Surgery - Science topic

I'm also interested to do some collaborated research with you, as I'm also belonging in the field of neuroscience.

in case of interest

Greetings Qamar,

Thank you for your question.

General Surgery is a broad specialty with a plethora of sub-specialties and sub-subspecialties underneath it.

To find a valid meta-analysis idea, I would personally advise you to narrow down your scope to a subspecialty of your interest. Try subscribing to journals & updates falling under this particular specialty and read - as frequently as possible - the most recent publications. Additionally, you may use websites such as "Medscape" to remain up-to-date with the latest advancements in your specialty of choice. This approach may help you identify possible gaps in literature which may be addressed appropriately by conducting a meta-analysis.

When validating your meta-analytic idea, try making sure it follows the FINER criteria [Although ethics might be overlooked when conducting secondary research as the primary studies you're trying to pool have already had their ethical approval].

Hopefully this answers your question!

Best Regards,

Mohamed Ibrahim

Neat idea, how about letting or certifying someone just in simple antibiotics and Corticosteroid pills (usually prednisone)? For example, for severe rashes like poison ivy are always of prednisone and go home. You could easily make a list of 20 common ailments and their protocols that are almost knee-jerk reactions.

Volodymyr, it is important to find the reason of the pain.

- Infection (endometritis, perineal, UTI)?

- Urinary retention?

- Haematoma or other trauma?

- Neurological? (for example from sacral plexus or pudendus?)

Women postpartum generally can receive both paracetamol and NSAID, some few days of Oxykodon can be okay if the neonatologists are fine with it (or if she is not breastfeeding). In some cases, epidural or nerve block can help postpartum also. But the priority is to find out what's the problem, not just releive pain.

It's Psychological illness.

A loupe with at least 3 to 3.5x magnification should suffice.

How soon after AAV injection do you notice the seizures? While the mice are still anesthetized, or during recovery?

4 ul sounds like a lot to me - that's more than 10% of total CSF in a mouse (as far as I know). Could it be that you are generating too much intracranial pressure? I'm not familiar with ventricular injections, though, so perhaps that is a normal volume? For brain injections typical AAV volumes are ~50-500 nanoliters.

Admittedly, if you haven't changed anything and previously you didn't run into any issues with the same procedure, same virus, and same mouse strain, then this seems odd.

I recommend you ask your staff veterinarian for advice; this type of adverse outcome likely needs to be reported to them anyhow.

There may be various reasons for stiff fingers following wrist surgeries such as lack of occupational therapy and complex regional pain syndrome (reflex sympathetic dystrophy syndrome) . Best option is to start graded occupational therapy combined with wax therapy . If the stiff ness associated with pain ,then always need to suspect CRPS. so treat accordingly with various measures including drugs and therapy. It would be a long course to get normal functional hand.

In my sixty 60 yrs of practice I found Finger dissection's tonsillectomy with diathermic cauterization is safest, quickest & needs least post operative follow up

Thanks.

Apart from the pre-anesthesia clinic visit regarding fitness, all patients should be seen by the concerned anesthesia team at least a day prior and the plan of anesthesia should also be discussed and any preoperative instruction can be given at that time if required. This gives a sense of bonding between the patients and anesthesiologist in a better way.

For daycare surgeries, where patients directly come from home, the anesthesiologist should visit the patient's preoperative waiting room and meet the patients as early as possible (maybe at least 2 hours prior).

What a great idea, I am interested in this project.

To any peer-reviewed journal of neurosurgery or neuro-oncology.

A good family patient history, because, reports of latent myopathies and MHS by statins, as well as evidence of statin myotoxicity in small animals, has raised concerns that this drug class might adversely affect the outcomes of diagnostic MH susceptibility testing in vitro or the course of MH in vivo

Thanks Matti and Tageja.

In my humble opinion, the main goal that the surgeon should keep in mind is to make his surgery (cholecystectomy) safer.

You understand that the fear of the surgeon (my fear) during the realization of a cholecystectomy is to induce an operative bile duct injury, for that I take my time to protect my patients from my errors of identification.

The rush, ego, and ease of the procedure create an environment that fosters the illusion that lead to an involuntary injury.

The time lost in achieving hemostasis of the gallbladder bed is generally marginal compared to the time spent in identifying the different elements of the Calot's triangle and in the achievement out the critical view of safety.

This is an interesting question. 3 leaflets mitral valve is unusual. However, you can have prominent A1 or P1. AV canal can be associated with anomalies of the leaflets number and usually has associated mitral regurgitating.

