Meridian Surgical

Weight loss surgery is growing as a popular alternative in managing morbid obesity. The surgical procedure involves the restriction of the stomach to hold very little food at a time as well as re-arrangement of small intestines to reduce the amount of calorie absorption into the body.

Though most surgical options to lose weight severe your digestive system they are increasingly being used on people who are in immediate health danger yet they are unable to lose weight by the convential diet and exercises.

Obesity has been classified as a multifactorial disease. It is a condition of excessive accumulation of fat, exceeding the body skeleton and physical standards. In particular morbid obesity according to USA’s Metropolitan Life Insurance Company’s height and weight tables is being 100 pounds or 100% above ideal body weight. According to the World Health Organization (WHO), 20% above ideal body weight is the point where excess body fat starts becoming a health risk.

With weight loss surgery one has both drastic and dramatic results. One can lose 40-60% of their initial weight within two years. But in spite this convincing results, weight loss surgery is not for everyone.

Like other surgical operations, surgery to lose weight also has its inherent risks. And as such your physician will have to weight the risk of surgery against the risks you are facing for being overweight. If the risk of obesity is higher they then may recommend surgery.

To qualify you will have to be severely obese. Technically this means you should have a BMI above 40. (BMI or Body Mass Index is a calculation that uses your weight and height to estimate the amount of body fat) This is particularly important because at such a high BMI you face on ever present risk of developing obesity related diseases e.g. Cardio Vascular Diseases, hypertension, diabetes sleep apnea and more.

Infact most insurance companies will not cover your weight loss surgery expenses, unless you can explicitly show that all else has failed.

You also need to show that you have a lifestyle commitment to the new anticipated lifestyle after surgery. The surgery is literally life, changing. Not only will you drop pounds by the numbers but you will never eat the same. You will also not afford to lead a physically in active lifestyle. If one is unable to maintain the after surgery lifestyle it is possible to regain weight.

Finally you should show realistic expectations. Most centers will walk you through the process of the procedure and prepare you adequately for the life after. This makes sure you understand exactly what you are getting yourself into.

With all these conditions met the surgeon will then look at procedural risk and determine if its safe to go ahead.

SURVEILLANCE AND STERILISATION OF OPERATIon THEATRES

In the Developing World

Dr.T.V.Rao MD – Dr.Chithra.VN MD

In spite of brief stay of patients in the operation theatre (in majority of circumstances), the environment of operation theatre plays a great role in the onset and spread of infection because of a multifactor causation of infection. It is usually necessary to study the epidemiology of infection as a multidisciplinary approach. In resource poor circumstances as in most developing countries, work in isolation and few facilities to make any epidemiological surveys Many believe that routine Microbiological monitoring is most essential but in reality it is not practicable. But every hospital should pay good attention in proper maintenance of air conditioning plants, ventilator systems, and to have greater control on mechanisms and personnel involved in disinfection and sterilization of materials used in the theatres in operative procedures.

Operation theatres should be built with implementation of good civil Engineering standards.

OPERATION THEATRE – DISCIPLINE

1. Only people absolutely needed for an assigned work should be present.

2. People present in theatre should make minimal movements and curtail unnecessary movements in and out of theatres, which will greatly reduce bacterial count.

3. Air borne contamination is usually affected by type of surgery, quality of air which in fact depends on rate of air exchange.

All the persons including the least cadre of employers are partners in infection control and should be aware to comply with infection control regulations

4 Prompt disposal of Theatre waste out of the theatre is of top priority. Any spillage of Body fluids including Blood on the floors is highly hazardous and prompts the rapid multiplication of Nosocomial pathogens in particular Pseudomonas spp

SURVEILLANCE OF OPERATION THEATRE

Role of Microbiological Surveillance

The environments in the operation theatre are dynamic and subject to continuous change. Good infrastructures do not mean a safe environment as human make a greater difference in making the environment unsafe.

Microbiologists should be aware of organisms, sites and populations as surveillance cultures should be chosen carefully to allow meaningful interpretation of results.

Microbiologists should be familiar with the clinical techniques as those normally used for culturing clinical specimens may not yield correct result when applied to environmental specimens.

