Questions related to Surgery
The patient is 4 days postpartum after a physiological delivery. Complaints of unbearable pain in the perineum and lumbar pain. There were minor internal tears. On examination, there is no inflammation, no swelling. Pain relief with ketoprofen is of little help. Can you please advise how to anaesthetise or partially relieve the pain?
Please understand and note that I am not involved or interested in any preference of anybody at all .
The question is just only about very critical decision in relation with very expansive & risky surgery/surgeries & also hormonal with other chemical procedures which may even be fatal on short or long run !?
Kindly provide your valuable comments based on your experience with surgical loupes
- Magnification (2.5 x to 5x)
- Working distance
- field of vision
- Galilean (sph/cyl) vs Kepler (prism)
- TTL vs non TTL/flip
- Post use issues (eye strain/ headache/ neck strain etc)
- Recommended brand
- Post sales services
#Surgery #Loupes # HeadandNeck #Surgicaloncology #Otolaryngology
My p.21 mice have started developing seizures after intracranial injection of 4ul AAV to the left lateral ventricle. I’ve done ~22 of these procedures already with no issues. I’m using a 24G Hamilton to inject - which I’m aware is a large needle size but I’ve never had issues before.
Is anyone able to advise what might be causing these seizures? thanks
After the ORIF surgery of right hand wrist fracture, the fingers are stiffened - the finger segments getting as hard as stones (hardened edema) - making the bending of fingers to close the palm as fist almost impossible as the stone hard lower segment of the finger doesn't allow the finger to be bent downwards. The physiotherapist tries mobiisation applying his full might to bend the fingers downwards causing extreme pain to the patient, still the fingers do not bend beyond 90 degrees from their fully stretched position. Is this physiontherapy (extreme torture to the patient) - extending to 2 / 3 / 4 weeks or even more - the only way to restore the fingure movement or there are some easier / painless patient-friendly ways (such as some medication etc.) of treating the stiffened fingers without subjecting the patient to ubearable tortures?
I am looking into purchasing a new stereoscope setup for small animal surgery (rodent), specifically for viral injections into the brain and implants. I am looking for something that is ergonomic, moves/adjusts fluidly similar to a dental scope. At a previous lab, I had one with a floor stand that I liked, but I do not remember what the model was.
Does anyone have any recommendations? What would you purchase if money was not an object?
Dear Potential Participants,
For nearly a decade, I have been researching the use of bedside sonography in hemodynamic assessment of intravascular volume status (and related topics). Study logistics and getting enough critical mass at a single institution always have been my -- and probably your -- greatest limitation to collecting voluminous enough data for truly robust statistical analyses and comparisons.
Would there be interest "out there" to participate in an IRB-approved, centralized repository of standardized sonographic hemodynamic data in exchange for full access to collective data and authorship based on pre-defined criteria?
Examples of data to be collected/entered: IVC dimensions & collapsibility; Other central vein dimensions & collapsibility; Central venous pressures; Pulmonary artery catheter parameters (yes - this "dinosaur" is getting retired, but before it does, let's compare it to something we're going to use for the next 100+ years); Conventional vital signs; Ventilatory parameters (PEEP, Airway Pressures, etc).
Please let me know... Once a "coalition of the willing" is assembled, we can perhaps change and redefine the way our world views ultrasound in the ICU...
Possibily not an open access journal which does not add any publishing costs once being accepted. Thank you in advance
Malignant Hyperthermia, was first perceived in 1962 by Denborough et al., characterized by a state of hyper-metabolic syndrome accompanied with high fever and muscular rigidity, due to a hereditary skelelal muscle defect, excited by inhalant anesthetics.
Following the success of the OGAA Delphi and OG Covid-19 survey, we would like to invite you to participate in our multicenter project titled ‘Chyle LEak following Oesophagectomy for oesophageal cancer (CLEO)’.
• Please enter the email in the survey if you are willing to take part in the second round
• We are offering collaborative authorship for those taking part in both rounds (we need email for that- to contact you back)
• This study is open only for fully qualified Upper GI Consultants/ attendings performing Oesophagectomy
You can access the online Delphi survey by following this link
We look forward to your reply and again appreciate your participation.
