Ospan A. Mynbaev MD, PhD, ScD, MSc (MedPharm), Adjunct-Professor, The Principal Researcher, Moscow Institute of Physics & Technology (State University), Dolgoprudny, Moscow region, Russia Representative, The New European Surgical Academy, Berlin, Germany His main research topic is related to CO2-pneumoperitoneum pathophysiology and he published many research, editorial and critical articles and opinion letters concerning this topic. He developed an original theory of pathogenesis of CO2-pneumoperitoneum-induced metabolic hypoxemia in a rabbit model (2002), which was cited in Current opinion in obstetrics and gynecology in 2003. Ospan Mynbaev has won several awards presenting pathophysiological mechanisms of CO2-pneumoperitoneum on worldwide congresses, including: “The Appreciation Award in Recognition of Valuable Contribution” at the 2nd and the 3rd International Emirates Conference on Minimally Invasive Surgery & NOTES (21-22 May 2015 and 12-13 May 2016, Abu Dhabi); Appreciation award for scientific contribution to the 13th National Congress of Gynecology and Obstetrics of the Turkish Society of Physical Medicine and Rehabilitation May 11-15, 2015, Antalya, Turkey. “The Honarable Mention Prize-Diploma for Multidisciplinary Paper” at the SLS congress, ENDO-EXPO, Boston, USA (2006); “Raul Palmer prize” on ESGE congress, Lisboa, Portugal (2001); “Jerome J. Hoffmann prize”, AAGL annual meeting California, USA (2001); The award (1st prize) for scientific presentation at the All-Russian ObGyn Forum, Moscow (2010); Gratitude letters signed by: the IXth ESG congress president Copenhagen, Denmark(2011); the NESA president Berlin, Germany(2012); the president of Russian seminar on controversies in obstetrics and gynecology, Sochy (2014).
Background: The main indications for revision of bariatric surgery is inadequate weight loss, weight regain, or complications. The objective of revision is to restore the restrictive component and/or add a malabsorptive component. Objectives: To evaluate the effectiveness of revisional laparoscopic bariatric surgery for loss of weight and assess the risks and benefits associated with these technically demanding procedures. Methods: Revision cases performed between 2001- 2015 were identified and grouped according to the primary procedure and type of revision. A retrospective analysis was carried out for weight loss as well as perioperative morbidity and mortality. Results: The total of 337 patients underwent revisional laparoscopic surgery during the study period and were categorized into five groups. Group 1 (n=92) had an adjustable gastric band converted to gastric bypass (GBP). Group 2 (n=135) had a dilated gastric pouch after GBP and underwent pouch reduction. Group 3 (n=73) had a GBP and underwent pouch reduction and elongation of the biliopancreatic limb. Group 4 (n=21) had a Vertical Banded Gastroplasty (VBG) converted to a GBP. Group 5 (n=16) had a Sleeve Gastrectomy converted to GBP. The mean total body weight loss for groups 1-5 was 34.5%, 23.6%, 39.8%, 33.5%, and 32.9% respectively. The average operative times were 190, 75, 150, 215, and 135 minutes. The average hospitalization was1.5, 1.0, 2.0, 2.5, and 2.0 days. All cases were completed laparoscopically. Concomitant procedures were liver biopsy, cholecystectomy, partial gastrectomy, hiatal, ventral, and internal hernia repairs. Complication rates were 1.8%, 0%, 1.46%, 4.75% and 0% for each of the groups and there were no mortalities. Conclusion: Results of revisional bariatric surgery very depending on the original procedure and the reasons for revision. In particular, if the main reason for re-operation is inadequate weight loss, then the burden is to demonstrate a surgically correctable deficiency. Revisional procedures incorporating malabsorption result in greater weight loss than gastric restriction alone.
Constantine T Frantzides is the Director of the Chicago Institute of Minimally Invasive Surgery; Director of the Laparoscopic and Bariatric Fellowship Program at St. Francis Hospital and visiting Professor of surgery at University of Illinois in Chicago.He is recognized worldwide as an expert in the field of laparoscopic surgery and is a charter member of the United States Laparoscopic Founders Society. He was also named "America's Top Doctor" by the acclaimed Castle Connolly Medical Guide for 5 consecutive years (2009-2014). In addition, he was named "Top Doctor" by the Chicago Magazine (2012-2014), and the US News and World Report for 2011 -2013. In addition he was Professor of Surgery at Northwestern University from 2004-2009. He was the first surgeon to define and publish the importance of preserving the Vagus nerve during a gastric bypass for avoidance of the dumping syndrome (Obesity Surgery 2011). He is credited with inventing two surgical instruments used in laparoscopic surgery. He is a member of numerous professional societies and has been the recipient of several awards and honors as well as grants from the National Institutes of Health (NIH) and from the surgical industry. He has made more than 200 contributions to the medical literature and has written three books on laparoscopic surgery. He was the first in the world to introduce and perform 14 different laparoscopic procedures.
Harm Rutten is a surgeon-oncologist with a focus on the malignancies of the digestive tract and the breast. His special area of attention is rectal surgery. The Catharina Hospital is a national referral center for complex rectal cancer, both for the new tumors and locally returned tumors (local recurrences). The multidisciplinary approach, including the ability to irradiate during surgery, has meant that we can cure many more patients with this disease. We do a lot of scientific research in this area. He is also a trainer of young surgeons who want to become more proficient in the treatment of tumors of the digestive system. Harm Rutten is working as Chairman of the Gastrointestinal Tumors Working Group of the Integrated Cancer Center of the Netherlands (IKNL), Associate editor European Journal Surgical Oncology, Member of the scientific committee Dutch Surgical Colorectal Audit (DSCA) and Instructor CHIVO gastrointestinal surgery. He has been involving so many memberships like Dutch Society of Surgery, Dutch Society of Surgical Oncology, Dutch Association for Gastrointestinal Surgery, Fellow of the Royal College of Surgeons of England, London, Dutch Colorectal Cancer Group and Board member of the International Society for Intraoperative Radiotherapy.
Object: Meralgia paresthetica causes pain, burning, and loss of sensation in the anterolateral thigh. Surgical treatment traditionally involves neurolysis or neurectomy of the lateral femoral cutaneous nerve (LFCN). After publishing anatomical feasibility, we are now submitting our first series of LFCN transposition.Methods:Nineteen cases of meralgia paresthetica were treated at our institution between 2011 and 2016, four underwent simple decompression, five deep decompression, and ten medial transposition. Data was prospectively collected and retrospectively analyzed. The patients were not randomized. The groups were compared in terms of pain scores (Numeric Rating Scale, NRS) and reoperation rate. Results:The NRS scores dropped significantly in the deep decompression (p = 0.148) and transposition (p < 0.0001) groups both at 3 months and 12 months follow up. Reoperation rate was significantly lower in the deep decompression and transposition groups (p = 0.0454). Conclusions:Both deep decompression and transposition of the LFCN offer better results than simple decompression. Medial transposition has the advantage of mobilizing the nerve away from the ASIS, giving it a straighter and more relaxed course, in a softer muscle bed. Key Words: canal, lateral femoral cutaneous nerve, meralgia paresthetica, neurectomy, neurolysis, transposition
Dr. Amgad Hanna grew up in Cairo, Egypt and graduated from the faculty of Medicine at Cairo University. He completed his Neurosurgery residency at the University of Rennes, in France, in 1999. He also continued on to complete a Neurosurgery residency in the USA at Thomas Jefferson University hospital in Philadelphia. Dr. Hanna further specialized in spine and nerves by completing a spine fellowship at Washington University in St. Louis USA, and a combined spine and peripheral nerve fellowship at Mayo Clinic, Rochester USA. In 2009 he joined the University of Wisconsin as an assistant professor of Neurosurgery. As Dr. Hanna began treating spinal cord injured patients, he observed a lot of progress in spinal stabilization procedures but not in spinal cord regeneration. Thus, Dr. Hanna has devoted much research time into developing techniques to improve spinal cord regeneration after an injury. Over the past few years, he has published over a dozen research papers and clinical papers as well as a book on the Anatomy and Exposure of Spinal Nerves and another book on Nerve Cases. Dr. Hanna aspires to one day have his research help patients with nerve injuries or spinal cord injuries improve functional recovery and thus improve their quality of life.
