  Potential hospital savings for all operative colorectal cancer cases was estimated at AU $30.3 million each year.
Conclusions:
Surgical self-audit has the potential to create substantial hospital cost-savings for colorectal cancer surgery in Australia when considering the widespread incidence of this disease.  The study is limited by the current availability and quality of data estimates abstracted from the published literature.  Further evidence on the effectiveness of self-audit is required to substantiate these findings.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/10/3">
<title>Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study</title>
<link>http://www.biomedcentral.com/1471-2482/10/3</link>
<description><![CDATA[Background:
Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which  suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association.
Methods:
We conducted a population-based study of the risk of re-operation due to post-surgical bleeding within two weeks of primary surgery among Danish women with primary breast cancer. Patients were categorised according to their use of SSRI: never users, current users (SSRI prescription within 30 days of initial breast cancer surgery), and former users (SSRI prescription more than 30 days before initial breast cancer surgery).  We calculated the risk of re-operation due to post-surgical bleeding within 14 days of initial surgery, and the relative risk (RR) of re-operation comparing SSRI users with never users of SSRI adjusting for potential confounders.
Results:
389 of 14,464 women (2.7%) were re-operated. 1592 (11%) had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk=2.3; 95% confidence interval (CI)=1.4, 3.9) compared with never users.  There was no increased risk of re-operation associated with former use of SSRI (RR=0.93, 95% CI= 0.66, 1.3).
Conclusions:
Current use of SSRI is associated with an increased risk of re-operation due to bleeding after surgery for breast cancer.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/10/2">
<title>Indications and outcome of pediatric tracheostomy: results from a Nigerian tertiary hospital</title>
<link>http://www.biomedcentral.com/1471-2482/10/2</link>
<description><![CDATA[Background:
There is a change in the concept of pediatric tracheostomy. This study investigates the indications and outcomes of pediatric tracheostomy in a Nigerian teaching hospital finding out whether there is also a change in the trend in our environment as compared to other centers.
Methods:
A retrospective chart review of 46 patients aged between 2 months and 15 years who presented to our Otorhinolaryngological facility and had tracheostomy between January 2000 and December 2008.
Results:
The age range was 2 months to 15 years. There were 29 males and 17 females. Thirty-two (69.6%) patients were in the age range 6 to 10 years. Forty tracheostomies (87%) were performed as emergency while 6 (13%) as elective procedure. The commonest indication for tracheostomy was upper airway obstruction (n=29, 63%). Transverse skin incision was employed in all the cases. No intra-operative complication was recorded. The post-operative complication rate was 15.2%. The duration of tracheostomy ranged from 5 days to 3 months. All the patients were successfully decannulated. The overall mortality was 8 (17.4%). There was no tracheostomy related mortality.
Conclusions:
There is no increase in the incidence of tracheostomy in patients under 1 year of age and the commonest indication for the procedure in Nigeria has remained relief of upper airway obstruction. Pediatric tracheostomy is safe when performed in the tertiary hospital setting.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/10/1">
<title>Benign Ancient Schwannoma of the abdominal wall: An unwanted birthday present.</title>
<link>http://www.biomedcentral.com/1471-2482/10/1</link>
<description><![CDATA[Background:
There has been a recent growth in the use of whole body Computerised Tomography (CT) scans in the private sector as a screening test for asymptomatic disease. This is despite scant evidence to show any positive effect on morbidity or mortality.  There has been concern raised over the possible harms of the test in terms of radiation exposure as well as the risk and anxiety of further investigation and treatment for the large numbers of benign lesions identified.Case Presentation: A healthy 64 year old lady received a privately funded whole body CT scan for her birthday which revealed an incidental mass in the right iliac fossa.  This was investigated with further imaging and colonoscopy and as confident diagnosis could not be made, eventually excised. Histology demonstrated this to be a benign ancient schwannoma and we believe this to be the first reported case of an abdominal wall schwannoma in the English literature
Conclusions:
Ancient schwannomas are rare tumours of the peripheral nerve sheaths more usually found in the head, neck and flexor surfaces of extremities. They are a subtype of classical schwannomas with a predominance of degenerative changes. Our case highlights the pitfalls of such screening tests in demonstrating benign disease and subjecting patients to what turns out to be unnecessary invasive investigation and treatment. It provides evidence as to the consequences of the large number of false positive results that are created by blind CT scanning of asymptomatic patients i.e. its tendency to detect pseudodiesease rather than affect survival rates. Should the number of scans increase there may be an unnecessary burden on NHS resources due to the large numbers of benign lesions picked up, that are then referred for further investigation.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/9/20">
<title>Management of gastro-bronchial fistula complicating a subtotal  esophagectomy: a case report</title>
<link>http://www.biomedcentral.com/1471-2482/9/20</link>
<description><![CDATA[Background:
The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication.Case presentationA 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula
Conclusions:
This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/9/19">
<title>Laparoscopic retrograde (fundus first) cholecystectomy</title>
<link>http://www.biomedcentral.com/1471-2482/9/19</link>
<description><![CDATA[Background:
Retrograde ("fundus first") dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC) it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation.