We can implant tri leaflets biological valve in the mitral position with no hemodynamic effect provided that no LVOT obstruction

Dear Dr Sunny Chu Lik Au:

Thank for raising this important question. There is a dilemma of general or subspecialty. Subspecialty is important in developing the management of cases but in the same time it created a pinhole vision of the physicians and no one is looking to the patient as one unit and look to the overall need. Each subspecialty want to put the optimum for his work regardless of the overall need of the patient or his stage need.

I support my colleagues in the importance of training in general surgery for every other surgical specialty. I suggest 1 year as minimum time spend in general surgery if not making degree in general surgery as requirement for doing subspecialty study.

Every kind of procedures have a place in the treatment of patients and the surgeon must use the best for the patient (personalized surgery) For example ,Robotic surgery for gallbladder is not indicated for the cost and not superiority ,Some kinds of trauma due to the emergency situation, it is obvious, robotic procedure is not indicated. I think residents must learn all the kind of procedures to be used in specific situations .

The breast cancer treatment is similar in both, female and male. And this treatment may change by the stage, molecular profile (the last TNM by the AJCC).

The options are medical treatment (chemotherapy, anti-hormones, anti-her2, inmunotherapy), surgical options are more limited, normally in the male the surgery is a radical mastectomy w/wo sentinel node Vs LAD, and the third option like treatment is the radiotherapy.

There are no G-d scientists, although G-d is the greatest scientist. As earthlings, with respect to your question, the development of our genius, e.g. the full healing potential of physicians and the medical profession, is bound to step over certain rules of one or more disciplines. It is my informed guess, that the new global economic growth engine of the 21st century will be human health, in holistic terms. We will gain a more sacred or higher understanding of the humany body and our biological condition on this planet, also in terms of practical ethics and health. Concerning the medical sciences, profiteering-from-disease is no future model. Wishing you good luck with all your interviews and much progress in your field !!!

Equally, dear Dr. Hossein

Despite trying you best to prevent any air leak, fogging does take place eventually. Below mentioned is a evidence based study wherein gently washing your goggles with a detergent based product before application prevents fogging.

https://doi.org/10.1308/rcsann.2011.93.2.168b

I don't use it but it may be of some interest in the case of D3 lymph node dissection as the retroperitoneal mobilisation of the right colon allows easier dissection along the superior mesenteric vein axis and skeletonisation of the right colic branches.

I agree that the tenet of "no touch technique" prioritizes vascular ligation before mobilisation of the colon. Nevertheless, we have to accept that no data exist showing a survival benefit for laparoscopic medial to lateral, lateral to medial or D3 lymph node dissection in right colon cancers.

Prasanna Kumar Reddy do you continue using the craniocaudal dissection or have you shifted to another technique?

Did this get published? Am I to understand that the wound trajectory is almost vertical? If so, we may have another "Space Bullet" which is a low velocity bullet and can travel alone the path of least resistance, thus dissecting a path along tissue planes, and may miss major structures as it does not follow a straight line. This should be visualized well on a 3-D CT scan. You can read the full-text on "Spent Bullets" here on RG; which explains the research on a large series of the first published cases. Thank you for your support, Gary Ordog, MD

Thank you Dr Habib.

I work in a private facility in Nigeria and most of our surgical patients present for implant / joint /spine surgeries. We do postpone cases for non urgent / non emergent procedures with HbA1c > 8%, even when preop RBS is <200mg%. This is to reduce SSI and other postop morbidity and mortality rates. Other centres accept HbA1c between 8-9%.

Hello, in Portugal, during Covid there was a huge increase of tele consultation. Still some barriers were found:

- older people have more difficulties in using digital tools.

- 3G and 4G coverage is still low in some rural areas.

- Lack of good tele consultation tools available to be used, some physicians then still want to do the face to face consultation.

Theodor Billroth *26 Apr 1829 †06 Feb 1894

Remembering giants in science, medicine and surgery - German Surgeon & Co-Founder of academic surgery

Happy Birthday

"I can not understand how someone can read receptively only"

"Only those who know the past & present of science and art, will boost their progress with awareness"

~ Theodor Billroth

La proteína C reactiva (PCR) es una proteína producida por el hígado que aumenta en respuesta de la inflamación, es decir, cuando existe alguna inflamación en el cuerpo, y no es específica. Antes de la cirugía tener una PCR significa que existe un proceso inflamatorio y como no es específico, se debe investigar la razón, y ayuda mucho la clínica que presente el paciente, es decir, una adecuada Historia Clínica y las investigaciones en relación con la sintomatología deben confirmar la hipótesis planteada. Los niveles muy altos puede significar la existencia de una infección grave u otro trastorno.