Recently surgeons commonly use Harmonic Scalpel during laparoscopy. As we know Harmonic Scalpel is a effective method on hemostasis. What is your opinion about Harmonic Scalpel on operation time ?
I've been grappling with this question for a very long time. There must be a logical reason to explain why almost all humans have one bicuspid mitral valve and 3 tricuspid valves in their hearts.
In the same vein of thought,
- Are there any reported cases of people having a tricuspid mitral valve? How would they present in the clinic (if at all)?
- Theoretically, what do you think would happen if, during a mitral valve replacement, a prosthetic tricuspid valve was used instead of a bicuspid valve?
In the past 15 years or so, there has been exponential growth of technology in surgery. This new era requires a specialized workforce. The 20th century was truly the age of surgeons; however, the 21st century will be the age of multidisciplinary patient care. One good example is the treatment of cancer patients
Are General Surgery trained personnel perform better in other specialties too?
How are their performance on other surgical specialties?
Any evidence to suggest their skill transferability to other disciplines?
With the predominancy of minimal invasive surgery (MIS) , we will have a new generations of surgeons that are highly skilled in MIS but they are less expert in open traditional operation. which some times needed to be done obligatory. what do you think about that?
I am interested in different treatment modalities that are used for men with breast cancers. I will also highly appreciate if you can share relevant research on this topic as well. Many thanks in advance!
Hello dear researchers
I have an opportunity to have a series of interview with great Iranian scientists from all over the world on my social media account.
I am listing the possible questions that I can ask!
If you were me, what were the questions that you wanted to ask!?
Please help me with your nice ideas!
Is fogging of goggles as part of personal protective equipment (PPE) troublesome for you while performing surgery during Covid Crisis? How do you deal with it?
I've seen some colleagues posting cases online where they drain a cryptoglandular perianal abscess inside the anal canal by enlarging the internal opening found at the dentate line. I have not found any published cases with this technique nor any data on its efficiency and healing rates.
Does anybody have any experience with this drainage option or any idea if it is an acceptable surgical technique?
Our approach to R Hemicolectomy is starting from mid point of Transverse colon Gastro colic ligament using an articulating Enseal,Entire t colon can be mobilized with out frequent change of instruments,much faster,equally effective mobilisation and no added problem to duodenum and ureter.Please see the Link for the technique.
A young patient (28 years) presented to our casualty with gunshot right chest within 1 hour of injury with stable vitals except tachycardia. The entry wound was in the right lower chest in mid-clavicular line tracting towards right side of abdomen. The bullet was found to lie in the pelvis on x-ray abdomen erect and lateral views but there was no pneumoperitoneum. Patient had right pneumothorax on x-ray of chest. Due to the mechanism of injury, direction of bullet tract and location of bullet, bowel injury and diaphragmatic injury was presumed; and patient underwent laparotomy within 3 hours of injury but per-operatively no bowel, solid organ injury or hemoperitoneum was found. The bullet could be palpated retroperitoneally against the right pubic bone. Limited retroperitoneal exploration on right side which revealed no retroperioteal injury or hematoma. No diaphragmatic rent was found. How this location of bullet can be explained on the basis of above findings? Patient was discharged after 6 days without any complications.
As an anesthesiologist and also perioperative management, is more concerned with the level of blood sugar at the time or during perioperative time. If that time level is ok, then, will it have an effect in management by knowing the last three months status (even if it was poorly controlled)?
COVID-19 has pull people apart from each other. Social distancing is the main way to prevent spreading of infection. Tele-medicine, once used for rural area remote healthcare model, is the emerging new way of practice under COVID-19.
Different specialties have different practicing needs, what difficulties do you encounter on applying tele-medicine under COVID-19 in your specialty? Will tele-medicine totally uproot the usual face-to-face room consultation of medical practitioners? And becoming the new service model?
What is your view?
