Computer imaging software for profile photograph analysis

OBJECTIVES: To describe a novel calibration technique for photographs of different sizes and to test a new method of chin evaluation in relation to established analysis measurements. DESIGN: A photograph analysis and medical record review of 14 patients who underwent combined rhinoplasty and chin correction at an academic center. Patients undergoing concurrent orthognathic surgery, rhytidectomy, or submental liposuction were excluded. Preoperative and postoperative digital photographs were analyzed using computer imaging software with a new method, the soft tissue porion to pogonion distance, and with established measurements, including the cervicomental angle, the mentocervical angle, and the facial convexity angle. RESULTS: The porion to pogonion distance consistently increased after the chin correction procedure (more in the osseous group). All photograph angle measurements changed toward the established normal range postoperatively. CONCLUSIONS: Surgery for facial disharmony requires artistic judgment and objective evaluation. Although 3-dimensional video analysis of the face seems promising, its clinical use is limited by cost. For surgeons who use computer imaging software, analysis of profile photographs is the most valuable tool. Even when preoperative and postoperative photographs are of different sizes, relative distance comparisons are possible with a new calibration technique using the constant facial landmarks, the porion and the pupil. The porion-pogonion distance is a simple reproducible measurement that can be used along with established soft tissue measurements as a guide for profile facial analysis.     

Use of personal computers for translation and publication of an anesthesia textbook

We used personal computers extensively for translating and publishing in Japanese an anesthesia textbook originally written in English. The procedure included optical character recognition, scanning of figures, use of computer translation, use of electronic mail and computer type-setting. While these have individually been done previously, this is process of any medical textbook published in Japanese. The advantages of combining these technologies are good exchange of information among individual authors/translators, rapid translation process, preliminary visualization of the final product, and overall high quality of the published book.     

Using the internet to enhance physician-patient communication

The rise in Internet use by patients with musculoskeletal problems has put orthopaedic surgeons under increased pressure to provide Web-based resources. Patients are researching musculoskeletal conditions online, and many want to communicate electronically with their physicians. Online medical information may be a useful adjunct to traditional physician-patient interaction because it is readily available, is wide in scope, and can provide the patient with basic knowledge on a given topic. A clinical encounter may then be efficiently spent refining information and answering specific questions. Orthopaedic surgeons should be aware of the advantages of using Internet resources as part of their practice as well as the potential legal and confidentiality pitfalls in electronic communication. Some patient concerns may be easily satisfied and communication enhanced through the use of e-mail. Physicians planning to incorporate electronic communication with their patients must be prepared to manage unsolicited e-mail, maintain patient confidentiality, and adopt practices that maximize the use of online resources to enhance patient education.     

Safety management in operating rooms

In operating rooms, patients with a wide range of conditions are transferred from the wards to undergo surgery. Furthermore, because surgeons with different specialties perform various operations using instruments unique to their specialty, it is possible that operating room nurses, surgeons, and ward nurses do not always communicate clearly. Patients are anesthetized and unconscious, and as a general rule, family members are not allowed entry. As a result, operating rooms are unique environments where neither the patients receiving medical services nor their families can express opinions and concerns. Therefore an especially strict crisis management approach is needed in operating rooms. At present, individual hospital implement their own crisis management systems to prevent medical accidents. However, national debate is needed to establish medical accident prevention guidelines before each hospital compiles a manual that suits its needs.     

Integrating Digital Image Management Software for Improved Patient Care and Optimal Practice Management

BACKGROUND: Photographic images provide vital documentation of preoperative, intraoperative, and postoperative results in the clinical dermatologic surgery practice and can document histologic findings from skin biopsies, thereby enhancing patient care. Images may be printed as part of text documents, transmitted via electronic mail, or included in electronic medical records. OBJECTIVES: To describe existing computer software that integrates digital photography and the medical record to improve patient care and practice management. CONCLUSIONS: A variety of computer applications are available to optimize the use of digital images in the dermatologic practice.     

Access and use of the internet in a hand surgery population.

Internet use is increasing and its applications to medicine and patient information are widening daily. Previous studies have focused on the quality and quantity of medical information on the Internet. The current study focuses on a population of 120 new patients presenting to a hand surgery practice. A questionnaire was used to analyse patterns of Internet access, use of the Internet to look up personal symptoms, and patients' opinions on the use of electronic mail by office staff. Results showed that approximately 90% of the group had some form of Internet access, with a significant age-related decrease in Internet access. Only 17% used the Internet to look up their symptoms, but this group was more likely to correctly match their self-diagnosis to the surgeon's diagnosis. On average, 65% of the study group favoured the use of electronic mail for office staff's communications with patients.     

