American journal of surgery
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Diabetes mellitus affects 5-10% of the US population at some point in their lives. Hyperglycemia produces serious chronic complications. ⋯ Secondary infection of these ulcers is by far the leading cause of major amputations of feet and legs. Proper preventative care will dramatically reduce ulcer formation and costs related to this complication.
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Several decades ago, a shift occurred in the management of adult splenic injuries. Influenced by the experience in pediatric trauma patients, adult trauma surgeons began turning from mandatory operative treatment of all splenic injuries toward nonoperative management. ⋯ However, controversy exists about how to appropriately select patients for nonoperative treatment since bleeding from splenic injuries can incur significant morbidity and mortality. Recent refinements in the management of adult blunt splenic injuries will be reviewed.
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Surgical training in the United Kingdom and Europe is in transition given the pressure to decrease the number of workweek hours and the numbers of years in training. To achieve this shortened training in the United Kingdom, the primary component will be the foundational education, which will last for 2 years, with the second year perhaps counting toward specialist training. ⋯ During the foundation period there is exists the question of assessment, so this might be a natural point at which to preselect these students. This article considers psychometric assessment as a methodology of preselecting surgeons and considers objective assessment as a possibility during the foundational education period.
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Review Comparative Study
A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer.
Sentinel lymph node biopsy (SLNB) is an established means of staging the axilla in patients with breast cancer. Recently, methylene blue dye has been shown to be an efficacious and cost-effective alternative to isosulfan blue. With the increasing popularity of SLNB, the potential complications of isosulfan blue use must be appreciated. ⋯ The use of isosulfan blue due for SLNB is associated with a significant number of allergic reactions, some of which are life-threatening. Because methylene blue dye has been shown to be equally effective and does not pose a serious risk of serious allergic reactions, it offers an improved technique above isosulfan blue dye for SLNB.
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Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image-guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed.