Mapping language dominance through the lens of the Wada test.

The sodium amytal test, or Wada test, named after Juhn Wada, has remained a pillar of presurgical planning and is used to identify the laterality of the dominant language and memory areas in the brain. What is perhaps less well known is that the original intent of the test was to abort seizure activity from an affected hemisphere and also to protect that hemisphere from the effects of electroconvulsive treatment. Some 80 years after Paul Broca described the frontal operculum as an essential area of expressive language and well before the age of MRI, Wada used the test to determine language dominance. The test was later adopted to study hemispheric memory dominance but was met with less consistent success because of the vascular anatomy of the mesial temporal structures. With the advent of functional MRI, the use of the Wada test has narrowed to application in select patients. The concept of selectively inhibiting part of the brain to determine its function, however, remains crucial to understanding brain function. In this review, the authors discuss the rise and fall of the Wada test, an important historical example of the innovation of clinicians in neuroscience.

Chapter 9 prehospital tourniquets: review, recommendations, and future research.

The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.

Osteotomy around the knee: evolution, principles and results.

PURPOSE: This article summarises the history and evolution of osteotomy around the knee, examining the changes in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years (1940-2000) and Modern Later Years (2000-Present). We aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific indications. MATERIALS AND METHODS: A thorough literature review was performed to identify the important steps in the development of osteotomy around the knee. RESULTS: The indications and surgical technique for knee osteotomy have never been standardised, and historically, the results were unpredictable and at times poor. These factors, combined with the success of knee arthroplasty from the 1980s onward, led to knee osteotomy being regarded as an irrelevant surgical option by many surgeons. Despite its fluctuating reputation, this article demonstrates the reasons for the enduring practice of osteotomy, not least because achieving the appropriate alignment is now recognised as the foundation step when planning any surgical intervention. CONCLUSIONS: With appropriate patient selection, accurate pre-operative planning, modern surgical fixation techniques and rapid rehabilitation, osteotomy around the knee is now an effective biological treatment for degenerative disease, deformity, knee instability and also as an adjunct to other complex joint surface and meniscal cartilage surgery. LEVEL OF EVIDENCE: V.

Essential tips for nurses.

A useful book for teachers of nurses as well as for their pupils was reviewed in the BJN 100 years ago. It was called, 'A Quiz Book of Nursing,' by Miss Amy Elizabeth Pope, with regard to the restraint of patients, it is suggested that the following points should be emphasized by the instructor:

[A century since the publication of Grossich's paper in Zentralblatt für Chirurgie--an innovation in the field of antisepsis]. / Hundert Jahre seit der Veröffentlichung von Grossichs Werk in Zentralblatt für Chirurgie - Eine Innovation im Bereich der Antisepsis.

This review recalls the first presentation of a modified method for the use of iodine tincture in preoperative disinfection of skin and minor injuries by the Rijeka physician Antonio Grossich (1849-1926), which was published in "Zentralblatt für Chirurgie" 100 years ago. It did not have to wait long before it received acclaim from 20 other medical journals, and in 1909, from the audience at the International Surgery Congress held in Budapest for an extended presentation on the subject. In the following 2 years, surgeons all over the world published their experiences with this optimised technique in over a hundred journals. Doctor Grossich put these articles together and published them with his commentary in 1911 in a monograph entitled "Meine Präparationsmethode des Operationsfelds mittels Jodtinktur" (English: "My personal approach for the preparation of the surgical field using iodine tincture"). Although iodine tincture was also used by other physicians and surgeons at that time, Grossich optimised the method for its use, and he was the first to publish his experience in surgical practice.

The Moe Maximal Correction Test to determine true curve flexibility: a historical note with current application.

This is not a prospective randomized clinical trial or a consecutive case series, but rather the description of a technique developed years ago, but still applicable. As spine surgeons, we wish to know the true correctability of a curvature before determining the best method of treatment. Do we need to do a posterior surgery only? Do we need to do a combined anterior and posterior surgery? Do we need to place the patient in preoperative skeletal traction? Although many different techniques have been described for the determination of true curve flexibility, the Moe Maximal Correction Test has never before been described.

Preoperative evaluation clinics.

PURPOSE OF REVIEW: The ever-increasing demand for productivity has forced anesthesiology departments to implement a safe, efficient, and structured approach to the preoperative evaluation of surgical patients. The goal of the present article is to discuss the evolution, benefits, and the future of preoperative clinics including a telephone-based system. RECENT FINDINGS: Outpatient preoperative evaluation clinics are common, but the optimal model is unknown and may depend on a hospital's characteristics such as the types of specialty care provided, geographic and socioeconomic differences of the population served by the hospital, the expectations of patients, and whether the facility is private versus academic practice where house staff education is necessary. The advantages of a telephone-based screening and assessment system include that patients need not make a separate visit to the hospital that typically would require taking time off from work. SUMMARY: It is difficult to compare the efficacy of different preoperative evaluation systems with regard to properly educating the patient, minimizing complications, and maximizing surgical suite functioning. Several authors have pointed out that quality improvement of the preoperative clinic should be guided by obtaining patient feedback.

