Emergency laparoscopy – current best practice

Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions

Single Incision Laparoscopic Surgery for Acute Appendicitis: Feasibility in Pediatric Patients

Background. Laparoscopic appendicectomy is accepted by many as the gold standard approach for the treatment of acute appendicitis. The use of Single Incision Laparoscopic Surgery (SILS) has the potential of further reducing postoperative port site complications as well as improving cosmesis and patient satisfaction. Method. In this paper we report our experience and assess the feasibility of SILS appendicectomy in the pediatric setting. Results. Five pediatric patients with uncomplicated appendicitis underwent SILS appendicectomy. There were no significant intraoperative or postoperative complications. All patients were discharged within 24 hours. Conclusions. The use of Single Incision Laparoscopic Surgery appears to be a feasible and safe technique for the treatment of uncomplicated appendicitis in the pediatric setting. Further studies are warranted to fully investigate the potential advantages of this new technique

Giant liposarcoma of the back with 4 types of histopathology: a case report

The incidence of soft tissue tumours, both malignant and benign, is very common. However, the coexistence of 4 types of histopathology is rare and the aim of this article is to present one treated in our Department. An 87-year-old Greek man was treated in our Department for a huge tumour on his back, under local anaesthesia. The pathology report of the specimen referred 4 types of neoplasia. This case represents this incidence in a giant liposarcoma of the back

Handheld computers and the 21(st )century surgical team: a pilot study

BACKGROUND: The commercial development and expansion of mobile phone networks has led to the creation of devices combining mobile phones and personal digital assistants, which could prove invaluable in a clinical setting. This pilot study aimed to look at how one such device compared with the current pager system in facilitating inter-professional communication in a hospital clinical team. METHODS: The study looked at a heterogeneous team of doctors (n = 9) working in a busy surgical setting at St. Mary's Hospital in London and compared the use of a personal digital assistant with mobile phone and web-browsing facilities to the existing pager system. The primary feature of this device being compared to the conventional pager was its use as a mobile phone, but other features evaluated included the ability to access the internet, and reference data on the device. A crossover study was carried out for 6 weeks in 2004, with the team having access to the personal digital assistant every alternate week. The primary outcome measure for assessing efficiency of communication was the length of time it took for clinicians to respond to a call. We also sought to assess the ease of adoption of new technology by evaluating the perceptions of the team (n = 9) to personal digital assistants, by administering a questionnaire. RESULTS: Doctors equipped with a personal digital assistant rather than a pager, responded more quickly to a call and had a lower of failure to respond rate (RR: 0.44; 95%CI 0.20–0.93). Clinicians also found this technology easy to adopt as seen by a significant reduction in perceptions of nervousness to the technology over the six-week study period (mean (SD) week 1: 4.10 (SD 1.69) vs. mean (SD) week 6: 2.20 (1.99); p = 0.04). CONCLUSION: The results of this pilot study show the possible effects of replacing the current hospital pager with a newer, more technologically advanced device, and suggest that a combined personal digital assistant and mobile phone device may improve communication between doctors. In the light of these encouraging preliminary findings, we propose a large-scale clinical trial of the use of these devices in facilitating inter-professional communication in a hospital setting

Does a hypoxic operative environment enhance the metastatic potential of tumours?

Imperial Users onl

Does a hypoxic operative environment enhance the metastatic potential of tumours?

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Use of online rapid sampling microdialysis electrochemical biosensor for bowel anastomosis monitoring in swine model

Bowel anastomosis ischemia carries a significant rise in morbidity and mortality after bowel surgery. Clinical measures of bowel ischemia are often non-specific and only become evident at a late stage. There is currently no method to continuously monitor, in real time, metabolic impairment at the anastomosis site. Our online rapid sampling microdialysis biosensor system has proved its efficacy in monitoring ischemia in the bowel. Selective glucose and lactate biosensors are coupled online to the microdialysis probe through a flow injection analysis (FIA) system, which performs in vivo bowel monitoring at high time resolution, typically every 30 seconds. The enzymatic reactors containing substrate oxidase (SOx) and horseradish peroxidase (IIRP) are coupled to flow cell electrodes. The system was used to monitor ischemia at the bowel anastomosis level, by monitoring in vivo changes in the metabolic substrates, like glucose and lactate in the colon of swine models. The rapid decrease in glucose and increase in lactate 5 minutes post-clamping of the artery feeding the anastomosis highlights the vulnerability of the bowel to damage with surgical stress and previous ischemic insults

Hospital Surgery:Foundations in Surgical Practice

Combining key surgical principles with modern practical knowledge, and packaged in a clear and concise format, Hospital Surgery is an invaluable tool for those studying for exams and managing patients on the wards. Divided into logical sections covering the major stages in the journey of the surgical patient, the reader will have ready access to the key information required to guide clinical management. Major sections of the book on procedures, investigations and operations are structured to provide stepwise and methodical accounts of how to perform surgical interventions. The text is supported by a superb set of surgical and anatomical drawings. This is essential reading for all junior doctors and foundation-level trainees seeking to build their surgical expertise. </jats:p