Abstract:

Despite a seemingly increased knowledge about the underlying causes of chronic leg ulcers, their management remains a challenge. Though some ulcers respond to various local treatment options appropriately, others seem to remain unresolved or with a chronic recurrent theme over months to years. The failure to heal these ulcers can be related to the underlying disease process,' sometimes lack of patient compliance, and possibly, less than optimal treatment. Even when the exact diagnosis is made and appropriate treatment instituted, many ulcers may, nonetheless, require months of intervention. Certainly, the nonresponsive ulcer is best managed by an appropriate wound biopsy and culture, including a colony count.

Authors:

Christina Chung, A.B., Michael Cackovic, A.B., Tateru Matsumoto, A.B., Morris D. Kerstein, M.D., F.A.C.S.

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Abstract:

The in situ destruction of malignant tissue by freezing is a relatively new addition to the list of treatment options for patients with cancer in solid organs. Although skin cancers have long been treated by cryosurgery] the lack of suitable equipment for both delivering and monitoring the freezing process hindered further development of the treatment of more inaccessible lesions until the 1960s. At this time, Cooperz developed cryosurgical machines which enabled the destruction of CNS lesions in patients with Parkinson’s disease and stimulated renewed interest in the application of cryosurgery to the treatment of cancer.

Authors:

Simon J. Dwerryhouse, F.R.C.S., Paul J. Cozzi, M.B.B.S., David L. Morris, M.B., Ch.B., F.R.C.S., M.D., Ph.D., F.R.A.C.S.

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Abstract:

Management of the vast array and sheer volume of clinical data generated during the care of the critically ill patient is a formidable task. Not only must the data be acquired accurately, but it must be retrievable readily and in an interpretable form. Such characteristics are essential features, but the mere uncritical compilation of biomedical data barely takes advantage of the enormous computing power that is available at the bedside. A complete medical informatics package can assist the caregiver with clinical decision making, suggest or even carry out changes in management, and provide continuous, always vigilant surveillance for both dangerous alterations in physiology or ill-advised orders. For optimal implementation, knowledge of the origin, synthesis, and utility of clinical information is essential. A successful implementation using the skills of physicians, nurses, biomedical engineers, computer scientists, and hospital administrators must be collaborative. The characteristics of a clinical information system were defined recently by the Institute of Medicine of the National Academy of Sciences (Table 1). However, even the ideal system, implemented and administered by a harmonious and committed team, will not ensure clinical acceptance. The issue of accessibility can become paramount. If the system is not responsive to the needs of the occasional user, a great deal of expensive hardware will not be used to its full capability.

Authors:

Joseph Cooke, M.D., F.C.C.P.,Philip S. Barie, M.D., F.C.C.M., F.A.C.S.

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Abstract:

Colon cleansing preparations for diagnostic and surgical proced.ures continue to be evaluated in an effort to improve the quality of colon exam. Modifications of older barium enema x-ray preparations have led to the development of many alter native forms of bowel cleansing. Forrnal study has allowed carefui compar ison of gut lavage, diet and cathartic as well as oral sodium phosphate preparation. Gut lavage with electrolyte lavage solutions represents the most popular form ofbowel preparation. Patient variability and special circumstances such as gastroparesis, surgically alter ed anatomy or patient preferences may dictate selection of colon cleansing preparations.

Authors:

Michael A. Berry, M.D., Jack A. DiPalma, M.D.

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Abstract:

The clinical management of painful conditions has seen great changes and improvements over the past two decades brought about, in a large part, by re-evaluating the basic theories on which we base our clinical practice. At the beginning of this century, we still believed in the model of pain transmission first expressed by Descartes, over 300 years ago. In the mid-1960s, a re-examination of transmission of pain was first promulgated and popularized. The Gate Control Theory of Melzak and WalP revolutionized the way we think about pain, and consequentially, the way we have come to treat it.

