Call Us: +91-779-979-0002/+91-779-979-0003

Plenary Talks

Abstract

Background Severe end-stage arthritis of the ankle is a debilitating condition that affects patients’ function as well as pain. Traditionally, orthopaedic surgeons have opted for joint arthrodesis over replacement because of high failure rates with early prostheses. Newer ankle replacements have been introduced with better results. Therefore, more surgeons are opting for ankle replacement to preserve ankle motion and to prevent adjacent joint arthritis. Currently, there is debate in the orthopaedic community about whether a mobile-bearing or fixed-bearing ankle replacement is superior in terms of longevity, satisfaction, and function. This study was designed to evaluate patient satisfaction and functional outcomes of total ankle replacement for ankle osteoarthritis by one of two currently available and approved ankle prosthetic devices, the mobile-bearing STAR and the fixed-bearing Salto-Talaris. Methods and Materials This study was approved by the institution’s IRB committee. From November 2011–November 2014, adult patients over the age of 18 who have severe osteoarthritis of the ankle joint, significant enough to be treated with a total ankle replacement as determined by a surgeon along with the aid of the physical exam and routine radiographs were recruited for this study. Patients recorded preoperatively,at 6 and 12 months postoperatively, then at yearly intervals the visual analog pain score, short form 36, AOFAS hindfoot score, a short musculoskeletal functional assessment, and FADI. Additionally, routine 6-view radiographs were obtained at the same time intervals. Exclusion criterion Patients with weight greater than 230 pounds and with radiographic coronal deformity more than 15 degrees. Results 100 patients were enrolled in the study. One STAR patient died immediately postoperatively, leaving 99 patients eligible to participate. One enrolled patient never had surgery. 94 patients returned for follow-up at an average of 2.3 years (range 6 months to 5 years, median 3 years). For the STAR patients, the average preoperative AOFAS 46, FADI 54, SF-36 63, VAS 73. At most recent follow-up, STAR AOFAS 73, FADI 23, SF-36 75, VAS 26. Salto average preoperative AOFAS 45, FADI 58, SF-36 61, VAS 74. At most recent follow-up, Salto AOFAS 81, FADI 13, SF-36 81, VAS 14. Both series showed significant improvements from preop to most recent postoperative follow-up in all scores. There was no statistically significant difference between the twogroups. Of the 50 STAR patients, six have had additional surgery for gutter debridement, poly exchange and grafting of bone cysts. Two additional STAR patients with large cysts have been advised to have a revision. Two of 50 Salto patients have had gutter debridement, and one prosthesis was revised to an INBONE. TABLE STAR Salto PreOp VAS 73 74 Most Recent VAS 26 14 PreOp AOFAS 46 45 Most Recent AOFAS 73 81 PreOp SF36 63 61 Most Recent SF36 75 81 PreOp FADI 54 58 Most Recent FADI 23 13 Conclusion Our study confirms that patient reported and clinical outcomes are favorable for both mobile and fixed bearing designs and there is no significant difference in clinical improvement between the two implants at early follow up The incidence of lucency/cyst formation was similar for the MB and FB tibial components but the MB had greatertalarlucency/cyst and more tibial and talar subsidence Reoperations were more common for the MB and the majority were for impingement

Biography

James Nunley, M.D. is the J. Leonard Goldner/ Billy Jones Endowed Professor and Chairman Emeritus of the Department of Orthopaedic Surgery at Duke University Medical Center. Dr. Nunley has served as President of the American Society of Reconstructive Microsurgery, the American Orthopaedic Foot and Ankle Society, the Eastern Orthopaedic Association, the Southern Orthopaedic Association, the Orthopaedic Learning Center in Rosemont, Illinois, the North Carolina Orthopaedic Association, the North Carolina Society for Surgery of the Hand, the Hand Forum, and the Southeastern Hand Club. He was awarded honorary membership in the Israeli Foot and Ankle Society, the Swiss Foot and Ankle Society and the Hellenic Orthopaedic Society Dr. Nunley has given more than 340 national and international presentations, and has authored more than 200 publications in peer-reviewed journals. Dr Nunley has authored two textbooks and sits on the editorial board of several Orthopaedic journals. Dr. Nunley has been the recipient of the prestigious American/British/Canadian Traveling Fellowship presented by the American Orthopaedic Association, and The Goldner Award for the most outstanding research paper presented at the American Orthopaedic Foot and Ankle Society. Additionally he was presented with the Bassett Award as the outstanding teacher by the Duke orthopaedic residents. Graduating from Duke University with a BS degree in Chemistry, he then attended Tulane University Medical Center in New Orleans, Louisiana, completing his MS/MD degree, Dr. Nunley continued on to the University of California, Los Angeles to train for two years in general surgery, before completing his four year orthopaedic residency training at Duke Medical Center in Durham, North Carolina. Dr Nunley then joined the Duke faculty in 1980. Dr. Nunley’s research is related to sports injuries of the foot and ankle, arthritis of the foot and ankle, and vascularized bone grafting.

Speaker
James Nunley II / Duke University School of Medicine, USA

Abstract

Biography

Dr. Nabil Atweh is a surgeon in Bridgeport, Connecticut and is affiliated with multiple hospitals in the area, including Bridgeport Hospital and Yale New Haven Hospital. He received his medical degree from American University of Beirut Faculty of Medicine and has been in practice for more than 20 years. Dr. Atweh accepts several types of health insurance. He is one of 43 doctors at Bridgeport Hospital and one of 89 at Yale New Haven Hospital who specialize in Surgery.

Speaker
Nabil Atweh / Yale New Haven Health-Bridgeport Hospital, USA

Abstract

Biography

Conor Delaney MD MCh PhD FRCSI FACS FASCRS, is Chairman of the Digestive Disease Institute at the Cleveland Clinic in Cleveland, Ohio. He is a Professor of Surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. Dr. Delaney serves on the administrative committees of many national and international professional societies, serves on the editorial board of ten international journals, and is past-President of the International Society of Laparoscopic Colorectal Surgery, and President of the Midwest Surgical Association. Dr. Delaney has given over 250 invited lectures nationally and internationally, has published seven books and published more than 250 manuscripts in scientific journals on topics relating to surgical education, colorectal cancer surgery, laparoscopic colorectal surgery and peri-operative care and cost-efficiency for colorectal and intestinal surgery. [Please see PubMed link listed below in Publications section] Dr. Delaney also founded a health-care software company called Socrates Analytics. Socrates is a novel IT solution which links disparate hospital and other health care administrative databases and provides risk adjusted analytics for clinical outcomes and cost information.

Speaker
Conor P. Delaney / Case Western Reserve University, USA

Keynote Talks

Abstract

In the field of liver transplantation, the current trend of performing combined, more complicated organ transplants on ever-increasing number of sicker patients with severe cardio-vasular co-morbidities, once considered as posing insurmountably high risk, prohibitive for surgery, is quickly becoming an everyday reality. Among those, non-ischemic cardiomyopathy in its chronic form (alcoholic, cirrhotic, hemochromatosis-related and more) may be identified as a separate clinical entity in the spectrum of comorbidities, that accompany End-Stage Liver Disease in more than 70% of cases, eligible for transplantation. However important for the perioperative management and outcome, these conditions oftentimes remain underestimated,even unacknowledged and non-diagnosed. In its acute form, such as stress-induced Takotsubo cardiomyopathy, its’ intraoperative manifestation may be life-threatening, even fatal. Etiology of most common forms of non-ischemic cardiomyopathy, pathophysiological mechanisms, diagnostic criteria, hemodynamic impact &clinical manifestations, and outcomes with special focus on perioperative management of liver transplant recipients, are discussed in this comprehensive review. Published cases of acute non-ischemic stress-induced cardiomyopathy, occurred in liver transplant recipients in the perioperative period, along with predisposing factors, precipitating events, potential physiological mechanisms, acute(intraoperative) and post-event management arealso discussed. Analysis of these cases revealed no possible correlations between etiology of ESLD, Model for End-stage Liver Disease score, renal dysfunction, blood loss,hemodynamic instability, or other clinical features and TC intraoperative occurrence.Authors’ case of intraoperative Takotsubo cardiomyopathy,occurred during unhepatic stage of liver transplant surgery, is presented