Intra-cardiac thrombosis (ICT) is one of the most devastating complications the transplant anesthesia team could ever encounter. Reported incidence of ICT has been between 0.71% and 6.25%. It can occur during OLT with a reported overall mortality rate of 68% and an 82% intraoperatively. In majority of cases, ICT, following by massive pulmonary embolism, occurs a few minutes after liver graft reperfusion, but also can happen at any stage of the surgery. The clinical picture is typical for rapidly developing, sometimes abrupt, cardiovascular collapse, with catastrophic drop of overall myocardial performance and circulatory arrest. In most cases, CPR is ineffective, and fatal outcome is common. Intra-operative TEE is the only way to correctly diagnose intra-cardiac chambers thrombus formation, its size, location and dynamics, as well as to monitor myocardial performance and effects (or lack thereof) of resuscitation efforts. Single-center experience of 4 cases, where intra-cardiac thrombosis occurred during liver transplant surgery, including authorâ€™s case of four-chamber clot formation during pre-unhepatic (dissection) stage, as well as treatment options and possible ways of prediction/prevention, will be discussed.
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. Dr. research interests are Anesthesiology, Care Medicine, Surgical Critical Care, Transplant Surgery, Traumatology.
The Droopy nasal tip is one of the most frequent common nasal deformities among our patients which required a careful history and comprehensive nasal analysis to have successful intervention for correcting nasal ptosis. To select the exact surgical technique for correction, it is very important to assess the degree of tip rotation deficit and whether this associated with normal, insufficient, or excessive degree of tip projection. So, a prospective study was done to assess the incidence and causes of droopy tip deformity & to evaluate the role of different techniques in correcting such deformity. Identification and correction of the etiology will allow for surgical modification with predictable and reliable outcomes. Considering the tripod theory principles will guide this successful surgical plan. The external rhinoplasty approach was used in all cases. Our goal in correcting the droopy nasal tip is to eliminate the forces that inferiorly displace the alar cartilages before adopting any alar cartilage modifying technique, and finally increase the tip support mechanisms. More than one technique were used in each case, to reach satisfied correction. The most different effective techniques used in correction will be discussed. Conclusions: A multitude of surgical maneuvers are often necessary to address all the features of the droopy nose and to produce the desired aesthetic long-term result. Strong nasal tip columellar strut is very important in all cases to increase the strength & stability of the alar cartilage complex, which essential to a have a good long-term result & adjusting optimal nasal tip projection on the operating table. Keywords: Droopy nose; Nasal Tip Ptosis; tip inferiorly rotated
Mr. Sameer Ali Bafaqeeh is a university professor in King Saud University, College of Medicine, Otolaryngology Department, Past Program director of KSU Facial Plastic fellowship, Facial Plastic Division Chairman, PAAFPRS Vice President, Chairman annual international Rhinoplasty & Otoplasty courses. Received higher surgical training from University Hospital of George August (Gottingen West Germany), He has trained as a clinical fellow in facial plastic surgery in Oregon Health Sciences University (Portland, Oregon, USA) Under supervision of Prof. Ted Cook. He has invited for lectures in various national & international facial plastic surgery meetings and published many scientific papers as well as authored chapters related to facial plastic surgery in reference books. Since started He is passionate about teaching these skills in King Saud University Facial Plastic fellowship program, Otolaryngology Residency program, and runs the first middle east advanced Rhinoplasty & Otoplasty courses in SAUDIA ARABIA, and he is a faculty of various national and international workshops and courses. (11 Days of Singapore Facial Plastic Surgery, AAFPRS Advanced Rhinoplasty, Istanbul Rhinoplasty Workshopped. Etc.)
Personalized Medicine uses pharmacogenomics (PGx) to guide drug choices and improve patient outcomes. PGx is the study of how genetic variation can affect an individualâ€™s response to specific drugs. Genetic variation in metabolizing enzymes, drug transporters, and drug receptors can affect the efficacy and expected clinical response of any given drug. Personalized pharmacogenomic profiles can be generated for any patient and help the provider choose the â€œcorrect â€œdrug to maximize the clinical response and decrease adverse effects. PGx is currently used in many areas of medicine such as Oncology to guide choices of chemotherapy, Cardiology to aid with Warfarin and Plavix dosing, as well as Psychiatry and the use of antidepressant medication. The use of Pgx in perioperative medicine is novel. Importantly, many drugs used in the perioperative period, including opioids, antiemetics, and anesthetics have important genetic determinants. Using Pgx to aid our drug choices could potentially decrease postoperative nausea and vomiting, improve pain control, improve patient satisfaction, and decrease PACU and hospital length of stay. Implementing a pharmacogenomic program at any institution must involve clinicians, pharmacists, information technologists, and pharmacogenomic experts. Education on the use of PGx is paramount and must be available for providers that will be using the PGx profiles to guide their medication choices.
Wendy Suhre is a general anesthesiologist at University of Washington Medical Center. She is the Medical Director of the Pre-Anesthesia Clinic. She has implemented a pharmacogenomics program at her institution and continues to work on extending the program to other areas across of medicine across her institution.
The IASP defined pain as: â€œan unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.â€ American Pain Society in mid 1990s promoted the concept of â€œpain as the 5th vital signâ€ to elevate the awareness of pain treatment among healthcare professionals. Pain is the only vital sign that is not objectively measured. Different subjective pain intensity scales such as Numeric Rating Scale (NRS), Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale (VAS) are used for assessing the pain. While these remain the generally accepted assessment paradigm, and while we all agree that these pain scores are highly subjective entity, we nevertheless rely to make judgments about the effectiveness of treatments and/or procedures that we provide to our patients. Misinterpretation of pain complaints can lead physicians to underestimate or overestimate the patientsâ€™ medical condition, thus misguiding them in providing appropriate therapies. NRS or VAS are reliably used to assess acute pain, both at rest (important for comfort) and during movement (function and risk of postoperative complications). Dynamic pain provoked by deep breathing, coughing, and getting out of the bed is more important for reducing the risks of cardiopulmonary and thromboembolic complications after surgery. Besides pain scores, other indirect measures might be used to assess acute postoperative pain such as opioid consumption, length of stay, discharge readiness, etc. We will discuss different meassures that can be used for meassuring acupte postoperative as well as chronic pan.
Dr. Nebojsa Nick Knezevic is the Vice Chairman for Research and Education at Department of Anesthesiology and Pain Management at Advocate Illinois Masonic Medical Center, and also an Associate Professor of Anesthesiology and Surgery at the College of Medicine, University of Illinois Chicago. Dr. Knezevic has extensive expertise in basic and clinical research, and he has published more than 90 highly-cited, peer-reviewed scientific articles. He also serves as a reviewer for many anesthesia and pain journals. Dr. Knezevic is the Section-Editor of the Pain Physician journal; Associate Editor of the BMC Anesthesiology and Assistant Editor of the Anesthesia & Analgesia journal. Dr. Knezevic is a designated member of the Advocate Healthcare IRB. He is serving as a Vice Chair of the ASA Abstract Review Subcommittee on Chronic and Cancer Pain, and served as Chair or Committee member for many national and international meetings, including NYSORA, AAPM, ASIPP, NWAC, MARC, etc. Dr. Knezevic has developed many research and educational anesthesia and pain programs for residents, fellows, and attending physicians. Dr. Knezevic manages multiple US and global clinical trials (phases I-IV) for the testing of different pain medications and innovative medical devices for acute and chronic pain. Dr. Knezevic is a recognized lecturer in many national and international conferences with multiple awards for outstanding academic achievements.
