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Surgical Technology International I contains 66 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

1991 - ISBN 1 85745 020 5

 

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Introduction by Ben Eiseman MD, FACS

Sections

General Surgery

 

Laparoscopic Cholecystectomy after the Learning Curve
Eddie Joe Reddick MD, FACS, Laparoscopic Laser Center, Baptist Medical Center, Nashville, Tennessee

01-248

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Abstract

Management of gallbladder disease has changed dramatically since the introduction of laparoscopic cholecystectomy (LC) in 1988. Removal of the gallbladder has always been the 'gold standard'. However, the morbidity associated with the large transrectus incision has caused patients and referring physicians alike to refrain from surgical treatment whenever possible. LC offers the same excellent end results of a standard cholecystectomy, but without the pain and ileus seen with the operation.

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The Future of Laparoscopic General Surgery
Henry L. Laws MD, J. Barry McKernan MD, PhD, Woodstock, GA

01-255

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Abstract

Video controlled laparoscopy has dramatically changed general surgery. Further striking alteration is sure to occur in the immediate future. Not only are the surgeons who are concentrating on this area making great strides, but innovative equipment and technological innovation are certain to make more complex procedures feasible. Thus the future of laparoscopic surgery is very bright.

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Endoscopic Methods for Control of Non-variceal Gastrointestinal Bleeding
Jeffrey L. Ponsky MD, Department of Surgery, Case Western Reserve University School of Medicine and the Mt. Sinai Medical Center, Cleveland, Ohio, Russell Howerton MD, Department of Surgery, Case Western Reserve University School of Medicine and the Mt. Sinai Medical Center, Cleveland, Ohio

01-261

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Abstract

Flexible upper gastrointestinal endoscopy has a well established place in the diagnosis of upper gastrointestinal bleeding. Increasing experience with a variety of modalities has made endoscopic therapy appropriate for many significant bleeding lesions of the upper GI tract. In many instances endoscopic therapy will eliminate the need for surgical control of the bleeding lesion. In other patients the temporary endoscopic control of bleeding may allow appropriate surgical intervention to be postponed until optimal stabilisation can be accomplished.

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Endoscopic, Diagnostic and Therapeutic Procedures of the Biliary and Pancreatic Tract
K. Huibregtse MD, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, S. Rivera-MacMurray MD, Academic Medical Center, University of Amsterdam, Ansterdam, The etherlands

01-265

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Abstract

Endoscopic cannulation of the biliary tree and the pancreatic duct (ERCP) was first described in 1968. Six years later the technique of endoscopic sphincterotomy (ES) opened the door to endoscopic treatment procedures of pancreatic and biliary diseases. Techniques have been developed to remove bile duct stones, to break large stones and to drain bile duct or pancreatic duct strictures.

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New Challenges in Trauma Surgery
Care of the paediatric, geriatric and pregnant patient

M. Margaret Knudson MD, Assistant Professor of Surgery, University of California, San Francisco and Attending Trauma Surgeon, San Francisco General Hospital, San Francisco, California

01-277

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Abstract

Trauma surgery originated with military surgeons who cared for otherwise healthy young males injured in combat. During the past two decades, many areas of the United States have established trauma systems, organised to sift seriously injured patients of all ages to trauma centres that have the medical personnel and equipment needed to provide immediate trauma care. The organisation of trauma care has greatly increased the experience of civilian surgeons based at designated trauma centres, and has lead to a recognition of three 'special care' areas of trauma surgery: paediatric trauma, geriatric trauma, and trauma during pregnancy.

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The Quadrantectomy Technique for Small Breast Carcinomas
Umberto Veronesi MD, PhD, General Director, National Cancer Institute, Milan, Italy

01-285

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Abstract

Quadrantectomy describes removal of the quadrant in which a breast neoplasm is located, by excision of skin overlying the tumour en bloc with the sub-cutaneous fatty tissue and a relatively large area of the mammary gland, including the corresponding parts of the fasciae of the major pectoralis muscle.

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Hyperparathyroidism
Orlo H. Clark MD, Chief, Mount Zion Medical Center and Professor of Surgery, UCSF School of Medicine, San Francisco, California

01-291

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Abstract

Approximately 100,000 new cases of primary hyperparathyroidism are diagnosed in the United States each year. Thus a disorder that was once considered to be rare is now known to be relatively common. Many patients with primary hyperparathyroidism are diagnosed today with only minimal hypercalcemia (serum calcium less than 1mg/dl above the upper limit of normal) and many have few or no classic symptoms or clinical manifestations of hyperparathyroidism, such as kidney stones or osteitis fibrosa cystica. Many patients with hyperparathyroidism today have fatigue or increased lethargy, muscular weakness, bone or joint pain and depression. It is difficult preoperatively to know whether these clinical manifestations are related to the primary hyperparathyroidism or not. Our own studies suggest that in about 80 per cent of patients with hyperparathyroidism the preoperative symptoms either improve or disappear after parathyroidectomy.

