Contemporary psychosurgery and a look to the future.

OBJECT: Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The goal of this study was to review the current state of psychosurgery. METHODS: In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for cingulotomy, subcaudate tractotomy, anterior capsulotomy, and limbic leukotomy are discussed. The historical developments, modern procedures, and results of these four contemporary psychosurgical procedures are also reviewed. Examples of recent advances in neuroscience indicating a future role for neurosurgical intervention for psychiatric disease are also mentioned. CONCLUSIONS: A thorough understanding of contemporary psychosurgery will help neurosurgeons and other physicians face the ethical, social, and technical challenges that are sure to lie ahead as modern science continues to unlock the secrets of the mind and brain.     

Sex-based centers of care: a look to the future

Although sex-based centers of care have played a critical historic role in improving the health of their constituents and drawing attention to the different health care needs of men and women, it is time to challenge them to do an even better job. There are now overwhelming data showing that men and women are profoundly different at the molecular and cellular level in virtually all aspects of musculoskeletal health and disease, but the clinical implications of these differences have generally been unexplored. Sex-based health centers of care can play a critical role in exploring these difference, and, in doing so, reduce disability and enhance quality of life in our growing population of senior men and women.     

Presidential address, 1995. Surgery 2000: a look back to the future

The present demoralized state of Canadian surgery is due to a number of short-term influences. They include financial restraints, the desire of government agencies to off-load blame for unpopular decisions onto doctors and altered public expectations. The major long-term challenge will be a shortage of physicians and a severe shortage of general surgeons because of the superimposition of longer-term trends in medical demographics on short-term political reactions to a perceived oversupply of doctors. General surgeons need to identify the significant, long-term threats and challenges. If they can do this and plan their responses knowledgably, with some measure of altruism, the future in general surgery will be a bright one for present and future residents and medical students.     

A look to the future: Pandemic-induced digital technologies in vascular surgery

Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.     

The VA Transplant Program: A rebuttal to criticism and a look to the future

The Department of Veterans Affairs (VA) Transplant Program was established decades ago, is well resourced, and provides timely and high quality solid organ transplant care and services to a Nation of Veterans. In the past few years, the VA Transplant Program has received criticism that can be characterized as follows: the location of VA Transplant Centers (VATCs) requires Veterans to travel considerable distances for transplant care and services; the National Surgery Office (NSO) that provides oversight limits the number of active VATCs; Veterans Health Administration (VHA) policy limits referral of Veterans to non‐VA transplant centers (community care); and the VA Transplant Program does not provide living donor transplant procedures. The MISSION Act of 2018 (Public Law 115‐182) was enacted in part to address these themes by promoting community care and living donation. This article provides perspective regarding the VA Transplant Program and rebuttal to stated criticism: Travel to a transplant center is not isolated to the VA; the NSO does not limit VATC activation; current VHA policy authorizes community care; and the VA Transplant Program currently performs living donor procedures. The MISSION Act, as intended, has the potential to decrease referrals to the VA Transplant Program by 30%.     

The management of CKD: a look into the future

The increasing global prevalence of chronic kidney disease (CKD) and end-stage renal disease with the associated spiraling cost has profound public health and economic implications. This has made slowing the progression of CKD, a major health-care priority. CKD is invariably characterized by progressive kidney fibrosis and at present, treatment aiming to slow the progression of CKD is limited to aggressive blood pressure control, with few therapies targeting the fibrotic process itself. In this review, we explore the potential of experimental therapeutic strategies, based on preventing or reversing the pathophysiologic steps of kidney remodeling that lead to fibrosis.     

关注患者生存质量展望烧伤康复未来

After 50 years' development,a rather comprehensive burn care system has been built up in China,and it has played key roles in wound healing and salvaging victims of burn trauma.Since survival is no lon...     

Surgical treatment of atrial fibrillation: a look into the future

The surgical treatment of atrial fibrillation began in 1987, when Dr. James Cox introduced the maze procedure. This operation proved to be extremely effective in curing atrial fibrillation and preventing its most dreaded complication, stroke. However, many surgeons found the operation to be too difficult and invasive. Over the last 5 to 10 years, various groups have tried to develop less invasive approaches using a number of different energy sources to create linear lines of ablation to replace the surgical incisions. This has led to a plethora of new operations for this arrhythmia. There is significant confusion in the literature at the present time as to what is the best lesion pattern and what is the best energy source. It is our feeling that a great deal of this confusion is due to our lack of understanding of the mechanisms of atrial fibrillation and the effect of ablation technology on atrial hemodynamics and electrophysiology. Future progress will require a better understanding of this arrhythmia and continued research into the safety and efficacy of ablation devices.     

Composite tissue transplantation: what does the future look like?

Achievements in clinical composite tissue transplantation have motivated investigation for more widespread clinical application. The first successes with facial allotransplantation and hand allografts have been reported in the past few years. The advances that have made recent clinical landmarks attainable have been based on technical understanding and expertise with complicated vascular anatomy of the tissue allografts, whereas the immunologic therapies with these grafts have mirrored standard immunosuppressive regimens and have resulted in comparable challenges with rejection and graft loss. Although life-saving solid organ transplantation offers survival advantage even when graft life is measured in years, transplants of composite tissue facial or limb allografts ideally need to achieve reliable long-term or permanent graft survival. The additional risks of lifelong standard immunosuppression including malignancy, infection, and renal failure also necessitate strategies toward drug minimization and/or tolerance. Research is necessary to develop alternate immunologic approaches unique to composite tissue allografts achieving improved graft survival and reduced lifelong exposure to immunosuppression. The fields of plastic and reconstructive surgery, trauma surgery, and burn surgery all have clinical demands that could be met by a successful and durable immunologic approach for composite tissue allotransplantation. The future of composite tissue transplantation will be dependent on the development of specialized clinical centers with expertise in transplant and reconstructive surgery, transplant coordinators, and immunologists investigating strategies for minimized immunosuppression and tolerance strategies.