Sites and cultured reports should not be chosen as etiological sources in the present infections. Culturing unnecessary surface areas causes confusion and meaningful interpretation is lost.

AIR IS THE IMPORTANT SOURCE OF INFECTION

Bacterial counts in operation theatres are influenced by the number of individuals present, ventilation and air flow, the results should be interpreted taking the above facts into consideration.

Surveillance for Air borne Pathogens:

In resource poor Hospitals settle plates with blood agar are used and can detect pathogens, commensals and saprophytic bacteria. Multiple plates are kept and results are based on overall assessment rather than on a single plate study in the room. Microbiologists will clarify the acceptable counts at the different physical locations in multispeciality hospitals.

There is a sea change in analysis of bacterial counts in recent past with advances in medical technologies like Joint replacement surgeries dealing with critical patients. Slit sampler and Air centrifuge equipment for bacterial counts are replacing settle plates, the safe level of colony counts can be calculated as per the standards created with peer reviewed studies by the manufacturers.

How frequently we can do the Surveillance for Air borne Microbes.

Yet there is no definite answer to this question

Doing too frequent surveys are expensive and will not correlate the existing infection rate in the Hospital.

But can indicate the circumstance we operate which can have bearing effect if the safety standards fall

Surveillance for Clostridia spores

The age old tradition of detection of anaerobic spores of C.tetani, and Gas gangrene producing organisms are losing ground with onset of more awareness on theatre sterilization. Routine testing for the Anaerobes is not essential except when there were suspected cases of Tetanus or Gas gangrene attributed to operating in a particular Operation theatre.

But it is ideal to survey the Operation theatres for anaerobes when newly constructed or any remodeling or structural alterations are done. In such situations which will have trust worthy safety of the theatre.

STERILISATION AND DISINFECTION OF OPERATION THEATRES AND CRITICAL CARE AREAS

GENERAL INSTRUCTIONS

1. Keep the floor dry when in use.

2. Use only vacuum cleaners (booming to be forbidden as it will dispense the infected material all around and on the equipments.

3. Chemical disinfection of an operation room floor is probably unnecessary. The bacteria carrying particles already on the floor are unlikely to reach an open wound in sufficient numbers to cause an infection

(Ayliffe et al 1967. Hombroeus et al 1978)

Cleaning alone followed by drying will considerably reduce bacterial population.

4. Wall and Ceilings- Wall and ceiling are rarely contaminated. The numbers of bacteria do not appear to increase even if walls are not cleaned. Frequent cleaning is not necessary and has little influence on bacterial counts. Routine disinfection is therefore unnecessary, but only cleaned when dirty.

ENVIRONMENTAL CLEANING OF OPERATION THEATRES

At the Beginning of the Day

1. Only remove the dust with cloth wetted with clean water. ( Mop theatre furniture lamps, sitting tables, trolley tops, operation tables, procedure tables, Boyle’s apparatus)

Note: Need not use chemicals/disinfectants unless contaminated with blood or body fluids

Between the procedures

Clean operation tables or contaminated surfaces with disinfectant solutions.

1. In case of spillages of blood/ body fluids decontaminate with bleaching solution/ chlorine solution (10% available chlorine)

2. All discard waste in plastic bags (do not accumulate around surgical sites)

3. Do not discard soiled linen and gowns in the operation theatre floor.

At the end of the day

1. Clean all the table tops, sinks, door handles with detergent followed by low level disinfectant.

2. Clean the floors with detergents mixed with warm water.

3. Finally mop with disinfectant like phenol in the concentration of 1 in 10 (low concentrations of phenol will not serve the purpose).

4. Keep the operation theatre dry for the next day’s work

Fumigation

1. Seal the room with adhesive tapes round the edges of the doors/windows and ventilators and apertures.

2 For Each 1000 cu.ft of space place 500ml formaldehyde (40% solution) and 1000ml of water in an electric boiler. Switch on the boiler, leave the room and seal the door.