Biography

Alexander A. Vitin, MD, Ph.D has completed his Ph.D on Extracorporeal detoxication for ESLD patients in 1986. Over 32 years of experience in Anesthesiology and Critical Care medicine, 13 years in perioperative care for liver transplantation. Author of 28 peer-reviewed publications, 8 book chapters, 5 books (as author, co-author, editor) and more than 25 other publications. Member of 6 US-based and international professional and educational Societies and Committees. Invited speaker on 2 USA- and 6 International meetings in 5 countries. Currently Associate Professor, and UNOS-appointed Director of Transplant Anesthesia at University of Washington MC

Speaker
Alexander A. Vitin / University of Washington, USA

Abstract

The United States is experiencing a public health crisis with opiate drug abuse. Nearly 200 people in this country die every day from opioid overdoses; some due to illegal drug use, but many due to misuse of pharmaceutical opioids. Mainstays of acute surgical pain like hydrocodone, morphine, and fentanyl can be addictive, and patients are prone to misuse them when not educated on proper use or when these drugs are over prescribed. Intensemarketing campaigns by pharmaceutical companies is partly responsible for the dependency of almost 2 million patientsprescribed opioids1. Opioid dependence often leads to disruptions in personal relationships, finances, and can lead patients into diverting medications, doctor shopping, and illegal drug trafficking. It is also a pathway to serious illegal drug use. In August 2018 the White House released an interim report2and declared an opioid crisis in the United States. In response the American Society of Anesthesiologists (ASA) isdemonstrating opioid-sparing techniques (regional anesthesia and multimodal analgesia) can reduce perioperative opioid use, providing broad based resources in opiate use, addiction treatment, and advocating for patient access to therapy. The ASA is supporting The Safer-Post-Operative Pain Management Recuing Opioid Related Harm Pilot Project to reduce opioid-related harm in high volume surgeries, developing post-op pain management strategies with the American Academy of Orthopedic Surgeons, and co-sponsored the National Rx Drug Abuse and Heroin Summit(the “Opioid Summit”)

Biography

Gary R. Haynes is Professor and the Merryl and Sam Israel Chairin Anesthesiology at Tulane University School of Medicine, New Orleans, Louisiana, USA. He was awarded the PhD and MD degrees from Case Western Reserve University in Cleveland, Ohio. His undergraduate degree is from Illinois College in Jacksonville, Illinois, where he is a member of the Board of Trustees. He is a member of the American Society of Anethesiologists and serves on a number of professional committees.

Speaker
Gary Haynes / Tulane University School of Medicine, USA

Abstract

As Cesarean Section is the most performed abdominal operation it is of utmost importance to evaluate the different steps for their necessity andthe best way of performance. The modified Joel-Cohen method was proved in many studies to result in a shorter incision to delivery time and lower rate of febrile morbidity when compared to the Pfannenstiel incision. The uterus should be opened transversely in the low segment due to embryological considerations which influences the muscle fibers percentage. Suturing the uterus with one layer results in stronger scar. The more stitching material left behind, more foreign body reaction occurs which weakens the scar. In order to standardize this operation as well as any other open surgery, it is important to use constantly the same needles and instruments. Big needle is necessary for the uterus, as fewer steps are done and therefore less foreign body reaction. Leaving both peritoneum layers open reduces adhesions and results in reduced need for analgesics. The fascia being sutured continuously, and the skin with few sutures as possible. Since the introduction of this evidence-based simplified method, it has been evaluated by scores of peer-reviewed publications from different countries. Without exception, all showed various advantages of this method. Similar evaluations should be done to any procedure and discipline, as surgeries following traditional rather than evidence based methods are not resulting necessarily with better outcome.

Biography

Prof. Dr. Michael Stark is the President of the New European Surgical Academy (NESA), an international inter- disciplinary surgical academy. He is today the scientific and medical advisor of the ELSAN, a 123 hospital group in France and a guest scientist at the Charite’s University hospital in Berlin. In the years 1983-2000 he was the director of Ob/Gyn department of the MisgavLadach Hospital in Jerusalem, and between 2001 and 2009 the chairman of Gynecology at the HELIOS, European Hospital Group. He was visiting Professor at the Universities of Toronto, Moscow, Beijing, Milan, Adana, Uppsala and New York.

Speaker
Michael Stark / The New European surgical Academy, Berlin, Germany
Sessions:

Abstract

Pediatric ambulatory surgery utilization is increasing nationwide mainly due to Changes in health care delivery, emphasis on cost containment, changes in revenue stream, shifting payment models, rising delivery costs and increased competition in the health care market. The result of that trend that we see more chronic illness patients in ambulatory surgery centers, surgical procedures and patients once considered inappropriate for ambulatory surgery are now considered appropriate which challenge us as anesthesiologist how to adequately assess and prepare children preoperatively. The literature on optimal patient selection for pediatric ambulatory surgery is sparse and of limited quality and concentrates mainly on respiratory complications and those children with OSA . As a result of the recent changes in health care delivery, tendency to perform complex proceduresin sicker kids as outpatient surgery is increasing with no clear guidelines to adhere to, in this presentation will address where we should draw a line.

Biography

Sam Nour, MD is Associate professor of Pediatric Anesthesiology at Keck School of Medicine. He is the Director of Pediatric Ambulatory Surgery Center at Children’s Hospital of Los Angeles.

Speaker
Sameh I Nour / Keck School of Medicine, USA

Abstract

Breast cancer is the result of uncontrolled growth and division of abnormal breast cells. Tumor markers are substances that are shed from the original tumor directly into the blood stream or filtered out through the urine. They can include proteins, peptides, or other parts of the malignant cells. CA15-3 is a glycoprotein from the MUC1 protein. It is used to guide treatment and monitor progression of disease. The aim of this study was to measure the level of serum tumor marker (CA 15-3) collected from King Abdulaziz National Guard Hospital, Al-Ahsa, Saudi Arabia from male and female patients diagnosed with breast cancer at different stages and to correlate the level of serum tumor marker (CA15.3) with other parameters included in our study. In conclusion, we found that the level of CA15-3 was independent with age and receptors. It was found that there was no significant correlation between the level of CA15-3 and stages. Significant correlation of CA15-3 was seen in grade 1 only. This elevation of CA15-3 was mainly affected by one patient who was diagnosed with advanced stages of breast cancer, therefore it is not representative of the sample group which does not indicate significant correlation.

Biography

Dr. Tahani Al Qurashi is a consultant Breast Surgeon. She is the Program Director for the General Surgery Residency Program at King Abdulaziz National Guard Hospital, Al Ahsa, Saudi Arabia. Dr. Tahani also serves as the Associate Dean and Assistant Professor of Surgery at the College of Applied Medical Sciences - Al Ahsa, King Saud bin Abdulaziz University for Health Sciences. She is Arab and Saudi board certified in General Surgery. She obtained the European Board in Breast Surgery, and also completed an Oncoplastic Breast Surgery Clinical Fellowship from Heidelberg, Germany. She also received a Master’s Degree in Medical Education.

Speaker
Tahani Al Qurashi / Ministry of National Guard Health Affairs, Saudi Arabia

Abstract

The mastoidectomy is a surgery performed for a multitude of reasons, the first and most basic being infection (acute mastoiditis), followed by cholesteatoma, chronic middle ear disease, chronic/recurrent tympanic membrane perforations, tumours and surgical access as well as artificial cochlear implantation. These indications mandate a varied surgical approach to the mastoidectomy. Mastoidectomies are commonly categorised into ‘radical mastoidectomy’, ‘modified radical mastoidectomy’, ‘canal wall down mastoidectomy (CWD)’, ‘canal wall up mastoidectomy (CWU)’ and ‘simple’ or ‘cortical mastoidectomy’. This paper evaluates epidemiological data from CWD and CWU mastoidectomies, as well as revision procedures for both approaches, focusing on the incidence and indications in the Indigenous population of Australia. To achieve this, a retrospective review combining clinical presentations, demographics and intraoperative findings was performed. Outcomes studied were complications on presentation, ossicular/tympanic damage present at time of operation, intra-operative pathology, the extent of the disease and the surgical technique used. There were 158mastoidectomies were performed in our institution over the ten-year period studied. Cholesteatoma (58%) was the most common indication. Extracranial complications recorded at presentation include; subperiosteal abscess, facial paralysis, labarynthitis and significant sensory neural deafness. Intracranial complications seen include meningitis, cerebellar abscess, and encephaloceles. Canal wall down and canal wall up surgical techniques were evaluated. A higher number of mastoidectomies are performed on the Indigenous population, the incidence of cholesteatoma reported is lower than expected and disease recurrence rates in canal wall down and canal wall up mastoidectomies are comparable to worldwide data.

