Principles of laser surgery. Advantages and disadvantages.

An attempt has been made in this article to present an honest and accurate state-of-art narrative of laser surgery for pedal conditions. The theory of operation, physiologic effects and procedural comparisons have been presented regarding those procedures and lasers that are available for use by podiatric surgeons and others treating the foot and leg. Although some information described within this article is anecdotal, it is elaborated with representative expert material from the scientific literature. Overall, a sound theoretic understanding of the mode of action of lasers and extensive training and experience is encouraged when engaging in this exciting discipline of surgery.     

Steroid treatment of brain edema.

Experimental brain edema due to extradural compression was studied in rats, and the beneficial effect of a steroid, betamethasone, on this was tested. Immediately following extradural compression, betamethasone therapy was begun by intraperitoneal injection. Three groups of animals received eight divided doses of betamethasone over 48 hours: total doses were 64 mg, 6.4 mg, and 0.64 mg/kg, respectively. Two other groups received doses at zero and 24 hours only, with total doses of 64 mg and 6.4 mg/kg. Water and sodium content of the brain were reduced depending upon dosage. Administration every 6 hours was superior to every 24 hours. Potassium content was not consistently altered. After injection of radioactive steroid, a significant increase in uptake of the drug was observed in the edematous brain.     

Further hazards of heparin therapy in vascular surgery.

Three consecutive patients were treated with heparin sodium administered intravenously for phlebitis and pulmonary embolism following abdominal aortic surgery. After the institution of heparin, hemorrhage in these patients occurred from the suture line 14 days, 18 days, and 31 days after surgery, respectively. the diagnosis was correctly made and control of the bleeding was achieved in each case. The first two patients required exploratory surgery and the third patient was treated successfully without surgical intervention. We propose that the integrity of the clot at the suture line is in dynamic balance. There is a continuous lysis and resorption of old thrombus and replacement with new clot formation until the suture line is sealed by regeneration of the new "intima". If the blood is anticoagulated by heparin, this balance is disrupted and hemorrhage may result.     

Occupational hazards in plastic surgery

The occurrence of occupational disorders among plastic surgeons has not had much attention in the literature thus far. A case of a plastic surgeon with distal interphalangeal arthrosis, considered to represent an occupational disorder, is presented. In a review of the literature, possible occupational hazards in plastic surgery are discussed.     

Advantages of interpositional long venous grafts in microvascular surgery.

Our clinical experience favors the use of long autologous venous micrografts any time excessive tension is noted along the anastomotic line or in case of a short pedicle in a free flap. The technical problems of harvesting and interposition of these long micrografts are presented.     

Advantages and disadvantages of celioscopic surgery in gynecology

In the last decade, operative laparoscopy has been a break through in the practice of gynecology. Recent progress has been made with the development of cold light, appropriate atraumatic instrumentation, video-camera and CO2 laser. Laparoscopy provides access to the pelvis, allowing for diagnosis and treatment of a variety of pathologies. The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases. Infertility surgery is the second most important indication for laparoscopic procedure. The authors have performed salpingoovariolysis in 49 cases, neosalpingostomy in 34 cases and fimbrioplasty in 31 cases. Reproductive outcome at 18 months post-operatively was comparable to results following microsurgical techniques, with a rate of ongoing pregnancies of 53% for adhesiolysis and 27.7% for distal tuboplasties. Immediate opening of hydrosalpinges at the time of diagnostic laparoscopy allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. Laparoscopy also allows for management or ovarian cyst, first explored to determine the absence of any sign of malignancy. In most cases, the cyst's contents and wall may be entirely removed by laparoscopy: 115 cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

The hazards of surgery in the obese

Obesity is an additional risk factor in surgical patients. The mortality rate in obese patients is high (3.6% in my series) and the morbidity is much higher. These patients may be prediabetic, diabetic, hypertensive or atherosclerotic and they are liable to develop postoperative coronary thromboses and chest complications such as acute massive collapse of the lung or bronchopneumonia. In upper abdominal operations, they are more liable to develop septic wounds and postoperative distension. Thrombo-embolic phenomena are more pronte to develop in the obese. Intraoperative bleeding is particularly frequent in obese patients with hypertension, atheroscleroses and fatty liver. Surgery in severe obesity should be limited to emergencies. Elective surgery is not recommended unless it is mandatory, e.g. to reduce weight in hard-core obesity which resists expert medical treatment. Many hard-core obesity cases have psychological problems and require special pre- and postoperative psychological care.     

Advantages of nerve-sparing pelvic surgery. Animal experiments and clinical results

Traditionally, oncological factors have been the only ones used in the evaluation of treatment outcome for urological tumor patients. With increased diagnoses of early, curable tumors in younger individuals, health-related quality of life and functional aspects are gaining importance. Sexual and urinary function are significant aspects of quality of life, which are especially vulnerable in urological patients. New insights into the anatomy and physiology of the pelvic organs have resulted in an improvement in surgical therapy. In this article, we present the results of current experimental and clinical studies, which underline the importance of nerve sparing techniques for maintaining a satisfying urinary and sexual function in this patient population.     

Advantages and limitations in minimally invasive cardiac surgery

The introduction of endoscopic technology to cardiovascular surgery was significantly delayed compared to abdominal and lung surgery, although it has been gradually introduced in this field during the past decade in closure of patent ductus arteriosus, repair of the vascular ring, implantation of pacemaker leads or AICD, and pericardectomy. Endoscopic technology also started to be used in harvesting saphenous vein grafts (SVG) and the left internal thoracic artery for coronary artery bypass grafting(CABG) from the mid-1990s. Although complete endoscopic surgery has not yet been established in the major field of standard cardiovascular surgery, many cardiac surgeons attempt to minimize the size of chest wounds with 6- to 8-cm skin incisions, which is called minimally invasive cardiac surgery (MICS) or minimally invasive direct coronary artery bypass (MIDCAB). Complete endoscopic cardiac surgeries were performed utilizing the Zeus system and Da Vinci system at the end of the 20th century. Another method to minimize the invasiveness of CABG is to perform it without cardiopulmonary bypass, so-called off-pump coronary artery bypass (OPCAB). Currently, less-invasive procedures are mainly applied for relatively simple cardiac surgeries, although these procedures are also potentially effective to avoid postoperative cerebral or respiratory complications in high-risk patients. MICS is effective in reducing the size of surgical wounds and in decreasing intraoperative blood loss. On the other hand, the duration of anesthesia and surgery can be prolonged due to technical difficulty, and the risk of unsatisfactory anastomosis or incomplete revascularization can also be increased. The cardiopulmonary bypass circuit utilized for MICS requires a more complicated system including negative pressure venous drainage. The detection of accidental trouble during surgery, which is related to the extracorporeal circulation or the MICS procedure itself, can be delayed due to the limited surgical view. MICS procedures carry additional risks related to the more complicated cardiopulmonary bypass system and small surgical wound. We must be deliberate in determining the indications for MICS and obtain complete informed consent from patients when we perform MICS, including informing them of the additional risks related to the MICS procedure itself and the possibility of conversion to standard open-heart surgery.     

Advantages of topical marcaine during spinal surgery. Technical note

Marcaine applied to irritated nerve roots during extradural spinal surgery may attenuate sympathetically mediated and somatosensory (pain)-related hypertensive and tachycardic crises.