BACKGROUND: Operation Giving Back (OGB) of the American College of Surgeons (ACS) and various other surgical missions in the developing world have become more popular and provide a valuable way of reducing the surgical burden worldwide. While most cases are "bread and butter" general surgery, difficult surgeries are often encountered. MATERIALS AND METHODS: Description of a total thyroidectomy for super giant goiter extending to chest inferiorly, lateral neck and behind both ears, compressing the trachea and causing chronic difficulties breathing. The surgical team was unable to intubate, but performed surgery under local anesthesia and sedation with Ketamine injection. RESULTS: Total thyroidectomy, as a life-saving procedure, was performed under local anesthesia and Ketamine with mild sedation. Once thyroid was removed, the outside diameter of trachea was assessed to be 4mm. Patient tolerated the procedure well and had no postoperative complication. Her breathing improved significantly post-operatively. Five years later, she is doing well. CONCLUSION: Total thyroidectomy for giant goiters can be done under local anesthesia with Ketamine and proper sedation. Surgeons and anesthesiologists participating in surgical missions may have to perform major surgery under local anesthesia. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Short‐term surgical missions (STSMs) provide an opportunity for the global health care community to address the surgical needs of developing communities worldwide. Conditions that require a one‐time intervention, such as cleft lip and palate, clearly demonstrate the positive impact these short‐term missions can have on the individual patient. However, the long‐term impact on the local health care system, economy, and community is less clear. Many in the global health care community believe that STSMs should seek to have a long‐term impact by establishing sustainable health care programs. Information regarding the impact of STSMs is scarce, however, due to limited regulation, research, and data from short‐term missions. This study investigates how short‐term international missions impact health care sustainability in low‐income and developing communities. This study uses a systematic review to investigate the impact of STSMs on health care sustainability. Additional outcomes included education and skills‐transfer, cost‐effectiveness, and cultural awareness. 15 articles were included in the study. The following outcomes were found: sustainability in 9 studies, education and skills‐transfer in 5, cost‐effectiveness in 4, and cultural awareness in 3. STSMs can successfully establish sustainable programs abroad. Factors that contribute to this success include education and training of host providers, cost‐effective services, and cultural awareness. Understanding the complex dynamic between STSMs and developing communities is key to developing effective and sustainable programs that offer long‐term benefits to those communities.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The (Surgical Implant Generation Network) SIGN Intramedullary (IM) nail is designed to fix long bone fractures without using a costly C‐arm imaging device. It is distributed for free to countries in need, allowing for elevation of care from the standard, lengthy traction treatment in those countries to clinically superior IM nailing. This paper compares the clinical outcomes of the SIGN IM nail to those of the IM nails used in developed countries with use of a C‐arm. The terms “Surgical Implant Generation Network” and “union” were searched in four databases. Primary studies of SIGN IM nails were included and their outcomes, including union rate, time to union, and complications, were recorded and compared to historical data of IM nails used in developed countries. Overall, there is a similar union rate in bones fixed with SIGN IM nails (94.6%) versus bones fixed with IM nails in developed countries (92.3%) (p = 0.009, OR = 1.67), while some bone types (tibia and femur) demonstrated a lower union rate when individually stratified (p = 0.008, OR = 0.26 and p = 0.002 and OR = 0.15, respectively). Mean time to union for all bone types combined showed no significant difference between SIGN IM nails and IM nails used in developed countries (p = 0.26). Complications rates were similar between SIGN IM nails and IM nails used in developed countries. It is possible for the SIGN IM nail to be used to fix long bone fractures in developing countries with outcomes comparable to the IM nail used in developed countries.