Biography

Thomas is a Principal House officer undertaking training in Otolaryngology, Head and Neck Surgery, and General Surgery at the Townsville Hospital in the far North Queensland region of Australia. He has completed a Bachelor of Science from the University of Queensland and a Doctor of Medicine from Griffith University.

Speaker
Thomas Placanica / The Townsville Hospital, Australia

Abstract

The number of older cancer patients is rising, and especially in older people with concomitant multi-morbidity, treatment considerations should balance the impact of disease and treatment on quality of life (QOL) and survival. Therefore, the shared decision-making (SDM) process is complex and challenging. From an exploration of communication patterns in real surgical oncology practice, we observed that a minimum of time was spent on discussing equipoise and decision-making. Patients’ perceptions of involvement are partly associated with patient characteristics such as QOL and satisfaction. In contrast, observers’ perceptions of patient involvement are partly influenced by encounter characteristics such as the total number and mean duration of consultations, and general communication skills. General communication skills are associated with both patients’ and observers’ perceptions of involvement. In order to optimize the SDM process among older patients with colorectal (CRC) or pancreatic cancer (PC), the EASYcare in Geriatric Onco-surgery (EASY-GO) intervention was developed and introduced at the surgical department of an academic hospital. The EASY-GO intervention comprised a working method with geriatric assessment and SDM training for surgeons and nurse specialists, and was evaluated by patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs). PREMs included the quality of SDM, involvement in decision-making, satisfaction about the decision-making process and decisional regret. 58 CRC and 22 PC patients were included (mean age: 71.8±5.2 years, 45.0% female). All PREMs showed a consistent but non-significant change in the direction of improved decision-making after training. Patient involvement as rated by surgeons also changed in the direction of improved decision-making. The quality of SDM and decisional regret among PC patients showed a clinically relevant change in the direction of improved decision-making. In conclusion, training of surgeons is needed to improve shared decision-making in surgical oncology.

Biography

Yvonne Schoon works as a geriatrician at the Radboud University Medical Center in Nijmegen, the Netherlands. In 2013 she obtained her PhD. Since 2015, she is also head of the Emergency Department at the Radboudumc. Her interests in medicine are specially focused on triage systems in elderly, shared decision making, integrated health care and healthcare improvements. In the Netherlands, she is member of the national committee of shared decision making. She has published more than 50 papers of which 35 papers in peer-reviewed journals.

Speaker
Yvonne Schoon / Radboud University Medical Center, Netherlands

Abstract

Primary pulmonary and mediastinal synovial sarcoma is rare and poses a diagnostic challenge particularly when unusual histological features are present. We present 60 cases of primary pulmonary and mediastinal synovial sarcoma (29 males and 27 females; mean age, 42 years) and compare our results with 5 prior series to better define unusual histological features. Clinically, patients with mediastinal synovial sarcoma were younger with a male gender bias. Radiologically, tumors were well-delineated with distinctive magnetic resonance imaging features and little vascular enhancement. 21/46 patients died of disease within 5 years. Histologically, all tumors had dense cellularity, interlacing fascicles, hyalinized stroma, and mast cell influx. Hemangiopericytoma-like vasculature (48/60), focal myxoid change (30/60), and entrapped pneumocytes (23/60) were seen. Calcification was not prevalent (10/60). Unusual histological features included Verocay body-like formations (7/60), vague rosettes (6/60), well-formed papillary structures (3/60), adenomatoid change (3/60), and rhabdoid morphology (2/60). Immunohistochemistry demonstrated expression of pancytokeratin (39/58), epithelial membrane antigen (29/53), cytokeratin 7 (26/40), cytokeratin 5/6 (5/7), calretinin (15/23), CD99 (19/23), bcl-2 (24/24), CD56 (11/11), S-100 (9/51) and smooth muscle actin (8/32). 92% (36/39) of primary pulmonary and mediastinal synovial sarcomas studied were positive for t(x;18). In conclusion, our study confirms the clinical, histological, immunohistochemical, and molecular data from previous large series of primary pulmonary and mediastinal synovial sarcoma. Compared with soft tissue synovial sarcoma, primary pulmonary and mediastinal synovial sarcoma has less calcification, less obvious mast cell influx, and less radiologic vascularity, but similar magnetic resonance imaging features, percentage of poorly differentiated tumors, and number of t(x;18) positive tumors. Awareness of focal unusual histology can prevent misdiagnosis particularly in t(x;18) negative tumors.

Biography

Dr Hartel is currently Consultant Histopathologist at Sligo University Hospital, Sligo, Ireland and Medical Director of Clinical Laboratory Medicine with Grafton City and Sistersville General Hospitals in West Virginia, USA. He is clinical associate professor with the Department of Pulmonary and Critical Care Medicine at West Virginia University School of Medicine and is Honorary Senior Lecturer in Pathology at National University of Ireland, Galway, School of Medicine. He is active in teaching and research endeavors, particularly in general histopathology, neoplastic and non-neoplastic lung disease, and sarcomas. He has numerous publications and has been invited to speak about his research nationally and internationally, and has served as expert witness and consultant for Irish and US law firms. Dr Hartel is a Diplomate of the American Board of Pathology and Fellow of the Faculty of Pathology, Royal College of Physicians in Ireland, College of American Pathologists and American Society of Clinical Pathology.

Speaker
Paul Hartel / Sligo University Hospital, Ireland

Abstract

Background: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. In our study, we applied a new method of laparoscopically closing the appendix stump and embedding it into the cecum. Methods: A single center retrospective study of clinical records of patients undergoing laparoscopic appendectomy for acute uncomplicated and complicated appendicitis between January 2017 and October 2018. Dissection of the mesoappendiks was performed by ligasure device and then it was ligated with an appendix radix intracorporealknotting technique and inverted into the cecum with a purse-string suture. The patients were analysed for age, sex, BMI, conversion rate,operation time, postoperative complications and length of hospital stay. Results:Seventy one (25 female, 46 male) patients were included. Thirty-two patients were complicated appendicitis and 39 patients were uncomplicated appendicitis.The mean age was 34,81±12,88 years; the mean body mass index (BMI) was 27,51±5,44 kg/m2. The mean operation time was 61,93±17,67 min. There were no intraoperative complications in any patients. In patients with uncomplicated appendicitis, ileus in 2 patients and trocar site infection in 2 patients developed; ileus in 2 patients and trocar site infection in 3 patients developed in complicated appendicitis cases. The mean hospital stay period was 38,92±25,90 hours. Conclusion: The laparoscopic intracorporeal knotting and purse-string suture technique is easy, simple, safe, fast, and effective for acute appendicitis and will probably become the method of choice in securing the base of the appendix.

Biography

TurgutDonmez has completed his PhD at the age of 15 years from Istanbul Universyt and postdoctoral studies from Istanbul University Cerrahpasa School of Medicine. He is the director of premier general surgery service organization. More than 40 articles and reports have been published in well-known magazines. He serves as a member of arbitration in international scientific journals.

Speaker
Turgut Donmez / Istanbul University, Turkey

Abstract

This study aimed to compare prophylactic effect of intra venous dexamethasone and intra venous lidocaine on respiratory and hemodynamic complications following cleft palate repairing surgery with general anesthesia in children.In a double blinded randomized controlled trial, 108 children with age range of 6months to 2 years old and ASA Class I and II were assigned to 3 equal groups by random allocation, during August to September 2018. Prior to anesthesia induction, first group received 0.2 mg/kg intra venous (IV) dexamethasone, second group received 1mg/kg IV lidocaine and third group received placebo as control group in the same manner. Blood Oxygen saturation (SPO2), End-tidal Carbon dioxide (ETCO2), mean atrial pressure (MAP) and heart rate (HR) were recorded during surgical and recovery time every 15 minutes and they were compared between groups. Mean of HRduring surgical time was lower in dexamethasone group than lidocaine group, and it was significantly lower in intervention groups than placebo group (p <0.001). MAP during surgery was lower in lidocaine group than dexamethasone group, and it was significantly lower in both groups than placebo group(p= 0.003). Mean of ETCO2 in placebo group was significantly higher than intervention groups (p=0.007).Use of IV dexamethasone or lidocaine prior to anesthesia could cause more stable hemodynamics and less respiratory complications during surgical and recovery time in children undergoing cleft palate repair surgery

Biography

Dorna Kheirabadi, a 6th year talented medicalstudentin Isfahan university of medical sciences (IUMS), Isfahan, Iran is a member as a researcher in anesthesiology research center of IUMS. She has published 2 and submitted 4 papers. She is interested in anesthesiology residency and researches.

