complex surgical procedures
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Author(s):  
Ratnakar Ambade ◽  
Ankit Jaiswal

Background: It is well understood that distal femoral and proximal tibia scale is lower in case of the Asian than that of their western counterparts. Because of the Asian population's comparatively smaller structure and stature, many surgeons claim that imported implants may not be well fitted for Asian origin patients, mainly based on Western morphometry. It is very likely that an overweight section will be used in many Asian centres in most operations, resulting in low results of the procedure of the implant. For joint substitution of distal femur, careful positioning of fitted implants as well as balancing of underlying soft tissues is important. It is also important to use incredibly complex surgical procedures. To retain its usual functional motion spectrum, use of a suitable femoral part dimension is necessary. Furthermore, owing to a discrepancy between the size of the prosthesis and the bone, there could be a host of serious issues. Objectives: To calculate the anthropometric distal femur parameter and determine the distal femur variations on the right and left side of the morph metric measurement and to evaluate dimension of current TKA as related to Indian population. Methodology: This study included visiting the out patients Department of Orthopedics, at AVBRH in the age group 30-50 year during the period of June-2020 to April-2023 with sample size of 50 patients. Detailed history and clinical review will be taken, including age, sex, socio-economic background, type of employment. In all patients involved in the study in Orthopedic OPD, thorough radiological assessment of all the knee joints will be performed. The radiological test and various anthropometrics will include knee joint Simple X-ray and CT-Scan. Expected Results: We expect that from our results, anthropometric measurements of Indian population may differ from other literatures.


2021 ◽  
Vol 32 (2) ◽  
pp. 137-145
Author(s):  
Colleen M. Nash

Vasoplegic syndrome is a rising problem affecting morbidity and mortality in patients undergoing cardiac surgery. Vasoplegia is a vasodilatory, shocklike syndrome characterized by decreased systemic vascular resistance, normal to high cardiac index, and hypotension refractory to fluid resuscitation and vasopressors. This review describes the presentation, physiology, risk factors, treatments, and implications of vasoplegia after cardiac surgery. No standardized methods for diagnosing and treating vasoplegia are available. Vasoplegia is caused by surgical trauma, systemic inflammation, and vascular dysregulation. Patients with comorbidities and those undergoing complex surgical procedures are at increased risk for vasoplegia. The use of β-blockers is protective. Vasoplegia is potentially reversible. Vasopressin is likely the most effective first-line vasopressor, and the use of methylene blue and/or hydroxocobalamin may restore vascular tone. Alternative therapies such as methylene blue and hydroxocobalamin show promise, but additional research and education are needed.


Author(s):  
Thomas Vogel ◽  
Dina Schippers ◽  
Balqees Aldarweesh ◽  
Ilaria Pergolini ◽  
Martina Stollreiter ◽  
...  

Abstract Purpose The SARS-CoV-2 pandemic has almost stopped all elective surgical treatment throughout the world. As operating room (OR) capacities are reduced everywhere to ensure availability of intensive care capacities, especially low-complex surgical procedures are often postponed. These include totally implantable central-venous access ports which are important for the oncologic treatment of cancer patients. Methods In our study, we investigated the potential of an outpatient surgical centre (OSC) in terms of workflow effectiveness compared to the central operating room complex (COR) of a university hospital using low-complex surgical procedures as an example. Data of 524 consecutive patients who received a Port-a-cath procedure (422 implantations (80.5%) and 102 explantations (19.5%)) in our department between February 2019 and February 2020 were evaluated. Results A total of 277 patients were operated in outpatient surgical centre (OSC), and 247 patients received the procedure in the central OR (COR) complex. Grade II and III complications according to the Clavien–Dindo classification occurred in 5.2% (OSC) and 7.3% (COR) of patients. Incision-to-suture time was significantly quicker in the OSC group (36 vs. 42 min., p < 0.032). Total OR time (01:08 vs. 01:20 h) and preparation-to-incision time were also shorter in the OSC group (12 vs. 17 min., p < 0.002). Conclusion In order to ensure effective OR utilization especially in times of the corona pandemic, the use of smaller decentralized OR units, e.g., outpatient surgical centres, for performing low-complex surgical cases is beneficial. Our study revealed shorter total OR and preparation-to-incision times.