Authors:

Howard L. Rosner, M.D. - Cornell University Medical College, New York

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Abstract:

Intraoperative ultrasound of the pancreas is a dynamic clinical diagnostic field providing crucial information to the surgeon at the time of exploration, and impacting on clinical management decisions and choices of surgical techniques. It is a rapid and effective technique for imaging the entire pancreas, differentiating normal from pathological processes, imaging the pancreatic and common bile ducts, and demonstrating the exact relationship between pathological processes of the pancreas and the adjacent arterial and venous structures, the common bile duct, and the duodenal wall. The demand for intraoperative ultrasound (IOUS) of the pancreas is expected to increase, particularly as management algorithms become accepted clinical practice, due to advances in intraoperative tumor ablation and radiotherapeutic techniques, as well as technical improvements in laparoscopic ultrasound methods and instrumentation. Not only is IOUS of the pancreas becoming a recognized modality for visualizing and characterizing solid and cystic lesions of the pancreas, but it also has superior lesion detection rates over other non-invasive preoperative imaging modalities. Provisional studies from our department suggest that data from lOllS significantly affects surgical decision making.

Authors:

Jonathan B. Kruskal, M.D., Ph.D., Robert A. Kane, M.D.

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Abstract:

Recently, hyperthermia has been employed clinically as one of a variety of multimodal therapies for cancer. Hyperthermia has been applied locally, regionally, and systemically to various tumors. Local or regional hyperthermia has the advantage that a localized tumor can be heated to temperatures higher th an 420C, the maximum for total-body hyper ther mia.V There is mounting evidence to support a hypothesis that cancer cells are more selectively sensitive to heat than are normal cells, due to the poor blood supply ofneoplastic tissue and the decreased vasodilatation capacity of the neovascular bed.

Authors:

Emma J. Patterson, B.Sc.(Hon), M.D., Charles H. Scudamore, M.D., F.A.C.S., F.R.C.S.(C, Ed, Eng), Andrzej K. Buczkowski, M.D., David A. Owen, M.B., F.R.C.P.ath, F.R.C.P.C., Alex G. Nagy, M.D., F.R.C.S.C.

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Abstract:

At the end of the 20th Century, the world lives in the midst of a tremendous contradiction. On one side we have great scientific and technological progress, designed for the well-being of mankind, and on . the other, the everyday widening gap between a few who have more than what they need and the vast majority of people who do not have enough.

Authors:

Prof. Edgar Rodas, M.D., F.A.C.S.

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Abstract:

Pneumothoraces and malignant pleural effusions are commonly encountered clinical problems in a general thoracic surgical practice. Pneumothoraces may be either iatrogenic or non-iatrogenic. Iatrogenic pneumothoraces can occur following transbronchial or percutaneous transthoracic lung biopsy, percutaneous central venous catheter insertion, or thoracentesis. Non-iatrogenic pneumothoraces are encountered frequently in the patient with chronic obstructive pulmonary disease and spontaneous rupture of pulmonary bullae, as well as blunt or penetrating thoracic trauma. Alternatively, pneumothoraces may be idiopathic or "simple pneumothoraces!"

Authors:

STEVEN P. KEY, M.D. SECTION OF GENERAL THORACIC SURGERY, DIVISION OF CARDIOTHORACIC SURGERY UNIVERSITY OF CALIFORNIA - SAN FRANCISCO SAN FRANCISCO, CALIFORNIA, ROBERT B. CAMERON, M.D. DIVISION OF CARDIOTHORACIC SURGERY, UNIVERSITY OF CALIFORNIA - Los ANGELES Los ANGELES, CALIFORNIA, DAVID M. JABLONS, M.D. SECTION OF GENERAL THORACIC SURGERY, DIVISION OF CARDIOTHORACIC SURGERY UNIVERSITY OF CALIFORNIA - SAN FRANCISCO SAN FRANCISCO, CALIFORNIA

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