Introduction: Pancreatic cancer (PC) has been showing an increasing incidence and associated mortality rates since 1950 in economically developed countries. More than 80 % of these are ductal adenocarcinomas. Epidemiology: It is estimated that by 2030, PC will be the second largest cause of cancer death in the US. In Europe, the seventh most prevalent cancers are currently in place. The Baltic and Northern and Central European countries have the highest incidence worldwide: > 9.5 / 100.000 men and 6.0 / 100.000 women. PC represents the second most common cancer of the digestive tract and the sixth most common cancer in the Czech Republic after colorectal cancer. With a total incidence of 10 new cases per 100 thousand inhabitants / year, however with the incidence several times higher in the age > 60 years, the Czech Republic is second in the world, just behind Japan. In absolute terms, this represents about 2,200 new cases for the Czech Republic with an annual increase of more than 1% - data from NCR, IHIS. Interesting is the finding of recent years regarding other primary neoplasms in patients treated for the first neoplasm. Due to the increasing survival rate of patients treated for malignant disease in general, there are an increasing number of patients where PC is another neoplasm. Mortality and survival: The current overall 1-year survival in patients with PC is 28.3 % and the 5-year survival of patients of all stages of PC in the last decade is only 7 %. Low survival makes PC the 4th most common cancer cause worldwide, with mortality almost identical to incidence and annual deaths nearly reaching the number of deaths from tumors with several times higher incidence (e.g. male prostate and colorectal cancer in women). The median survival of patients undergoing curative resection with adjuvant chemotherapy reaches 20 - 24 months, 5 years survival is 20 %, while the median survival of locally advanced pancreatic cancer is only 9 - 13 months. Therefore, a comparison of the median survival in unresected and radically resected patients clearly supports radically resected patients. An unfavourable fact remains that only 20 % of patients are resecable. The finding, assessed as locally advanced without distant metastases but primarily non-recurrent, is expected in 30 % of patients. More than 50 % are patients with generalized disease. Causes of late diagnosis: PC develops relatively slowly over approximately ten years and we only treat it at its terminal stage. The disease should be understood as systemic rather than locoregional. Moreover, the tumor spreads not only through lymphatic vessels, but also perineurally. Despite the fact that we know the risk factors, symptoms, T3cDM subtype accompanying PC, suitable disease markers have not been established. Repeated and combined use of high-resolution imaging examinations may only be performed in high-risk groups. The late diagnosis is also confirmed by the representation of individual clinical stages in the Czech Republic, where IV. stage prevails (70 %) with rising year-on-year trend and small numbers of other stages with stable numbers (see - www.svod.cz). Limited possibilities of prevention and early diagnosis leading to the finding of advanced stages of the disease at first contact with the doctor, recurrence after radical resection, low effectiveness of current systemic cancer treatment and short survival (e.g. compared to colorectal cancer) often lead to persistent feeling therapeutic despair. This ultimately leads not only to the underestimation of current therapeutic possibilities, but often to poor clinical practice. A number of patients are under long-term examination and wasted the time of resection procedure. Often the quality of life is not respected depending on the treatment method chosen. For these reasons, a significant percentage of patients do not benefit from the provided therapy in our country. In addition, a portion of the patients spend a short period of their remaining lives in a healthcare facility, whether with the complications of poorly effective treatment or in vain hope of cure. The unsatisfactory results and economic inefficiency of such a procedure are obvious. At this point, it should be stressed that this is not only a matter of the Czech Republic, but a global problem. Specification of PC diagnosis and determination of disease staging: Rapid determination of disease staging is crucial for the patient to determine optimal treatment within a multidisciplinary team. While the suspicion or primary diagnosis is usually done outside the centre, the most accurate staging is the task of the so-called high-volume centre (H-V). There are currently 13 of them in the Czech Republic, with more than half of the patients being treated in six of them. Computer tomography (CT) according to the standard protocol (max. 1mm sections, 3 contrast phases: parenchymatous, arterial, portal) without the use of an orally administered contrast agent is key for the evaluation of the finding and resecibility. The second major examination to specify PC staging is endoultrasonography (EUS) supplemented by a fine needle aspiration biopsy (FNAB). In addition to tumor location and size, EUS is beneficial in evaluating venous and arterial angioinvasion, especially when Doppler blood flow mapping is used. FNAB can morphologically confirm a suspension for malignancy. Its implementation is therefore not a condition for indication of the surgical solution. Cytological or histological verification of PC in potentially resectable (borderline) or non-resectable tumors is essential. It requires the administration of chemotherapy. CT/MR and EUS constitute the basic framework for the assessment of disease staging and, in particular, non-recurrence. CT and MR are interchangeable and in most cases it is not necessary to perform both examinations simultaneously. Endoscopic retrograde cholangiopancreaticography (ERCP) cannot currently be considered a diagnostic tool in PC patients. However, at this stage of the examination, ERCP may be beneficial in patients for whom histological verification of tumor of papilla Vateri or distal bile duct tumors (brush biopsy) is possible. It is indicated in patients with cholangitis, a bilirubin value greater than 250 mmol/l or at an expected delay in surgery. Positron emission tomography (PET) may be beneficial in detecting disease dissemination. However, it is not currently reported in the standard investigation, the implementation should be decided by the multidisciplinary team of the H-V centre and PET should not be a reason to delay for decision to indicate or not to indicate radical resection. Therapy: The majority of patients are treated in the Czech Republic at the sites of the Comprehensive Cancer Centres. These centres guarantee a functional multidisciplinary approach, including the provision of complications and dispensary solutions. On the other hand, a part of patients with PC is treated in workplaces with low frequency of surgical interventions and without transparent multidisciplinary team. Radical resection, palliative procedures: A radical resection procedure means removing the affected part of the pancreas by performing a standard lymphadenectomy. Proximal pancreatoduodenectomy is performed for localization in the head of the pancreas, left pancreatectomy with splenectomy for localization in the body and in each case. The condition of radicality is the detection of negative edges of the resect and absence of positive lymph nodes N3. Total pancreatectomy is not currently considered a standard performance in PC and is rational in approximately 10 â€“ 12 % of resected patients. Removal of liver metastases is not indicated in standard therapy. However, out of a total of 673 procedures assigned to the diagnosis of C25 in 2016, only 275 radical resections were performed: 175 proximal pancreatoduodenectomies, 64 left-sided resections and 42 total pancreatectomies. Other interventions were partly palliative (clutch interventions), partly dealing with complicated or postoperative conditions. At least 1 PC operation was performed in 61 hospitals - 7 hospitals covered 50 % of these operations, 14 hospitals covered 75 % of these operations. Gastroenteroanastomosis is rarely indicated in these patients in case of tumor duodenal obstruction. Its implementation does not have to mean a factual renewal of the passage. The reason is a disorder of stomach and small intestine motility caused by the underlying disease. In some patients, palliative resection may be performed, particularly from a psychological point of view. Most PC patients are treated palliative or symptomatically. Postoperative course and early complications: The course of the early postoperative period after the pancreatic resection procedure corresponds to the condition after a large abdominal procedure and therefore follows general rules (antithrombotic prophylaxis, epidural analgesia, early mobilization, early removal of nasogastric probe, correction of pathological glycaemia, fluid balance control, early removal of urinary catheter, oral intake, etc.). Specific measures relate primarily to the control of