Prospect of computer aided surgery]

To develop the new surgical fields of minimally invasive surgery, noninvasive surgery, virtual reality microsurgery, telesurgery, fetal surgery and others in the next century, it is necessary to use various advanced technologies; surgical robots, three-dimensional medical images etc. based on computer technology. Therefore, this new surgical field is called Computer Aided Surgery (CAS). Three-dimensional medical images provide the most recognizable information for medical doctors and the most advanced visualization for surgeons. Surgical robots function as advanced hands for surgeons, but do not perform the same actions as surgeons wielding scissors or scalpel. The advanced vision and hands available to surgeons are creating a new surgical environment. The philosophy behind the development of surgical robots is to assist surgeons in difficult procedures and extend the greatest possible help to patients with incurable disease.     

Trends in the Use of Cameras and Computer Technology Among Dermatologists in New York City 2001–2002

Background. Photography and computers can enhance dermatologic visit documentation and care.
Objective. To determine dermatologists' use of cameras and computers.
Methods. We surveyed computer and camera use during the Dermatologic Society of Greater New York's meetings in January 2001 and 2002.
Results. Approximately 75% of dermatologists can use computers. Between 2001 and 2002, 35-mm film camera use by attending and resident dermatologists fell from 60% to 47% and 43% to 32%, respectively, and digital camera increased from 25% to 38% and 35% to 59%, respectively. Approximately 50% of dermatologists use instant cameras. Approximately 15% of dermatologists use no camera. Most find images useful; however, medical dermatologists usually image only interesting patients, and dermatologic surgeons image almost all patients. Approximately 15% of dermatologist used electronic medical records (EMRs).
Conclusion. Computers and cameras are widely used but have not changed dermatologic practice. Images are not used to track skin disease or integrated with EMRs nor are EMRs widely used, probably because of difficulty of use and limited computer literacy. Where images appear to add value, for example, for preoperative and postoperative documentation among dermatologic surgeons, camera use is common, suggesting that utility drives technology adoption.     

Cardiac computed tomographic angiography and the primary care physician

Through advancements in computer processing speed and storage capacity, new cardiac imaging modalities have become clinically feasible and useful. Cardiac computed tomographic angiography, a new diagnostic imaging modality, is capable of assessing coronary artery disease and left ventricular function on a par with invasive coronary arteriography in selected patients who meet appropriate use criteria. This imaging modality is of clinical value in the assessment of patients with chest pain who have an intermediate risk of coronary atherosclerosis. The purpose of the present report is to educate primary care physicians about the basic principles of advanced cardiac imaging techniques and to convey a useful strategy for their appropriate use in the current environment of medical economics.     

Computers in surgical education and the operating room.

Medicine has gone through major changes over the last 50 years. Today it is recognized that medical knowledge doubles every 6-8 years. It is also true that with the advent of many new medical procedures, surgeons must continue to learn new techniques throughout their careers; this was not the case in the past. Significant changes have also occurred during the same period in computers. It has recently become apparent that there exists a synergy between these two industries - computers can be used to assist surgeons in both initial education and in learning new skills. The National Capital Area Medical Simulation Center is a unique resource that makes use of state-of-the-art computer resources to teach resuscitation and other skills. Both computerized mannequins and virtual reality training devices are used to teach surgical principles and technical procedures. The natural progression of this technology will be for virtual reality simulations to be used for selecting, training, certifying, and recertifying surgeons. Ultimately, surgeons will practice operative procedures using 3D data sets of the patients they plan to operate the next day and then use recordings to play back their optimal procedure robotically on their patients.     

The diagnosis of acute abdominal pain with computer assistance: worldwide perspective

This presentation describes the use of computer aided decision support in acute abdominal pain. The development of such support and the feasability of providing it are described with reference to worldwide studies involving nearly 100,000 patients in the UK, the European Community and worldwide. This presentation will give an overview of the experienced gained in these and other studies. As a result of this experience, it will be suggested: a) The diagnosis of acute abdominal pain by inexperienced emergency surgeons remains a difficult problem. 2) Doctors who have been assisted by a computer have, in many instances, improved their diagnostic and decision-making performance. 3) This improvement has not been due to superior "artificial intelligence" of the computer--but due to the computer acting as an educational focus and a stimulus to good clinical practice. 4) On an international level, these studies have been immensely valuable. They have helped bring together different national groups and helped to develop common medical terminology--as well as foster collaborative "spin-off" in terms of research around the world.     