The evolution of intramedullary spinal cord tumor surgery.

OBJECTIVE: Resections of intramedullary spinal cord tumors were attempted as early as 1890. More than a century after these primitive efforts, profound advancements in imaging, instrumentation, and operative techniques have greatly improved the modern surgeon's ability to treat such lesions successfully, often with curative results. METHODS: We review the history of intramedullary spinal cord tumor surgery, as well as the evolution and advancement of technologies and surgical techniques that have defined the procedure over the past 100 years. RESULTS: Surgery to remove intramedullary spinal cord tumors has evolved to include sophisticated imaging equipment to pinpoint tumor location, laser scalpel systems to provide precise incisions with minimal damage to surrounding tissue, and physiological monitoring to detect and prevent intraoperative motor deficits. CONCLUSION: Modern surgical devices and techniques have developed dramatically with the availability of new technologies. As a result, continual advancements have been achieved in intramedullary spinal cord tumor surgery, thus increasing the safety and effectiveness of tumor resection, and progressively improving the overall outcomes in patients undergoing such procedures.

Bowel preparation before colonoscopy in the era of mass screening for colo-rectal cancer: a practical approach.

Colonoscopy constitutes the principal investigation for colo-rectal neoplasms due to its ability to detect and remove most of precancerous lesions; due to the ongoing or planned colon cancer screening programs in many European countries we should expect an enormous increase in colonoscopic demand over the next few years. Diagnostic accuracy and therapeutic safety of colonoscopy strictly depends upon the quality of bowel cleansing which is often perceived as the most unpleasant part of the procedure in individuals undergoing this examination. The ideal preparation for colonoscopy should reliably empty the colon from all faecal material allowing the optimal visualization of the entire colonic mucosa without causing great patient's discomfort nor significant shifts in fluids or electrolytes. Standard PEG solutions and sodium phosphate (NaP) compounds are the most frequently used preparations; both are accepted and relatively well tolerated by the majority of patients undergoing colonoscopy; however, NaP compounds should be avoided in elderly subjects as well as in those with congestive heart failure, renal and hepatic insufficiency or taking diuretics, ACE inhibitors or angiotensin receptor blockers, since they can induce severe electrolyte and/or fluid disturbances. Standard PEG solutions are often taken incompletely due to the low palatability and the high volume of liquids required which induce nausea and vomiting with negative consequences in terms of colon cleansing. Reduced volume and better palatability of PEG solutions, such as those obtained with the newest PEG formulations, as well as improved patient education concerning the importance of bowel cleansing could undoubtedly increase compliance with oral bowel preparations and promote adherence to colo-rectal cancer screening programs.

Antonio Grossich- on the centenary of his introduction of iodine tincture painting in the preoperative infection control.

The article presents the life and achievements of Doctor Antonio Grossich, the head of the Department of surgery and gynecology of the Civic hospital in Rijeka. He wrote several literary works, but deserves to be remembered for his clinical and experimental work on antiseptic and aseptic procedure. He introduced the method of painting the operative field with 10% iodine tincture at first in traumas, then in general surgery. The method, for its rapidity, efficacy and not expensive had soon a worldwide success. He also participated actively in the political life of Rijeka before and after the World War I.

Early attempts at sterilization: BJN 100 years ago.

The cleanliness of the skin for operations was a big issue 100 years ago, and it is fascinating to read different accounts of how surgeons tackled the problem and came up with their solutions. Mr Stretton, a senior surgeon to the Kidderminster Infirmary and Children's Hospital, writing in the BJN at the time, said:

[Premedication, preoperative and postoperative visits. Importance as reflected in anaesthesiology textbooks]. / Prämedikation, prä- und postoperative Visite. Bedeutung im Spiegel der Anästhesie-Lehrbücher.

Proceeding from German and English language textbooks on anaesthesia as sources, this article asks what concepts of preoperative and postoperative visits have dominated since 1880 and what types of premedication have been preferred. The idea of obligatory premedication became widespread in the first third of the twentieth century. The premedication approach was gradually supplanted by concepts of anaesthesia introduction (basal anaesthesia). The preoperative visit was usually a separate topic in the textbooks and the focus was on the patient's psyche. Much less attention was devoted to the postoperative visit. The current emphasis on the postoperative visit in the framework of perioperative anaesthesia is barely dealt with at all in the textbooks that were consulted.

Preoperative reduction of spondylolisthesis.

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.