PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “General Surgery”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Low molecular weight heparin (parnaparin) versus calcium heparin in the prevention of thromboembolic disease in general surgery].

In general surgery the incidence of deep vein thrombosis is between 10 and 40% according to age, the length and type of operation and the pathology "risk" associated. Prevention is undoubtedly the best way to avoid this complication. The aim of this study was to confirm, in 160 patients split in two groups, the clinical effectiveness and the usefulness of a low molecular weight heparin (parnaparin) versus calcium heparin. Both drugs demonstrated high effectiveness in prevention of deep vein thrombosis and or pulmonary embolism. In our opinion, however, parnaparin has a more protective and a less hemorrhagic inter-operation effect than calcium heparin and, not last, the advantage of a single daily administration.

Adult↗
PubMed2004

Redefining the future of trauma surgery as a comprehensive trauma and emergency general surgery service.

BACKGROUND: Dwindling operative opportunities in trauma care may have a detrimental impact on career satisfaction among trauma surgeons and on career attractiveness to surgical trainees. Addition of emergency general surgery may alleviate some of these concerns. STUDY DESIGN: The trauma service at our institution incorporated nontrauma emergency general surgery over a 3-year period. The institution's trauma registry and hospital perioperative database were queried. The changes in operative caseload are described. Current trauma faculty anonymously completed a Web-based questionnaire about the addition of emergency general surgery to the trauma service. RESULTS: Operations for trauma decreased in 2002 compared with 1999, despite a higher number of penetrating injuries and total trauma contacts. Nontrauma general surgery operations performed by trauma faculty increased in proportion to coverage provided by the trauma service. In 2002, 57% of all cases performed by trauma surgeons were emergency general surgery, which accounted for 32% to 74% of an individual surgeon's caseload. In anonymously completed Web-based questionnaires, current trauma faculty expressed satisfaction with the combined trauma and emergency general surgery model. CONCLUSIONS: The combined trauma and nontrauma surgery service increased operative caseloads and improved satisfaction of trauma surgeons. A comprehensive trauma and emergency general surgery service may be an attractive model for the future of trauma surgery and provide logistical and medical advantages to the emergency general surgery patient population.

Clinical Competence↗
PubMed1990

Canadian general surgery: alive and well.

General surgery in Canada is alive and well because general surgeons remain versatile and adaptable. If this were not the case, the specialty of general surgery would go the way of the dinosaur. The continuing evolution of general surgery can only be maintained by reviewing the following: (a) training; (b) continuing education; (c) maintenance of competence; (d) manpower and economic aspects; and (e) interaction of general surgeons with other surgeons and specialties. The Canadian Association of General Surgeons will continue to play a vital role in maintaining liaison between all types of general surgeons across the country and help, in any way possible, to support the ever-changing face of general surgery.

Canada↗
PubMed2001

[The goals of the Japanese Surgical Society should not be merely for specialized surgery: they should be for general surgery, surgical education and better medical legislation].

The Japan Surgical Society (JSS) should investigate mainly general surgery, surgical education, and political approach. The Specialized surgery, which has also been studied by the JSS, should be fully evaluated in various subspecialty surgical societies, i.e. gastrointestinal, respiratory, circulatory, pediatric, and others. This is reasonable, since the board of each subspecialty has the same basic requirements as the board of the JSS and this is how the JSS and other surgical subspecialty societies can coexist. In addition, the JSS must make efforts to improve surgeons' lives overall by means of effective politics and to motivate medical students to become surgeons to prevent a scarcity, which will also contribute to the welfare of the public.

Education, Medical↗
PubMed2005

Prophylaxis and treatment of deep vein thrombosis in general surgery.

