scholarly journals Complications of Circumcision

2011 ◽  
Vol 11 ◽  
pp. 2458-2468 ◽  
Author(s):  
Aaron J. Krill ◽  
Lane S. Palmer ◽  
Jeffrey S. Palmer
Keyword(s):  
Health Care ◽  
Preoperative Evaluation ◽  
The United States ◽  
Safe Procedure ◽  
Significant Cost ◽  
Proper Selection ◽  
Significant Percentage ◽  
Bleeding History ◽  
Selection Of Patients ◽  
Selection Of

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

scholarly journals Assess frailty but avoid frailtyism

2019 ◽  
Vol 21 (Supplement_L) ◽  
pp. L17-L19
Author(s):  
Cristiana Vitale ◽  
Loreena Hill
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Clinical Practice ◽  
Care Plan ◽  
Heart Failure Patients ◽  
Frailty Assessment ◽  
Limited Health ◽  
Selection Of Patients ◽  
Selection Of ◽  
Made In

Abstract The assessment of frailty in heart failure patients can help clinicians to build a tailored care plan, aimed at improving the selection of patients likely to benefit from one treatment vs. another, thereby improving outcomes. Although progress has been made in the ‘operationalization’ of frailty assessment, there is still the need to provide an improved instrument to assess frailty that is easy, quick and at the same time predictive within the setting of a busy clinical practice. Using such an ideal instrument, clinicians would be able to optimize the use of limited health care resources and avoid what has been termed ‘frailtyism’. This term, similar to ageism, can be defined as prejudice or discrimination based on the presence of frailty.

scholarly journals Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

2017 ◽  
Vol 3 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Ecaterina Scarlatescu ◽  
Dana Tomescu ◽  
Sorin Stefan Arama
Keyword(s):  
Anticoagulant Therapy ◽  
Coagulation Activation ◽  
Proper Selection ◽  
Beneficial Effects ◽  
Patient Heterogeneity ◽  
The Difference ◽  
The Right ◽  
Harmful Effects ◽  
Selection Of Patients ◽  
Selection Of

Abstract Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.

Cardioversion of Atrial Fibrillation: How Important is a Long Arrhythmia Duration?

1994 ◽  
Vol 39 (3) ◽  
pp. 78-79
Author(s):  
G.Y.H. Lip ◽  
K.J. Hogg
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Successful Outcome ◽  
Proper Selection ◽  
Long Duration ◽  
Selection Of Patients ◽  
Selection Of

A long duration of atrial fibrillation is usually considered as an adverse feature for successful cardioversion of atrial fibrillation and the maintenance of sinus rhythm. This often leads to the exclusion of such patients from being considered for this procedure. We report three patients in whom atrial fibrillation was present for a long duration (one for 2 years, two for 10 years), and successful cardioversion to sinus rhythm was achieved. Proper selection of patients with atrial fibrillation with an understanding of all features predicting a successful outcome will often allow a good result.

Surgical Evaluation of Candidates for Cochlear Implants

1987 ◽  
Vol 96 (1_suppl) ◽  
pp. 96-99 ◽  
Author(s):  
F. O. Black ◽  
D. J. Lilly ◽  
L. P. Fowler ◽  
P. H. Stypulkowski
Keyword(s):  
Cochlear Implants ◽  
Preoperative Evaluation ◽  
The United States ◽  
Good Samaritan ◽  
Surgical Evaluation ◽  
Potential Benefits ◽  
Good Samaritan Hospital ◽  
Normal Speech ◽  
Arbitrary Selection ◽  
Selection Of

The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.

Management of Substernal and Intrathoracic Goiters

1986 ◽  
Vol 94 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Hyun T. Cho ◽  
Jason P. Cohen ◽  
Max L. Som
Keyword(s):  
Preoperative Evaluation ◽  
Surgical Removal ◽  
Team Approach ◽  
Vascular Compression ◽  
Intrathoracic Goiter ◽  
Transcervical Approach ◽  
Respiratory Embarrassment ◽  
Selection Of Patients ◽  
Mediastinal Goiter ◽  
Selection Of

Goiters that descend into the mediastinum can cause respiratory embarrassment, dysphagia, vascular compression, vocal cord paralysis, and sudden death. Although many such goiters remain clinically silent, their ability to produce sudden and unpredictable respiratory distress is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for Intrathoracic goiter. Though seen less frequently today, the only effective treatment for mediastinal goiter is surgical removal. We report our experience with the management of 70 consecutive patients with substernal or intrathoracic goiters. The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of Intrathoracic extension. The transcervical approach for resection is emphasized—even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidlsciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of patients for thyroidectomy, the Incidence of mediastinal goiter may be increasing.

