Surgery

Article Abstract:

New developments in surgery are evaluated. Substantial improvements have been made in cosmetic breast reconstruction after cancer surgery. The results of drug trials for patients with colon cancer that has invaded local lymph nodes indicate that treatment with levamisole and fluorouracil is effective, leading to an overall five-year survival of 62 percent (compared with 55 percent in the untreated group). Treatment of colorectal cancer metastasis (spread) to the liver and organ cluster transplantation are briefly discussed. Trauma patients currently consume 6.9 percent of health care expenditures, but reimbursement for their care is only 51 percent. This deficit has a major effect on hospital budgets and the future of trauma centers. Laser-assisted balloon angioplasty (in which a small balloon is inserted and expanded within a blood vessel) appears to be a successful approach for treating vascular diseases. Fetal surgery can be performed if certain criteria, listed here, are met. Diseases of the gallbladder, including gallstones, can now be treated by nonsurgical and surgical methods. Percutaneous (through the skin) drainage of abscesses in the abdomen is highly successful and is not associated with operative complications. Intestinal obstructions can lead to movement of bacteria out of the gastrointestinal tract, resulting in infections. Cytokines (proteins produced by immune cells), such as tumor necrosis factor, can have adverse effects, and monoclonal antibodies (other proteins) that antagonize their action may be therapeutic in fighting sepsis (infection that has spread to the bloodstream). Surgeons face occupational risks from HIV-infected (human immunodeficiency virus, which is associated with AIDS) patients; this subject has been addressed in other reviews. The issue of routine HIV screening of surgical patients is evaluated. The subject of residents' long on-duty hospital hours continues to be debated, with involvement of several professional organizations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Reports, Testing, Training, Gallstones, Surgery, Plastic, Plastic surgery, Residents (Medicine), Angioplasty, HIV antibodies

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Surgery

Article Abstract:

Prevention of complications and the impact of molecular biology are increasingly important for surgeons. Molecular biology has expanded understanding of the physiology of wound healing. Minimal invasive procedures (MIPs) such as laparoscopy for uncomplicated gall bladder removal reduce complication and death rates. MIPs could also be used in appendectomy, colon and spleen removal, surgery for ulcers, hernia, antireflux procedures and a variety of lung disorders. The United States may have a lack of trauma surgeons in the future, according to a 1991 survey of surgery residents which found that only 21% planned to pursue trauma surgery. Surgeons' concerns range from the increased risk of malpractice suits to the amount of reimbursement compared to the amount of time trauma patients require. New research also shows that chemotherapy in addition to surgery does not improve survival rates over surgery alone for premenopausal women whose breast cancer has spread to the lymph nodes.

Innovations

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Surgery

Article Abstract:

The expression of various oncogenes can be used to determine which patients will benefit most from surgery. These oncogenes include the c-erb B2 gene in esophageal cancer and the c-fos, c-myc, and Ha-ras genes in breast cancer. DNA testing of the ret oncogene in people with multiple endocrine neoplasia type IIA can determine which are likely to develop thyroid cancer. These patients can have their thyroid gland removed to reduce their risk. Elective lymph node dissection does not appear to confer additional survival benefits in patients treated for melanoma. A portacaval shunt appears to be effective in treating bleeding esophageal varices. Minimally invasive surgery is replacing many traditional surgical operations. This is especially true of gallbladder surgery. Laparoscopic surgery has also been used to treat inguinal hernias, perforated ulcers and appendicitis.

Research, Molecular biology, Melanoma, Endoscopic surgery, Portacaval anastomosis, Portal vein bypass

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