possible leakage of pancreatic juice from the drain. Although the early lethality of pancreatic resection has decreased significantly over the last 25 years and does not exceed 3 â€“ 5 % in H-V centres, morbidity is as high as about 60 %. The mentioned pancreato - digestive anastomosis dehiscence with the development of pancreatic and often enteral fistulae can be observed in 10 - 28.5 % of operated patients. In a minority of patients it means early reoperation. Concept of borderline, neoadjuvant treatment: The low resectability of patients with PC and the fact that preoperative staging in some patients does not reflect the disease progression, led to reflection on neoadjuvant chemotherapy as early as the early 1990s, when some clinical studies have shown its benefit in primarily unresectable patients. The concept of borderline resectable PCs was formulated by Katz and co-authors (modified): 1 - complete removal of tumor and lymph nodes with negative margins is a condition of long-term survival, including tumor-affected venous portomesenteric segment, 2 - resection of the affected part of a. hepatica is also a condition of long-term survival but not resection of the affected part of a. mesenterica sup. 3 - so-called downstaging can be achieved without resection only by administration of cytotoxic substances alone or rarely in combination with radiotherapy, 4 - neoadjuvant chemotherapy or chemoradiotherapy can be administered in selected patients with the aim of achieving subsequent radical intervention. Although the Katz definition was not accepted by consensus, its further refinement only concerned the degree of angioinvasion of the a. mesenterica sup. and preference for anatomical conditions over clinical ones. Neoadjuvant therapy is not expected to be downstaging but to stabilize the radiographic finding without developing metastases. Such a patient is indicated after two months of neoadjuvant chemo(radio)therapy for radical resection. In the Czech Republic, we do not yet have relevant data on the results of so-called borderline PC patients receiving neoadjuvant chemotherapy. Factors affecting survival after resection procedure: Independent factors influencing PC survival are tumor localization, tumor size (T>2 cm), presence of positive N2 - 3 nodes, and angioinvasiveness. The worse prognosis in cancer localised in processus uncinatus of the head of pancreas is due to late clinical symptoms. The negative factors are tumor grading and positivity of the resection area. Perineural spread of the tumor is clearly one of the most unfavourable factors in ductal pancreatic cancer. Peroperative blood transfer reduces the patient's chances of long-term survival. Icterus (bilirubin 100 â€“ 250 Âµmol/l) has no negative effect on long-term survival. There is a clear correlation between the number of resection procedures performed in a surgical unit with perioperative mortality and morbidity. It is also an argument for the centralization of these patients. Conclusion: Current uncertainties are associated with determining the optimal procedure for systemic treatment and its poor efficacy, with controversial views on the procedure for borderline findings. However, despite the current lack of screening, the effectiveness of PC therapy can already be linked to: 1 - monitoring of risk groups with early design of resection treatment, 2 - monitoring of persons over 50 years with newly diagnosed diabetes (T3cDM -?), 3 - patients with suspected or diagnosed PC early referral to a specialized H-V centre with maximum effort to make the decision of effective therapy as soon as possible, 4 - the care of an oncologist or general practitioner for patients after palliative chemotherapy or symptomatic therapy (in particular effective analgesic therapy), 5 - compliance with the rules of the follow-up program. Given the current knowledge in oncogenesis of pancreatic cancer, it is necessary to improve the whole diagnostic-therapeutic process. The persistent sense of despair among the professional community must be replaced by a rational approach. Only in this way can patients with pancreatic carcinoma be optimally helped within the present knowledge.
In 1983, Prof. Miroslav Ryska joined the Department of Surgery of the University Hospital in Vinohrady as an internal candidate. In 1981 he passed the 1st degree attestation of surgery and in 1983 defended his candidate work at the 2nd Medical Faculty of Charles University (Diagnosis and treatment of upper gastrointestinal bleeding). In 1984 he worked for 4 months at the surgical clinic in Uppsala, Sweden, from 1984 to 1992 he worked as an assistant clinic. In 1986 he passed the 2nd degree attestation of surgery. During 1986 - 1988 he completed several short-term study stays at the cancer center in Berlin - Buch. In 1991 he graduated from a postgraduate surgical school at Hammersmith Hospital in London. In 1992 he habilitated in surgery (Friedly surgery in the treatment of choledocholithiasis) and until 1994 he worked as an associate professor of surgery at the Surgical Clinic of the University Hospital in Vinohrady (3rd Faculty of Medicine, Charles University). In 1994 he joined the IKEM Department of Cardiovascular and Transplant Surgery and after a four-month internship at the Virchow University Surgical Clinic in Berlin, he started a liver transplant program at IKEM. In 1997 and 1998 he completed one-month study stays in Mt. Sinai Hospital in New York and UCLA in Los Angeles. In 1998, he founded the IKEM Transplant Surgery Clinic, where he worked as its head until 2004. Since 2004, when he was appointed Professor of Surgery at the 2nd Medical Faculty of Charles University in Prague, he has been working as the Head of the Surgical Department of the Central Military Hospital and the head of the Surgical Clinic of the 2nd Medical Faculty and the Central Military Hospital. In 2007 - 8 he was chief physician for 4 months. Field Hospital in Kabul. Since 2010 he has been the Deputy Director of the Central Military Research Institute for Science and Research.
A female patient of 81 years, in good health condition, living on her own in a house suffered a stroke in 2001, and in 2010 she was diagnosed with an inoperable brain tumour (meningeoma). Apart from occasional memory loss and short term nausea she had no difficulties and could take care of herself. Following a visit she paid to her relatives in December 2013 she suddenly lost consciousness, fell and was left lying on a stone floor until her relatives found her after two days. She developed an extensive pressure ulcer in the location between her shoulder blades and the occipital and parietal bone in the scull, accompanied by loss of hair, skin, and subcutaneous tissue up to the bone in the area of 10x12 cm. After two months of hospitalisation at the Department of Neurology her general condition has been stabilised, she communicates, but her mobility is limited. The pressure ulcer between her shoulder blades heals quite effectively, the manifestations on the cranium are stagnant, the pressure ulcer shows callous margins, and the bone is coloured dark brown to black. Since March 2014 the therapy included gel preparations, and we also have commenced stem cell (fibroblast) therapy with a very good effect, in October 2015 an extensive pressure ulcer is complete healing . Last check June 2019 - patient without difficulty.
Dr. H. ZelenkovÃ¡ has been active in the field of Dermatovenerology since 1973. Since 2000 she has been directing her own Private Clinic of Dermatovenereology. Professional orientation: aesthetic dermatology, acne and facial dermatoses, medicinal mycology (nail diseases), wound management, psoriasis, employment of Ichthyol and PRP in dermatology. Co-author of the dermatocosmetic formulae containing Ichthamol and glycyrrhizinic acid. More than 65 clinical studies testing pharmaceuticals and treatment materials were carried out at her clinic with results published in many international medical journals. She is a coordinator of many international multicentre trials. More than 550 expert lectures in the Slovak Republic as well as abroad, 370 scientific publications. Author of a publication on Ichthamol and Antioxidants on dermatological practice, In 2014 he wrote a monograph Carboxytherapy, which has so far published in English, Slovak, Polish and Russian, reedition this monograph 2018,2019. Associate editor of the journals Helios, Journal of Cosmetic Dermatology (Blackwell Publishing), Dermatologia estetyczna, DERMA 3rd Millennium, Dermatologia Kliniczna, Acta dermatovenereologica Albanica, Cosmetic Dermatology(Germany), PsoInternational (Italy). Since 2000 founder and publisher of the scientific journal DERMA 3. tisÃcroÄia (DERMA of the 3rd Millennium). Founder and President of the Slovak Society for Aesthetic and Cosmetic Dermatology (SSEDK), organizer and president of the traditional international DERMAPARTY congress. Since 2006 Vice-President European Society of Aesthetic and Cosmetic Dermatology, since 2007 President of the European Society of Aesthetic and Cosmetic Dermatology. Member of SSEDK, AAD, EADV, ISD, ESCAD, Slovak Dermatovenereology Society (SDS) and IACD.
