Does computer-aided surgical simulation improve efficiency in bimaxillary orthognathic surgery?

The purpose of this study was to compare the efficiency of bimaxillary orthognathic surgery using computer-aided surgical simulation (CASS), with cases planned using traditional methods. Total doctor time was used to measure efficiency. While costs vary widely in different localities and in different health schemes, time is a valuable and limited resource everywhere. For this reason, total doctor time is a more useful measure of efficiency than is cost. Even though we use CASS primarily for planning more complex cases at the present time, this study showed an average saving of 60 min for each case. In the context of a department that performs 200 bimaxillary cases each year, this would represent a saving of 25 days of doctor time, if applied to every case. It is concluded that CASS offers great potential for improving efficiency when used in the planning of bimaxillary orthognathic surgery. It saves significant doctor time that can be applied to additional surgical work.     

Microsurgical reconstruction of the head and neck – Current concepts of maxillofacial surgery in Europe

IntroductionMicrovascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe.MethodsThe questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS).Results65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role.ConclusionWithin Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome.     

腹腔镜下儿童腹股沟斜疝高位结扎术的疗效评价

目的：探讨腹腔镜下疝囊高位结扎术在儿童腹股沟斜疝中的临床疗效,评价该术式的临床应用价值。方法采集2012年1月至2013年6月,喀什地区第一人民医院收治的196例腹股沟斜疝患儿的临床资料进行回顾性分析。患儿均采用腹腔镜下疝囊高位结扎术,对手术时间、住院时间、住院费用、术后并发症发生率及术后复发率等指标进行统计学分析。结果本组患儿平均手术时间（17±5）min,平均住院时间4-6 d,平均住院费用（4125±25）元。术后随访1-18个月,术后复发2例,复发率为1．0％,无其他术后并发症发生。结论腹腔镜下疝囊高位结扎术用于儿童腹股沟斜疝的治疗,具有手术时间短、住院时间短、创伤小、疗效可靠等优点,值得广泛应用于临床。     

Comparison of phosphotungstate and dextran sulfate-Mg2+ precipitation procedures for determination of high density lipoprotein cholesterol

Because of the controversy over the best method for assaying high density lipoprotein (HDL) cholesterol in the clinical laboratory, a commonly used phosphotungstate method for precipitating low density and very low density lipoproteins (LDL and VLDL) was compared with a recently recommended dextran sulfate precipitation method. The accuracy and precision of HDL cholesterol determinations were similar for both methods. Either of these procedures would appear to be equally satisfactory for the assay of HDL cholesterol in the clinical laboratory.     

日间手术中心复合局部麻醉下腰骶部筋膜脂肪疝的治疗

目的：探讨分析日间手术中心（ambulatory surgery center,ASC）复合局部麻醉下腰骶部筋膜脂肪疝的手术治疗体会。方法回顾性分析2012年10月至2013年7月,佛山市第一人民医院ASC接收手术治疗腰骶部筋膜脂肪疝患者33例的临床资料。手术方式：疝囊口扩大＋内容物切除术。麻醉方式：复方利多卡因乳膏表面麻醉＋哌卡因局部浸润麻醉。结果本组患者均在复合局部麻醉下顺利完成手术治疗,术中、术后无手术相关并发症发生。术后随访6个月,手术疗效价：优良率为93．94％。结论 ACS复合局部麻醉下手术治疗腰骶部筋膜脂肪疝疗效确切、安全可靠,减少了患者在院时间,节省了医疗成本。     

A New Model for Teaching Corneal Foreign Body Removal

Objective: To determine whether a skills laboratory for corneal foreign body and rust ring removal improves self-assessed skill and confidence.
Methods: A prospective trial was conducted as part of the didactic curriculum of a university-based residency program in emergency medicine (EM). A convenience sample of 26 EM residents and five fourth-year medical students participated. The skills laboratory used model corneas made by coating 3.2-cm glass spheres with a 1–2-mm film of paraffin. Foreign bodies were simulated by embedding small pieces of metal into the paraffin. Rust rings were simulated by dipping a hot, straightened paper clip into a rust-colored crayon and then into the paraffin. The model eyes fit into a life-sized model of a human head. Participants removed the foreign bodies and rust rings under supervision, using the slit lamp. Each participant anonymously completed a questionnaire before and after participating in the skills laboratory. The questionnaire recorded educational level, previous experience, and self-assessed comfort and skill levels (0 = lowest, 10 = highest).
Results: Most (66%) of the participants had not previously removed a corneal foreign body; 86% had not previously removed a rust ring. On a ten-point scale, the median comfort level for removing a foreign body rose from 2 to 7, and the self-assessed skill level rose from 1 to 7 (p = 0.0001). Similar improvements in self-assessed comfort and skill levels were seen for rust ring removal.
Conclusions: Participation in this skills laboratory significantly improved the self-reported comfort and self-assessed skill levels in removing corneal foreign bodies and rust rings. This technique provides useful practice of a fine-motor procedural skill requiring eye-hand coordination prior to supervised application of these skills in clinical practice.     

Overview of methods for flexible endoscopic training and description of a simple explant model

The question of how to train surgeons in flexible endoscopy has been debated over the years as these skills have become an essential part of residency and practice. As many as two-thirds of surgeons perform flexible endoscopy, and for many, endoscopy represents up to 50% of their practice. Training in flexible endoscopy has evolved over many decades from an apprenticeship-type model to a more formal training program. Surgical residencies vary widely in their approach, with some having dedicated endoscopy rotations and others using an integrated approach. Innate to a good training program are faculty dedicated to teaching, an established curriculum, and adequate exposure of residents to proper training tools, whether as patient-based learning or supplemented by simulators. Hands-on models for teaching surgical endoscopy include mechanical, animal, and computer-based platforms. Herein, we describe our experience with a low-cost approach using porcine stomach explants that offers a breadth of endoscopic training including scope navigation, band ligation, endoscopic mucosal resection, hemostasis management, esophageal stenting, foreign body extraction, and ERCP. Simulation-based learning must be validated from a construct and internal validity perspective to be considered useful. Correlation between simulator learning and improvement in clinically relevant skills must then be shown using a validated scale, such as the Global Assessment of Gastrointestinal Endoscopy Skills. Competency in flexible endoscopy, which is currently measured by case volume, may be replaced by objective programs, such as Fundamentals of Endoscopic Surgery, that combine didactic teaching, cognitive assessment, and hands-on technical skills evaluation to determine a minimum level of proficiency.     

Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings

Achieving hemostasis is a crucial focus of clinicians working in surgical and trauma settings. Topical hemostatic agents—including mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants—are frequently used in efforts to control bleeding, and new options such as hemostatic dressings, initially used in combat situations, are increasingly being used in civilian settings. To achieve successful hemostasis, a number of vital factors must be considered by surgeons and perioperative nurses, such as the size of the wound; bleeding severity; and the efficacy, possible adverse effects, and method of application of potential hemostatic agents. Understanding how and when to use each of the available hemostatic agents can greatly affect clinical outcomes and help to limit the overall cost of treatment.