Surgeon

In 1775 the British surgeon Sir Percivall Pott suggested that scrotal cancer in chim ney sweeps was caused by soot This was the first pro posal that cancer could be caused by chemicals present in the workplace... 

Massive studies of the health problems associated with fats have included the Anti-Coronary Club study in New York City (2), the Framingham study (3) in Massachusetts, and the Chicago study (4). These studies were financed by the United States federal government and supported by the Surgeon General s office, which issued a statement recommending that the fat component of the diet be reduced from an estimated 40% of calories to 30% (5). 

C. E. Koop, The Surgeons Keport on Nutrition and Health, Prim a Publishing Co., Rocklin, Calif., 1988, 726 pp. 

In the cardiovascular arena, hundreds of thousands of patients are treated by interventional cardiologists, whereas in the past these people would have been treated by surgeons. The surgeons, to offset the loss of some patients, take on more difficult procedures which over time become routine in nature. Thus, more patients can be successfully treated and the marketplace expands. 

One of the more intriguing cardiovascular developments is cardiomyoplasty where implantable technologies are blended with another part of the body to take over for a diseased heart. One company, Medtronic, in close collaboration with surgeons, has developed a cardiomyoplasty system to accompany a technique of wrapping back muscle around a diseased heart which can no longer adequately pump. A combination pacemaker and neurological device senses the electrical activity of the heart and correspondingly trains and stimulates the dorsal muscle to cause the defective heart to contract and pump blood. Over 50 implants have been performed to date. 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

Placement of vascular access ports is similar to that of a long-term indwelling arterial catheter. A small incision is made over the selected vein and a second incision is made lower in the anterior chest to create a pocket to house the port. The catheter is tuimeled subcutaneously from its entry point into the vein with the tip inside the right atrium. The final position of the catheter is verified by fluoroscopy, secured with sutures, and the subcutaneous pocket is closed. The port septum is easily palpable transcutaneously, and the system may be used immediately. A surgeon typically inserts the vascular access port in an outpatient setting. 

Meniscus surgery can repair or remove the tom cartilage, depending on the nature of the tear. Arthroscopy, a procedure through small skin incisions to visualize and repair the affected joint, is frequentiy employed. This procedure is sometimes performed on an out-patient basis. If repair of the menisci is not possible the surgeon removes as tittle of the meniscus as possible. 

A bursa, a sac filled with fluid located around a principal joint, is lined with a synovial membrane and contains synovial fluid. This fluid minimizes friction between the tendon and the bone, or between tendon and ligament. Repeated small stresses and ovemse can cause the bursa in the shoulder, hip, knee, or ankle to swell. This swelling and irritation is referred to as bursitis. Some patients experience bursitis in association with tendonitis. Bursitis can usually be reheved by rest and in some cases by using antiinflammatory medications. Some orthopedic surgeons also inject the bursa with additional medication to reduce the inflammation. 

Titanium alloy, composed of titanium, aluminum, and vanadium, is preferred by some orthopedic surgeons primarily for its low modulus of... 

Although the USP defines the knot-pull tensile strength test in terms of a surgeon s knot, most surgeons use a variety of other knots depending on... 

Fig. 1. Illustrations of the USP test for tensile strength. The suture is tied in a surgeon s knot around a short length of mbber tubing.

Department of Health and Human Services. (1986) The Health Consequences of Involuntary Smoking—A Report to the Surgeon General. 

The extent to which these new tissue adhesives and hemostats will influence surgical procedures can be seen in the following analogy. An effective carpenter cannot create a masterpiece without a saw to cut wood, nails to ensure local fixation of separate pieces of wood, and glue to cause broad surface apposition between wood surfaces. Similarly, the surgeon presently uses a scalpel to cut and divide tissues as well as a suture to create local fixation of tissues, but until... 

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