VATS has become an established and widely used minimally invasive approach in many thoracic operations. The considerations of anesthesia have focused on rapidly complete recovery in addition on the conventional requirements such as perfect lung collapse for surgical interventions and adequate oxygenation during one lung ventilation. The components of anesthesia and operation were reconsidered to enhance postoperative recovery. In recent decade, we have changed the practice for VATS on both anesthesia and operations into a precise way. To reduce the unnecessary stress and potential trauma, rigid-angled uniblockers have been widely applied in our population (small Asians) with an easy way and a comparable result. Non-intubated VATS with a new anesthetic combinations by intravenous anesthesia and thoracoscopic intercostal nerve blocks have been successfully applied and with over 20 publications. Functional hemodynamic monitors connected to arterial lines were popularly applied instead of central venous monitors. EEG monitors were routinely applied to maintain anesthetic depth and as a guide to adjust anesthetic combinations. Along with the changes of practice, early discharge, minimized costs and comparable oncological outcomes have been reported. We will report the way our team evolve and cooperate on performing precise anesthesia and operations in VATS operations.
Dr. Ya-Jung Cheng is a Professor of Anesthesiology of medical college of National Taiwan University. She was graduated from Taipei medical college and completed as Ph.D of Physiology in National Taiwan University. Dr. Cheng has over 30 years of experience in the field of anesthesiology. Her research interests are precise anesthesia in thoracic operations; especially in the application of endobrobchial blockers and non-intubated VATS operations for small Asian people. She is the chair of Department of Anesthesiology, National Taiwan University Cancer Center.
Aortic stenosis is a common clinical problem â€“ symptomatic aortic stenosis effects a significant percentage of the aging population and timely therapy has been shown to result in a substantial improvement in both the quality and quantity of life. Advances in catheter-based therapies have offered therapeutic options, with reasonable outcomes, for patients previously felt to be either at high or prohibitive risk for post-operative surgical complications. However, there exists a substantial number of patients who are deemed to be low or intermediate risk for surgery as a function of their age or lack of substantial confounding comorbidities. Growing and established evidence from clinical trials also suggest non-inferior outcomes in intermediate risk patients. Increasing world-wide use and recent clinical trials suggest outcomes in low-risk patients are reasonable enough to suggest that catheter-based valve therapies might be the preferred approach over surgery in patients with symptomatic aortic stenosis. However, it is unclear if the results from highly selected randomized trials can be applied universally to all low-risk, younger, and otherwise healthy patients with comparable, or acceptable, short and long-term outcomes. Real-world data, especially in lower and intermediate risk patients suggests that caution must be applied before wide-spread application of this advanced technology. Concern is focused on the lack of long-term outcome data and the consequences of the known limitations of catheter-based therapies when compared to established surgical options. Recognition of the advantages â€“ and potential disadvantages â€“ of catheter-based aortic valve therapies and application of a Heart Team approach, combined with shared decision-making, that emphasized patient-specific factors is critical for providing the best overall care for this challenging patient population.
Dr Firstenberg is the Chief of Cardiothoracic and Vascular Surgery at The Medical Center of Aurora (Colorado, USA). He currently holds Adjunct appointments at Northeast Ohio Medical University and the Rocky Vista University. He attended Case Western Reserve University Medical School, received his General Surgery training at University Hospitals in Cleveland, and completed a Fellowship in Thoracic Surgery at The Ohio State University with advanced surgical training at The Cleveland Clinic. He is a member of the Society of Thoracic Surgeons (STS), American Association of Thoracic Surgeons (AATS), the American College of Cardiology (ACC), and the American College of Academic International Medicine. He currently serves as Chair of the ACC Credentialing and Member Services Committee and is on several other national committees. He had authored over 200 manuscripts, abstracts, and book chapters. He has Edited several textbooks on various leadership, patient safety, and clinical topics â€“ and has lectured extensively world-wide.
Pancreaticoenteric anastomosis is the origin of postoperative pancreatic fistula (POPF). Although a variety of methods have been proposed to decrease the POPF rate, randomized controlled trials performed so far have failed to demonstrate any particular method superior to the others. Cattell and Warrenâ€™s duct-to-mucosa pancreaticojejunostomy (PJ) is a widely practiced procedure. Their method is challenging especially when the pancreatic duct is small. We assumed that the difficulty resides in the pancreatic duct becoming hard to access when the posterior row is tied before suturing the anterior row. We have modified the duct-to-mucosa PJ so that the entire circumference of the inner layer can be sutured and tied in one-step by anchoring and retracting the anterior row. The jejunal roux-limb and pancreatic stump are positioned spatially apart, allowing enough space for free needle work. During a 13-year period, 151 patients received PD using this method, and the cumulative POPF and mortality rates were 37.1% and 4.6%, respectively. These rates were stable throughout the study period, implicating a relative independence to surgeonsâ€™ experience. We believe that our method is intuitive, easy to grasp, and can readily be adopted even by the surgeons not accustomed to PD.
Dr. KY Lee graduated from Seoul National University Medical College, Seoul, Republic of Korea in 1987 and has completed his PhD from the same institution in 1996. He is now Professor of Surgery, in the Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea, subdivision of Hepato-Biliary-Pancreatic Surgery.
Background Our Sugar-I study indicated that patients compliance to preoperative fasting guidelines was poor. Hence, Sugar-II study was conducted to investigate the reasons from the patientâ€™s perspective, which suggested poor understanding of the recommended fasting periods and what constituted a clear fluid. Based on these results, local fasting instructions have been revised, focusing on patient education regarding clear fluids. Aims To determine how effective patient education is on improving patients adherence to the fasting guidelines, understanding of the provided instructions and their experience during the preoperative fasting period. Methods Revised fasting instructions were sent to all elective surgical patients. During a two-month period, patients were randomly selected and followed up after their discharge from recovery room. When sufficiently alert, they were asked to consent and complete the same anonymous questionnaire survey that was used in the previous study. Results Data from 165 patients were examined and compared with the initial study. The results for adherence to the fasting guidelines indicated an improvement for both clear fluids and solid foods, particularly clear fluids, where the acceptable rate was increased by 20% (from 39% to 59%). There was a 10% drop from the previous study (84%) of patients who experienced preoperative discomfort from fasting, the incidence of thirst reduced from 60% to 44%, though hunger slightly worsened, 36% to 38%. While there was minimal change in patientsâ€™ understanding of recommended fasting periods for solid foods, prolonged or excessive fasting from clear fluids was significantly reduced. Of note, recognition of clear sugary beverages improved dramatically from 3-15% to 36-62%. Conclusions A simple measure, such as patient education in our study, could improve patient adherence to the current fasting guidelines, although still far from ideal. There were improvements to patients understanding of clear fluids and their experience with preoperative fasting. Approvals Eastern Health Research Ethics Committee: approval obtained (LR74-2018).
Dr Wu was an anaesthetist at Beijing Hospital in China. She went to UK in 2002 to do a masterâ€™s degree by research in the University of Edinburgh. Upon graduation, she was employed as a research fellow at St Barts Hospital and later Birmingham Heartlands Hospital. In 2005, she relocated to Perth, Western Australia and initially enrolled as a PhD student and later joined the Australian & New Zealand College of Anaesthetistsâ€™ overseas-trained-specialist (ANZCA OTS) training program. From 2010 to present, she has been employed by Eastern Health and Austin Health in Melbourne as a consultant anaesthetist. Academically, Dr Wu has been appointed as a clinical lecturer at various universities since joined the ANZCA OTS training program, and currently she is a clinical lecturer at Monash University in Victoria.
Anaesthesia related adverse outcomes have been extensively debated over the past few decades. Landmark papers and statements have applied critical incident analysis techniques, borrowed from fields such as aviation, in order to examine the causes and consider possible preventative strategies for such outcomes (also termed â€˜â€˜preventable mishapsâ€™â€™). The Closed Claims Project was initiated in mid-1985 by the ASA Committee on Professional Liability (CPL). These institutions focused on developing and implementing patient safety statements. The CPL had evaluated a total of 2,400 closed anaesthesia malpractice claims in the paediatric and adult populations; 10 % of claims involved patients younger than 16 years of age. Respiratory events were found to be more common in paediatric than in adult These findings fuelled the adoption of monitoring standards.  In the following years, studies analysing anaesthesia- related adverse outcomes implicated major human error and equipment failure amongst other factors.  In addition, they described the contributions of novel anaesthetic agents. Although these observations may not apply universally, they emphasise the importance of understanding, anticipating and dealing with perioperative adverse effects to improve patient management and thus paediatric anaesthesia outcomes.  A major development in the field has been the recognition that paediatric patients should be cared for by paediatric anaesthetists or physicians who can demonstrate the equivalent in terms of specific experience. In this review, we highlight the evidence on adverse outcomes related to paediatric anaesthesia and discuss the factors influencing morbidity and mortality over the past few decades. In addition, we present important issues which may drive the future course of paediatric anaesthesia.
