Abstract:

The search for the optimal environment that enhances tissue healing is well under way. Since Winter's landmark study over 30 years ago, moist wound healing has become the subject of intensive scientific and clinical research. Numerous studies of molecular and cell biology have demonstrated the benefits of wound healing in a moist environment. The use of occlusive dressings that retain moisture is now accepted as a first line of treatment in the management of a variety of wound types. Clinicians have a myriad of dressing alternatives at their disposal that enable more active control over the healing process. This article reviews the beneficial effects of moist wound healing and the occlusive dressings available to achieve such an environment.

Authors:

William Bruno, B.A., Morris D. Kerstein, M.D., Hahnemann University School of Medicine, Philadelphia, PA

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Abstract:

Historically, balloons have been used in surgery for a variety of applications. Over the past decades, balloons have been used by surgeons for retaining means (Foley catheter), extraction and occlusion (Fogarty catheter), tamponade (Sengstaken-Blakemore tube) as well as other uses such as dilation and calibration. The pioneering efforts of Gauer and Kieturakis have broadened the use of balloons for a new surgical application - dissection. An important feature of balloon dissection is that it allows the surgeon to create a new operative working space in which a surgical procedure can be performed. Currently, a particularly useful working space is the region immediately outside the peritoneum, frequently termed the extraperitoneal space. A variety of procedures can be performed laparoscopically in the extraperitoneal space such as herniorrhaphy, bladder neck suspension, lymph node dissection, and varicocelectomy.

Authors:

Thomas J. Fogarty, M.D., Stanford University School of Medicine, Stanford, CA, J. Stephen Scott, M.D., De Paul Hospital, St Louis, Mo, George Hermann, B.S.M.E., Fogarty Research, Portola Valley, CA

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Abstract:

Atremendous demand exists for enhancing the way by which physicians learn new invasive procedures. Appropriate education in new medical and surgical procedures is often outpaced by the desire of physicians to incorporate a procedure in their practice. Computerized surgical simulations have the potential for improving surgical morbidy and mortality. Studies have shown that, for a wide range of diagnostic and therapeutic procedures, doctors doing their first few to several dozen cases are much more likely to make a greater number of errors. This phenomenon has been referred to as 'the learning curve'. Adequate proctoring oflearners by experienced surgeons is cumbersome, as there are few surgeons experienced to proctor their colleagues. It is difficult for physicians, particularly those in rural areas, to travel to larger medical centers for training. The requirement also places a burden on experts who could become overwhelmed with proctoring requests, in addition to leaving their clinical responsibilities.

Authors:

Jonathan R. Merril, M.D., High Techsplanations Inc., Rockville, MD, Glenn M. Preminger M.D., Duke University Medical Center, Durham, NC, Richard Babayan M.D., Boston University Medical Center, Boston, MA, Rita T. Roy M.D., George Washington University Medical Center, Washington, DC, Gregory L. Merril, High Techsplanation, Inc., Rockville, MD

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Abstract:

Cryodestruction of hepatic tumors is done by freezing the tumor and an appropriate amount of surrounding normal tissue in situ. The goal is complete destruction of malignant tissue. Local and systemic host mechanisms activated by the cold injury complete the process. Resorption of devitalized tissue and stabilization of the residual scar occurs during the ensuing months. Immune factors may contribute to the long-term process of cryodestruction although such effects are inconstant and ill defined. The purpose of this overview is to delineate the mechanisms of cryodestruction, briefly summarize clinical results and discuss the technique for treatment of hepatic tumors.

Authors:

Greg V. Stiegmann, M.D., Allen L. Cohen, M.D., Suehiro Nakano, M.D., University of Colorado, Denver, CO

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Abstract:

All too often, it seems that the utilization of antibiotics by surgeons for either prophylaxis or the treatment of established infections is shrouded in a combination of mysticism and marketing. What should be straight forward, frequently becomes confused by factors such as superstition, habit, recent interaction with an industry representative, and faulty information. The rational use of antibiotics is surprising simply, and is based on the fact that these agents are, quite simply, systemic chemotherapy against bacteria.' Once delivered to the patient these agents act not only locally, but, more importantly, sistemically against susceptible microorganisms. This demands that the practitioner make an educated guess as to which bacteria are likely to be present, as well as use an agent that both safe and effective in that specific patient. The types and variety of bacteria present in a surgical infection, or likely to be present, can usually be deduced by the location and/ or organ system involved. The safest and most effective agent to be used against those organisms is primarily a function of the specific hospital that the patient in, and whether the infection is hospitalacquired (nosocomial) or community-acquired. The susceptibility patterns for bacteria vary from community to community (as noted by local hospitals), as well as from hospital to hospital dependent on whether it is a community hospital or a tertiary referral center. It is illogical to assume that the same drug or drugs will be just as effective in one setting as in another, regardless of whether they are used for prophylaxis or an established infection.

Authors:

Robert S. Bennion, M.D., University of California School of Medicine, Los Angeles, CA

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Abstract:

Once a technique used primarily for gynecologic surgery, laparoscopy is becoming increasingly popular for the performance of abdominal procedures such as cholecystectomy, bowel resection, splenectomy, adrenalectomy, nephrectomy and inguinal hernia repair. Laparoscopy results in a shorter postoperative hospital stay, less time between surgery and the resumption of full activity, reduced hospital costs, and an earlier return to the work force. By avoiding a large abdominal incision, laparoscopic surgery results in improved cosmetic results and a reduced incidence of postoperative intraabdominal adhesions. Compared to open procedures, postoperative pain is generally considered less after laparoscopic surgery. Finally, respiratory function is less compromising following Iaparoscop ic compared to open surgical procedures.

Authors:

Peter Rock, M.D., The John Hopkins Medical Institutions, Baltimore, MD

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