Methods:
A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle.
Results:
1041 LCs were carried out including 148 (14%) emergency operations and 131 (13%) associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%). Retrograde LC was attempted successfully in 11 patients (1.1%). The age ranged from 28 to 80 years (mean 61) and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2) with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1.
Conclusions:
In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/9/18">
<title>Risk factors for early recurrence after inguinal hernia repair  </title>
<link>http://www.biomedcentral.com/1471-2482/9/18</link>
<description><![CDATA[Background:
Family history, male gender and age are significant risk factors for inguinal hernia disease. Family history provides evidence for a genetic trait and could explain early recurrence after inguinal hernia repair despite technical advance at least in a subgroup of patients. This study evaluates if age and family history can be identified as risk factors for early recurrence after primary hernia repair.
Methods:
We performed an observational cohort study for 75 patients having at least two recurrent hernias. The impact of age, gender and family history on the onset of primary hernias, age at first recurrence and recurrence rates was investigated.
Results:
44% (33/75) of recurrent hernia patients had a family history and primary as well as recurrent hernias occurred significantly earlier in this group (p = 0.04). The older the patients were at onset the earlier they got a recurrent hernia. Smoking could be identified as on additional risk factor for early onset of hernia disease but not for hernia recurrence.
Conclusion:
Our data reveal an increased incidence of family history for recurrent hernia patients when compared with primary hernia patients. Patients with a family history have their primary hernias as well as their recurrence at younger age then patients without a family history. Though recurrent hernia has to be regarded as a disease caused by multiple factors, a family history may be considered as a criterion to identify the risk for recurrence before the primary operation.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/9/17">
<title>Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery</title>
<link>http://www.biomedcentral.com/1471-2482/9/17</link>
<description><![CDATA[Background:
The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery.
Methods:
Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again.
Results:
The SSI in the colorectal department increased from 19% to 30% (p = 0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p = 0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p = 0.02) and back to 12% (p = 0.003).
Conclusion:
Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.]]></description>
</item>

<item rdf:about="http://www.biomedcentral.com/1471-2482/9/16">
<title>Internal sphincterotomy reduces postoperative pain after Milligan Morgan haemorrhoidectomy.</title>
<link>http://www.biomedcentral.com/1471-2482/9/16</link>
<description><![CDATA[Background:
Over the last few years, there has been increasing attention on surgical procedures to treat haemorrhoids. The Milligan-Morgan haemorrhoidectomy is still one of the most popular surgical treatments of haemorrhoids. The aim of the present work is to assess postoperative pain, together with other early and late complications, after Milligan-Morgan haemorrhoidectomy as we could observe in our experience before and after performing an internal sphincterotomy.
Methods:
from January 1980 to May 2007, we operated 850 patients, but only 699 patients (median age 53) were included in the present study because they satisfied our inclusion criteria. The patients were divided into two groups: all the patients operated on before 1995 (group A); all the patients operated on after 1995 (group B). Since 1995 an internal sphincterotomy of about 1 cm has been performed at the end of the procedure. The data concerning the complications of these two groups were compared. All the patients received a check-up at one and six months after operation and a telephone questionnaire three years after operation to evalue medium and long term results.
Results:
after one month 507 patients (72.5%) did not have any postoperative complication. Only 192 patients (27.46%) out of 699 presented postoperative complication and the most frequent one (23.03%) was pain. The number of patients who suffered from postoperative pain decreased significantly when performing internal sphincterotomy, going from 28.8% down to 10.45% (χ2: 10,880; p = 0,0001); 95% Confidence Interval (CI) 24.7 to 28.9 (group A) and 10.17 to 10.72 (group B). In 51 cases (7.29%) urinary retention was registered. Six cases of bleeding (0.85%) were registered. Medium and long term follow up did not show any difference among the two groups.
Conclusion:
internal sphincterotomy: reduces significantly pain only in the first postoperative period, but not in the medium-long term follow up; does not increase the incidence of continence impairment when performed; does not influence the incidence of the other postoperative complications especially as regard medium and long term results.]]></description>
</item>

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