Mostafa Somri is the Professor and Director of Anesthesia Department in Bnai Zion Medical Centre, Israel. His research includes anesthesiology, trauma mass causalities, incidents, ICU, emergency, etc
Although mortality following pancreatoduodenectomy (PD) has been decreased substantially in high case volume centers to less than 1% over the last two decades, surgical morbidity remains high at about 30-40%. Post pancreatoduodenectomy hemorrhage (PPH) occurs in less than 10% of patients. A retrospective study over 9 years was performed at the General Surgery Department in Rambam Hospital, Israel. Patients older than 18 years, who underwent PD were included. During the aformentioned period, data on 347 patients were reported. 5.18% (n=18) had PPH. 1 patient, out of 18 (5.5%) suffer early PPH due to bleeding from gastric staple line and was reoperated. 2 patients (11.1%) had intermediate PPH- one patient treated conservativley and bleeding stopped spontanoeusly (unknown cause) and one patient bleeded from the gastroenteric anastomotic line and treated by endoscopic measures. 15 patients (83.3%) developed late PPH, with vascular pseudoaneurysm being the most common cause. Overall, the most common causes for PPH were vascular pseudoaneurysm (n=6, 33.3%) and gastro-enteric marginal ulcer (n=6, 33.3%), followed by undetected etiology (n=5, 27.7%) and gastric staple line bleeding (n=1, 5.5%). All patients who bleeded due to pseudoaneurysm were all preceded by post operative pancreatic fistula, and 5/6 patients suffered severe PPH. All patients who bleeded from marginal ulcer underwent PD with a Roux-En-Y reconstruction, and all patients had mild PPH. Upper gastrointetinal bleeding in the form of hematemesis was the most common presentation in 12 patients (66.6%), while 5 patients (27.7%) presented with bloody discharge in drains and 1 (5.5%) presented with hemorrhagic shock. Computed Tomographic Angiography (CTA) was diagnostic for all bleeding pseudoaneurysm, which indicates the important role for this exam as an investigation for PPH, followed by successful endovascular management by angiographic embolization. Mortality rate due to PPH was 0%.
Safi Khuri MD, is a General Surgeon at the Department of General Surgery, Rambam Health Campus, Haifa, Israel. He is Junior surgeon at the HPB and surgical oncology unit. He received a MD diploma from the Jordanian university of science and technology at 2010, and had been resident at the general surgery department at Rambam Health Care Campus between 2012-2017. He is the director of the internship program at hhis department for 3 years. He has published more than 15 papers in reputed journals, most of them were about surgical oncology. Of his ongoing researches is the impact of elevated intra-abdominal pressure on kidney injury, the correlation between vascular anomalies faced during pancreaticoduodenectomy and intra/post operative complications.
As the regionâ€™s leading academic oncology medical center, Kuwait Cancer Control Center ( KCCC ) using a remote robot physician ( RP ) presence robot network since 2011, as one part of its initiative across Kuwait. RP has been used for healthcare services for more than a decade; however, its use within an oncology ICU is not yet widespread. ICU RPâ€™s used to increase access to off-site supervising ICU physicians and other specialists, reducing possible wait time for difficult admissions and procedures (9). The Robot Physicianâ€™s will provide the highly specialized expertise and support resources of the hospital medical faculty to outlying hospitals via a remote controlled robot. The network is the first of its kind in the region, and provide quality oncology surgical and medical care to hospitals in a way that will bring together the capacity at regional hospitals and those of the cancer care centers. Hospital sharing partnerships with many other hospitals in the regionâ€™s in this exciting new endeavor. The remote physician presence robot network is one aspect of the modern oncology care initiative, which is designed to extend hospital capacity in a cooperative and complementary fashion improving patient access to a wider range of specialists, technologies and services. The program is designed as a partnership with regional health centers that will create better diagnoses, allow patients to remain in their regions where appropriate and create a direct access to treatments in oncology patientâ€™s care and management (1). The RP-7â„¢ Robot ( InTouch Health, USA) through the utilization of a secured wireless, broadband, internet connection and provide ICU physician care to ICU Oncology patients in another location. Within moments of a request for a ICU oncology consultation, an ICU physician, seated at a computer (either at home, ICU or anywhere in the world that has a wireless connection) connects via the Internet to the RP-7 Robot located in the ICU to consult on the patient. Through the RP -7.
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 â€“ 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 of 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 of Anaesthesia and ICU Management Surgical and Medical ICU Oncology Patients. His using extensively Robots Physians in ICU Management of Oncology ICU patients.
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.
Currently he is 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. I 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. He worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016. He worked as consultant hepatobiliary surgery in King Faisal hospital, Taif, KSA.
Introduction Obesity is one of the greatest health problems. Bariatric surgery is more effective than non-surgical options; however, postoperative pain is bound to a greater morbidity. Control of postoperative pain is important in facilitating patient convalescence. In this study, we assessed the efficacy of intraperitoneal instillation of bupivacaine after bariatric surgery. Methods A hundred patients who underwent bariatric procedures including sleeve gastrectomy, sleeve gastrectomy with cardioplasty, gastric bypass, and gastric mini bypass (one anastomosis gastric bypass) were included in the study. Patients were divided into two groups randomly, 50 patients for each; group I had intraperitoneal instillation of 40 ml bupivacaine 0.25% at the end of the procedure, while group II had normal saline instillation. Monitoring of pain control in the first 24 h after surgery was done using the visual analogue scale (VAS) to assess the efficacy of intraperitoneal bupivacaine instillation and its effect on the overall opioid usage, postoperative nausea and vomiting (PONV), and shoulder tip pain. Results Pain scores were significantly lower in group I compared to group II at recovery, 2, 4 and 6 h after surgery, P = 0.004, 0.001, < 0.001, and 0.001 respectively. However, there were no significant differences between 12 and 24 h postoperatively. Additionally, there was a significant difference regarding the need for rescue analgesia at recovery P = < 0.001*. Further analysis revealed lower morphine consumption via PCA in group I compared to group II P= 0.013*. There were no significant differences with the use of intraperitoneal bupivacaine as regards nausea, vomiting, or shoulder tip pain, P = 0.688, 0.249, and 0.487, respectively. Conclusions Intraperitoneal instillation of bupivacaine provides a good analgesia in the early postoperative period, reduces the overall consumption of opioid, and decreases the rescue analgesia requirement in the first 24 h after surgery.
Islam Omar, General Surgery Specialist Registrar, Furness General Hospital, NHS, UK He has a clinical Master degree in General Surgery from Alexandria University and he is a member of the Royal College of Surgeons of Ireland. He is a Fellow of the European Board of Surgery. He has an active research recently and managed to publish some of his recent papers in recognized international journals
End-of-life vital organ transplantation involves singular ethical issues, because survival of the donor is impossible, and organ retrieval is ideally as close to death of the donor as possible to minimize organ ischemic time. To date, transplant ethics have held to the â€œdead donorâ€ rule, meaning that a donor must be dead (and not merely dying) to provide vital organs for transplantation. Defining death is therefore critical. Historical efforts to define death have been met with confusion and discord. Fifty years on, the Harvard criteria for brain death continue to be problematic and now still face significant philosophical debate. In the United States, brain death is still not well accepted among many growing ethnic and religious groups. Legislative efforts to limit the authority of physicians to declare brain death have increased, and significant legislation has passed to prevent doctors from diagnosing â€œbrain deathâ€. It is unlikely that brain death criteria alone will continue in the future to sufficiently identify eligible heart-beating vital organ donors, and it is important for both anesthesiologists and surgeons involved in vital organ transplantation to be knowledgeable about legislative trends and shifting public opinion. The speaker will discuss current issues in diagnosis of brain death, ethnic and theological concerns over brain death criteria, and legislative developments limiting brain death determination
Gail A. Van Norman MD is a Professor of Anesthesiology and Pain Medicine and Adjunct Professor of Bioethics at the University of Washington in Seattle Washington, USA. She is fellowship trained and has practiced in Cardiothoracic and Transplant Anesthesiology, was a member of the American Society of Anesthesiologists Committee on Ethics for 19 years and also served as Chair of the Committee. She has more than 110 published book chapters and article, over 50 of which appear in peer reviewed journals, and is editor-in-chief of the Cambridge Textbook of Clinical Ethics for Anesthesiologists published by Cambridge University Press.