Call number: LD2668 .T4 1986 F72 / Master of Science / Clinical Sciences

M.Cur / To be able to nurse effectively in a critical care unit, a nurse needs to have extensive theoretical knowledge, excellent clinical skills and a certain degree of technological knowledge. The Diploma in Critical Care offered at higher educational institutions, in collaboration with private/public health delivery institutions within South Africa, aims to equip nurses with the necessary knowledge and clinical skills they need to work in this stressful and complex environment. Learners found that during the programme for the Diploma in Critical Care they were faced with a large amount of stress and demotivation due to reasons such as not being treated like an adult, the increased workload and the demands of the theoretical and clinical programmes. Some learners were faced with theoretical and clinical challenges and felt that they needed to be prepared for academic work at a higher educational institution, some found that they experienced emotional stress due to a lack of knowledge and the responsibility of being delegated to nurse critically ill patients. If a learner is unable to succeed in the programme the first time there are financial implications for the learner, the higher educational institution and the health delivery institution. It was previously thought that prior experience in a critical care unit was sufficient preparation to succeed in the critical care programme, but not all learners are exposed to the same learning opportunities prior to commencing with the programme and therefore learners do not enter the programme with the same knowledge base. There are also various factors that influence the learner during the programme. A private health group in Gauteng implemented the successful completion of a clinical skills workbook as part of the requirements for learners registering for the Diploma in Critical Care. The workbook focuses on the attainment of basic clinical skills that are required to be able to work in a critical care unit and not on basic theoretical knowledge. In view of the above it remains unclear whether the clinical skills workbook implemented by a specific private health care group is sufficient preparation for a learner prior to commencing with the critical care programme. The aim of this study is to determine whether the completion of a critical care pre-programme study guide will make a significant difference in the success of learners from a private health group in Gauteng who register for the Diploma in Critical Care at a specific higher educational institution. To achieve this goal the following objectives were stated: 1. Develop a pre-programme study guide. 2. Implement the pre-programme study guide. 3. Determine if the completion of a critical care pre-programme study guide makes a significant difference to the success of learners from a specific private health care delivery group during the Diploma in Medical & Surgical Nursing Science: Critical Care Nursing (General). To achieve the goal of the study, a quantitative, quasi-experimental and correlational design will be used. The study will be divided into two phases: phase one will involve the development of a pre-programme study guide for the critical care programme, based on a literature review. Phase two will include the implementation of the pre-programme study guide, and the research methodology for this phase will be an untreated control group with a pre-test and post-test. The pre-programme study guide made a significant difference to the cores of the experimental group in terms of the pre-test and pot-test scores, whilst the control groups scores neither improved nor deteriorated. There was no significant difference between the experimental and control group in terms of the pre-test, post-test, semester marks and exam marks. This could be due to the large standard of deviations that were obtained. The null hypothesis was accepted. The completion of the pre-programme study guide can be used as part of the requirements for learners registering for the Diploma in Critical Care and can help alleviate the stress and demotivation experienced by the learners during the Diploma in Critical Care.

A dissertation submitted to the Faculty of Dentistry, University of the Witwatersrand, Johannesburg, in part- fulfilment of the requirements for the Degree of Master of Science in Dentistry 1982 / Rat embryos of the post-implantation stage are grown on a static culture medium, for the purpose of assessing growth and development over a 2 day period. The technique used is referred to as the petri-dish culture chamber method. This involves the culture of rat embryos on rat serum, in a controlled environment. Postimplantation embryos from the 6,5 to 8 day stage, and consisting simply of the 3 germ layers, showed a 60% survival rate in. vit/io after 2h hours and A8 hours respectively. After a full A8 hours in vitfio the embryos demonstrated well developed beating hearts, and a neural groove in the process of closing. The survival rate of embryos explanted at later stages was not as successful. The results compare favourably with the results of other workers, using the same method of culture. An advantage of the petri-dish culture chamber is that it allows for easy experimental access to the embryos at all times;a factor to be considered in any technique involving surgical intervention. Although more sophisticated methods have since superseded the static environment petri-dish technique, it is recommended here that this method should not be totally replaced by the more modern circulating culture medium technique. / IT2017

This study seeks to serve as a baseline survey of the knowledge, attitudes and practices (KAP) of surgical registrars concerning hospital disaster preparedness across 3 tertiary hospitals in Gauteng. This is owing to the fact that a perusal of the relevant literature reveals that while considerable research exists for the assessment of hospital disaster preparedness within an international context, there was a lack of information pertaining to the South African setting. A stratified random sampling process was applied to 30 surgical registrars who were asked to complete a self-administered questionnaire. Thus the study design was a cross sectional descriptive study of the surgical registrars working across 3 tertiary hospitals in Gauteng. A response rate of 83% was achieved. The study concluded that while 80% of surgical registrars surveyed had an excellent level of knowledge about hospital disaster preparedness, only 52% of the respondents have positive attitudes towards hospital disaster preparedness. An overwhelming majority of the surgical registrars (84%) reported poor practices concerning hospital disaster preparedness. The findings of this study has lead to the following key recommendations being made: a) the need for a dedicated national hospital disaster preparedness fund, b) the provision of regular in-service training on hospital disaster preparedness with special attention being given to registrars with greater than 11 years of clinical experience c) need for hospital disaster preparedness training to adhere to some form of quality control d) setting up of a task team to conduct regular audits on the practices of hospitals in terms of disaster preparedness.