Virtually Perfect? Telemedicine for Covid-19
Covid-19 and Health Care’s Digital Revolution
Telemedicine in the Era of COVID-19
The Journal of Allergy and Clinical Immunology: In Practice
Keep Calm and Log On: Telemedicine for COVID-19 Pandemic Response.
‘Healing at a distance’—telemedicine and COVID-19
Public Money & Management
The Role of Telehealth in Reducing the Mental Health Burden from COVID-19
Telemedicine and e-Health
A milestone by Theodor Billroth in surgery and cancer surgery.
- the 139th anniversary day (Jan 29, 1881)
Christian Albert Theodor Billroth (1829-1894)
the first successful distal gastrectomy
for gastric cancer within 90 min
However, we may should be aware that everything in medicine surgery cancersurgery science needs teamwork
We are nothing without the Team!
I am conducting a research project to see whether demographic/patient factors can predict patients who are likely to suffer a post-operative death (Categorical outcome Y/N).
I have conducted univariate regression procedure using SPSS Firths regression as I have a small sample size with the dependant variable being a sparse event. This has given me 3-4 variables with P<0.10.
DO I now proceed to perform a multi-logistic regression? If so, do I run Firths regression with all of these variables selected as co-variates or do I perform a more traditional multi-nominal regression model instead?
Any help would be appreciated as I can't find any guidance on this issue.
Hi, do you have any experience on pre-bariatric panniculactomy in BMI 50-90? Our endocrinologists/bariatric surgeons are excited that we plastic surgeons should start doing this, I am not excited about this. Their idea is that first we do panniculectomy, and after some months/years they do the bariatric procedure.
Like to hear your experiences and recommendations for literature. Maybe I did the search with wrong words, but the catch was small.
Is there any selective advantage to the brachial plexus being a network instead of independent nerves? Same question for the lumbosacral plexus.
What is the best way to perform a urethrolysis? With or without martius flap? With or without synthetic sling (to prevent urinary incontinence)?
The patient should consult which specialty if he wants to know, will he stop aspirin prior to the operation or not? Will he consult the Cardiologist, the surgeon or the anesthesiologist?
In the following video, we suggested an important surgery for our macaque monkey to find whether there are entanglements between the retina and the visual stimulus, and whether tachyon (faster than light particle) does exist; and we wish to hear opinions for the scholars in the field! See the video below:
Radical cystectomy (rCx) for MIBC is the only curative therapeutic option.
Standardized preoperative protocols such as ERAS help shorten recovery time and reduce postoperative complication rates.
But is there something missing? Can we do something different or even better?
There are many techniques for managing pilonidal sinus disease. I would be interested to know which you refer and how you decide which technique to perform if you use more than one.
53 Y F, last degree prolapsed uterus presents with four ulcers, 2 on the surface of the uterus, one on the surface of cervix and another one (Can't recall the location). There is daily discharge. What is the appropriate treatment to eliminate the discharge until she undergoes vaginal hysterectomy? Local antibiotic therapy or what?
Medications she takes:
Bisoprolol 2.5 mg once daily for Atrial Fibrillation
Cetirizine 10 mg once daily for Allergic Rhinitis
Daflon 500 mg once daily for chronic venous insufficiency
Non-Alcoholic-Fatty liver disease (Not managed with medications)
Blood tests were done and no other abnormalities.
What we know:
- We know that ~35-45% of colorectal cancer cells bear the KRAS mutation.
- We know that certain chemotherapy drugs are NOT effective in treating colorectal cancer cells bearing K-ras mutations (cetuximab (Erbitux) and panitumumab (Vectibix)).
- We know that most experts agree KRAS testing is important in determining chemotherapy treatment.
So, what percentage of physicians actually order KRAS genetic testing for their colon cancer patients? To be determined.
Is it cost effective? Turns out it's average.
Screening for both KRAS and BRAF mutations compared with the base strategy (of no anti-EGFR therapy) increases expected overall survival by 0.034 years at a cost of $22 033, yielding an incremental cost-effectiveness ratio of approximately $650 000 per additional year of life. Compared with anti-EGFR therapy without screening, adding KRAS testing saves approximately $7500 per patient; adding BRAF testing saves another $1023, with little reduction in expected survival.
Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year."
(1) What drugs might be more effective against colon cancer cells bearing the KRAS mutation?
(2) What drugs might be more cost effective against colon cancer cells bearing the KRAS mutation?
(3) Relating to cost effective treatment, how often do we prescribe drugs or assign treatment plans that are expensive $$$, decrease the length of the patient's life, and decrease the patient's quality of life? How can this be prevented? (E.g., recommending surgery procedures for aged colon cancer patients). How do we incentivize treatment that is most cost effective?
When you prescribe a medication, what is your go-to-site/book/reference to check for adverse reactions? And what type of adverse reactions do you check? Is it type A adverse reactions only that you check?
And in other words: what are the most important adverse reactions that you must check?
I am looking for opinions of pediatric urologist about best approach and treatment of 3 months old boy with megaureter with hydronephroses grade 4 on left side. Right side with no problem.
First US taken 16 hours after birth:
Left kidney size 52mm
pelvis diameter: 12-14mm
parenchyma: thinnest part 2mm
ureter: 8mm juxtavezical
VUR (5 days after birth): negative
MAG3: DRF: 34.8%
Second ultrasound (22.jan2019 at age 3 month and 5 days):
pelvis diameter: 14-19mm
parenchyma: thinnest part 3mm
ureter: 14mm juxtavezical
Boy is on prophylaxy ATB. Would you recommend surgery and which method?
MArtina Suchar Liptakova
The technique is like open surgical stenting. Absorb-able suture acts as a non-hollow stent till it gets absorbed. Therefore the technique should give good results while doing fallopian tube reversal. Suggestions and opinions are solicited.
Conference Paper prepubic midscrotal Vatsyayann's technique of Vasectomy
in these days , are the oncologists and clinicans still used transcatheter oily chemoembolization for treating hepatoma cancer ?
hepatoma is the live cancer that sticks to the liver's vessels so it cant be treated by surgery , so this method is used , but I dont know that this method is still working or some new approaches came for treatment .
After Pilonidal Surgery we always advise the Patient to shave/remove hair from natal cleft repeatedly to prevent recurrence. Usually many patients do not follow these instructions and in some cases recurrence takes place. We started advising permanent hair removal by laser or by other methods. Now we have observed no recurrence (4 yrs. follow up). Are we right ?
Sometime it has been seen that surgical team approach the patient party / attendant for a radical procedure (for example - consent taken and planned for cystectomy and introp surgeon decided to do hysterectomy) in an general anaesthetized patient. Is it valid or acceptable? The operation is elective, patient is otherwise capable to give consent when awake and consent; taking consent from attendant / party isn't against patients autonomy?
63 yr old male.
Apr 2015 radical nephrectomy (left) . for CCRC grade 4. PT3a N0M0.
Aug 2016 local récurrence 1,5 cm 1yr after. Complete resection.
Feb 2017 2nd local récurrence with left colic angle obstruction. Complete resection.
MDRD: 32 ml/mn
do you propose targeted therapies? When? Which?
How much of the synthetic substance is examined in a way that the hemostasis properties is well studied?
I think no other person knows a surgeon better than an anaesthesiologist as a professional especially about the surgical skill and quality. (because they closely observe different surgeons of same and different specialty). Many a time even a highly qualified surgeon is very poor in skill and delivers very poor for the patient. (The same may be true for anaesthesiologist too). This in turn leads to unwanted morbidity and even mortality. Anaesthesiologist is equally or may be more responsible for the well being of the patient during perioperative and especially intraoperative period. So, if the anaesthesiologist knows that the surgeon supposed to do the case is not good enough for the proposed surgery, can anaesthesiologist refuse to give (anaesthetize) the case?
Different opinions arose in the last few years about the timing for operating chidren with congenital esotropia? What do you suggest and why on the basis of strong scientific evidence?
Efficacy of sclerosurgery (sclerotherapy).
Or with a microcystic form of malformation, surgical removal (laser, cryosurgery, radical surgery) should be used?