A simple and inexpensive method of preoperative computer imaging for rhinoplasty

GOALS/PURPOSE: Despite concerns of legal liability, preoperative computer imaging has become a popular tool for the plastic surgeon. The ability to project possible surgical outcomes can facilitate communication between the patient and surgeon. It can be an effective tool in the education and training of residents. Unfortunately, these imaging programs are expensive and have a steep learning curve. The purpose of this paper is to present a relatively inexpensive method of preoperative computer imaging with a reasonable learning curve. MATERIALS AND METHODS: The price of currently available imaging programs was acquired through an online search, and inquiries were made to the software distributors. Their prices were compared to Adobe PhotoShop, which has special filters called "liquify" and "photocopy." It was used in the preoperative computer planning of 2 patients who presented for rhinoplasty at our institution. Projected images were created based on harmonious discussions between the patient and physician. Importantly, these images were presented to the patient as potential results, with no guarantees as to actual outcomes. RESULTS: Adobe PhotoShop can be purchased for 900-5800 dollars less than the leading computer imaging software for cosmetic rhinoplasty. Effective projected images were created using the "liquify" and "photocopy" filters in PhotoShop. Both patients had surgical planning and operations based on these images. They were satisfied with the results. CONCLUSIONS: Preoperative computer imaging can be a very effective tool for the plastic surgeon by providing improved physician-patient communication, increased patient confidence, and enhanced surgical planning. Adobe PhotoShop is a relatively inexpensive program that can provide these benefits using only 1 or 2 features.     

Trends in the use of cameras and computer technology among dermatologists in New York City 2001-2002.

BACKGROUND: Photography and computers can enhance dermatologic visit documentation and care. OBJECTIVE: To determine dermatologists' use of cameras and computers. METHODS: We surveyed computer and camera use during the Dermatologic Society of Greater New York's meetings in January 2001 and 2002. RESULTS: Approximately 75% of dermatologists can use computers. Between 2001 and 2002, 35-mm film camera use by attending and resident dermatologists fell from 60% to 47% and 43% to 32%, respectively, and digital camera increased from 25% to 38% and 35% to 59%, respectively. Approximately 50% of dermatologists use instant cameras. Approximately 15% of dermatologists use no camera. Most find images useful; however, medical dermatologists usually image only interesting patients, and dermatologic surgeons image almost all patients. Approximately 15% of dermatologist used electronic medical records (EMRs). CONCLUSION: Computers and cameras are widely used but have not changed dermatologic practice. Images are not used to track skin disease or integrated with EMRs nor are EMRs widely used, probably because of difficulty of use and limited computer literacy. Where images appear to add value, for example, for preoperative and postoperative documentation among dermatologic surgeons, camera use is common, suggesting that utility drives technology adoption.     

Anesthesiologists, general surgeons, and tobacco interventions in the perioperative period

Surgery presents an opportunity for interventions in cigarette smokers that will facilitate abstinence from tobacco. However, little attention has been paid to the role of anesthesiologists and surgeons in addressing tobacco use. To determine the practices and attitudes of these physicians regarding this issue, we sent a postal mail survey to a national random sampling of anesthesiologists and general surgeons engaged in active practice within the United States (1000 in each group). Response rates were 33% and 31% for anesthesiologists and surgeons, respectively. More than 90% of both groups almost always ask their patients about tobacco use, and almost all respondents believed that surgical patients should maintain abstinence after surgery. Most believed that it was their responsibility to advise their patients to quit smoking, but only 30% of anesthesiologists and 58% of surgeons routinely do so. Nonetheless, approximately 70% of both groups would be willing to spend an extra 5 min before surgery to help their patients quit. Barriers to intervention included a lack of training regarding intervention techniques, a perceived lack of effective interventions, and insufficient time to intervene. Intervention opportunities are not exploited consistently in the surgical population; educational efforts directed at physicians in surgical specialties are indicated.     