2021 ◽  
Vol 12 ◽  
Author(s):  
Neha Sharma ◽  
Daniel Ostas ◽  
Horatiu Rotar ◽  
Philipp Brantner ◽  
Florian Markus Thieringer

Reconstruction of cranial defects is an arduous task for craniomaxillofacial surgeons. Additive manufacturing (AM) or three-dimensional (3D) printing of titanium patient-specific implants (PSIs) made its way into cranioplasty, improving the clinical outcomes in complex surgical procedures. There has been a significant interest within the medical community in redesigning implants based on natural analogies. This paper proposes a workflow to create a biomimetic patient-specific cranial prosthesis with an interconnected strut macrostructure mimicking bone trabeculae. The method implements an interactive generative design approach based on the Voronoi diagram or tessellations. Furthermore, the quasi-self-supporting fabrication feasibility of the biomimetic, lightweight titanium cranial prosthesis design is assessed using Selective Laser Melting (SLM) technology.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Dave R. Listijono ◽  
David M. B. Rosen ◽  
Sarah Choi ◽  
Mujahid Bukhari ◽  
Gregory M. Cario ◽  
...  

Over the last few years, there is an apparent growing concern amongst O&G trainees of the inadequacy in exposure to minimally invasive gynaecology surgical training, which has been inadvertently compounded by the more stringent working hour regulations and disproportionately increasing number of trainees relative to surgical volume. Therefore, it is vitally important for trainees to maximise opportunities in the operating theatre and develop autonomy in carrying out more complex surgical procedures. This case report outlines the step-by-step approach of laparoscopic excision of a cornual ectopic pregnancy performed by a trainee under the supervision of a surgical mentor. This manuscript highlights key characteristic traits of a trainee that serve to foster surgical trust and simple but effective steps to foster surgical preparedness.


2021 ◽  

Despite obvious progress in perioperative morbidity and mortality we still face challenges in explaining why complex surgical procedures in children are associated with poorer outcomes. This review aims to address the importance of improving perioperative outcome through the implementation of strategies for quality assurance and the safe conduct of paediatric anaesthesia.


Polymers ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 123
Author(s):  
Hyeonu Heo ◽  
Yuqi Jin ◽  
David Yang ◽  
Christopher Wier ◽  
Aaron Minard ◽  
...  

The advent of 3D digital printers has led to the evolution of realistic anatomical organ shaped structures that are being currently used as experimental models for rehearsing and preparing complex surgical procedures by clinicians. However, the actual material properties are still far from being ideal, which necessitates the need to develop new materials and processing techniques for the next generation of 3D printers optimized for clinical applications. Recently, the voxelated soft matter technique has been introduced to provide a much broader range of materials and a profile much more like the actual organ that can be designed and fabricated voxel by voxel with high precision. For the practical applications of 3D voxelated materials, it is crucial to develop the novel high precision material manufacturing and characterization technique to control the mechanical properties that can be difficult using the conventional methods due to the complexity and the size of the combination of materials. Here we propose the non-destructive ultrasound effective density and bulk modulus imaging to evaluate 3D voxelated materials printed by J750 Digital Anatomy 3D Printer of Stratasys. Our method provides the design map of voxelated materials and substantially broadens the applications of 3D digital printing in the clinical research area.


2020 ◽  
Vol 9 (9) ◽  
pp. e557997715
Author(s):  
Luiz Carlos Volp Junior ◽  
Iago Ridão Scandinari ◽  
Helder Fernando Borges Junior ◽  
Fernanda Ferruzzi Lima ◽  
Sérgio Sábio

This study aims to present the dynamic UCLA as a prosthetic option to restore a tilted implant, replacing a missing maxillary left lateral incisor with a functional and aesthetic screw-retained crown. Dental implants show high success rates; however, complications related to three-dimensional positioning of the implant are common. The correction of the implant position usually requires machined angled abutments or complex surgical procedures, which results in long and difficult treatment, and increases the treatment final cost. A 45-years-old male patient sought for specialized dental care to restore the front missing tooth esthetic area. The patient has limited mouth opening, mental and physical disabilities, so the construction of a metal-ceramic prosthesis with the aid of dynamic UCLA was proposed as a straightforward and low-cost procedure under the sign of free and informed consent. The prosthetic treatment provided aesthetic results and patient satisfaction without complications after a four-year follow-up.


Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2547 ◽  
Author(s):  
Beata Jabłońska ◽  
Sławomir Mrowiec

Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.


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