The optothermoacoustic focusing element was suggested in . This element can create a great local stress in a special shaped area inside the matter. Is it possible to use this technique for surgical operation upon internals without cutting the upper body tissues? In principle, this method gives the possibility to reproduce action of the scalpel or the other surgical armaments.
Imagine using stem cells from a baby’s own umbilical cord to “patch” its damaged heart – one surgery that enables the implanted engineered tissue to grow with patients as they age.
“The goal is one operation and then a lifetime of normal heart function . . . it would be a normal heart,” said Craig Simmons, a Distinguished Professor of mechanobiology in the University of Toronto’s department of mechanical and industrial engineering and Institute of Biomaterials & Biomedical Engineering.
If hip damages severely by arthritis, a fracture, or other conditions, hip replacement is needed to relieve pain and increase motion.
Its more common in elderly , however the risk of problems after surgery increases because of their weaknesses and age . Most of them are forbidden from such aggressive treatment and implantation .
So whats solution ? can the risk of surgery be managed?
Or a substitute treatment is required ?
Is stem cell infusion as effective as surgery ?
- A person who has a lot of bleeding needs to have blood.
- Can one person's blood be used directly and immediately as a source of blood supply? and if so, what requirements should be considered?
Hi! I am a medical student looking for published data on MIC and ITC detection rate in early-stage cervical cancer patients who underwent robot-assisted surgery and can't seem to find any in pubmed.
It may be that there is nothing published on the subject but if there is, could someone point me towards where I can find that data?
Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. (WHO) It is also recommended to assume that every person is potentially infected or colonized with an organism that could be transmitted in the health-care setting and apply the following infection control practices during the delivery of health care. (Guideline recommendation). Personal Protective equipment are to be used as one such measure. But I am unable to find whether the OT table and floor should also be covered with plastic? Please give your opinion with logic (reasoning) and evidences.
a gentleman with isr has prolapse of colon after isr, while a feels a whitehead procedure in 2 phases may be good, has anyone any experience on this
Cost is always a concern in the present health care delivery, even in developed countries. The prevalence of such disease is quite low (in most of the area of the world). In such scenario, doing these tests in all patients costs billion. Is this cost-effective? if it should be done mandatorily, why? Or, should these tests be done based on history and examination?
We have reported several years ago the 5-year-old male patient with Li-Fraumeni syndrome with osteosarcoma and atypical type of hepatic cancer. Intriguingly, the cancer stem cell marker CD44 variant was ectopically induced after chemotherapy probably due to the selective pressure of excessive reactive oxygen species (ROS) provoked by chemotherapy.
I am appreciated if you would give me some feedback or comment on the following article.
Li-Fraumeni syndrome with simultaneous osteosarcoma and liver cancer: Increased expression of a CD44 variant isoform after chemotherapy
I realli need an exact answer about quality and geometrical shape of screws and angle that we use for nailing.
I was operated by laparoscopic technique from two large indirect inguinal hernias located on the left side of my groin and one smaller on the right side of my groin. I don't have any other complication from the surgery except that after two days large bulges on the left and the right sides returned back almost to the same size as before the surgery. I panicked today when I started to experience pain on the left side of my groin. I do have appointment with the surgeon on January 19 th 2017. Please advice what I do in case the pain becomes more frequent.
Research shows that medic legal apprehension is a big factor contributing towards the continued practice of routine preoperative testing. [doi:10.4103/ija.IJA_92_17] Whereas it is very much evident that routine preoperative laboratory testing is unnecessary and is not recommended.
This is with reference to a patient suffering from low hemoglobin (as low as 4-5) for over a decade. With blood transfusion or medication (including some injections etc.), the hemoglobin rises slowly to 7-8-9 but then again has a tendency to fall back. What could be the reason?
The question is with reference to a patient suffering from differential body temperature, her right side (particularly the hand) occasionally being substantially colder than the left.
All articles describing this model give 5% dextrose in drinking water without food.
Can I give them hi calorie drink during their healing period (2 days before surgery and until 4-5 days after it)?