Articles: surgery.
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Medicine has gone through major changes over the last 50 years. Today it is recognized that medical knowledge doubles every 6-8 years. It is also true that with the advent of many new medical procedures, surgeons must continue to learn new techniques throughout their careers; this was not the case in the past. ⋯ Both computerized mannequins and virtual reality training devices are used to teach surgical principles and technical procedures. The natural progression of this technology will be for virtual reality simulations to be used for selecting, training, certifying, and recertifying surgeons. Ultimately, surgeons will practice operative procedures using 3D data sets of the patients they plan to operate the next day and then use recordings to play back their optimal procedure robotically on their patients.
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General anaesthesia is still the most common anaesthetic technique in the ambulatory surgery setting. With the introduction of propofol, total intravenous anaesthesia gained widespread acceptance. Recently, the combination with remifentanil, an ultra-short acting opioid analgesic, allowed even more control over the duration of the anaesthetic. ⋯ No differences have so far been demonstrated in respect to long-term recovery, discharge from the post-anaesthesia care unit and discharge from the ambulatory care centre. Currently the anaesthesiologist has the possibility to choose his preferred anaesthetic technique based on individual patient needs, the surgery performed and the side-effects each technique may have. However, in contrast to the situation at the beginning of the 1990s total intravenous anaesthesia is not the technique that fits all needs but balanced anaesthesia presents an alternative.
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Regional anaesthesia plays an important role in day case surgery because it combines reliable effects with low risk and the possibility of local postoperative analgesia without systemic side-effects. Fast-track regional anaesthesia allows short-term postoperative surveillance or even bypassing the post-anaesthesia care unit. ⋯ Multiple peripheral nerve stimulation and injection techniques may help to realize differential blockades with a pronounced analgesic rather than a motor blocking effect. Nerve blocks with local anaesthetics in combination with alpha2-adrenoceptor agonists or non-steroidal anti-inflammatory drugs and short-acting parenteral opioids represent an effective multimodal concept for ambulatory surgery.
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A comprehensive review of the history of free fat transplantation reveals that since 1893 when Neuber used small pearls of fat taken from the arm to fill out depressed facial scars after trauma and underlying bone loss, free fat graft has been used with success in facial surgery, brain and nervous system surgery, various orthopedic uses, general surgery, craniofacial surgery, and cosmetic surgery. ⋯ The hypothesis that applied fat grafts are real grafts was demonstrated. Not only are the grafts real, they are able to live and persist with the patients, growing if the patient gained weight over the gluteus area, and not losing circumference when reducing weight.