Este trabalho foi conduzido para avaliar o efeito da condição sexual sobre o desempenho, concentração de testosterona, características de carcaça e qualidade da carne de bovinos Nelore confinados. Cinquenta e oito machos bovinos (430 ± 36 kg; 24 meses de idade), foram divididos em três grupos em um delineamento inteiramente casualizado. Foi realizado, em 15 animais, o procedimento de castração cirúrgica (CC), aos 12 meses de idade, enquanto que 21 animais receberam duas doses da vacina de imunocastração (IC), dentro de um intervalo de 30 dias, e 22 animais permaneceram não-castrados (NC). Os animais foram alocados em baias individuais e alimentados com uma dieta contendo 70% concentrado e 30% volumoso durante noventa dias precedidos por um período de adaptação de vinte e um dias. Foi avaliado o desempenho e características de carcaça a cada 28 dias. Os animais foram abatidos e foi avaliada a qualidade da carne. Animais NC apresentaram maior ganho de peso, eficiência alimentar, peso de carcaça quente e rendimento de carcaça comparado com animais CC e IC (P<0.05). Animais castrados apresentaram maiores valores de cor L*, a*, b* e perda por cocção que animais NC (P<0.05). A imunocastração diminuiu o desempenho dos animais, comparado com animais CC ou NC. Porém, é uma alternativa à castração cirúrgica pois possui as mesmas características de carcaça e qualidade da carne. A imunocastração melhora a cor da carne e diminui a frequência de carnes DFD comparado com animais NC. / This study was carried out to evaluate the effect of the sexual condition on performance, testosterone concentration, carcass traits and meat quality of feedlot Nellore cattle. Fifty-eight males (430 ± 36 kg BW; 24 mo old) were divided into three groups in a randomized complete design. Surgical castration (SC) procedure was performed in 15 animals at 12 months old, whereas 21 animals received two doses of immunocastration vaccine (IM), within an interval of 30 days. In addition, 22 animals remained intact (NC). The animals were allotted in individual pens and daily fed a diet containing 70% concentrate and 30% roughage during ninety days preceded by an adaptation period of twenty one days. Performance and carcass characteristics were evaluated every 28 days. The animals were slaughtered and the meat quality was evaluated. The NC animals showed greater average daily gain, feed efficiency, hot carcass weight and carcass yield compared with SC animals and IM (P <0.05). Castrated animals had higher color values L *, a *, b * and cooking loss that NC animals (P <0.05). Immunocastration decreased performance when compared to SC or NC animals. However, it is an alternative tool to surgical castration because it has the same carcass characteristics and meat quality. Immunocastration improves the color of the meat and reduces the frequency of DFD meat compared to NC animals.