Speaker
Dorna Kheirabadi / Isfahan University of Medical Sciences, Iran

Abstract

The removal of the thyroid gland has changed from classical (Kochers’ technique) to minimal invasive (Miccolis’ technique) and now to transoral endoscopic thyroidectomy (TOETVA). The procedure, known as a transoral endoscopic thyroidectomy (TOETVA), involves the removal of the thyroid gland through small hidden incisions inside the lower lip, an approach that can be used in select cases when traditional thyroidectomy, typically performed through the front of the neck, is not the best course of action. TOETVA is best suited for cases involving smaller nodules and early-stage papillary thyroid cancer. The aim of the present presentation is to give an overview of TOETVA. It is going to present on the one hand tips and tricks on the technique with the use of videos, while on the other it is going to discuss issues concerning the practical application.

Biography

Theodosios Papavramidis is the youngest professor of surgery in Greece. He is specialy interested in endocrine surgery and research. As a result of his work, he attended numerous congresses, and participated with announcement and/or poster presentations. He has participated to many panel discussions and was invited to give several conferences. For his work he has received 8 prizes. He has published more than 75 papers in reputed journals and serving as an editorial board member of repute. He was elected member of the Scientific Board of AHEPA university hospital for 3 consecutive years, and member of the general assembly of the medical faculty of Aristotle University of Thessaloniki for 2 consecutive years. In his free time he enjoys fencing and scuba diving.

Speaker
Papavramidis Theodossis / Aristotle University of Thessaloniki, Greece

Abstract

Introduction: Performing epidural anaesthesia needs a lot of experience and learning. The APAD is a relatively new device used to detect the epidural space by automatically sensing the loss of resistance when the epidural needle pares the ligamenta flava and display a pressure graph with an audible signal to mark the event. However, the ease of learning the epidural anaesthesia using the APAD was never tested or compared to other conventional techniques. Aim of the work: Is to Compare between the learning curve of the epidural catheter placement using the traditional loss of the resistance technique and the acoustic puncture assisted device. Secondary objective is to detect any differences in the rate of complications that occurred during the learning period using either techniques. 30 first year anaesthesia residents with no experience in performing an epidural anaesthesia were enrolled in This study. Group I consisted of 15 first year residents performing there first 60 epidural using acoustic puncture assisted device. While Group II consisted of another 15 first year residents performing there first 60 epidural using the traditional loss of resistance technique with a glass syringe. Results: shows that the success rate of group I and group II reached 90 % after the 28th and 44th attempt respectively the time to perform the epidural and the number of attempts was reduced much faster during the learning period in group I than in group II. The complication that occurred during the learning period was much less in group I than in group II. Conclusion: it was concluded that it is easier, safer, and faster to learn epidural using the APAD rather than using the conventional loss of resistance using a glass syringe technique.

Biography

Dr. Yasser osman Assistant professor of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Egypt. He has completed MBBch at Alexandria university in Feb 2000, Grade: excellent with honor. Yasser Osman have completed • Master degree in Anesthesia and surgical intensive care, Alexandria university, Oct 2005, Grade: very good. He doctorate in Anesthesia and surgical intensive care, Alexandria University, July 2010 And has published 18 different papers during his carer.

Speaker
Yasser osman / Alexandria University, Egypt

Abstract

BACKGROUND: Adverse effects may still limit the use of continuous epiduralanaesthesia / patient controlled epidural analgesia (PCEA) and intravenous patient controlled analgesia ( IV PCA) in surgical oncology patients. This study postulated that postoperative PCEA was more efficient, and had fewer side-effects than IV PCA morphine, fentanyl, oxynorm. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large oncology surgical patient population. METHODS: During a five-year period 3010 patients undergoing major surgery, received either PCEA or ICV PCA for postoperative pain relief. The patients were monitored in ICU, HDU and in surgical wards. Pain was evaluated with a numeric rating scale (0-10) or visual analog scale at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/nightmares/confusion, nausea/vomiting, pruritus, orthostatism/leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest. RESULTS: PCEA were used in 1605patients and IV PCA in 1405 patients. Patients with PCEA experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism, leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the IV PCA group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements. CONCLUSION: In a large patient population the use of PCEA and IV PCA postoperative analgesia was considered safe in ICU, HDU and surgical wards, and the incidence of adverse effects was low. Patients with PCEA experienced overall less pain, while opioid related side-effects were more common with IV PCA analgesia.

Biography

Dr. Alisher Agzamov has completed his MD in 1981 from Tashkent University, USSR and postdoctoral PhD studies from Moscow University, USSR in 1991. During 1992 – 1998 He was a Senior Consultant Cardiac Anaesthesioligst of the Europen Cardiac Surgery Programme and Professor of Anaesthesiology of the University of Zambia and University Teaching Hospital, Lusaka, Zambia; From 1998 till up to date He is the Senior Consultant Anaesthesiologist fo the Department of Anaesthesiology & ICU, Kuwait Cancer Control Center ( KCCC). Ministry of Health, Kuwait City, Kuwait. He has published more than 550 papers in reputed journals and has been serving as an editorial International board member of reputable Anaesthesia and Intensive Care Journals. His main Scientic interest in fileds fo Anaesthesia and ICU Management Surgical and Medical ICU Oncology Patients. His using extensively Robots Physians in ICU Management of Oncology ICU patients.

Speaker
AlisherAgzamov / Kuwait Cancer Control Center, Kuwait

Abstract

With improved laparoscopic techniques and experience, availability of newer tools and instruments like ultrasonic shears; laparoscopic cholecystectomy (LC) became feasible option in cirrhotic patients, the aim of this study was to analyze the outcome of LC in cirrhotic patients, and the rule of harmonic device. Patients and methods: We retrospectively analyzed 213 cirrhotic patients underwent LC, in the period from 2011 to 2019, the overall male /female ratio was 114/99. Results: The most frequent CTP score was A, The most frequent cause of cirrhosis was HCV, while biliary colic was the most frequent presentation. Harmonic device was used in around 40% of patients, and on comparing patients with and without harmonic use, there were significant lower operative bleeding, less amount of blood and plasma transfusion, shorter operative time and hospital stay, and lower conversion and morbidity rates in the former. The morbidity was around 22% while mortality was around 2%, and morbidity significant predictors were CTP score B, C, non harmonic group, operative bleeding, increased MELD score, blood and plasma transfusion units, lower platelet count and longer operative time. Conclusion: LC can be safely performed in cirrhotic patients with appropriate patient selection. However, operative bleeding, increased blood and plasma transfusion units, CTP, and MELD scores are predictors of poor outcome that can be improved by using harmonic scalpel shears

Biography

Currently, Emad Hamdy Gad working as associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014( part time) He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/ 2015 to 8/2015 Emad Hamdy Gad worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.

Speaker
Emad Hamdy Gad / Menoufia University, Egypt

Plenary Talks

Abstract

Objectives: The incidence of Differentiated Thyroid Cancers DTC in China is increasing, and this has been attributed to increased diagnosis of early stage disease by Ultrasound. In addition to an increase in early stage Cancer, a simultaneous increase in the Locally Advanced disease such as larger tumors (>4 cm),adverse features, and extrathyroid extension (ETE) .it presents an operative challenge for both the clinician and patient. The aim of this study is to report our experience at the Sichuan Cancer Center; with the management of locally advanced DTC and to further analyze factors predictive of outcome within this group. Methods: Overall survival outcomes were not analyzed due to the relatively slow disease progression in thyroid cancer. Disease-specific survival (DSS) was calculated from the time of cancer diagnosis to the date of first disease recurrence. Distant recurrence-free probability (DRFP) was calculated from diagnosis to date of first distant disease recurrence, while locoregional recurrence-free probability (LRRFP) was calculated from diagnosis to the date of first thyroid bed or cervical lymph node recurrence. The median follow-up was 53 months (range 1–270 months). Outcomes data were calculated at 5 years. Recurrence events were recorded for all patients. Because progression of local disease in patients who had an R2 resection is not comparable with patients with R0 and R1 resections, patients with R2 resections were excluded from analysis of locoregional recurrence. Statistical analysis was carried out using SPSS (Version 21, IBM Corp, Armonk, NY). Variables were compared between R0, R1, and R2 groups using the Pearson χ2 test. DSS, DRFP, and LRRFP were analyzed using the Kaplan-Meier method. Factors predictive of outcome were determined by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards method. Results: A total of 137 patients underwent total thyroidectomy, 35 had thyroid lobectomy , and 6 patients underwent subtotal thyroidectomy with a portion of the contralateral lobe preserved. The median age of the 122 patients with extra thyroidal DTC was 43 years (range 9–82 years), 50 men and 72women. 21 patients were M1, and 101 patients were considered M0 after initial therapy. Nine of the M1 patients were identified preoperatively and 16 postoperatively on RAI scan within 5 months of thyroidectomy . With a median follow-up of 60.1months (range 1–270 months), 41 patients died, 15of whom died with active disease. There were 4 local recurrences, 18 cervical nodal recurrences, and 17 distant recurrences. Conclusions: Locally advanced (T4) DTC is rare. The gross ETE predicts worse survival. In patients with T3 disease due to minimal extension to the overlying strap muscles, en bloc removal of strap muscles with the underlying thyroid gland achieves equivalent outcomes to patients with T1/T2 disease. The approach, accurate, preoperative assessment of patients with suspected advanced DTC is crucial. Assessment includes identifying a history of changes in voice, compromise of the airway, dysphagia, or hemoptysis. The examination should include looking for a mass fixed to the airway, paralysis of the vocal cord, or intraluminal disease visible on flexible laryngoscopy. Preoperative investigation should include US routinely. For this reason, multidisciplinary management teams must select the most appropriate treatment strategies to optimize both oncologic and functional outcome. Key words: Surgical Management,Differentiated Thyroid Cancer ,Extrathyroid extension, Multidisciplinary management teams, Disease-specific survival

