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1.
J Perioper Pract ; : 17504589241244996, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38828977

RESUMEN

Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.

2.
J Perioper Pract ; 34(5): 154-163, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38149615

RESUMEN

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.


Asunto(s)
Procedimientos Quirúrgicos Urológicos , Humanos , Procedimientos Quirúrgicos Urológicos/historia , Historia del Siglo XX , Procedimientos Quirúrgicos Robotizados/historia , Procedimientos Quirúrgicos Robotizados/tendencias , Historia del Siglo XXI , Historia del Siglo XIX , Masculino , Litotricia/historia , Litotricia/métodos , Resección Transuretral de la Próstata/historia
3.
J Perioper Pract ; : 17504589231212967, 2023 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-38149619

RESUMEN

Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.

4.
Pract Neurol ; 23(2): 160-163, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36863868

RESUMEN

Posterior spinal artery syndrome has a variable presentation and often poses a clinical challenge. We describe an acute posterior spinal artery syndrome in a man in his 60s with vascular risk factors, who presented with altered sensation in the left arm and left side of his torso but with normal tone, strength and deep tendon reflexes. MR imaging showed a left paracentral T2 hyperintense area affecting the posterior spinal cord at the level of C1. Diffusion-weighted MRI (DWI) showed high signal intensity in the same location. He was medically managed as having ischaemic stroke and made a good recovery. Three-month MRI follow-up showed a persisting T2 lesion but the DWI changes had resolved, consistent with the time course for infarction. Posterior spinal artery stroke has a variable presentation and is probably under-recognised clinically, requiring careful attention to MR imaging for its diagnosis.


Asunto(s)
Isquemia Encefálica , Enfermedades Vasculares de la Médula Espinal , Accidente Cerebrovascular , Masculino , Humanos , Isquemia Encefálica/complicaciones , Accidente Cerebrovascular/complicaciones , Médula Espinal/irrigación sanguínea , Imagen por Resonancia Magnética/efectos adversos , Infarto/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/complicaciones , Enfermedades Vasculares de la Médula Espinal/patología , Arterias
5.
Eur J Orthop Surg Traumatol ; 33(5): 1621-1627, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35789295

RESUMEN

BACKGROUND: Scapula fractures occur in the setting of high-energy trauma. Operative treatment of complex intra-articular scapular fractures can result in adequate surgical and functional outcomes. MATERIALS AND METHODS: Twenty-seven patients with complex, displaced intra-articular scapular fractures with or without involvement of the scapular body, were treated operatively in a single trauma center between 2010 and 2021. Associated injuries such as ipsilateral upper limb fractures and nerve injuries were identified in the majority of the patients. Fixation with anatomical medial and lateral border precontoured plates was utilized following posterior modified Judet approach or/and anterior deltopectoral approach. Functional outcome was assessed using the Oxford Shoulder Score and detailed shoulder range of motion and return to work/activities data were obtained. RESULTS: At a mean follow-up of 69 months (range 4-135 months), individual functional outcomes for 25 of the 27 patients revealed a mean Oxford Shoulder Score of 33 (69%), mean active flexion of 120 degrees, active abduction of 110 degrees, mean active external rotation of 35 degrees and mean internal rotation to the level of T5. All patients were pain-free at the latest follow-up, and 23 of 25 had returned to their preinjury occupation and activities. CONCLUSION: Operative treatment for these complex injuries is a viable option at centers equipped to handle critically ill patients and can result in satisfactory range of motion and functional score measurements along with a relatively low number of complications.


Asunto(s)
Fracturas Óseas , Fracturas del Hombro , Traumatismos Torácicos , Humanos , Fijación Interna de Fracturas/efectos adversos , Estudios Retrospectivos , Fracturas Óseas/cirugía , Hombro , Escápula/cirugía , Escápula/lesiones , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento
6.
Cureus ; 14(3): e22775, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35371864

RESUMEN

This case report highlights a case of testicular torsion in a man over the age of 25 with Duchenne muscular dystrophy (DMD), who presented with an atypical pain history, and a Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score negative for exploration. However, based purely on the examination findings, scrotal exploration was performed and a torted testis was found. The report demonstrates that in this cohort of patients, a higher index of suspicion is needed to ensure early recognition of the condition. Furthermore, scrotal exploration can be safely conducted under local anaesthesia given the multiple cardiovascular and spinal co-morbidities attributed to DMD.