Hello Suliman,

You didn't indicate how small a number the less-observed outcome was for your data set. If it's 100 or more, I wouldn't worry at all about using ordinary logistic regression. If 50-80, then LR may be fine if you have only a modest number of IVs in your model. If it's, say, 10 or fewer, then you're better off sticking with Firth method or some adjustment thereto (see link below). There are other, penalty-added methods available; I just don't know how they might perform with your data.

It's possible that someone has done a simulation study that includes conditions that match well to your data set. If not, you could always try that, to be more confident about your ultimate choice.

Good luck with your work.

I would be interested to know the reasoning for this request please.

Any body suffering from any infectious disease must not go for surgery including eye.

i have found it is difficult to get clear answers to questions about the original design of the body...

why would the taste sense of the anterior part of the tongue run through the middle ear

There are 2 ways to perform an urethrolysis: abdominal and/or vaginal approach.

The best way depends on the reason why you have to perform it.

In my opinion there are only few indications for urethrolysis nowadays.

Is it for a cyst? a diverticule? or something like this? so you have to choose vaginal approach.

Is it for a AUS implantation? Choose the abdominal approach (open or laparoscopic).

We always use a radio tracer but in many cases we combined it with ICG (hybrid tracer with a very low concentration of ICG) )or with ICG just before surgery (concentration 2,5 mg/ml) in 1 to 3 ml depending on the tumor. For example, in melanoma or oral cavity tumors we use hybrid tracer and for gynecological cancer sometimes we use the hybrid tracer but other cases we inject ICG alone (after a pre-operative lymphatic mapping with the radiotracer)

Courtney Seligman Please bring your references. By the way, had you read about 'worm holes'?

thank u sir

Homeopathy has a long history as you mentioned and as a holistic medicine in many treatments work and heal .

Artificial intelligence (AI) has been used in medicine to create symptom checker in which the AI is able to provide differential diagnoses based on the initial symptom(s) of a user and subsequently provide appropriate triage to the user. Besides, it has been used for the purpose of healthcheck to determine the risk of certain diseases in an individual. People also use AI in the field of radiology to diagnose breast cancer by artificially interpreting the results of a mammogram, that’s usually done by a radiologist. This could potentially reduce the waiting time of the review of mammograms by a radiologist and increase the early detection of potentially curable breast cancer.

The attached is the link to a study conducted on artificial intelligence and how its being utilised to provide triage and diagnosis.

This patient need to sent pap smear and accordingly she may need punch biobsy for ulcerative edges to exclude premalignant and malignant condition

regard her compleant she can putted on medication that improve the healing of these ulcers ,by return her uterus back inside pelvice by pack and local antibiotic eg.flumazin and treatment that decrase frction of pack with ulcer and treatment improving healing of ulcer

Read Anatomy books and watch Acland's Anatomy

https://www.youtube.com/watch?v=jWtDaWsR1E0&list=PLHsFQaqph2ZBWe9YESaXlttNwt2RUlJgV

Amr Mahmoud RPMI is generally used for culturing lymphocytes, I've grown primary T cells and B cell lines in RPMI and they are fine. I have not used these media for generating cell lines so I can't comment on which is more suitable for your procedure. AIM-V might be a good shot for lymphocytes if you wish to avoid bovine serum supplementation. Good luck.

More can be found here https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf

Several:

1. Package insert

2. Physician Desk Reference

3. Online resources of FDA

4. Review published peer-reviewed journal articles

Regarding surgical aggression, I suppose if your only tool is a hammer, everything looks like a nail. Others have written works that confirm my experience with observing megaureters. (DiRento J Urol 190; 1021, 2013 Shukala J Urol 173; 1353, 2005). These and most current authors base clinical decisions on the result of the nuclear scan, but my experience suggests that the differential function of a kidney (determined by scan) changes little with or without surgery. Additionally the measurement of differential function itself is flawed. Many "obstructed" kidneys have greater differential function than the opposite normal kidney. (Liss J Ped Urol 9; 613, 2013). Jacobsen et al (J Urol 200; 440,2018) have conclusions that I don't agree with, but their work points out that the nuclear scintigraphy often does not change in concert with improved ultrasound appearance...which is worth noting in this case. In any event, I base my operative decisions not on the scan, but rather on the degree of sonographically determined hydronephrosis and, in general, the degree of hydronephrosis will generally improve with time. As the ureter is large, reimplanting it in a larger bladder is easier and therefore I generally wait to at least a year of age before making any surgical decisions. In this case, the scan was obtained too early, but it demonstrated that there was decreased function in the involved kidney. Enough so that I would not think that the contralateral kidney is sonographically "normal"...I would predict that it should be bigger than normal compensating a bit for the decreased function in the involved kidney. How big should a kidney be? Check out https//:wwwprevmed.sunysb.edu/jjc/MrNomogram/Default.aspx

I follow

Yes it is still used in advanced HCC provided that preserved liver fiumctio and performance status of the patient.

it also can be used as a bridge for OLT

Patients with cardiovascular disease and or cardiovascular risk factor submitted to dental implant surgery require monitoring by multidisciplinary team.