Biography

Chao Li is working as the director in Department of Head & Neck Surgery of Sichuan Cancer Hospital & institute now. He has been working as a doctor in prevention and treatment of head and neck surgery for more than 10 years. He is an expert in head and neck cancer surgery and one of academic leader of Sichuan Provincial Health and Family Planning Commission. He can perform surgical treatments for various types of head and neck tumors in high quality, especially do well in the comprehensive treatment of advanced tumors and the first stage of tumor defect and function restriction in the head and neck. He participated in the writing "Diagnostic Guidelines for Differentiated Thyroid Cancer", which is the first diagnostic guidelines for differentiated thyroid cancer in China. He attended the cancer conferences several times, such as Global Oncology Academic Exchange Program(GAP), Current Status of Surgical Treatment of Head and Neck Tumors in the United States (CCHNS), Advances in the Treatment of Thyroid and Parathyroid Gland Tumors in the United States, Cancer Biology and Medical Conferences in the Asia-Pacific Region, National Head and Neck Cancer and so on. He was invited as a guest to attend the 14th World Head and Neck Cancer Conference of RGCON and exchange at the conference in 2015. He is the editorial board member and reviewer of many international publications, including Current Oncology, ORL. Reviewer of the Medical Research Archives and so on. He published more than 100 papers, won 12 provincial and municipal science and technology awards and obtained 11 national patents. His clinical study of thyroid cancer make him to win the first prize in the National Oncology Conference in 2014. Chao Li is a member of International Academy of Oral Oncology(IAOO), American Academy of Otolaryngology-Head and Neck Surgery(AAOHNS)and American Association for Cancer Research(AACR).

Speaker
Chao li / Sichuan Cancer Hospital and Institute, China

Abstract

Biography

Mahmoud A Hafez has been interested in orthopaedics since his graduation in 1985. He worked in 5 countries (Egypt, KSA, UK, USA & Canada) with different health care systems. His special interest is in hip and knee arthroplasty but has a broad based experience in general orthopaedics and traumatology that was gained during my training and work in UK for >10 years. The North American fellowship (Pittsburgh and Toronto) gave him a valuable experience in lower limb arthroplasty & computer assisted surgery. He is the Head of the Orthopaedic Department, October 6 University Hospital, Cairo, Egypt. In UK, he works as a part time consultant orthopaedic surgeon in NHS hospitals (locum during summer holiday)

Speaker
Mahmoud A Hafez / October 6 University, Egypt

Abstract

Biography

Prof. Abdou Mohammed Abd Allah Darwish working as a professor in Plastic Surgery Department at Minia University, Egypt. He has completed Ph.D in General surgery at Al Azhar University, Egypt and M.B.B.Ch at Alazhar University, Egypt. Abdou Mohammed has four years experience in External Rhinoplasty. Prof. Abdou Mohammed publications are 1) Abdominal dermolipectomy versus suction assisted dermolipectomy (paper published in Al Azhar Medical Journal vol.31 (2) April 2002). 2)Effect of dermal excision off inferiorly based flap in reduction mammaplasty (Paper published in the Egyptian journal of surgery October 2005). 3) Open Rhinoplasty: versatility of the technique. Published in Journal of Egyptian society of surgeons October 2005. 4) Preliminary results of gastric banding. Published in Elminia medical Journal January 2006. 5) Bipedicled flap in reconstruction of exposed tibia: Published in JPRAS December 2008. 6) Crainioplasty: effective use of rib graft: Published in Journal of plastic and reconstructive surgery January 2008. 7) Superiorly Based Fasciocutaneous Limberg Flap in Reconstruction of Sacrococxygeal Defects: Published in Journal of plastic and reconstructive surgery January 2009. 8) Reconstruction following excision of sacrococcygeal pilonidal sinus by Superiorly Based Fasciocutaneous Limberg Flap Published in JPRAS May 2009. 9) Reconstruction of the Hand Defects by Pedicled Groin Flap. Journal of Al Azhar faculty of Medicine (Girls) Vol.30 May 2009 and 10) The Prognostic Values of the Immunohistochemical Expression of Ezrin and larger Safety Margins in Basal Cell Carcinoma of the Face Egyptian Journal of Plastic and Reconstructive Surgery Vol 35 No.2 July 2011.

Speaker
Abdou Mohammed Darwish / Minia University, Egypt

Keynote Talks

Abstract

Background: There is increasing recognition that opioids have limited long-term efficacy and are associated with hyperalgesia, addiction and increased morbidity and mortality. Therefore, alternative strategies to combat chronic pain are paramount. We initiated a multicenter retrospective case series to review the efficacy of DRG stimulation in facilitating opioid tapering, opioid discontinuation and as a viable alternative to chronic opioid therapy. Purpose: The dorsal root ganglion (DRG) plays a key role in the development and maintenance of pain. Recent innovations in neuromodulation, specifically, dorsal root ganglion stimulation, offers an effective alternative to opioids in the treatment of chronic pain. A Retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy. Procedure: A multicenterretrospective analysis was completed. Visual analog scale pain scores and pain medication usage were collected at the baseline visit and after four weeks, 3 months and 6 months of treatment. Ten consecutive patients across two study centers were included. The pain was rated 7.38 at baseline and decreased to 1.50 at the 4-week follow-up, a reduction of 79.5% . All patients significantly decreased their opioid pain medication use with an average >30% reduction in morphine equivalents and four were able to discontinue their medications entirely. Conclusion: This Retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy.

Biography

Dr. Adam J Carinci, M.D. is a nationally recognized and sought after clinician, author and speaker with over a decade of pain medicine experience. He is double-board certified in both Anesthesiology and in Pain Medicine and maintains an active, full time medical practice. Dr. Carinci is Chief of the Pain Management Division and Director of the Pain Treatment Center at the University of Rochester Medical Center and an Associate Professor at the University of Rochester School of Medicine. He is a consultant to the Centers for Disease Control and Prevention (CDC), The Department of Health and Human Services (HHS) and the U.S. Department of Veterans Affairs (DVA).

Speaker
Adam Carinci / University of Rochester School of Medicine and Dentistry, USA

Abstract

AIMS: Vaginal reconstructive surgery can be performed with or without mesh. We sought to determine comparative rates of perioperative complications of native tissue versus vaginal mesh repairs for pelvic organ prolapse. METHODS: Using the National Surgical Quality Improvement Program (NSQIP) database, we concatenated surgical data from vaginal procedures for prolapse repair, including anterior and posterior colporrhaphy, paravaginal defect repair, enterocele repair, and vaginal colpopexy using Current Procedural Terminology (CPT) coding. We stratified this data by the modifier associated with mesh usage at the time of the procedure. We then compared 30-day perioperative outcomes, postoperative complications (bleeding, infection etc), and readmission rates between women with and without mesh-based repairs. RESULTS: We identified 10657 vaginal reconstructive procedures without mesh and 959 mesh-based repairs from 2009 through 2013. Patients undergoing mesh repair were more likely to experience at least one complication than native tissue repair (9.28% vs 6.15%, P<0.001), with the overall complication rate also being higher in the mesh group (11.37% vs 9.39%, P=0.03). Procedures with mesh had a higher rate of perioperative bleeding requiring transfusion than native tissue repair (2.3% vs 0.49%, P<0.001), and organ surgical site infection (SSI) (0.52% vs 0.17%, P=0.02). There were no significant differences in rates of readmission, superficial, or deep SSIs, pneumonia, urinary tract infection, sepsis, or renal failure. CONCLUSIONS: The use of vaginal mesh for pelvic organ prolapse repair appears to result in a higher rate of perioperative complications than native tissue repair. Patients undergoing these procedures should be counselled preoperatively concerning these risks.