7.
Cureus ; 14(2): e22420, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35345745

RESUMEN

A 17-year-old female, who was previously fit and well with no preexisting health conditions, presented with a four-day history of worsening shortness of breath and diarrhoea. She had recent close contact with a relative diagnosed with COVID-19. On clinical examination, she was drowsy, hypotensive, tachycardic, tachypnoeic, and pyrexial. Her blood tests showed elevated inflammatory markers and lymphopenia. She underwent a transthoracic echocardiogram, which confirmed a severely impaired left ventricular (LV) systolic function with an ejection fraction of 35%. An initial impression of acute viral myocarditis was made. Three separate polymerase chain reaction (PCR) tests for SARS-CoV-2 RNA were performed, but they all returned negative. The patient was not responding to initial therapy. Therefore, the regional paediatrics hospital was consulted, and a diagnosis of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) was made, based on similar regional presentations. The patient was administered IV immunoglobulin therapy, to which she responded very well. Following a five-day hospital stay, the patient was discharged home as medically stable. A repeat transthoracic echocardiogram (TTE) showed recovery of the LV systolic function to 62%. Few cases have been reported on myocardial involvement in young patients with PIMS-TS. This case report highlights the initial presentation, medical care, and clinical course of this patient.

8.
Surgeon ; 20(6): 345-350, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34772635

RESUMEN

BACKGROUND: It is unknown whether rectus sheath catheter (RSC) continuous infusion of local anaesthetic is superior to standard post-operative opiate analgesia following major abdominal surgery. Previous audit in our Trust had suggested RSC was very effective and reduced opiate analgesia use. We aimed to see if this was maintained as the technique became more widespread comparing clinical outcomes and post-operative opiate analgesia requirements between patients who had RSCs and those that did not following major abdominal surgery over a 32-month period. METHODS: A retrospective observational study investigated patients who had major abdominal surgery at a single centre in the UK between January 2018 and August 2020. Placement of RSCs was at the discretion of the surgical team according to their own personal choice. All patients having the procedure in both an elective and non-elective setting have been included in this study, including patients requiring higher level care after emergency surgery. Clinical outcomes and post-operative opiate analgesia requirements (oral and intravenous) were analysed using multivariate logistic regression models adjusting for American Association of Anesthesiologists (ASA) grade and type of surgery (emergency vs elective and open vs laparoscopic). RESULTS: There were 911 patients; 276/911 (30.3%) RSC and 635/911 (69.7%) non-RSC. Median age was 64 (52-74) years; 51.6% were male. In the adjusted models, RSC was associated with a reduced likelihood of serious complications (OR 0.49 (95% CI 0.33, 0.72); p < 0.001) and lower length of stay in ICU (OR 0.95 (95% CI 0.91, 0.99); p = 0.029). RSC was not associated with reduced post-operative opiate analgesia use. There were 3/276 (1.1%) adverse events following RSC placement during the period of data collection. CONCLUSIONS: Clinical outcomes may be superior for patients following major abdominal surgery when RSCs are placed for post-operative analgesia but uncertainty remains. This paper highlights the difficulty with retrospective non-selected data in answering this question. High quality prospective randomised data are required to determine the effects on clinical outcomes and post-operative opiate analgesia requirements.


Asunto(s)
Analgesia , Alcaloides Opiáceos , Humanos , Masculino , Persona de Mediana Edad , Femenino , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Estudios Retrospectivos , Estudios Prospectivos , Dimensión del Dolor , Analgesia/métodos , Anestésicos Locales , Catéteres , Alcaloides Opiáceos/uso terapéutico
9.
Res Rep Urol ; 13: 739-744, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34616694

RESUMEN

BACKGROUND AND AIMS: The impact of coronavirus disease 2019 presented an unprecedented challenge to urological service globally. In many countries, outpatient clinics were cancelled, and the use of telemedicine visits was increased. For urological complaints, the need to perform a sensitive clinical examination via telemedicine posed an unfamiliar environment. Our aim is to explore the clinical and ethical factors involved in performing remote sensitive clinical examinations. METHODS: A comprehensive review of literature and guidance from various medical bodies internationally was conducted using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar, and Research Gate in the first week of March 2021 including "COVID-19," "telemedicine," "urology," and "sensitive examinations." RESULTS: Telemedicine reduced unnecessary visits to medical facilities and was useful for reducing the risk of transmission during the COVID-19 pandemic. We propose that in order to perform a sensitive clinical examination via telemedicine, the following four steps must be considered: assessment of the clinical need, obtaining informed consent, use of a chaperone, and thorough documentation. CONCLUSION: Telemedicine will play a pivotal role in the future of urological practice beyond this present pandemic. However, sensitive clinical examinations using such technology must be performed in appropriate settings and situations. Suitable training, enhanced documentation, communication, and observing information governance guidance will aid in avoiding clinical and ethical pitfalls.

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