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Using Lasers in Head and Neck Oncologic Surgery
Jeffrey D. Spiro MD, Assistant Professor of Surgery, Division of Otolaryncology, Head and Neck Surgery, University of Connecticut School of Medicine, Ronald H. Spiro MD, Clinical Professor of Surgery, Cornell University Medical College and Attending Surgeon, Head and Neck Service, Memorial Sloankettering Cancer Center, New York

01-297

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Abstract

Few technologic advances in medicine have captured the imagination of the general public, and physicians, to the extent that the laser has. The laser clearly evokes images of space-age technology, and is frequently regarded as a panacea by patients. The reality is, of course, that the laser has no inherent special ability to cure diseases, and is simply another tool available to contemporary surgeons. We will review the current application of lasers in head and neck oncologic surgery. The basic mechanism of lasers will be discussed, with emphasis on the carbon dioxide (C02) laser. This discussion will include analysis of photodynamic therapy for cancer of the upper aerodigestive tract, which is rapidly evolving as a means of incorporating lasers in the treatment of head and neck cancer.

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TIPS Transjugular Intrahepatic Portosystenlic Shunts
Jean M. LaBerge MD, Department of Radiology, UCSF, San Francisco, California, Ernest J. Ring MD, Department of Radiology, UCSF, San Francisco, California, Roy L. Gordon MD, Department of Radiology, UCSF, San Francisco, California

01-300

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Abstract

The emergency management of patients with acute variceal bleeding has evolved dramatically over the past 20 years. Initially, bleeding was controlled by supportive medical measures in conjunction with surgical portal decompression procedures. However, the high operative mortality and the significant incidence of post-operative encephalopathy associated with emergency portal decompression led to the development of alternative therapeutic techniques. Injection sclerotherapy has been used in large numbers of patients for the past 10 years with considerable success and is now advocated by many authors as the treatment of choice for acute variceal hemorrhage. While sclerotherapy controls bleeding in approximately 70 per cent of patients, repeat sessions are necessary in 20 per cent and sclerotherapy may be unsuccessful in 10 per cent. When sclerotherapy fails, most authors recommend surgical shunting. While the side-side portacaval shunt is still the most popular operation in this setting, other types of shunts have been advocated by some authors. A small mesocaval or portacaval H-graft, or a distal splenorenal shunt may he performed in an attempt to reduce the incidence of post-operative encephalopathy and liver failure.

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Regional Hyperthermic Perfusion for Cancer
Robert E. Allen Jr. MD, Professor of Surgery, UCSF, San Francisco, California

01-306

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Abstract

Regional perfusion of cancer resulted from studies that infused nitrogen mustard into arteries supplying tumours while at the same time blocking the venous return to maximise exposure of the tumour to the chemotherapeutic agent.

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Lung Transplantation in the 1990s
John R. Pepper, Senior Lecturer and Honourable Consultant, Royal Brompton National Heart and Lung Hospital, London, UK

01-309

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Abstract

Over the past 10 years there has been a rapid increase in the application of single lung, double lung and heart/lung transplantation to patients with a variety of end-stage cardiopulmonary diseases. As a result there has been a significant expansion in our knowledge of these procedures and their potential therapeutic role, limitations and complications.

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Liver Transplantation Modern techniques in donor and recipient operations
Carlos O. Esquivel MD, PhD, FACS, Pacific Transplant Institute, California Pacific Medical Center, San Francisco, Paul Z. Nakazato MD,
Pacific Transplant Institute, California Pacific Medical Center, San Francisco, Waldo Concepcion MD

01-315

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Abstract

Pacific Transplant Institute, California Pacific Medical Center, San Francisco Orthotopic hepatic transplantation provides hope for patients with irreversible liver disease, and the operation is becoming more accepted by the medical community and the public in general. Still, the operation is difficult and the postoperative and long-term management can be rather complex. Unlike pancreas, kidney and heart transplantation, liver transplantation lacks a back-up system, such as Insulin, dialysis or a ventricular support device, if graft failure occurs. Therefore, the Slightest error in the management of the patient after hepatic transplantation may prove fatal. Complications during the post-operative period often originate from the time of the procurement and/or transplantation operations. Thus, good techniques are crucial for a satisfactory outcome.

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