3. Seal the room for 24 hrs

4. Then open the door and neutralize any residual formaldehyde with ammonia by exposing 250ml of S.G 880 ammonia/ 1Lt of formaldehyde used. (Ref – Mackie and McCartney Practical Medical Microbiology 13th Edition)

5. Fumigation is obsolete in many developed nations in view of toxic nature of Formalin. Too frequent use and inhalation is hazardous

6 Several new safe chemicals are emerging but constrains of economy limit the use and several hours of closure of operation theatres can be curtailed with Fumigation.

THE FOLLOWING PRECAUTIONS HAVE GREATLY REDUCED THE RATES OF INFECTION

1. Every Hospital must constitute Infection control committee to monitor the events in the Hospital, on all matters related to control of Infections.

2. The entry of unnecessary personnel to be restricted into operation theatres as every one contributes to Infection.

3. A thorough washing with warm water and good detergent and carbolisation can bring overall improvement than mere fumigation.

4. Frequent monitoring and training of medical and paramedical staff must carry high priority than mere mechanical and chemical methods.

5. Thorough washing and carbolisation if done everyday after the surgeries will greatly enhance the safety standards and economize the repeated expenditure on fumigation.

TRAINING OF PARAMEDICAL STAFF/ RESIDENTS

1. The short solution to control infection lies with trained staff.

2. The principal and control of infection to all new comers and junior staff should be a goal of any good Institution.

3. Formulate guidelines update as per the changing situation in control the infection.

4. Institute should formulate ideas on infection control to the need of circumstances, as there are no fixed guidelines or formulae to control to suit all occasional.

5. Simple repeated hygienic hand wash is most cost effective method to reduce several infections in Hospitals, in particular operation theatres

Note

The knowledge on Maintenance, Sterilization and control of Infections in Operation theatres a rapidly evolving Science

Wish to know more about Operation theatre Maintenance for control of Infection Read through

Principles, And Practice of Disinfection, Preservation and Sterilization by A.D.Russel, W.B.Hugo & G.A.J Ayliffe.

All Institutes wish to develop to improve hygiene and sterilization standards, and start critical surgeries doing Cardiothoracic, Organ replacement and prosthetic surgeries should subscribe to the internationally accredited Journal

“The Operating Theatre journal” published from U K.

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Obesity

Obesity is a major health problem approaching an epidemic proportions. An NIH consensus conference on the surgical treatment of obesity recommended consideration of surgery in patients with a BMI of greater than 40 kg/m2 without medical complications or a BMI of greater than 35 kg/m2 if severe co morbidity were present. Obesity accelerates the progression of coronary arteriosclerosis in young men (age range 15 to 34 yr). Obesity increases the risk of developing:

Hypertension,

Hyperlipidemia,

Type 2 diabetes,

Coronary artery disease,

Cerebrovascular disease,

Osteoarthritis,

Sleep apnea,

Endometrial, breast, Prostate, and colon Cancers.

Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery for obesity, also called Bariatric surgery, is an option for persons who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems.

Bariatric surgery

Bariatric is derived from the Greek term bars, meaning weight. Bariatric surgery creates an anatomic barrier preventing over-consumption and accumulation of excess calories either by restricting the gastric reservoir or by inducing malabsorption. Bariatric surgery alters the digestive process and is classified into two categories:

Restrictive

Malabsorptive.

Nearly all morbidly obese patients with satisfactory postoperative weight loss, experience substantial improvement in the quality of their lives. At present, Roux en Y Gastric Bypass (RYGB) may be the only Bariatric operation that has produced durable long-term weight loss at an acceptable level of risk.

Indications:

Body mass index (BMI) above 40

Significant obesity comorbidity (e.g., hypertension, diabetes, sleep apnea, pickwickian syndrome, incapacitating osteoarthritis)

Obesity-related physical problems that interfere with employment, walking, or family function may be a candidate.

Procedure of Bariatric Surgery:

1.Restrictive procedures

Promote weight loss by closing off parts of the stomach to make it smaller, thus restricting the amount of food the stomach can hold. Restrictive procedures do not interfere with the normal digestive process.

As a result of this surgery, most persons lose the ability to eat large amounts of food at one time. After an operation, the person usually can eat only ¾ to 1 cup of food without discomfort or nausea. Also, food has to be well chewed.