Biography

Majid Mirzazadeh, MD is assistant professor of urology, obstetrics and gynecology at Wake Forest Baptist Medical Center. He received his postgraduate degree in urology focusing on reconstructive surgery. He also completed fellowships in female urology and pelvic reconstructive surgery at Wake Forest School of Medicine. Majid Mirzazadeh’s primary research focuses on biofilms on kidney stones causing urinary tract infections and using stem cells from myoblasts to improve incontinence in women. He has conducted preclinical research, as well as Phase I and II clinical trials of these injections. His interests in industry-sponsored research include studies focusing on urinary tract infections, urinary incontinence, stem cells from myoblasts and improving the design and safety of clinical and surgical instruments. Mirzazadeh also investigates design alterations to improve the function and durability of staplers used in laparoscopic surgeries and endoscopic devices. In addition, he is in the early stages of exploring approaches to make urinary catheters more infection resistant

Speaker
Majid Mirzazadeh / Wake Forest University, USA

Abstract

Several quality measures have been introduced in healthcare organizations. Some are practice on daily basis like infection control, hand hygiene,prevention of lines related sepsis and enhanced recovery after surgery (ERAS). Yet all these efforts should be monitored to determine if patient outcome has improved or not. In this regard selecting a benchmark is important: 1 Select what benchmark? 2 Identifying the bench marking pattern 3 Collect and analysing internal data. 4 Comparing internal data with external data 5 Set performance goals. 6 Communicate the benchmarking results with the organization 7 Create action plan 8 Take action. In this regards we established the collobortive between three hospitals within our organization and joined the National Surgical quality Improvement (NSQIP) project of the American College of surgeons (ACS). This helped us to compare our results internally , between the three hospitals and externally by NSQIP. Areas of improvements for a better outcome were identified. The following lessons learnt: 1) There are variations in outcome between the three hospitals within the organizations. 2) WE applied the successful measures from one hospitals to others. 3) To combat Surgical site infection( SSI) we introduced ERAS protocol 4) We strive to overall improvemts to match the NSQIP 210 hospitals.

Biography

Sami El-Boghdadly has completed Diploma of Medical Education at Dundee, UK in July 1995. He worked as Consultant General Surgery, Acting Head of Division of General Surgery, Head of Division of General Surgery and Chairman, Department of Surgery from July 1987 to March 2003 at King Fahad National Guard Hospital Riyadh, Saudi Arabia. He also worked as Director of the OR and Day Surgery Services from September 2006 to November 2017 at king Abdulaziz Medial city and Consultant, Laparoscopic and General Surgeon Lead Surgeon of General Surgery from April 2004 to September 2006 at Princess Alexandra Hospital, Harlow, Essex. Now, Sami El-Boghdadly working as Consultant, Laparoscopic and General Surgeon and chairman, National Surgical Quality Improvement Program(NSQIP) at King Abdulaziz Medical City King Fahad National Guard Hospital and Assistant Surgical professor at Kind Saud bin Abdulaziz University for Health Sciences. Regarding academic post, Clinical Assistant Professor of Surgery at King Saud University Hospital Riyadh, Saudi Arabia and Assistant Professor of Surgery at King Saud bin Abdulaziz University for Health Sciences college of medicine. Literally served in every hospital Standing and Some of Ad Hoc Committees. Sami El-Boghdadly involved with National Faculty ATLS/ American College of Surgery, Disaster Committee, Department of Surgery, Therapeutic and Pharmacy Committee, Nutritional Support Committee, Riyadh Surgical Club/ Riyadh Gastroenterology Club / Riyadh Oncology Club, Tumor Board / Educational Committee, Medical Credentialing, Privileging and Promotions Committee and National Surgical Quality Improvement Program (NSQIP).

Speaker
Sami El-Boghdadly / King Abdulaziz Medical City, Saudi Arabia

Sessions:

Abstract

This lecture will give a brief overview of basic and advanced hemodynamic parameters, various methods of non-invasive and invasive hemodynamic monitoring and strategies to guide fluid management and vasopressor/inotropic support in the ICU setting. Critically ill patients are frequently hemodynamically unstable owing to hypovolemia, cardiac dysfunction or alterations of vasomotor function. Hemodynamic compromise, causing a mismatch between oxygen delivery and demand, is a major contributive factor for organ failure. Hemodynamic monitoring aims to guide medical management so as to prevent or treat organ failure and improve patient outcome. A pragmatic algorithm for hemodynamic monitoring and management in the ICU is presented.

Biography

Dr. med. Oliver Herden-Kirchhoff, MBA is Chair and Medical Director of Anesthesia and Intensive Care at AMEOS Klinika Bremerhaven. His main clinical interest is in the field of cardiothoracic anesthesia. Dr. Herden-Kirchhoff worked at numerous renowned institutions including Leipzig Heart Centre, Bart´s Heart at St Bartholomew´s Hospital and Oxford University Hospitals. He has been involved in charity work in Africa and the Carribean. Dr Herden-Kirchhoff helped to set up and run a heart hospital to western standards in Changchun, China.

Speaker
Oliver Herden-Kirchhoff / Medical Director AMEOS Klinika Bremerhaven Geestland, Germany

Abstract

Craniofacial malformations involves a surgical and anesthetic particular procedure, as they present not only anatomical abnormalities (for example, midface hipoplasia, mandibular hypoplasia or retrognathia, facial asymmetry) but may also present difficulty in the airway area due to said anatomy and have a negative impact on the facial reconstruction of the patient as well as the ability to achieve essential functions in the patient during the surgical procedure, which implies the need for close communication between the surgeon and the anesthesiologist, the anestesiologist´s understanding of the the surgery and the problems that the surgeon can face , and the surgeon's attention to the fundamental principles in the area of anesthesiology during the surgery. Therefore, detailed evaluation of the airway and craniomaxillofacial malformations is important, keeping in mind the comorbidity of the patient, the type of surgery and the patient´s perioperative clinical status, in order to achieve the desired results through an interdisciplinary and coordinated work during the craniofacial surgery.

Biography

María del Carmen Navas-Aparicio is a head of the Cleft Lip and Palate- Craniomaxillofacial Surgery Unit at Hospital Nacional de Niños, and is a Professor at the Universidad de Costa Rica She is a researcher at the Universidad de Costa Rica and Hospital Nacional de Niños, Costa Rica. She is a speaker at national and international congress and she has publications in national and international journals.

Speaker
María del Carmen Navas-Aparicio / Hospital Nacional de Niños, Costa Rica

Abstract

Introduction: Ambu®AuraGain™ laryngeal airway is one of the newer supraglottic airway devices introduced in 2014. Cervical spine stabilization with hard cervical collar is a routine practice in patients with cervical spine instability, which makes insertion of supra-glottic airways and tracheal intubation difficult. This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure(OSP) and fiberoptic view of the glottis in airways secured with the AmbuAuraGain LMA. Methods: This was a randomised cross over study. Thirty five ASA 1-3 patients undergoing elective surgery under general anaesthesia were recruited for the study. In each patient AmbuAuraGain LMA was inserted twice in a crossover manner once with and once without a hard cervical collar in situ, with the sequence of insertion randomised. During each insertion of LMA, the oropharyngeal sealing pressure, fiberoptic view of the glottis (assessed by the Brimacombe score), insertion parameters (number of attempts, ease of insertion, time taken to insert, ease of passage of nasogastric tube), ventilator data and complicationswere noted. Results: The mean oropharyngeal sealing pressures in both the groups were similar with no significant difference [29.60±3.77 cmH2O without collar and 30.17±3.12 cmH2O with collar (p-0.310)]. The fiberoptic view of glottiswas also similar in both groups. The insertion with collar was more difficult than without collar. The number of attempts for successful insertion was same in both the groups. The time taken for appropriate placement of LMA was significantly prolonged in patients with collar [without collar 21.34±9.67 seconds and with collar 26.17±11.71 (p-0.025)]. Statistically significant difference in ease of insertion of nasogastric tube was noted between the groups. Conclusion: We conclude that the AmbuAuraGain LMA can be used in patients whose cervical spine is immobilised with a hard cervical collar, though its safety and efficacy in preventing cervical spine motion and spinal cord injury are yet to be studied.

