It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.
Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.
More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery
Heart transplant Replacement of a person’s unhealthy heart with a normal heart from a healthy donor. The donor’s heart needs to be removed immediately after death and kept chilled in saline before rapid transport to the recipient. Heart transplants are technically demanding operations used to treat patients with progressive untreatable heart disease but whose other body systems are in good shape. They usually have advanced coronary artery disease and damaged heart muscle (CARDIOMYOPATHY). Apart from the technical diffculties of the operation, preventing rejection of the transplanted heart by the recipient’s immune system requires complex drug treatment. But once the patient has passed the immediate postoperative phase, the chances of ?ve-year survival is as high as 80 per cent in some cardiac centres. A key di?culty in doing heart transplants is a serious shortage of donor organs.... heart surgery
MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent
of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.
This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)
In developed countries ORT is useful in treating gastroenteritis. There are a number of proprietary preparations, often dispensed as ?avoured sachets, including Dioralyte® and Rehydrate®.... oral rehydration therapy (ort)
In suction lipectomy (liposuction), a rigid hollow tube is inserted through a small skin incision and use to break up large areas of fat, which can then be sucked out through the instrument.
Minor irregularities and dimpling of the skin commonly occur after surgery.... body contour surgery
Cardiovascular surgery includes operations to prevent or repair damage caused, for example, by congenital heart disease (see heart disease, congenital), atherosclerosis, or a myocardial infarction (heart attack).
Procedures include heart valve surgery, coronary artery bypass, and heart transplant.... cardiovascular surgery
Cosmetic surgery techniques include the removal of skin blemishes or dermabrasion; rhinoplasty to alter the shape or size of the nose; face-lifts; mammoplasty to reduce or enlarge the breasts; body contour surgery to remove excess body fat and tissue; hair transplants; blepharoplasty to remove excess skin on the eyelids; and mentoplasty to alter the size or shape of the chin.
All cosmetic surgery carries the risk of side effects from the anaesthetic, as well as of complications of the procedure itself.... cosmetic surgery
Too high a dose may provoke the onset of hypoglycaemia.... hypoglycaemics, oral
Combined and phased pills increase oestrogen and progesterone levels. This interferes with the production of two hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn prevents ovulation. The minipill works mainly by making the mucus lining of the cervix too thick to be penetrated by sperm.
Oestrogen-containing pills offer protection against uterine and ovarian cancer, ovarian cysts, endometriosis, and irondeficiency anaemia. They also tend to make menstrual periods regular, lighter, and relatively pain-free. Possible side effects include nausea, weight gain, depression, swollen breasts, reduced sex drive, increased appetite, leg and abdominal cramps, headaches, and dizziness. More seriously, there is a risk of thrombosis causing a stroke or a pulmonary embolism. These pills may also aggravate heart disease or cause hypertension, gallstones, jaundice, and, very rarely, liver cancer. All oral contraceptives can cause bleeding between periods, especially the minipill. Other possible adverse effects of the minipill include irregular periods, ectopic pregnancy, and ovarian cysts. There may be a slightly increased long-term risk of breast cancer for women taking the combined pill.
Oestrogen-based pills should generally be avoided in women with hypertension, hyperlipidaemia, liver disease, migraine, otosclerosis, or who are at increased risk of a thrombosis. They are not usually prescribed to a woman with a personal or family history of heart or circulatory disorders, or who suffers from unexplained vaginal bleeding. The minipill or a lowoestrogen pill may be used by women who should avoid oestrogens. Combined or phased pills may interfere with milk production and should not be taken during breast-feeding. Certain drugs may impair the effectiveness of oral contraceptives. (See also contraception.) ... oral contraceptives
Professional treatment to remove calculus and stubborn plaque by scaling and polishing is usually carried out by a dentist or dental hygienist during a routine check-up.
In periodontal disease, treatment may be needed more often.... oral hygiene
Stereotaxic procedures can be used to treat pituitary tumours; for a brain biopsy; or to destroy small areas of the brain to treat disabling neurological disorders.... stereotaxic surgery
Rejection is a major problem. However, a combination of a corticosteroid drug and ciclosporin are given in order to suppress this response.
Every patient who undergoes an organ transplant operation must take immunosuppressant drugs indefinitely. (See also heart transplant; heart–lung transplant; liver transplant; kidney transplant.)... transplant surgery