Prof. Jiao is a professor of surgery, chair and consultant in hepatobiliary and pancreatic surgery (HPB) at Hammersmith Hospital Campus of Imperial College London. He is the lead surgeon in HPB Surgery at Imperial College Healthcare NHS Trust (ICHNT), and an academic Professor at Imperial College teaching and supervising both under and post graduates, MD and PhD students. He is the training programme director of the Northwest London of England for general surgery and the local postgraduate education chair at Hammersmith Hospital. He is an examiner for both MRCS of Royal Colleges of Surgeons and FRCS of Intercollegiate Examination. He has developed his research interest in pancreatic and liver diseases, wishing to improve patient outcomes through surgical innovation and translational research. His basic science work focused on MicroRNAs, circulating tumour cells (CTCs) and liver regeneration. He has investigated pathogenic mechanisms in pancreatic cystic tumours and pancreatic cancer. For the first time he described CTCs residing in organs local to pancreatic or colon cancers, and identified a few mRNAs to differentiate benign from premalignant pancreatic cystic tumours. Furthermore, he has described a range of innovative surgical techniques to improve pancreatic and liver surgery, and have introduced laparoscopic liver and pancreatic resection including laparoscopic Whipple’s. In liver surgery, he invented and described radiofrequency assisted liver partition with portal vein ligation for staged liver resection (RALPP) for major liver resection (Ann Surg 2015). In pancreatic surgery, he described longitudinal pancreaticojejunostomy following Whipple’s for pancreatic reconstruction (Arch Surg 2011), and laparoscopie Long’s sleeve pancreaticogastrostomy (LPG) for central pancreatectomy (HBSN 2016). The results of his research work have already been published in a range of high IF journals as the first or senior author in The Lancet Oncology, the Journal of Clinical Oncology, Gastroenterology and Annals of Surgery. He has published over 200 peer-reviewed papers in journals such as Annals of Surgery, Journal of Clinical Oncology, Hepatology and Lancet. He is a regular contributor to JAMA Surgery and other surgical journals.
Cardiac trauma has challenged the trauma services all around the world for decades. The balance is still against us. The mortality is still high. Only during the last 120 years of humankind, we have been able to prove that its treatment is feasible, and only in the last 70 years we have been able to perform full anatomic intracardiac corrections. Fifty years ago, nearly all significant cardiac injuries were fatal, many were untreatable, and most were undiagnosed until the autopsy suite. In the last 50 years, however, dramatic improvements in prehospital trauma management, new diagnostic modalities, and the availability of cardiac surgery in many hospitals have rendered treatable most cardiac injuries. The history of cardiac trauma has been written since 3000 BC and its beginning wasnâ€™t promising. Great thinkers of humankind erroneously manifested that the heart could not be operated under any circumstances. The cardiac trauma has been treated by general trauma surgeons but the heart surgeon has a lot to say about how to approach this type of patients. The rapid and early diagnosis associated with an organized and available cardiac staff (interventional cardiologists and cardiac surgeons) may be a productive collaboration.
Dr Fernï¿½ndez was born in the city of Medellï¿½n. He graduated as a Physician and Surgeon from the first accredited University in Medicine in Colombia, the CES University of Medellï¿½n. Then he specialized in General Surgery (4 years). He immediately finished his degree in General Surgery and became the first resident of the Cardiovascular and Thoracic Surgery program (3 years) at the Clinica Medellin, with a university degree granted by the CES. He participated in a large number of academic events as an exhibitor, presented international papers and publications. This effort earned him to be accepted as the first fellowship in Pediatric Cardiovascular Surgery (1 year) of the Fundaciï¿½n Cardioinfantil in Bogota. Dr. Fernï¿½ndez has been a pioneer in the Colombian Atlantic coast of cardiac procedures of high complexity. Dr. Fernï¿½ndez is a founding member of the World Society for Pediatric and Congenital Heart Surgery and an active member of the Colombian Society of Cardiology and Cardiovascular Surgery. Dr. Fernï¿½ndez has always taken care of providing the best care to his patients, therefore he attends the annual congresses of the American Association for Thoracic Surgery, Society for Thoracic Surgery and European Association for Cardiothoracic Surgery annually as part of his commitment to be at the forefront of knowledge.
Background Hip fractures (HF) in the elderly are a leading cause of morbidity and mortality in orthopaedic surgery and impose heavy medico-economic burden on the health system. A recent editorial1 has called for large observational studies in various countries so that comparative effectiveness research is possible for this population. In Australia, there are only a few small studies reporting on mortality rates with minimal exploration into other outcome measures and therefore a research gap on local data is present. Aims This study aims to estimate the mortality rates in the elderly patients presenting with HF, the survival days until study cut-off date and days alive out of hospital at 90 days (DAOH-90d) after hospital admission (non-operative group) or surgical repair (operative group). Methods A historical cohort study was performed on patients aged 70 years or older, who were admitted to a Victorian metropolitan hospital during the period July-2011 to July-2015 due to HF. After institutional ethics approval, the hospitalâ€™s diagnostic related group database identified 1048 eligible patients. Of this, 105 patients were excluded from this study due to incomplete data, predominately because of hospital transfers. Based on the mortality data, retrieved from Victorian Registry of Births, Death and Marriages, the survival days up to the study cut-off date (1st August 2016, i.e., one year after the last patientâ€™s operation) and DAOH-90d were calculated. Unpaired t test and descriptive statistics were used.
The objective of this study is to assess the surgical reconstruction of the nasal dorsum using an autogenous graft from the tibial crest, in a three hundred patients with nasal sequelae of infectious disease, trauma and secondary rinoplasties who were analyzed clinical and radiologycal. Ages ranging tweenty to sixty years old, fifty males and fifty females. Satisfactory results without complications were obtained in293 patients, dislocation of the graft occurred in three, extrusion in two and dehiscence in one. The tibial crest graft is extremely useful for reconstruction of the nasal dorsum in HansenÂ´s disease because it is easily obtainable, integrates well with a minimun of complications improving both the function and the aesthetic appearance.
Introduction ; The treatment of acute lithiasis or alithiasis cholecystitis is classically surgical, but the mortality and morbidity of this surgery are high when it is aimed at elderly or in general poor condition. The existence of a serious morbid association may contraindicate general anesthesia. That is, during anesthesia and surgery, the body's ability to tolerate stress is reduced, especially in the elderly and those with concomitant illness. Percutaneous cholecystostomy is a recommended alternative technique for the management of acute cholecystitis in high-risk surgical patients and can be considered as an intermediate step for the definitive treatment of gallstone complications. ï‚ž The objective of this work is to report our experience of percutaneous drainage of acute gallstone cholecystitis and emergency. ï‚ž Patients and methods Retrospective study over a period of 5 years concerning the emergency management of 30 patients admitted for the treatment of acute gallstone and alithiasis cholecystitis.