Restrictive operations for obesity include the following:

Adjustable gastric banding

Vertical banded gastroplasty

Both the methods are used to create a small stomach pouch.

2. Malabsorptive Procedure

The most common gastrointestinal surgeries for weight loss, combine stomach restriction with a partial bypass of the small intestine. A direct connection from the stomach to the lower segment of the small intestine is created, bypassing portions of the digestive tract that absorb calories and nutrients.

Biliopancreatic diversion (BPD):

In this more complicated malabsorptive operation, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is used less frequently than other types of surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a "duodenal switch," which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RGB) is an accepted operation for the control of body weight in morbidly obese patients. This operation is the most common and successful malabsorptive surgery. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum, and the first portion of the jejunum. This bypass reduces the amount of calories and nutrients the body absorbs

Operative Consideration :

Severely obese patients tolerate general anesthesia remarkably well. However, Endotracheal intubation may be difficult.

Patients may require admission to the intensive care unit postoperatively.

Patients with sleep apnea, congestive heart failure, and severe asthmatic bronchitis should spend one or two nights in the intensive care unit for close monitoring of their cardiopulmonary status

Complications from bariatric surgery:

The risk of formation of gallstones.

Inflammatory hepatitis.

Occult cirrhosis

Dumping Syndrome, (stomach contents move too rapidly through the small intestine includes nausea, weakness, sweating, faintness, and sometimes diarrhea after eating)

Constipation / Diarrhea

Vitamin B12 Deficiency

Nutritional deficiencies

Anemia (due to reduced absorption of Iron in the stomach)

Metabolic bone disease (due to less calcium absorption in the small intestine)

Abdominal Pain

Vomiting

Incisional Hernia / Abdominal Hernia

Bleeding (including splenic injury)

Gastrointestinal leaks(inadvertent injury to the GI tract)

Wearing away of the band and breakdown of the staple line.

In very less cases post operative infection or death from complications may occur.

REVISION OPERATIONS

Early technical complications and inadequate weight loss, well-known sequelae of this procedure, necessitated reoperation . The incidence of major postoperative complications following revisional bariatric procedures is substantially higher compared to primary operations.

Patients who have gastric bypass occasionally require revision, either for inadequate weight loss or for complications. The incidence of major postoperative complications following revision Bariatric procedures is substantially higher compared to primary operations. Early morbidity rates range from 15% to 50%. The mortality rate reported after revision operations ranges as high as 10%, undoing any Bariatric operation without conversion to another weight-reduction procedure is invariably associated with the patient’s promptly regaining the lost weight.

Indications for reoperation includes

Dilated gastrojejunal anastomosis

Inadequate weight loss without demonstrable enlargement of the anastomosis

Staple line breakdown

Anastomotic obstruction

Anastomotic leak

Enlarged proximal gastric pouch .

Reoperation consisted of :

Completely redoing the initial RGB

Redoing the anastomosis alone

Staple line revision

Intraoperative dilatation of the anastomosis

.

Intractable marginal ulcer

Major postoperative complications are:

RGB failure

RGB revision for early technical failure

Inadequate weight loss is associated with a high incidence of major complications

subsequently, negligible weight loss.

Intractable marginal ulcer.

Severe metabolic complications

Therefore repair of RGB for technical failure or complications is not recommended.

Gastric bypass patients with anatomically intact operations and unsatisfactory weight loss have probably "outeaten" the operation.Gastric bypass patients with unsatisfactory weight loss are best converted to a more malabsorptive modification of Roux-en-Y gastric bypass, or in some cases biliopancreatic diversion. Unfortunately, some patients who are converted to a malabsorptive procedure suffer severe metabolic complications.

The more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Persons with extensive bypasses of the normal digestive process require close monitoring and life-long use of special foods, supplements, and medications

Why to undergo gastric bypass surgery in India

Revision Gastric bypass surgery in India has seen a phenomenal growth during recent past. Most patients from countries like USA and UK travel to India for treatment.

Few main reasons:

India offers wide range of cheapest pricing options of treatment.

While planning a treatment in India, one does not require waiting in patient queues or registering for a waiting list.

Moreover the doctors and the medical facilities in India are comparable to the best in the world.