During osseointegration some factors that increase implant failure rate include health problems that affect the bone healing process such as uncontrolled diabetes (cardiovascular risk factor).

After osseointegration, clinical and radiographic follow up of these patients with implants should include evaluations of pain, mobility, bone crest loss, probing depth and peri-implantitis. Also, genetic factors such as polymorphisms in interleukin-1 genes can be used to monitor the status of the implant site and minimize the chances of failure.

It looks like pdf files.

They have their own template for submission.

The website has a template on Elservier-

Current problems in surgery

3. Submit and revise

You can submit to most Elsevier journals using our online systems; the system you use will depend on the journal to which you submit. You can access the relevant submission system via the 'Submit Your Paper' link on the Elsevier.com journal homepage of your chosen journal. Alternatively, if you have been invited to submit to a journal, follow the instructions provided to you. "

Fracture pattern: comminuted or transverse, spiral or oblique. May want more locking options

Fracture location: Proximal or distal can determine antegrade or retrograde nail, or if specific types of nails are better at proximal or distal fixation

Bone quality: osteopenic, osteoporotic can have effects on nail fixation, or especially size of nail.

First whats your decision on this case?

It seems that Dr. Dwivedi has opened up a can of worms with his question ! I think this is a very relevant and pertinent question, with pilonidal sinus being a common problem, notorious for its recurrence.

I agree with Dr. Naqvi - there is a theory for recurrence in a hairless cleft. It's most likely due to the hairs that fall from the head down the back and eventually into the cleft.

I don't remember that I read or do vesicotomy in transverse direction, we usually open the bladder in the Medline vertically, because it is always away from ureters, easily and safely extended, so you can bifid the bladder without risk, though if the bladder is opened by trauma in a transverse direction, it can be sutured in the same direction with the same healing rate.

If the surgeon performs an operation to which the patient has not consented he may be liable for battery. If the patient has only been informed of the procedure involving a cystectomy then she is unlikely to have given consent to the much more radical intervention of a hysterectomy. The problem with the type of consent needed in battery lies ‘in working out when the information about a proposed treatment is so fundamental that, without it, consent must be regarded as ineffective’ SA McLean (ed), First Do No Harm: Law, Ethics and Healthcare (Ashgate 2006) 276. Would the removal of the uterus not be such a fundamental information? In any case, it is the patient herself who has to give consent and not some other member of the family unless she has agreed before the surgery that she is happy for any decision to be taken on her behalf by that other family member.

But we don’t heal the proper mechanism of the microscopic disease , i.e , cell spreading....

I hope you are well guided now

I would be very careful to pass judgement on a colleague's competency in a speciality other than my own. Are you qualified to judge? are you a trained surgeon?

What would you achieve by declining the case - are you protecting the patient, or yourself? If he is truly incompetent and you decline the case, will your place be taken by an anaesthesiologist who is unaware of the surgeon's incompetence? In this situation the patient might be in even greater peril.

Another issue is what are the results of the surgeon's incompetence? Is there an obvious problem such as increased mortality or morbidity - do his cases bleed more and more often require transfusions? How do you see his incompetence in the OR - is he clumsy, does he perform the wrong procedures? (assuming you would know what the correct ones are). Does he have an increased rate of emergency reopening? etc., etc.

You are potentially opening a can of worms. It is important that you share your concerns with a senior colleague.

This sort of situation is best dealt with quietly and confidentially by a hospital board of senior, experienced clinicians to whom you might express your concerns and seek advice.

1. The CEOS found that infantile esotropia persists in 98% of infants who have large-magnitude (≥20° or 40 PD) constant esotropia with onset after 10 weeks of age and refractive error ≤3.00 diopters. Thus these patients will benefit from early surgery.

2. Go through doi:  10.3129/i08-115 , Wong et al. The protocol attached is from this study.

3. The ELISS study (early vs. late infantile strabismus surgery study) also reported that children operated early had better gross stereopsis at age six as compared to children operated late .

4. Rule out an unstable angle of deviation and a paralytic component, then do early surgery for chances of stereopsis. This study also confirms the same.

Hirabe H, Mori Y, Dogru M, et al

Early surgery for infantile esotropia

British Journal of Ophthalmology 2000;84:536-538.