Background: Hypospadias is one of the most common congenital genital anomalies for which surgery is indicated early in life. Traditionally, successful repair of hypospadias was deï¬ned as straight penis in erection and a meatus near the tip of the glans, permitting voiding in a standing position and allowing sexual intercourse. Nevertheless, modern surgery claims that it is possible to create a functionally and cosmetically normal penis. The majority of publications present single-center and single-surgeon retrospective case series with a limited number of patients undergoing follow-up. High-quality randomized trials in pediatric urology are extremely challenging and therefore rarely performed. Continuous re-evaluation may have a major impact on future clinical practice. Repair of hypospadias is demanding and needs. Purpose: To assess our experience and the outcomes of hypospadias repair performed by trainees in regard to hypospadias Hadidiâ€™s classification. Material & Methods: A retrospective study of all hypospadias repair done by trainees from January 2014 to December 2018. Data were collected including age at repair, type of hypospadias, degree of curvature, urethroplasty technique, complications, number of surgeries done for each patient, urinary stent, follow up and outcomes. Disorder/difference of sex development( DSD) patients were excluded. Results: A total number of 177 hypospadias patients were included in this study. Distal penile was reported in 102 cases (58%), proximal in 50 cases (28%)and glanular in 25 cases (14%). Mean age at repair was 24 months (24 Â± 20.73 SD). TIP repair was the most common repair in 83 cases (47 %). Complications included urethero-cutaneous fistula in 21 cases (12% ) repair disruption in 15 cases (8%) [ 4 of them were penoscrotal 27%], meatal retraction in 13 cases (7%) , meatal stenosis in 7 cases (4%) other complications in 9 (5 %). Number of surgery ranged between 1 to 5 operations, one surgery 112 (63%) two surgeries 34 (19%) three surgeries 17 (10%) four surgeries 6 (3.3%) five surgeries 1 (0.6%). Follow up period ranged between 3 months to 5 years. Good outcome was reported in 126 cases (71%). Conclusion: Hypospadias is a common genital anomaly which needs standardization of surgical techniques. Good handling of tissues, modern surgical techniques and good ancillary services have significantly reduced complication rates and improved the outcome.
Background: Scar formation is a natural part of the healing process following a physical injury to body tissues. The two most common types of scars are Keloid and Hypertrophic scars. These pathological scars result from an abnormal response to trauma. They can be painful and itchy leading to a considerable functional and aesthetical disability. Post-surgical scars require a complex treatment and can be very challenging for surgeons. Purpose: To evaluate the level of general satisfaction of surgeons and patients regarding the aesthetical results following the application of the Automated Micro-Needling Technology. Materials and methods: The study evaluates 18 scars from 10 patients: 6 males (13 scars) and 4 females (5 scars) aged between 18 and 36. The patients were treated using the Automated Micro-Needling Technology at three stages of healing with intervals of 20 days. Using the Patient and Observer Scar Assessment Scale V2.0 (POSAS), each scar has been evaluated from the patientsâ€™ scale in terms of pain, itchiness, skin colour, hardness, thickness, shape and the state of the abnormal facial scar. The same abnormal facial scars have been evaluated by three different observers in terms of vascularity, pigmentation, thickness, relief, pliability, surface area and the overall state of the scars using the POSAS doctorâ€™s scale at four distinct stages. Result: The findings of the study reveal statistical differences at the significance level of 5% between each session. This indicates a reduction in the scale values of the studied variables, with the exception of pigmentation, pain and itchiness, which only display slight changes. Conclusion: The Automated Micro-Needling Technology leads to a significant improvement in the characteristics of the evaluated scars. Keywords: Micro-Needling; Hypertrophic scar; Keloid, Matrix Metalloprotease; Pigmentation
Introduction Gastrointestinal stromal tumors are rare tumors of the GIT accounting for 0.1%-3% of all gastrointestinal tumors. The most common location is the stomach (55%) followed by small bowel (31.8%), colon (6%), other various locations (5.5%), and esophagus (0.7%). They may also occur in extra-intestinal locations. The signs and symptoms of GIST depend on tumor location and size. Gastrointestinal bleeding is one of the most common symptoms. Other signs and symptoms include abdominal discomfort, pain, or distention; intestinal obstruction; and weight loss. The association between the development of GISTs and Neurofibromatosis 1 (NF1) has been established. NF1-associated GISTs tend to have a distinct phenotype and absence of KIT/PDGRFð›¼ mutations which in turn has an implication on further management where they do not respond well to Imatinib treatment. Case Presentation Here we present one of the largest GISTs reported in the currently available literature with a total volume of (25.3 x 20 x 14 cm+ 27.9 x 23 x 8 cm) and an overall weight of 7.3 Kgs, which developed in a 43-year-old female patient with NF1 and was resected on an emergency basis due to the rapid deterioration and development of abdominal compartment syndrome. Pathology assessment showed a malignant GIST composed of spindle cells with elongated nuclei with necrosis, marked pleomorphism and numerous tumor giant cells. The mitotic count was >15/50 HPF, Ki-67 was 80%, and the lymphovascular invasion was clear. Immunohistochemistry investigations showed that Vimentin, CD117, and DOG1 were positive, while BCL-2 and CD99 were focal positives. Pan-CK, S-100, CD34, Desmin, SMA and HMB-45 were negatives
Background: Colon cancer continues to be a major health problem worldwide. Being the third most common type of cancer in men and the second in women. Standard treatment of colon cancer is based on surgical resection. An adequate number of lymph nodes harvested are important for a correct stabilization of the disease; thereby the extension of the colonic resection remains controversial. Complete mesocolic excision (CME) with central vascular ligation (CVL) has recently been found to improve oncological outcomes in patient with colonic cancer. Complete mesocolic excision is based on a correct identification of the dissection plan between the mesofascial plane and the retroperitoneal fascia, central vascular ligation of the vessels to remove vertical lymph nodes and resection of the affected colonic segment. Methods: This is a prospective study done at general surgery department of Fayoum University hospitals from January 2015 to January 2019 including 60 patients with operable colonic cancer operated with adequate surgical margin, complete mesocolic excision and high vascular ligation. Results: The number of dissected lymph node was 27.7 Â± 4.2 and this number is more than that dissected in the conventional colectomy mentioned in many studies in literature, more over larger mesocolon area, longer distance from vascular high ligation point to intestinal wall, and longer distance from vascular high ligation point to tumor center were observed. Conclusion: Surgery in colon cancer patients remains the only curative treatment and applying the principles of complete mesocolic excision and central vascular ligation in colon cancer surgery can improve cancer outcomes without increase the incidence of postoperative complications. Keywords: complete mesocolic excision; central vascular ligation; colon cancer surgery
Background: With improved laparoscopic techniques, experience, and availability of newer tools and instruments like ultrasonic shears; laparoscopic cholecystectomy (LC) became a feasible option in cirrhotic patients, the aim of this study was to analyze the outcome of LC in cirrhotic patients. 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 Child-Turcotte-Pugh (CTP) score was A, The most frequent cause of cirrhosis was hepatitis C virus (HCV), while biliary colic was the most frequent presentation. The harmonic device was used in 39.9% of patients, with a significant correlation between it and lower operative bleeding, lower blood and plasma transfusion rates, higher operative adhesions rates, lower conversion to open surgery and 30-day complication rates, shorter operative time and post-operative hospital stays where operative adhesions and times were independently correlated. The 30-day morbidity and mortality were 22.1% and 2.3% respectively while overall survival was 91.5%, higher CTP, and model for end-stage liver disease (MELD) scores, higher mean international normalization ratio (INR) value, lower mean platelet count, higher operative bleeding, higher blood, and plasma transfusion rates, longer mean operative time and postoperative hospital stays were significantly correlated with all conversion to open surgery, 30-day morbidities and mortalities. Conclusion: LC can be safely performed in cirrhotic patients. However, higher CTP and MELD scores, operative bleeding, more blood and plasma transfusion units, longer operative time, lower platelet count, and higher INR values are predictors of poor outcome that can be improved by proper patient selection and meticulous peri-operative care and by using Harmonic scalpel shears.