Another main reason for choosing India for revision gastric bypass surgery is comfort of communication; one does not face a problem as most people speak English.

Above all, India always offers a good holiday, which can help in fast health recovery. Another important reason why more and more people from overseas are considering India for health treatments is the advancement and the medical and technical superiority of the medical fraternity in India. Hence India is the most ideal destination for Medical tourism.

Do surgery seems the last resort to you to get relief from severe back pain? Well, the number of cases where the doctors recommend surgery is on the increase these days. So you are not the only one who is recommended surgery to get back pain relief. But before you go through the surgery procedure, you need to take extreme care. After all it is your back! The doctor may have several patients, but you just have one back!

Moreover, in such matters where the decision for surgery is the important one, it is better to go for another specialist opinion of a health care official. This is a must despite the fact that your family doctor is your trusted man.

When you go for the second consultation, you need to understand the meaning of second consultation. You are not expected to give the second doctor, the opinion of the first doctor. This will enable him to evaluate your case, honestly and independently without any biases.

Moreover, make a thorough study of similar cases through books or information available on the net. This may not help you take a decision, but still this will certainly boost your morale. Remember, each operation is a special operation, and different persons react to a particular condition in a different manner.

With all the precautions you have taken, and in spite of the fact that the operation is conducted by one of the reputed surgeons you still may have back pain after surgery.

There is enough evidence from clinical trials and data available from the past operations that surgery has proved ineffective in many cases. This is usually a case wherein the surgical procedure is not apt for the patient. One operation, and for the failure of it, another operation is not desirable, and sometimes dangerous. For those with suspected herniated discs, non-surgical treatment is advisable.

It is a proven fact that only one out of every 100 back pain cases is fit for surgery. The most startling revelation is that 67 % of low back pain surgeries became worse after surgery and 2/3 patients complained of more pain after the surgery. Some of the operations cost astronomical figure For example, lumber fusion may cost about $ 63,000.

As per the reports regarding the failing surgical operations, in some cases the patients were operated on the wrong side. You can well imagine its consequences. The patients will then suffer from what is called Failed Back Surgery Syndrome.

What is the remedy ultimately for back pain after surgery? Come back to square one. Proper nutrition, stretching, lifestyle changes and corrective exercises are the only solutions. These are the reliable ones that will not lead to any side effects. They will not certainly add to your misery. Who knows, you may be cured totally. The natural healing process within your body wants your appropriate support. Health matters are so simple; only we complicate them with our ignorance!

Beauty lies in the yes of the beholder, but what about the person who has problematic eyesight? I have often wondered about that student who is burdened with heavy spectacles at a young age due to defective eyesight or that girl who feels she is unattractive because her lovely eyes are hidden behind glasses. A defective vision can alter our lives in more ways than one and even day to day activities like reading a book, watching television or reading the number of a bus can become a challenging activity. Although, devices like contact lenses have solved the problem to quite an extent, but even then they require high maintenance and are difficult to use on a regular basis. A lasik surgery is the preferred alternative in this scenario and can change the way you view the world around you.

Lasik surgery is a simple operation that reshapes the cornea of an individual and rectifies the eyesight of the patient within a very short duration. The post operative care is also minimal and the patient can resume his or her normal activities on the very next day of the operation. However, the skill sets required to perform this kind of lasik surgery is very high and only the very best and competent eye surgeon can carry out such an operation. So before you opt for this kind of surgery, it is highly advisable to gain a complete understanding and knowledge about the entire process and its effects on the patient. It would be best to get the reference of a competent surgeon from a person who ahs already undergone the operation successfully as this will definitely increase your faith and confidence in your doctor and this is of crucial importance.

A lasik surgery has long lasting results and therefore very popular method of rectifying any vision related problems. Whether you are suffering from short sightedness or long sightedness, the surgery can rectify the defect easily. However, be sure to find out all about the process and the post operative treatment before you decide to go in for the operation. Also, the cost of the surgery is an important factor and hence you should carefully consider your financial capacity to pay for such kind of a treatment. In case the cost of operation is high in your place of residence, opting for a different location to get the treatment done is advisable. Many other countries may be having competent professionals and advanced medical facilities for this surgery and it would be easier on your pocket to select one such country for the surgery.