O Laser de Alta potência, também denominado, Laser Cirúrgico, tem sido usado em procedimentos médicos, para coagulação e vaporização dos tecidos. O maior problema, hoje encontrado, pela medicina no uso deste Laser, especialmente o laser de CO2, é a destruição térmica, causada pelo acúmulo de energia, convertida em calor, nos tecidos adjacentes, por ele irradiado. Uma vez absorvida esta energia, o tecido acumulará mudanças, que ocorrerão, durante o processo de irradiação e resfriamento. Estas variações poderão ir desde: uma mudança física, química e alterando completamente, os mecanismos biológicos, antes efetuados, pelo tecido irradiado. Este estudo tem como objetivo, analisar tais mudanças, verificando as diferenças morfológicas e geométricas, bem como utilizar experimentação para reconhecer, as zonas limitantes, ao processo de ablação. Para isto, quatro partes iguais de uma mandíbula bovina, foram usadas. Sendo que, cada uma destas, recebeu uma potência, diferente de laser. A cada amostra, foi aplicada a potência escolhida, em cinco diferentes tempos, mantendo uma distância aproximada de 250mm, entre uma aplicação e outra, com uma distância focal de 6mm. Em primeiro, observou-se característica macroscópica da região de interação, utilizando-se de um modelo zonal, para análise. Através de uma análise, mais aprofundada, com o uso de microscopia eletrônica, pode-se notar as variações imprevistas, ocorridas pelo processo de acúmulo e condução térmicos, advindos da ablação. A região de interação foi delineada em zonas de variações, denominadas as mesmas, como: Z I, Z2, e Z3. Sendo que a Z1, é o diâmetro formado pelo ponto de penetração da luz no tecido, ora irradiado.(Cratera). Z2 é o diâmetro envolvendo, a primeira camada de alteração do tecido irradiado, circundante a cratera. Z3, determina todo o diâmetro das alterações, por nós verificadas nas microfotografias. A partir deste ponto, usamos as amostras irradiadas, para calcular a quantidade de material removido, pela ablação. Através de um corte histológico, parafinado, analisamos todas profundidades, dos orifícios de entrada, formadas pela interação, por nós estudadas. Para cada lâmina, foi feita uma medida, da profundidade, formada pela entrada do raio, e pela material removido pela ablação. Tendo-se as medidas dos orifícios das crateras, as profundidades das mesmas, calculamos, aproximadamente, o material removido pela ablação. Considerando para isto, que os orifícios de penetrações, sendo, todos eles, de formatos de circunferências e as profundidades, em formatos Gaussianos. Obtendo, portanto, um formato conforme, para cada cratera. . Obtivemos, a partir do calculo matemático, o volume de massa de material retirado por ablação / The high power lasers are being widely used in surgical procedures, where there are vaporization and coagulation of the soft tissues. For hard tissues, such as, bones and teeth, pulsed lasers are stranded out because they may cause less thermal damage, as an example, the CO2 laser. Termal effects on tissue are recognized as being an accumulation of changes that occur during the entire period of irradiation and ensuing cooling (Mc KENZIE 1990). Located heating is affected by termal conductivity and convection by blood flow. Upon heating tissue experiences an alteration in a variety of physical, chemical and biological mechanism at the scale of chemical, organelle cell and tissue. Changes in tissue geometry and local microcirculation, could be affected. The purpose of these studies was to verify the physical and chemical variation and also reactions during the process of light exposure in the bone parts, especially the laser beam ablation patters. The generation of craters and other abnormal superficial termal damage, and craters that\'s show irregular wall contours. The relation and interaction between medicai CO2 laser beam and animal, human, and other biological tissues. For this experiment, a cattle\' s jaw, of four years old, were chosen for these experimental. Procedure to be described in this paper Those jaws were cut in four different pieces, in an effort, those parts were kept in the same shape and size, so no different variation of depth or length, would make it improper for the studies about to be made. Numbers were put in each different piece, showing in each sample, the time and the potency that were applied in that part. All samples were under favorable conditions (with long pulses and without water spray). Since classical pathology techniques for characterizing thermal damage to tissue are based on the microscopic examination of prepared tissue specimens for evidence of coagulation necrosis (nuclear psychoses, disintegration of organelles, hyalinization of collagen, loss of birefringence in muscle tissue, carbonization, etc.) Once the experimental appliance were done, a different colored circle were clear and optical visible around each bole, In a suggestion of that changes have happened in the material, used indeed. For almost, all the averages of the holes, in the electronic microscope, could be seeing the presence of minimal layer of superficial carbonization in the remaining bone. Therefore, the bone that received irradiation caused by CO2 laser, in a agreement with the proposal methodology, showed a variation of the tissue, that changed as the exposure changed the TIME/POWER. For each different pulse, the samples were analyzed. The tissues response to extreme temperature change in this zone usually consists of immediate coagulation necrosis, coagulation of vessels and macroscopic destruction of the tissue. An intermediary volume Between the necrosis core and the reversibly affected region is referred to as the Marginal Zone\". Therefore in this task, we called each analyzed zone as Z1 for the crater\'s diameter and Z2 for following areas, and finally, Z3 for the total diameter of the affected tissue. . All the measured zones, contains the shift from perfusion increases to coagulation, and the transition from structurally intact cells to dead cells. The most interest, issue that this study, may bring up, is for the clinical for the future\'s procedures because it contains the boundaries between the reversible and the irreversible tissue changes. Very few studies describe the presence and the address the consequences of the ablative aberrations, which can frequently and randomly happen during laser surgery. The knowledge of the different boundaries, of the affected areas, could predict severe impacts on the quality of the final surgical outcome, specially, when precision surgery techniques are required. The results of this discussed experiment shows how important it is to constantly and carefully observe, both the irradiated tissue\'s structure and the beam\'s broadening at the surface during the ablation.