BACKGROUND: Patients undergoing general surgery present an inherent risk of deep vein thrombosis (DVT). Evidence-based strategies for prevention and treatment of DVT should be continuously upgraded on the basis of good-quality recent trials. DATA SOURCES: Articles were identified using MEDLINE, EMBASE, and the Cochrane Library databases (January 1980 to July 2003). Randomized clinical trials and meta-analyses in which different prophylactic and treatment methods were compared for general surgery patients were selected. CONCLUSIONS: In general surgery, low-molecular weight heparins (LMWHs) are relied upon more and more for prophylaxis and initial anticoagulant treatment of DVT, because of their multiple advantages in efficacy, safety, and convenience in handling. For cost-effective reasons, full-dose vitamin K antagonists are still preferred as the standard long-term anticoagulation method, while LMWHs represent the exception. Long-term use of low-intensity warfarin should be considered a new standard of care for the management of venous thrombosis. Compared to LMWH, the new anticoagulant molecules fondaparinux and ximelagatran seem to have similar efficacy in the treatment of venous thromboembolism, but they have a 2-fold increased efficacy in its prophylaxis. Clinical implementation of these new anticoagulant molecules depends on their cost-effectiveness; however, they have the potential to become the treatment of choice in the next decade. Thrombolysis has an unacceptable risk of hemorrhagic complications when used in the treatment of postoperative DVT. Furthermore, there are no data to prove that thrombolysis reduces the incidence of postthrombotic syndrome (PTS), despite early and complete recanalization achieved by thrombolysis. Surgical thrombectomy is only meant to decompress the venous hypertension consecutive to massive thrombosis (phlegmasia cerulea dolens) and thus to avoid venous gangrene. Other mechanical percutaneous thrombectomy devices are under evaluation. In selected cases, a combination treatment consisting of locoregional thrombolysis of the crurofemoral venous axis and mechanical thrombectomy of the pelvic venous axis achieves high rates of complete desobliteration.

Anticoagulants↗
PubMed2000

Increased levels of S-100 protein after cardiac surgery with cardiopulmonary bypass and general surgery in children.

The aim of this study was to evaluate changes in concentrations of the neurospecific protein S-100 in relation to cardiac surgery with cardiopulmonary bypass (CPB) and noncardiac general surgery in children below 3 years of age. Seventeen children underwent surgery for congenital heart disease and all survived without clinical signs of neurological complications. Samples for plasma concentrations of S-100 in these patients were taken on three occasions in connection with surgery: before the start of surgery, after CPB and finally 16-20 h after CPB. In the noncardiac group of 31 children, S-100 concentrations were measured on two occasions: before surgery and during surgery. In both groups, a significant increase in S-100 concentrations was observed during surgery, although the increase in the CPB group was significantly higher than in the noncardiac group. The CPB group included four children with Down's syndrome who had higher mean S-100 concentrations on all sampling occasions compared to the remaining patients. The peak S-100 concentrations after cardiac surgery were related to the duration of CPB, the time from the termination of CPB to the first post-CPB sample, as well as mean arterial pressure and cerebral arteriovenous lactate difference during rewarming. All the children studied (Down's patients excluded) had age-dependent plasma concentrations of S-100 measured before surgery. It can be concluded that CPB initiates a marked but transient release of S-100 into the systemic circulation during open heart surgery in children who are not developing clinical signs of neurological sequelae.

Cardiac Surgical Procedures↗
PubMed1991

Presidential address, 1990. Should general surgery be redefined?

The definition of general surgery, adopted by the Canadian Association of General Surgeons in 1983, has raised the expectations of the general surgical community. It was thought, at the time, that a definition that took into account the broad aspects of the specialty would make general surgeons more aware of their role in clinical and teaching activities, counteract the negative effects of subspecialization and prevent further fragmentation. Because of the many changes that have taken place in the 1980s, the author considered that a review of that definition was justified. To address this issue, the author has attempted to answer the following two questions: What are general surgeons doing in 1990? To what extent are they trained to do what they are supposed to do, according to the definition of general surgery? Data were obtained from la Régie de l'assurance-maladie du Québec in order to answer to the first question; with respect to the second, a questionnaire was sent to the chairmen of the 16 Canadian departments of surgery. The results of the study indicate that the definition of general surgery has not kept up with the times and should be revised. The author suggests that a modified definition should include primary and secondary components of the specialty in order to allow some flexibility. In the event that such a change seems appropriate, head and neck surgery should be only a secondary component of general surgery.

Canada↗
PubMed2001

[Stomach surgery--are the requirements for specialist in general surgery still realistic?].

This paper discusses the possibility for a surgical trainee to acquire the necessary experience in gastric operations for his fellowship in general surgery. All operations of the stomach performed at the surgical unit of Lucerne Hospital between January 1994 and September 1997 were analysed retrospectively. Of 184 operations performed only nine were done by a trainee, four of which were gastrostomies and five operations of a perforated ulcer. These results prove the difficulties for a trainee to achieve the required number of operations. Possible solutions would be the acknowledgement of assisted operations for the fellowship in general surgery and/or the limitation of gastric operations performed by the trainee himself to the curriculum for the fellowship in visceral surgery.

Clinical Competence↗
PubMed1999

Impact of a colon and rectal surgeon on a general surgery residency training program.

PURPOSE: Most general surgery residents obtain scant exposure to anorectal disease during training. The aim of this study was to determine whether adding a colon and rectal surgeon to the faculty of a general surgery training program improves the amount or quality of the anorectal surgical experience. METHODS: The surgical experience of all graduating residents from our university teaching program was reviewed during a ten-year period. Complete case data were obtained from the Residency Review Committee for surgery. The total small-intestine, colon and anorectal caseload was analyzed during the five-year period preceding the arrival of the colon and rectal surgeon and compared with the subsequent five-year period after the surgeon's arrival. RESULTS: There was a substantial increase in small-intestine (470 vs. 306) and anorectal cases (462 vs. 338). There was a particularly dramatic increase in anorectal cases performed during the chief resident year (159 vs. 36), which held true for all categories of anorectal cases. CONCLUSIONS: The addition of a full-time colon and rectal surgeon to a university general surgery residency program was associated with an increase in small-intestine and especially anorectal cases. However, most striking was the greater than fourfold increase in the number of anorectal cases performed during the chief resident year. This seems to reflect an increase in complexity of anorectal cases and an increased interest in anorectal surgery among general surgery residents.

Colon↗
PubMed1996

Initial experience of 3-D video endoscopy in general surgery.

The worldwide explosion of Iaparoscopic surgery within general surgery began in the late 1980sand early 1990s.From its inception, surgeons have expected the image on the video monitor to resemble closely the . image obtained in similar open surgery.The monitor image, however, is presented in two dimensions- height and width. Orientation of the surgeon to the anatomy is more difficult and requires a sound knowl- edge of anatomy, the relationships of organs to each other, and an understanding of the individual patient's unique structures. Adding a third dimension, depth, to imitate natural vision in open surgery may provide surgeons with the confidence to perform more advanced procedures. In addition, trainee surgeons, without the experience of open surgery which their senior colleagues have gained, may more rapidly appreciate orientation of the anatomy and learn the surgical task more quickly.

Journal Article↗
PubMed2004

Determining benchmarks for evaluation and management coding in an academic division of general surgery.

BACKGROUND: Academic divisions of general surgery are facing ever-increasing financial pressures. Cost-cutting is a common approach to maintaining profitability, but strategies to increase revenue should not be ignored. One specific avenue for enhanced revenue generation in general surgery is that of coding for evaluation and management (E&M). Although this is the financial life-blood for many of the consultative services in departments of medicine, E&M coding is an often neglected and misunderstood component of surgical care. STUDY DESIGN: The financial records for the Division of General Surgery were reviewed for the period of January 2001 to June 2003. Specifically, charges and receipts for inpatient procedures and hospital visits (CPT codes 99231, 99232, and 99233) were determined. The analysis was limited to surgeons with a primary clinical focus based at the University hospital rather than the neighboring community or Veteran's Affairs hospitals. In addition, ICD-9 and All Patient Refined Diagnosis Related Groups (APR-DRG) data were analyzed to determine the surgeon-specific number of inpatients and inpatient-days with more than one ICD-9 code or secondary ICD-9 codes, or both, or an APR-DRG severity of illness score of 2, 3, or 4. These categories were defined to determine the number of inpatient-days for which E&M coding could be billed for management of secondary medical diagnoses. RESULTS: Analysis demonstrates that actual E&M charges were 40% to 47% of predicted minimums for E&M charges for the period under study. In theory, this result translates into an annual gain in receipts of 400,000 dollars to 600,000 dollars. CONCLUSIONS: We conclude that the ICD-9 and APR-DRG models may serve as benchmarks to determine the limits for E&M revenue stream, and E&M coding may represent an underutilized source of revenue among academic departments of surgery.

Academic Medical Centers↗