Biography

Suman Lata has completed the degrees of MBBS, DCH & MD (ANAESTHESIOLOGY) from Patna & Ranchi University RIMS School of Medicine, India. Presently she is working as Faculty in a premier organization JIPMER India. Dr. Suman has published more than 25 papers in reputed journals and also has been serving as a reviewer of reputed national journals. She has presented papers in national and international conferences. Also underwent short course in hospital administration from ministry of health and family welfare and training in transplant anaesthesia.

Speaker
Suman Lata / Jawaharlal Institute of Postgraduate Medical Education and Research, India

Abstract

Cervical Spondylotic Myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. Changes in myelopathic signs following cervical decompression surgery and the relationship of the changes in myelopathic signs to functional outcome remains unclear. We prospectively followed 36 patients preoperatively and one year post-operatively and examined changes in myelopathic signs and functional outcome and compared the relationship with each other. Functional outcome was measured with the modified Japanese Orthopaedic Association (mJOA) scale and five myelopathic signs were examined individually and collectively with our newly proposed myelopathic scale. The results and conclusions of these findings will be discussed, as well as an outline of our new myelopathic scale.

Biography

Dr. Edward Kachur received his Bachelor of Science (B.Sc.) degree from the University of Toronto, followed by his Doctor of Medicine (M.D.) degree from the University of Western Ontario in 1996. He completed a neurosurgery residency in London, Ontario, Canada – University of Western Ontario, in 2002, receiving his Neurosurgery Fellowship (FRCSC) designation from the Royal College of Physicians and Surgeons of Canada in 2002. He completed a spine fellowship from Virginia Commonwealth University in 2003. He has been a neurosurgeon / spine surgeon at Hamilton Health Sciences, General Site (Hamilton, Ontario, Canada) from 2003 to the present. He is an Associate Professor at McMaster University (Hamilton, Ontario, Canada). His research interests focus on spinal disorders.

Speaker
Edward Kachur / McMaster University, Canada

Abstract

Rising cost of health care in most jurisdictions has resulted in physician-lead innovations for more cost-effective health services. One area is to shorten the length of stay. In our effort to contain the cost of providing surgery in a public system, we looked at the efficacy of performing anterior cervical surgery for patients in our day-surgery unit (DSU). Retrospective review of prospectively collected data from 2008 to present was conducted. Data focused on surgical details, demographic, patient reported outcome and safety. Approximately 144 cases were completed between June 2008 and present day. Overall 48% were single level anterior cervical discectomy and instrumented fusion, two level an additional 38% and three levels represented 14%. Gradual increase in the percentage of more multi-level cases was seen in the first four years. The 30-day re-admission rate was below 3%. The conversion rate from DSU to admission is currently being reviewed. Efforts for more cost-effective health care should not be at the cost of compromising patient safety. By reporting our institutional experience, a comprehensive process spanning the entire episode of care for patients undergoing anterior cervical spine surgery, we hope to demonstrate not only the safety but efficiencies. Development of a process, which includes education of not only the patients but also the entire health care team has been vital. Each component of this process allows for maintenance of safety and ensures delivery of health service with greater patient satisfaction and uncompromising outcomes.

Biography

Dr. Massicotte has focused his academic neurosurgical career in Toronto since his faculty appointment in 2002. As an Associate Professor with the University of Toronto, he recently completed an MBA to further advance his role as medical director for two programs, Back & Neck and Concussionat Altum Health a division of University Health Network (UHN). The Concussion program was an innovation started in collaboration with Dr. Charles Tator. Special interest in education and patient outcome for better delivery of care his collaboration with multiple colleagues have contributed to over 70 publications in peered-review articles and numerous international speaking engagement.

Speaker
Eric M. Massicotte / University of Toronto, Canada

Abstract

Objectives: For complicated large difficult common bile duct (CBD) stones that cannot be extracted by ERCP, patients can be managed safely by open or laparoscopic CBD exploration. The aim of this study was to assess these surgical procedures of CBDE after endoscopic failure. Methods: We retrospectively reviewed and analyzed 85 patients underwent surgical management of large difficult CBD stones after ERCP failure, in the period from the beginning of 2013 to the beginning of 2018. The overall male/female ratio was 27/58. Results: Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively with a significant correlation between number of ERCP sessions and post-ERCP complications (P=0.009). An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBD exploration (LCBDE), open CBD exploration (OCBDE) and the converted cases were 24.7% (n=21), 70.6% (n=60), and 4.7% (n= 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively (P< 0.05), Eleven (12.9%) of our patients had postoperative complications (14.3% post LCBDE and 11.7% post OCBDE, P<0.05) without mortality. By comparing LCBDE and OCBDE groups; there was a significant association between the former and younger age, shorter referral time, more frequent choledochoscopy, and longer operative time with independent correlation regarding operative time. On comparing, T-tube and 1ry CBD closure in LCBDE group, there was significant longer operative time, and post-operative hospital stays in the former. However, on comparing them in OCBDE group, there was a significant correlation between 1ry CBD closure and a smaller diameter of CBD, single stone, choledochoscopy, shorter operative times and post-operative hospital stays. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay. Conclusion: Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.

Biography

Currently, Emad Hamdy Gad working as associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014( part time) He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/ 2015 to 8/2015 Emad Hamdy Gad worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.

Speaker
Emad Hamdy Gad / Menoufia University, Egypt

Abstract

Introduction: Soft tissue sarcomas(STS) are rare malignancies whose mainstay of therapy is margin-negative surgical resection. Complete removal of tumors may necessitate resection and reconstruction of major arteries and veins. The purpose of this study is to investigate the short- and long-term risks of vascular reconstruction in STS resection. Methods:This IRB-approved retrospective study analyzed data from one hundred fifty-three patients undergoing surgical resection of sarcomas at Mayo Clinic Florida between April 1998 and April 2017. Outcomes measured included thirty-day morbidity and mortality, long-term graft patency, and overall survival. Results:Seventeen patients (11.1%) underwent revascularization after sarcoma resection. There was no statistically significant difference in demographics or comorbidities between revascularization and non-revascularization groups. Tumor size and grade were not significantly different between the groups and did not predict vascular involvement. Selected operative characteristics and thirty-day post-operative outcomes are shown in Table 1. PTFE graft was used most frequently in patients undergoing vascular reconstruction (47.1%). Saphenous vein was used in 23.5% of patients and primary repair occurred in 17.6%. Four of eight patients with PTFE graft experienced thirty-day complications of graft occlusion, reintervention, renal failure, death and amputation. Graft patency was 82.4% at a median 14.8 months. Graft failure occurred in three revascularization patients, two with arterial PTFE grafts and one patient with venous and arterial saphenous vein grafts. A statistical trend towards early complication was observed in the reconstruction group (p=.056). Overall survival at one year for the revascularized and non-revascularized groups was72.5% and 89.8%, respectively(p=.3611). There were no statistically significant differencesbetween the groups in overall survival, recurrence-free survival ordistant metastasis-free survival.Metastasis was the only statistically significant time-dependent predictor for overall mortality; p=<0.001. Conclusion:This study suggests that revascularization after sarcoma resection is not associated with increased adverse outcomes and should not dissuade surgeons from resecting and revascularizing vessels to achieve margin-negative resection. Confirmation of these results with a larger patient sample is recommended. Comparison of outcomes based on graft material and the role of postoperative anticoagulationis also warranted. Table 1. Selected patient characteristics and 30-day outcomes Variable Non-revascularization, n=136 Revascularization, n=17 p-value Median age at surgery 64.5 years 49.0 years .0718 Male gender 64 (47.1%) 8 (47.1%) 1.0000 Leiomyosarcoma 14 (10.3%) 5 (29.4%) .0404* Computed tomography 49 (36.0%) 12 (70.6%) .0083* Preoperative angiography 7 (5.1%) 7 (41.2%) .0001* Intraoperative anticoagulation 1 (0.7%) 11 (64.7%) <.0001* Motor nerve resection 9 (6.6%) 5 (29.4%) .0100* Complete resection 128 (94.1%) 17 (100%) 0.5987 Median operative time 256.5 min. 389.0 min. .0023* Median blood loss 250.0 mL 800.0 mL .0041* Median length of stay 4.0 days 5.5 days .1599 Surgical site infection, 30-day 10 (7.4%) 2 (11.8%) .6249 Renal failure requiring dialysis, 30-day 0 (0.0%) 2 (11.8%) .0117* Readmission, 30-day 9 (6.6%) 2 (11.8%) .3514 Reintervention, 30-day 11 (8.1%) 3 (17.6%) .1906 Graft occlusion, 30-day 0 (0.0%) 2 (11.8%) .0117* Extremity amputation, 30-day 0 (0.0%) 1 (5.9%) .1111 Mortality, 30-day 0 (0.0%) 1 (5.9%) .1111