Combined Use of Subdural and Intracerebral Electrodes in Preoperative Evaluation of Epilepsy

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 93-101 ◽  
Author(s):  
C. W. M. van Veelen ◽  
R. M. Chr. Debets ◽  
A. C. van Huffelen ◽  
W. van Emde Boas ◽  
C. D. Binnie ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Epileptogenic Zone ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Depth Electrodes ◽  
Combined Use ◽  
Intracranial Recording ◽  
Burr Holes ◽  
Selection Of Patients ◽  
Selection Of

Abstract For intracranial recording of partial seizures considered to originate from one of the temporal or frontal lobes, the team in the Utrecht Academic Hospital has used subdural, multicontact, flexible electrodes since 1972. These are introduced through bilateral, frontocentral trephine holes and are manipulated under fluoroscopy to cover most of the cerebral convexity. It became evident that in many patients, additional placements to record from intracerebral structures were indispensable. Therefore, using the same trephine holes, an additional 2 to 4 depth electrodes were stereotactically implanted in the mesial temporal and/or frontal structures, as appropriate. An extensive intra- and extracerebral spatial representation of the epileptogenic zone was thus obtained. We report here the methods for manufacturing and applying these electrodes and our clinical experience with 28 patients. The results obtained so far stress the value of combining subdural and depth electroencephalographic monitoring in the presurgical selection of patients suffering from medically refractory complex partial seizures. By miniaturizing the electrodes, extensive areas of the brain can be investigated without craniotomy or multiple burr holes. (Neurosurgery 26:93-101, 1990)

Cochlear Nerve Section for Intractable Tinnitus

1995 ◽  
Vol 74 (7) ◽  
pp. 468-476 ◽  
Author(s):  
Jack L. Pulec
Keyword(s):  
Spiral Ganglion ◽  
Accurate Diagnosis ◽  
Cochlear Nerve ◽  
Careful Examination ◽  
Complete Relief ◽  
Proper Selection ◽  
Nerve Section ◽  
Subjective Tinnitus ◽  
Selection Of Patients ◽  
Selection Of

Tinnitus is a common and often very disturbing symptom. The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery. Intractable subjective tinnitus originating within the cochlea or cochlear nerve can frequently be successfully treated by cochlear nerve section. The cochlear nerve must be severed medial to the spiral ganglion to obtain optimum results. One hundred fifty-one cases are reported. Complete relief of tinnitus was achieved in 101 patients, worthwhile improvement was obtained in 43 patients and 7 patients obtained no improvement. The indications for this surgery will be given. Careful examination, accurate diagnosis, and proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success.

scholarly journals The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings (Preprint)

2017 ◽  
Author(s):  
Robert J McGrath ◽  
Jennifer Lewis Priestley ◽  
Yiyun Zhou ◽  
Patrick J Culligan
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Health Care ◽  
Family Medicine ◽  
Peer Review ◽  
Large Scale ◽  
The United States ◽  
Medical Specialization ◽  
Peer Reviews ◽  
Selection Of

BACKGROUND Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. OBJECTIVE The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. METHODS We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as “America’s Top Doctors” through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. RESULTS Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed “Top Doctor” versus those who were not. CONCLUSIONS The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization.

scholarly journals A STUDY OF PORT SITE INFECTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mahesh Joshi ◽  
Prama Dubey
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Quality Of Healthcare ◽  
Port Site ◽  
Site Infection ◽  
Proper Selection ◽  
Basic Principles ◽  
Elective Laparoscopic Cholecystectomy ◽  
Selection Of Patients ◽  
Selection Of

Background: Port site infections though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted on100 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were analysed for port site infection. Result:   Out of 100 patients studied only 3 patients presented with port site infection. Conclusion: It is concluded that port site infection are rare in elective laparoscopic cholecystectomy and can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy Keywords: Port site infection, laparoscopic, Cholecystectomy

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