ANZ journal of surgery
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ANZ journal of surgery · Dec 2013
Modified distally based sural adipofascial flap for reconstructing of leg and ankle.
While free flaps can be used in many cases to cover soft tissue defects in the distal leg and ankle in a single stage, factors such as diabetes and advanced age can interfere with success of vascular anastomoses. ⋯ The modified reverse sural adipofascial flap preserved the sensation of the donor site and the anatomic contour of both recipient and donor sites.
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ANZ journal of surgery · Dec 2013
Review Meta AnalysisEffectiveness of massive transfusion protocols on mortality in trauma: a systematic review and meta-analysis.
The effectiveness of massive transfusion protocols (MTPs) has been assumed from low quality studies with multiple biases. This review aimed to (i) evaluate the association between the institution of an MTP and mortality and (ii) determine the effect of MTPs on transfusion practice post trauma. ⋯ Despite the popularity of MTPs and directives mandating their use in trauma centres, in before-after studies, MTPs have not always been associated with improved mortality. Evidence-based standardization of MTPs, improved compliance and analysis of broader endpoints were identified as areas for further research.
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ANZ journal of surgery · Dec 2013
ReviewIs it time to include point-of-care ultrasound in general surgery training? A review to stimulate discussion.
Point-of-care ultrasound scanning or POCUS is a focused ultrasound (US) scan, performed by non-imaging clinicians during physical examination, an invasive procedure or surgery. As this technology becomes cheaper, smaller and easier to use, its scope for use by surgeons grows, a trend that may generate a gap between use and training. Opportunities for enhanced general surgery skill sets may be reduced unless consideration is given to inclusion of POCUS in general surgery training. ⋯ Increasingly, medical students are graduating with basic POCUS skills. Specialty-specific uses of POCUS are proliferating. Training and assessment resources are not keeping up, in accessibility or standardization. A learned surgical college led training and accreditation process would require aligned education in anatomy and US technology and collaboration with the specialist imaging community to ensure appropriate standards are clarified and met. Research is also required into how general surgery trainees can best achieve and maintain POCUS competence.
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ANZ journal of surgery · Dec 2013
Biography Historical ArticlePaintings from the Cushing/Whitney Library of Yale University: the Eleventh Kenneth Fitzpatrick Russell Memorial Lecture - 2012.
In the early years of the introduction of Christianity into China, one American medical missionary distinguished himself by his kindness and generosity towards the Chinese people, and also by his surgical prowess. Peter Parker (1804-1888) was a graduate from the Yale University Medical School and was also an ordained minister. He came to the south China city of Canton (now called Guangzhou) in 1834, built a hospital, treated the patients without charge and also groomed medical apprentices to help him in his work. ⋯ Altogether, there are about 109 paintings. More than 80 of them are in the Harvey Cushing/John Hay Whitney Medical Historical Library of the Yale University Medical School, New Haven, and 23 of them are in Guy's Hospital, London. A description of some of the paintings, together with accounts of Parker and Lam are discussed.
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Mucinous cystic neoplasms (MCNs) of the pancreas are rare, but have recently been increasing in incidence. The aim of this retrospective clinical study was to elucidate the clinicopathological features and prognosis of MCNs with ovarian stroma at a single centre. ⋯ The prognosis of the resected non-invasive MCNs was excellent. Although resection should be considered for all cases, in low-risk MCNs (<5 cm and without nodules), nonradical resections (i.e. enucleations) are appropriate.