INTRODUÇÃO: A propriedade de induzir angiogênese torna o omento um promissor pedículo para pré-fabricar retalhos. OBJETIVO: Estabelecer a área abdominal a ser pré-fabricada por um pedículo omental e analisar o potencial de pré-fabricação (PPF) conforme o tempo de espera entre a introdução do pedículo e a elevação do retalho. MÉTODOS: Foram utilizados 44 coelhos divididos em quatro grupos (A, B, C e D). No grupo A, um fragmento de pele, tecido subcutâneo e músculo cutâneo abdominal foi totalmente separado e ressuturado. Nos demais grupos, um pedículo omental, contendo os vasos gastromentais ligados distalmente, com área equivalente a 9 cm² foi transposto e suturado ao músculo cutâneo abdominal. Um segundo procedimento de incisão e elevação de um retalho contendo pele, subcutâneo e músculo cutâneo abdominal pediculado apenas pelo omento transposto, foi realizado, variando apenas o período de espera entre os dois procedimentos de 7, 21 e 56 dias para os grupos B, C e D respectivamente. Após 15 dias do último procedimento, os retalhos foram visualizados e as áreas viáveis foram calculadas através do programa de computador Image Tool®. Cortes de áreas viáveis foram imunocoradas pelo anti-CD31 para cálculo da densidade microvascular (DMV). RESULTADOS: Os valores médio e máximo das áreas viáveis no grupo D foram respectivamente 45,29 cm² e 99,37 cm² (PPF mediano = 5,03 e PPF máximo = 11,04). Não houve diferença significativa entre as áreas viáveis do grupo D e C. As médias da DMV dos grupos B, C e D foram respectivamente 24,54 vasos/mm², 33,20 vasos/mm² e 27,03 vasos/mm² e maiores do que as médias da DMV das áreas controles de 14,63 vasos/mm², 17,33 vasos/mm² e 18,12 vasos/mm². No grupo A, houve necrose total em todos os retalhos. CONCLUSÃO: O PPF mediano do pedículo omental foi de 5,03 vezes sua área e o tempo de espera para o segundo procedimento foi de, no mínimo, 21dias / INTRODUCTION: The angiogenic induction property of the omentum makes it a promising pedicle to prefabricate flaps. OBJECTIVE: To establish the abdominal area to be prefabricated by the omental pedicle and to analyze the prefabricate potential according to the time delay between the pedicle introduction and the flap release. METHODS: 44 rabbits were divided into four groups (A, B, C and D). In group A, a piece of skin, subcutaneous tissue and abdominal cutaneous muscle has been fully released and sutured again in its place. In other groups, a 9 cm2 omental pedicle containing the gastromental vessels distally tied has been transposed and sutured to abdominal cutaneous muscle. A second procedure, an incision and release of the flap that contained skin, subcutaneous and cutaneous abdominal muscle pediculated only by the omentum, has been carried out. The only variation was the time delay between the two procedures: 7, 21and 56 days for groups B, C and D, respectively. The flaps have been inspected 15 days after the last procedure, and the viable areas have been estimated using the software Image Tool®. The pieces of viable area have been immunostained using anti-CD31 allowing the estimation of the microvascular density. RESULTS: The mean and maximum viable areas in group D were 45.29 cm2 and 99.37 cm2 respectively (average prefabricate potential = 5.03 and maximum prefabricate potential = 11.04). There was no significant difference between the viable areas in groups C and D. The mean microvascular densities of groups B, C and D were 24.54 vessels/mm2, 33.20 vessels/mm2 and 27.03 vessels/mm2 respectively. This was higher than the mean microvascular densities of the control areas, which were 14.63 vessels/mm2, 17.33 vessels/mm2 and 18.12 vessels/mm2. In group A, there were total necrosis in all flaps. CONCLUSION: The prefabricate potential of the omentum was found to be 5.03 times its area and the delay time for the second procedure was, at least, 21 days