Once you have made up your mind about going in for a lasik surgery you can be confident about seeing the world with new eyes after the operation. The success rates of such a surgery are very high, further adding to the confidence of a potential candidate of lasik surgery. Once you have located a competent doctor on whom you can entrust the responsibility of operating on your precious eyes, you can leave the rest on your doctor.

People want it the easy way, even in losing weight. Who would not want to lose weight easily? There are many weight loss methods everywhere nowadays. So many options but are they good for you? Are they effective and safe?

Surgery has been considered as a great way to lose weight. Its benefits are known tremendously from all the medical research and development in the past decades but is it really the best option when it comes to weight loss?

If you are seriously overweight and you believe surgery is for you, then you can go to almost any clinic and be evaluated for operation. Some doctors will tell you there are risks involved or you have to enroll in a weight loss program first and prove you are committed to changing your lifestyle. Choose the right and good doctor for you. Be careful with doctors whose main concern is only the money you’ll pay. They’ll definitely put you into trouble.

The first thing a doctor can do is to talk you out of surgery. And there is no sign that medicine will progress so far as to make plastic surgery 99% safe for the patients. You have to ask yourself just how much pain you can take. Plastic surgery is very painful.

Surgical methods for weight loss are dangerous because the skin doesn’t heal as easily, the scars will be there forever, sometimes swollen and infected for months. It might also cause you implications like in surgical breast enhancement. All women are tempted in this but there’s a high possibility that you’ll undergo another operation to eliminate infections, to hide scars or to have your breasts remodeled to look even.

Think many times before engaging in a surgery because there’ll be no turning back once your skin has been cut. You have to consider a lot of things because you couldn’t just sue the doctor if your body reacts badly to it. You should remember that you signed an agreement that you’ll be responsible of whatever happens in your body. The surgery doesn’t end that, think of the pain that you’ll go through. So think very hard before spending money on surgery. You better try other ways to lose weight – ways that will give assurance to your overall health and confidence.

Trade LASIK surgery is specially intentional around you and your unique needs. Now ideate the multitude scenario. You are accomplishment in for a regular brainpower surgery and are told by the sawbones that instead of tailoring the surgery especially for you, they would try something that activity for most people.

Would you be ok with such a proposal or would you monstrosity out? Now, something similar that would right monster me out and I believe the homophonic goes for you.

The show that I’m disagreeable to straighten is that it is e’er surpass to fuck surgery tailored for your claim needs than change something that activity for most group. Because you are a unparalleled earthborn being with unparalleled needs. Something that works for somebody else strength not play for you.

And when you discussion of painful areas much as the brainpower or your eyes you cannot purchase much a adventure. If something goes wrongheaded you can turn blind for the suspension of your period.

Now in the former LASIK eye surgery was not so innovative and what happened was that there were accepted procedures operative procedures that were practical to every soul undergoing LASIK eye surgery. However things make denatured with the arrival of tailored LASIK laser surgery.

Practice LASIK eye surgery captures tercet dimensional photos of your eyes as they are accepting nonfat. These imagesare then old to map out a preoperative strategy for your LASIK surgery. This process is noted as wave-front field and is statesman exact compared to occurrence lenses, glasses or additional LASIK procedures.

By making use of computer-based tests to canvas the way your eye allows floaty in, the optimum series of action can be plotted. As this is a tercet dimensional image that perfectly fits the tolerant’s eye, the surgeon ensures that the dimensions of the undulation over the cornea are perfect.

Regularize though bespoke LASIK offers quality results, it may not be the soul deciding for everyone. Hence you moldiness ordinal be authorised by the FDA who gift assess your specialised eye shape to see if you modify. Early your usance LASIK physician give recognise you with the open options. If you determine to get duty LASIK, he gift then looking at the precondition of your eyes to see if their premise is specified that Tailored LASIK offers the mass advantages:

- Restored ratio of effort a 20/20 sensation

- The occurrence of brilliance or nighttime exteroception disturbances are cut or eliminated

-Lower ratio of losing oppositeness sentience or modality dimension

Research indicates that in spite of the higher outgo of tradition LASIK, author and solon fill select this process compared to non bespoken LASIK. Nonetheless, it is indispensable to enquire with your eye theologizer before the surgery on what can be rectified. This is because still tho’ usance LASIK is perhaps the unsurpassed LASIK work in damage of its results, it may not fix all types of exteroception abnormalities at inform.read articles more in http://lasik-doctor-eye.blogspot.com

The non-surgical facial rejuvenation revolution is now, prematurely in my opinion, being applied to eyelids for correction of dark circles under the eyes, removal of eyelid bags and other eyelid aging changes.

