Minor surgical procedures. III. Minor burns.
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Minor preprosthetic surgical procedures used in correcting an existing problem or in preparing the mouth for prostheses must be based on an exact diagnosis and carefully planned and executed to satisfy clearly definable goals. This article emphasizes that philosophy and includes surgical techniques for managing commonly encountered problems as well as those problems associated with placement of immediate dentures. Predictable results with minimal complications can be expected when one adheres to these guidelines.
PROBLEM ADDRESSED: Minor surgical procedures are an important part of general practice. Family medicine faculty members must feel competent in performing common office procedures in order to teach them to residents. OBJECTIVE OF PROGRAM: To upgrade the skills of 25 family medicine faculty members in minor surgical procedures through a half-day workshop. MAIN COMPONENTS OF PROGRAM: The workshop covered seven procedures: removal of lumps and bumps, basic suturing, intrauterine contraceptive device insertion, endometrial biopsy, casting and splinting, injection of joints, and office microscopy. Small groups of faculty members spent 30 minutes at each station where brief didactic sessions were followed by hands-on practice. The workshop was evaluated using an evaluation form immediately after the workshop and questionnaires before and 6 months after. CONCLUSION: Teaching minor surgical procedures is an essential part of the curriculum in a family medicine residency program. A faculty development workshop in minor surgical procedures is one means of upgrading the skills of faculty members in order to ensure that they can teach adequately in this area.
INTRODUCTION: The aim of this survey was to ascertain the level of competency and training of basic surgical trainees (SHOs) in performing incision and drainage of a perianal abscess (a minor surgical procedure). MATERIALS AND METHODS: Questionnaires were sent to SHOs enquiring about preferred methods of incision and drainage and the teaching received to perform this procedure. RESULTS: Of respondent SHOs, 10% did not receive teaching when performing their first incision and drainage and over half did not received any feedback from their trainers. A mere 65% received practical supervision. Use of the curette and de-roofing of the abscess are not routine methods used. In addition, 13% reported inadequate incision and drainage, which required a second procedure. CONCLUSIONS: Competency-based training in minor surgical procedures benefits not only from didactic teaching, immediate supervision and appraisal but also from frequent practise. This was found to be lacking for incision and drainage of perianal abscesses by basic surgical trainees surveyed in the study.
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Three patients with recurrent uterine cancer, unresectable rectal cancer, and recurrent rectal cancer in the pelvis were treated by percutaneous superselective transarterial embolisation (TAE) of the hypogastric artery and it's branches with ethanol or gelatin sponge particles. TAE was performed for the control of life-threatening hemorrhage, severe pain and the diminishing tumor's bulk. In addition to conservative cares, this TAE needed minor surgical procedures such as urinary diversion, colostomy and drainage of abdominal abscess just when urinary bladder's necrosis, rectosigmoidal necrosis and peritonitis would be expected before and after the TAE. One local hematoma in the site inserted catheter and right ischiadic nerve paralysis occurred by TAE. Two patients died on 6 days and 2 months after TAE, respectively, however one patient is still alive one year after the TAE without the growth of tumours. As a result, this TAE with minor surgical procedures is expected as a suitable treatment for the improvement of the survival and quality of life in the patients with unresectable intrapelvic tumors.
The influence of 4 ml lidocaine 2% without vasoconstrictor, and with epinephrine 0.001%, or with norepinephrine 0.005% on the heart rate and blood pressure was investigated in one group of patients (n = 30) during a minor surgical procedure (tooth extraction) and in an age-matched group of volunteers (n = 30) with injection only and without any intervention. The difference between the 2 groups underlines the presence of emotional stress. Lidocaine without and with a vasoconstrictor changes the heart rate and blood pressure differently. These haemodynamic changes are superposed by alterations caused by emotional stress and are similar in all test series. The so-called epinephrine-collapse often seems to have its cause in an abrupt relative deficiency of epinephrine after stress. It is possible to significantly influence the cardiovascular system in connection with a local anaesthesia with the choice of vasoconstrictor.
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