Biography

Albert G. Hakaim, M.D., is a vascular and endovascular surgeon specializing in endovascular repair of abdominal aortic aneurysms and thoracic aneurysms. His clinical practice includes general vascular surgery and endovascular treatment of occlusive and aneurysmal arterial disease and arterial reconstruction in patients with dialysis dependent renal failure. Dr. Hakaim's areas of clinical expertise include: Endovascular and open surgery repair of aortic aneurysms, Carotid surgery, Lower extremity revascularization, Vascular access surgery and Thoracoabdominal aneurysm repair

Speaker
Albert G. Hakaim / Mayo Clinic, USA

Abstract

Emergency intubations result in higher rates of complications than elective intubations. We sought to evaluate the utility of performing bronchoscopy immediately after urgent intubation. Prospectively collected data were reviewed on all patients admitted to SICU of a Level I urban trauma center between July 2016 and January 2018 who were urgently intubated and immediately followed with flexible bronchoscopy. Intubations were performed by residents and fellows. Demographic, clinical, and intubation data including distance from the carina, quality of visualization, and times for STAT portable CXR to be performed and interpreted were recorded. A total of 101 patients met inclusion criteria. 82% of attempted intubations were successful on the first attempt. The rate of inappropriate tube position was 34%, including 7% rate of right mainstem placement. No esophageal intubations were recorded. The median time (interquartile range) for an CXR to be obtained was 44 minutes (27-86 minutes), and for an official interpretation, 3.7 hours (1.5-8.8 hours). 69% of these CXR were obtained solely to verify ETT position. The use of flexible bronchoscopy as an intubating adjunct allows for the immediate correction of tube placement, provides airway clearance, and potentially avoids the need for post-intubation CXR

Biography

Matthew Bloom, MD, MSEE is the Trauma and Critical Care Surgeon from Cedars-Sinai Medical Center Los Angeles, CA, USA. He received his masters degree in Electrical Engineering from MIT, USA. He is the director of the Minimally Invasive Surgery Research Lab at Cedars-Sinai.

Speaker
Matthew Bloom / Cedars-Sinai Medical Center, USA

Abstract

Previously, the only treatment for avascular necrosis of the talus was tibiotalocalcaneal arthrodesis. Now, with the advent of 3 D printing an exact cobalt chrome replica of a patient’s talus can be created and used to replace the damaged bone. This can be used to replace avascular tali from trauma and steroids or collapsed tali secondary to total ankle replacement. A series of 13 patients with total tali, their results and examples of such use will be presented

Biography

James K. DeOrio is Professor of Orthopedics at Duke University and Director of the Foot and Ankle Fellowship. He is a 1977 graduate of the GW Med School, trained at the Mayo Clinic and performed an AO fellowship in Chur, Switzerland. A frequent contributor to research with over 130 original articles and book chapters, he’s been recognized in the Top 1% in the US in foot and ankle,, Top 20 Surgeons in NC, Feb 2012 and elected by peers in US News as one of the The 23 Top Foot & Ankle Surgeons in the U.S., 2012.

Speaker
James K. DeOrio / Duke University, USA

Abstract

Biowave research has been from the foundation40 years agountil Clinical application recently. It has already enteredtumor cell RNA anti-cancerresearch.Two experimental models of non-tumor mice were to verify thattumor cell RNA couldcross-anticancer. It preliminarily displays a new field of cancer prevention and control is emerging.The efficacyprinciple has been elucidated. It included as following: To trace the source of vitality from a material characteristic: 1.The mechanism of efficacy lies in the ability of bioticoscillator of RNA.Just asFrancis crick proposed for genetic central dogma thatinvolves RNA transmitted ability.Studies recognized the function depending on persistent coupled oscillationcapacity of RNA sub-molecules. Just asArthurT. Winfreethinks fireflies flash synchronously in the Amazon Basin. This particularity also shows that when the organic structure of life changes into a single physical structure. It can still show lifebehavior.In addition, it can pass throughtarget selectingto take places host transformation.Especially the chemotactic selectionandevenit also can through heterogeneous integrationto form“Rivet effect”.Biowave basic experiment and clinic trial result reveals theseare the basis for long term efficacy.In the microcosmic architecture organismenvironment appears complex and orderly opennesscharacteristics.These are exactly the clinical effects on the basis. 1.Apply to restrict preinvasive cancer In 2013received early lung cancersecondary fromcavitary pulmonary tuberculosis. Shewillinglyaccepts of autologous tumorsRNA vaccine preparation. from then,She has been in a healthy state. 2.Same year a stage II to III breast cancer patient by axillary lymph nodes (1/5) metastases, post-treatment, looking as complete recovery. 3. Totreat advanced liver cancer In 2011,start usinga liver cancer originated in thehepatitis B and liver cirrhosis.After received vaccine treatment,six years unfortunately died of liver failure. 4.Applied tooperation treatment of elderly rectal cancer 82-year-old patient of colorectal cancerFaster wound healing after operation only 28 days. With the popularization of RNA, not only promote the dominant position of oncology surgery, but also realize the third breakthrough in medical history.

Biography

Qiwang Xu at the age of 26 years was appointed a military doctor and has completed Master of Medicine at the age of 31 years from Third Military Medical University. In the afterwards years, leading team of the research established biowave theory foundation. And successively has published 60 papers in professional journals and serving as five editorial board members. Two monographs have been published. It is one of the inventors of the national class 1.1 new drugs.

Speaker
Qiwang Xu / International Medical Academy Beijing, China

Abstract

BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists. We hypothesized that the use of Robot Physician’s (RP) in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Biography

Dr. Alisher Agzamov has completed his MD in 1981 from Tashkent University, USSR and postdoctoral PhD studies from Moscow University, USSR in 1991. During 1992 – 1998 He was a Senior Consultant Cardiac Anaesthesioligst of the Europen Cardiac Surgery Programme and Professor of Anaesthesiology of the University of Zambia and University Teaching Hospital, Lusaka, Zambia; From 1998 till up to date He is the Senior Consultant Anaesthesiologist fo the Department of Anaesthesiology & ICU, Kuwait Cancer Control Center ( KCCC). Ministry of Health, Kuwait City, Kuwait. He has published more than 550 papers in reputed journals and has been serving as an editorial International board member of reputable Anaesthesia and Intensive Care Journals. His main Scientic interest in fileds fo Anaesthesia and ICU Management Surgical and Medical ICU Oncology Patients. His using extensively Robots Physians in ICU Management of Oncology ICU patients.

Speaker
Alisher Agzamov / Kuwait Cancer Control Center, Kuwait

Abstract

BACKGROUND: Bullae can occur with or without emphysema. It’s a thin wall air filled space less than 1 mmin diameter in the lung parenchyma. When distended more than 1 cm in size it requires surgical removal ( bullectomy). OBJECTIVE: The aim of this study is to assess the presentation and surgical outcome for bullous lung disease. RESULT: From all patients attending Al Shaab cardiothoracic clinic in the 2013; 135 patients had lung Bullae. Bullous Lung Disease were identified radio graphically in young healthy adults with no underlying lung disease. Smoking does not play an important role in the development of Bullae in healthy young adults in our patients. The most symptoms in presentation where chest pain and SOB and half of them (50%) had exertional dyspnea. The duration of symptoms before presentation was more than 2 months. Asthma was only respiratory disease associated and seen in 20%. Bullectomy was done to majority of patients. Muscle sparing thoracotomy approach ( Minithoracotomy – incision size ) CONCLUSIONS:We found no association between lung bullae and smoking in Sudanese population, it's associated with other respiratory disease. The outcome was excellent and no death was reported.

Biography

Dr. Nada F. Mansour. MBBS, Faculty of Medicine, University of El Fasher. P ST2 ( Specialist trainee, 2nd year in cardiothoracic surgery ). Department of Cardiothoracic surgery. Al Shaab Teaching Hospital, Khartoum, Sudan.

Speaker
Nada Faisal Hassan Mansour / 4Al shaab Teaching Hospital, Sudan

Will be updated soon...