Until recently the traditional plastic surgery operation called blepharoplasty has been the “Gold Standard” for rejuvenation of the eyelids to remove puffiness or lower eyelid bags, loose skin and hooding of the eyelids. More recent advances have included the use of the CO2 laser instead of a scalpel for blepharoplasty with a resultant decrease in the amount of bleeding and bruising and thus a shorter recovery. In addition, transconjunctival blepharoplasty, a technique done through the inside of the lower eyelid has improved results by avoiding an incision on the outside of the lower eyelid preserving eyelid support and natural shape. More recently, an internal eyelid ligament release called an arcus marginalis release, combined with fat grafting, has allowed plastic surgeons to permanently remove dark circles under the eyes. It is safe to say that in 2006, plastic surgical eyelid rejuvenation techniques are better, more effective, and when properly done by an experienced plastic surgeon more safe than ever before.

However, patients’ desire to avoid surgery coupled with advances in non-surgical technology, and also influenced by the vast number of physicians with no surgical training entering the field of “aesthetic medicine”, have resulted in many new non-surgical applications in the field of eyelid rejuvenation. While some non-surgical techniques have been dramatically successful e.g. Botox, many others are being marketed to patients and offered to patients before safety and effectiveness have been proven in clinical studies.

Two such techniques being promoted today are of concern to me.

The first is the use of soft tissue fillers to correct dark circles under the eyes. Many physicians are now injecting fillers like Restylane, Radiesse, Sculptra, Cosmoplast, Cosmoderm, Hylaform and others into the dark circles under the eyes to plump the dark circle. While acceptable cosmetic results can be achieved, the risks of injury to the eye are unacceptable, not only in my opinion, but the opinion of the manufacturers of the fillers. Companies that make the fillers recommend that the fillers not be injected around the eye. Unfortunately many doctors are not heeding these warnings, I assume out of ignorance of the vital structures that lie beneath the eyelid and can be damaged by the needle, or lack of concern for their patient’s safety. It is not a matter of if, but when a patient will be blinded by this technique. If you would like to read the unfortunate experience of many patients who have been injured by filler injections around the eye check the following link: http://saveyourface.com/askdoc/category/filler-eyelids/

The second technique that concerns me is the non-surgical blepharoplasty or eyelift performed by using a radiofrequency skin-tightening machine on the eyelids, directly over the eyeball. Astoundingly the demonstration on a web link showed a doctor performing this procedure with no eye protection for the patient. Radiofrequency is a high-energy heat source that shrinks skin by heating the deep dermis. Sophisticated cooling devices are used to cool the skin as the radiofrequency energy passes through the skin so that the skin is not burned. Were the eye exposed to radiofrequency energy the eye could be severely injured. Thermage, one such radiofrequency skin-tightening device has already been shown to melt fat beneath the skin resulting in permanent defects or depressions in the skin. I am concerned about the effect of such high-energy heat on the delicate eye structure and the fat and muscles beneath the eyelid. The device being promoted had a suction mechanism that pulled the eyelid up into the radiofrequency head and thus presumably avoided radiofrequency irradiation of the eyeball, but the patient had no eye protection. Noteworthy is the fact that the doctor performing this procedure was not a plastic surgeon and I assume was likely lacking in an intimate knowledge of the surgical anatomy of the eye and the serious complications and their management if they were to occur.