Legal implications of xenotransplantation

Abstract: Xenotransplantation (XTx) offers a possible solution to the severe shortage of organs for transplantation, but it will raise new legal questions. There are currently no legal impediments to XTx in the United States nor do animals possess common law or constitutional rights that would prevent it. The law remains indefinite regarding what constitutes a human being, allowing the possibility that legal arguments will be raised regarding the legal status of transgenic animals expressing human tissues or cells. As successful XTx will eliminate the organ shortage, Congress or state legislatures will have to reconsider the need for the current centralized system of allocation and distribution of organs, for this could be replaced by a commercial system based on market forces. The most significant legal issue relating to XTx is probably the potential threat to the public health and safety through the transmission of an infectious disease. The Public Health Service has recently issued draft guidelines which make recommendations about how XTx procedures might be performed. These guidelines currently have no legal authority but offer insight into how XTx might be regulated if it becomes a clinical, reality. Existing federal laws, however, empower federal agencies to regulate XTx, in part because of the potential risk to the public health. Additionally, tort liability will impose legal pressure on transplant centers to minimize the level of risk that the general public might face. The most difficult questions facing legislatures and the Public Health Service may well prove to be those raised by the behavior of individual patients or their social contacts who do not comply with the guidelines/regulations relating to long-term monitoring for infectious complications.     

Current practice patterns in the treatment of perforated appendicitis in children

BACKGROUND: The treatment of perforated appendicitis in children often involves a combination of surgical and medical therapy. The aim of this study was to document the degree of consensus in the current management of perforated appendicitis in children. STUDY DESIGN: A survey was sent to all practicing pediatric surgeons in North America in April 2000 who were members of the American Pediatric Surgical Association for 1999-2000. Survey questions pertained to preoperative, perioperative, and postoperative practice patterns, particularly those issues related to use of antibiotic therapy. RESULTS: Among eligible surgeons, 80.2% completed the survey. Although more than 80% of respondents practiced in an academic setting, only 17% of surgeons used a formal clinical practice guideline to direct care. Responses varied substantially in the duration of postoperative antibiotic therapy, the use of intravenous or oral agents or both, and the duration of hospitalization. A considerable number of patients are receiving a portion of their intravenous antibiotic therapy as outpatients. CONCLUSIONS: There is little apparent consensus in the many aspects of perioperative and postoperative care of perforated appendicitis in children across North America. Only a fraction of surgeons currently uses a formal clinical practice guideline for treatment of perforated appendicitis, although increased pressures to develop more cost-effective therapeutic strategies can encourage development of additional guidelines. Definitive evidence to inform development of such guidelines and enhance consensus is lacking. Further studies are needed across institutions to better inform clinical decisions in light of a changing practice environment and treatment alternatives.     

Ethical Issues in the Use of Suboptimal Kidneys for Transplants: An Italian Point of View

The shortage of organs leads to the need for utilizing suboptimal kidneys for transplantation. The distinction between optimal, marginal, and suboptimal kidneys leads surgeons to face not only technical problems but also ethical and legal issues related to clinical advantages offered by the transplant of a nonstandard kidney and the acquisition of consent. Between 1999 and 2015, we performed 658 transplants, 49 (7.5%) using suboptimal kidneys. All patients were alive and with vital graft throughout follow-up. We did not encounter any major surgical complications. From a technical point of view, our experience and literature review confirm that transplant of suboptimal kidney leads to good clinical results but exposes patients to a increased risks of surgical complications. Therefore, these interventions must take place in hospitals fully prepared for this type of surgery and performed by experienced transplant surgeons with proper matching between organ and recipient. Considering the insufficient resources available, from an ethical and legal point of view, doctors play an essential role in optimizing the use of these kidneys by avoiding wastage of organs, ensuring that transplants are done in suitable patients, and that patients are fully informed and aware of the risks and benefits associated with the specific suboptimal kidney being transplanted. We believe that, in highly specialized centers, the number of suboptimal kidney transplants should be increased, as their use has shown good clinical results and carries fewer ethical issues compared with marginal kidneys. Further, suboptimal kidneys may also be proposed for use in young patients with end-stage renal disease.     

Evaluation of the incidentally discovered adrenal mass

The increased use of abdominal ultrasonography, computed tomography, and magnetic resonance imaging has led to the classification of adrenal lesions termed the incidentally identified adrenal mass or adrenal incidentaloma. Unlike for the large, clinically, or biochemically symptomatic adrenal mass, the evaluation of patients with small, asymptomatic, or nonfunctional adrenal lesions remains controversial. The evaluation of these adrenal incidentalomas presents a challenge to endocrinologists, radiologists, and urologic surgeons alike. A multidisciplinary approach with biochemical screening and radiologic evaluation is essential to assess the nature and function of these lesions. Furthermore, it is of great importance to identify patients who are morbidly affected by hormonal hypersecretion or malignant potential. This article describes the emerging guidelines for the evaluation of the incidental adrenal mass.