Cosmetic surgery, certificates and the 'head-baker' of Eeclo

The legend of the head-baker of Eeclo, an imaginary cosmetic surgeon, clearly illustrates that the improvement of the human physionomy was of great interest to people as long ago as the mid-16th century. In order to display their credentials the surgeons of that time and in the succeeding centuries would display certificates that testified in glowing terms to their knowledge and expertise. One only has to open a modern newspaper to see that this phenomenon has not died out.     

Self, identity and radical surgery

Data are reported from interviews, analysed qualitatively, with persons who had had ulcerative colitis cured by radical surgery. The procedures performed on the subjects were total colectomy and ileostomy. The subjects were left permanently faecally incontinent by these procedures. Using concepts derived from the work of Mead, and developed in interactionist sociology, the consequences for self and identity of these operations are considered. The tension between the private self of the person with an ileostomy and their public social identity as an ileostomist is examined.     

Income, race, and surgery in Maryland.

BACKGROUND. We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS. The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS. Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS. Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.     

Anaesthetists, the discourse on patient fitness and the organisation of surgery

The organization of daily procedures within the operating theatre is considered in terms of rival perspectives on their patient held by surgeon and anaesthetist. The privileging of the surgeon's authority is challenged in anaesthetists' efforts to fabricate a distinctive position on the patient. While surgeons focus on patient as the carrier of disease, for the anaesthetist, the focus is upon the patient's complement of fitness. A postmodern analysis of the organization of surgery reflects the continual struggle between the two specialisms to privilege its particular definition of the surgical patient. In some circumstances, the struggle can have damaging consequences for patient care.     

Aesthetic surgery, medical discourse and health

The increase in plastic surgery interventions in Brazil and the growth of the beauty industry, as well as care of the body and corporal enhancement, are part of a broader process of medical and aesthetic preoccupation with health. According to the Brazilian Plastic Surgery Association there has been a substantial increase in the number of plastic surgery procedures in Brazil. Every year, approximately 350,000 aesthetic surgical interventions are performed in the country. Our work investigated the construction of meaning and value, the use of aesthetic parameters in this construction and how those meanings are appropriated and treated by those representatives of the medical profession who work in the body transformation process, namely plastic surgeons. In this respect, an analysis of the pronouncements and discourse posted on the Brazilian Plastic Surgery Association website was conducted, as it is the regulatory body of the field and is responsible for training professionals and supervising the sector. Analysis of the official content of the website page posted on September 26, 2005 was the basis for this research.     

Ambulatory surgery in the United States, 1996

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 1996. Data are presented by types of facilities, age and sex of the patient, and geographic region. Major categories of procedures and diagnoses are shown by age, sex, and region. METHODS: The estimates are based on data collected by the 1996 National Survey of Ambulatory Surgery conducted by the National Center for Health Statistics. The 1996 data were abstracted from 125,000 medical records in 488 hospitals and freestanding ambulatory surgery centers.     

Women and cosmetic breast surgery: weighing the medical, social, and lifestyle risks

In this article we provide a comparative analysis of qualitative, semistructured interviews with 24 women who had undergone different forms of cosmetic breast surgery (CBS). We argue that women must negotiate three types of risk: potential medical risks, lifestyle risks connected with choosing "frivolous" self-enhancements, and countervailing social risks affiliated with pressures to maximize one's feminine beauty. In addition, we highlight the challenges faced in negotiating these risks by examining the limits to traditional forms of medical informed consent provided to the women, who received little information on the medical risks associated with CBS, or who were given uncertain and contradictory risk information. Even respondents who felt that they were well informed expressed difficulties in making "wise" choices because the risks were distant or unlikely, and hence easily minimized. Given this, it is fairly understandable that the known social risks of "failed" beauty faced by the women often outweighed the ambiguous or understated risks outlined by medicine. We argue that traditional notions of informed consent and risk awareness might not be adequate for women choosing CBS.     

Boundary breaches: the body, sex and sexuality after stoma surgery

People with limited or no bladder or bowel control, who have had a stoma to manage elimination, have a particular awareness of the proximity of the sites of pleasure and excretion. Drawing on interviews and related ethnography conducted in Australia from 1998 to 2001, this paper explores how men and women with permanent continence problems negotiate their sexuality around their bodily unreliability. Pleasurable sex, idealized, involves losing control. People who are incontinent or rely on a stoma, however, must monitor their bladder and bowel, disguising the stoma and bag and controlling their body in sex as in other circumstances. The need to negotiate bodily boundaries with established partners, or to disclose to new sexual partners, results in self-consciousness and social unease, and people need to reconstruct notions of privacy and dignity so that breaches in bodily control do not undermine the sexual relationship. For many, the stoma undermines self-esteem and body image, while its management confuses the status of the individual as "normal" and the partner as carer or lover.     

Reflections on the past, present and future of minimally invasive surgery

So-called "minimally invasive surgery" aims to contribute to reducing the effects of surgical trauma and its consequences. A milestone in the development of this concept has been the generalisation of techniques of the videoendoscopic approach in numerous surgical procedures. Outstanding amongst these is laparoscopy, which makes it possible to carry out different abdominal surgical techniques while guaranteeing maximum respect for the peritoneal surface and the abdominal wall itself. This is translated into lower morbidity and mortality and better recovery by the patients. For videoendoscopic access to become consolidated as the first option against the traditional or open approach, it is necessary that two requisites be met: the indication of surgery must be the same irrespective of the approach, and the results in terms of efficiency, safety and cost must be similar or superior. In the immediate future, with the increase in the experience of surgical teams and the improvement of technological capacity, there will be a growth in the number of procedures susceptible to approach using this technique.     

Carpal tunnel release surgery: small-area variation and impact of ambulatory surgery in the autonomous region of Valencia,Spain

Objective

This study aimed to analyze variability in rates of carpal tunnel release surgery among the healthcare areas of the autonomous region of Valencia, and to evaluate the contribution of ambulatory surgery and referrals to private hospitals to the variability found.

Methods

We carried out a cross-sectional, population-based study, describing the rates of carpal tunnel release surgery, standardized by age and sex, among areas in the region of Valencia in 2006. The observed variation was then analyzed using small-area analysis methods. Data from hospital admissions, referrals to private hospitals, population statistics and hospital resources were used to construct standardized rates, and Spearman's correlation was used to test the association with surgical setting and hospital resources.

Results

There were 8.2 carpal tunnel release surgeries per 10,000 inhabitants in the region of Valencia in 2006. Most (88.2%) of these interventions were performed as ambulatory surgery. After we excluded areas outside the 5th-95th percentiles, variation among areas was moderate and was similar for men and women. Variation was not associated with the proportion of the distinct surgical settings (admission to a public hospital, outpatient clinic, or referral to a private hospital) used in each area, or with the availability of resources.

Conclusions

Variation in carpal tunnel release surgery among areas in the region of Valencia is moderate, but has a strong impact on the population because of the high prevalence of this disorder. This variation is not explained by the hospital resources available in each area or the surgical setting.