There is an article that describes two architectural subtypes of microcystic lesions: open-cell and closed-cell, suggesting the success of sclerotherapy with OK-432 in microcystic lesions may vary depending on the subtype. Here is link to the abstract in pubmed:

Dear Anatoly, I

completely agree with you. Please my new article in GR is attached Sad news. Anry Amrosivich Ruchadze died one day ago. The parting procedure will take place on Monday in 11-00 in General Physics Institute in Moscow. Sincerely, Alexander.

With all the studies we have pursued, both pre-clinical and clinical, the stem cells will react to local environmental cues to direct their integration, growth, and renewal. Our results have shown that it is best to start with the most prinmitive stem cells possible and allow the body to dictate what cell type it wants (local factors affect the stem cell's particular differentiation process) and where it places that partiuclar cell type. For example, in a pre-clinical animal study we infused pluripotent stem cells systemically to repair hearts that we had previously damaged either by freezing the apex of the heart or destroying cardiac muscle by transient coronary artery (LAD) ligation. The pluripotent stem cells repaired ALL tissues damaged, i.e., cardic muscle, vasculature, and cardiac skeleton (see attached paper), not just the hoped for cardiac muscle. And intuitively, it makes sense. The "body" will want ALL damaged tissues replaced, i.e., supportive elements, such as vascular supply (for nutrient delivery and waste removal) and cardiac skeleton (restore function), as well as the desired cardiac muscle.

Advances in Pre and post operative optimisation of patient and overall bone health and rehab part should play good role in making most patients lead optimal outcome and should be the focus than stem cells as of now.

Thank you! Sorry for the late answer: I didn't receive any email notifying me of your answer. Will check the article right away!

The built environment should be appropriate to allow cleaning and disinfection e.g. Impervious and intact surfaces for floors , walls , coverings on the mattresses, that allow ease of cleaning and prevent ingress. The principles of environmental decontamention after any patient is based on cleaning then disinfection if needed Including after spillage of blood or body fluids or patient known to be infected e.g. MRSA! CPE etc . All medical devices which includes the theatre table and any device used for treatment and therapy must be provided with manufacturer instructions for decontamination which must include method, product for risk levels of contamination low, medium, high risk!. In the UK, decontamination is guided by medical devices directives and Health technical memorandum's on decon. There are also national standards for environmental cleanliness and infection control in the built environment guidance to refer to. Therefore plastic covering for floor and table is not needed as the environment should be appropriate to prevent infection and allow decontaminationalongside management and decontamination of equipment and medical devices.

You've misunderstood - we all perform ISR/ ULARs etc. And all of us who do are aware of the possibility of prolapse. The issue is having the facilities available to diagnose and know-how to manage the complication which technically, we have created.

Are you saying you have an ano-rectal physiology lab? If so, then those figures should help you make a decision as to whether surgery is indicated or not. The abstract above doesn't answer the query

No, all patients should be considered as infectious. as there is a window period during which the patient is more infectious inspite of testing negative.

I am appreciated for your kind comment.

It has been shown that CD44 variant 8-10 (CD44v), produced by the alternative splicing machinery regulated by ESRP1 protein, contributes to the attenuation of high level of redox stress in the tumor microenvironment.

My colleagues and I have demonstrated that CD44v interacts with and stabilizes the protein xCT at the cell membrane. This latter protein, together with CD98 heavy chain, forms an antiporter known as system Xc(−) that exchanges intracellular glutamate for extracellular cystine. Cysteine as well as glycine and glutamate are essential substrates for synthesis of GSH. CD44v8–10 thus promotes GSH synthesis by increasing the import of cystine and thereby increasing the intracellular concentration of cysteine. The elimination of ROS by GSH inhibits the activation of p38 MAPK signaling and thereby prevents ROS-induced senescence, apoptosis, or differentiation of cancer cells. The CD44v8–10–xCT–GSH axis thus protects CSCs from redox stress.

Ref.

* Inversed relationship between CD44 variant and c-Myc due to oxidative stress-induced canonical Wnt activation.

Biochem Biophys Res Commun. 2014 Jan 10;443(2):622-7.

* Alternative splicing of CD44 mRNA by ESRP1 enhances lung colonization of metastatic cancer cell.

Nat Commun. 2012 Jun 6;3:883.

* Therapeutic strategies targeting cancer stem cells. (Review)

Cancer Sci. 2016 Jan;107(1):5-11.

Sincerely yours

Go J. Yoshida MD, PhD.

Once there is an indication for warfarin in patients with a history of atrial fibrillation it should not ever be permanently stopped.

In the study indicated below oral anticoagulation was a protective factor for survival among the CE patients.