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Santa Maria Nuova, Italy

BACKGROUND: Since Theodor Kocher reduced the mortality rate of thyroidectomy from the 40% reported by Billroth to 0.2% in 1895, a collar incision with open removal of the thyroid gland is the standard procedure. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. A first attempt was replacement of the central "Kocher incision" with lateral neck incisions and endoscopic removal of a thyroid lobe by Hüscher on 8 July 1996. This lateral access was limited to removing only one lobe of the gland. The most common technique to date is the one developed by Miccoli et al. These authors reduced the incision to a size of 20 to 25 mm and operated on the thyroid by the use of video-endoscopic assistance (MIVAT). Several groups have described an access outside the frontal neck region via a chest, axillary, or combined axillary bilateral breast approach. These accesses only moved the entry point from the frontal neck region to other regions, where they are still visible. The aforementioned minimally invasive approach and the conventional open approach do not respect anatomically given surgical planes and may therefore result in patient complaints, especially swallowing disorders after the scaring of the subcutaneous tissues. These extracervical approaches are associated with an extensive dissection in the access area and thus are maximally invasive. Source


Bokhari A.R.,University of New South Wales | Davies M.A.,Head | Diamond T.,St George Hospital
British Journal of Neurosurgery | Year: 2013

Endoscopic transsphenoidal surgery for pituitary adenomas has been introduced as an alternative to transsphenoidal microsurgery. This is the first Australian study to evaluate a single surgeon's experience by comparing our results with other series and attempting to identify a learning curve. Retrospective analysis was carried out on 79 consecutively treated patients by fully endoscopic transsphenoidal surgery by a single neurosurgeon over a period spanning from July 1998 to September 2010 at St George Public and Private hospitals. The mean age at time of surgery was 56.7 years (SD ±16.3, range 26-85) and the mean follow-up period was 38.2 months (SD ±33, range 1-136). Gross total resection (GTR) was noted in 63% of patients, endocrinological cure was achieved in 53% and visual field improvements were noted in 86% of patients. Intra-operative CSF leaks occurred in 19% of procedures, while the rates of post-operative CSF rhinorrhea was 3% and post-operative diabetes insipidus was 13%. There was one post-operative death (1%). Compared to microsurgery, intra-operative CSF leaks and meningitis seem less frequent with an endoscopic approach. With increasing experience, we found a non-statistically significant trend towards higher rates of GTR, and improved visual fields. Endocrinological cure rates were clearly better with experience (p <0.01). There may be a learning curve that can be overcome in 30-40 cases. Endoscopic transsphenoidal surgery provides similar tumour and patient outcomes when compared to transsphenoidal microsurgery. In this single surgeon's experience, there was a trend to indicate improved performance with more case experience. © 2013 The Neurosurgical Foundation. Source


Miziara I.D.,Head
Indian journal of medical ethics | Year: 2013

Bioethics is a relatively new way of thinking about relationships in medical practice. It enables reflection on ethical conflicts, and opens up management options without dictating rules. Despite this historical context, medical ethics has been sidelined in the course of the development of bioethics. Bioethical reflection does not automatically result in changes to conflict resolution in daily doctor-patient relationships. However, these reflections are important because they promote the search for a "moral consensus" that establishes new ethical rules for day-to-day medical practice. We suggest that there is no conflict between bioethics and medical ethics; rather, these areas interact to establish new standards of behaviour among physicians. The legalisation of orthothanasia in Brazil is one example of how this theory of moral consensus might operate. On the other hand, the legal battle on abortion illustrates how the law cannot change without such a moral consensus. Source


Kappas C.,Head
Forum of Clinical Oncology | Year: 2013

Once an Oncologist or other Health Care Professional (HCP) agrees to treat a patient, he/she has a professional duty to provide competent care. A patient who believes that he/she has received improper medical treatment may be entited to take legal action against those who administrated that treatment. Typically, all persons, institutions and organizational entities involved with the treatment are named as defendants. This work reviews and comments all types of lawsuits following malpractice (simple negligence, gross negligence and deliberated torts) and product liability; the elements legally required by the plaintiff to prove malpractice and by the defendant to prove innocence and furthermore the profile of the "Reasonable Health Care Professional". Moreover, it presents the potential areas of litigation, characteristic examples of lawsuits, legal defenses to liability and "scientific arms" to avoid litigation for Oncologist Experts. Source


Ausset S.,Anesthesia and Intensive Care | Auroy Y.,Anesthesia and Intensive Care | Auroy Y.,Institute Of Medecine Aerospatiale Du Service Of Sante Des Armees | Verret C.,Epidemiologist | And 4 more authors.
Anesthesiology | Year: 2010

Background: The aim of this study performed in patients undergoing major orthopedic surgery was to assess the impact of changes in practice on both the incidence of postoperative myocardial ischemia (PMI) detected by serial measurements of troponin Ic and long-term cardiac outcome. Methods: During a 3-yr period, troponin Ic was measured on the first 3 days after major orthopedic surgery in a multidisciplinary hospital. After 16 months of study, postoperative care was improved. Cardiac death, myocardial infarction, and cardiac failure were considered major adverse cardiac events and were recorded during the hospital stay and the first postoperative year. The incidences of PMI and major adverse cardiac events were used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement. Results: Three hundred seventy-eight surgical procedures were included (P1, 123; P2, 255). Incidences of PMI and major adverse cardiac events were 8.9 versus 3.9% (P=0.04) and 8.1 versus 1.9% (P=0.004) for P1 and P2, respectively. Using a multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a major adverse cardiac event were phase P1 (hazard ratio = 4.5; 97.8% confidence interval [CI], 1.1-17.4) and PMI (Hazard ratio = 6.4; 97.8% CI, 1.6 -26.4). Conclusions: Our postoperative care policy after major orthopedic surgery strongly correlated with both short-term cardiac outcome (i.e., PMI with troponin Ic release) and long-term cardiac outcome. Thus, in a given surgical population, variation of incidence of troponin Ic elevations could be used as a result indicator for postoperative care policy. Copyright © 2010, the American Society of Anesthesiologists, Inc. Source

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