Unfortunately it is up to you, the patient to educate yourself and avoid unproven, risky new techniques that promise the miracle of non-surgical eyelid rejuvenation or blepharoplasty. Your safest course is to consult an expert. Seek the advice of an experienced board certified plastic surgeon when considering eyelid rejuvenation, blepharoplasty or eyelid lift. An experienced up to date plastic surgeon will be aware of which non-surgical facial and eyelid rejuvenation techniques work and are safe. Avoid the hype and marketing-if it sounds too good to be true it usually is. With thousands of physicians with no plastic surgical training entering this field every year these are dangerous times. Do not pay to become an experimental subject. Caveat Emptor.

Dr. Brooke Seckel

Surgical technologists play a vital role in different surgical operations. They have equal role or importance to a surgeon while performing an operation. There minute mistake can bring about serious problems sometimes even to death. They set up the surgical room before an operation is conducted. They also have to check all the instruments so that they all are in perfect working conditions. Other duty includes the making up of patient before surgery which includes shaving, disinfecting etc. They are the one who supply surgical instruments to surgeons during the operation.

Surgical technologists check patient’s current situation and give patients check chart signs to the main surgeon. They assist the patients to the operation theatre and help them to lay for operation process. They look after the specimens taken for laboratory research also and to dress the patient. Surgical technologists duty also includes taking back patients to their respective rooms and to clean up the operation room and make it back to old form. The course conducted ranges from 9 to 24 months. A diploma or a graduate degree is obtained after successful completion of the course. High school education is the primary qualification needed for admission. Physiology, anatomies are some of the topics covered during the course time. Also they include how to take care and security of patients and different sterile techniques.

Clerical practical knowledge is also provided for students. At first voluntary professional certification is needed. Then a graduation course from a CAAHEP-accredited program and a course certificate in national certification examination is needed. These certificates are not compulsory. But since most of the firms need highly qualified technologists these certificates is now a days essential. Every four years these certificates should be renewed. Certificate courses are also achieved from National center for competency testing. Technologists can specialize in certain areas.

They include open-heart surgery, neurosurgery liver transplant etc. Circulating technologists specialize in preparing patient before operation and other procedures such as anesthesia, dressing etc. The salary ranges from 23000 dollars to 45000 dollars. Dental technologists receive higher payment than general and physician technologists. Job opportunities are rising to a higher extend. .Even though hospitals are primary provider of placements to them various other surgical centers and outpatient offices provides jobs to these technologists. As the population increases with time and health problems goes on tandem with it the need for surgical technologist increase. This shows the wide chance of surgical technologist in the medical field.

Surgical Weight Loss or otherwise called as Bariatric surgery has been available for the past several years. However, bar iatric surgery is not a magic cure and is not an easy option for people suffering from morbid obesity. It is a drastic step rather that involves the usual risk and pain of any other major gastro-intestinal surgical operation. In this type of surgery, the size of the stomach is hugely reduced by using different techniques.

After this surgery, the person cannot eat much at a time, which can lead to dramatic weight loss, to the range of about twenty percent over the next one to two years. But the large question is, if it is significant. There are considerable health costs involved by being obese and with having undergone the surgery. i.e., serious heart problems may occur by being obese on one hand while on the other, various health problems or even a huge risk of death is associated by having the weight loss surgery.

Who can qualify for surgical weight loss?

National Health Institute, The Unites States has approved certain standards in determining whether an individual is qualified as morbidly obese. Generally obesity is measured using body mass index or BMI that is determined by dividing the weight of a person in kilograms by the height of the person in meters squared. Individuals with a BMI greater than 35 to 40 associated with other severe disorders qualify for the weight loss surgery. It is also a common requirement that the patient should have had a failed attempt earlier at other weight loss programs for a minimum of 18 months period.

After having met with the NIH standards and disorders assessed, the psychological state of the patient is assessed by most doctors, which may also require consultation with a psychiatrist to evaluate the issues like familial relationships, body image and addiction. Finally the decision to perform the surgery is made by taking into account all these issues. Many people who inquire about the weight loss surgery do not receive surgery and instead counseling is done on other weight loss programs that do not require surgery because of the stringent legal requirements.

Types of weight loss surgery

Billiopancreatic Diversion is a rare type of weight loss surgery in which almost three-fourth of the stomach is completely removed and the rest is connected to the last segment of the small intestine. Several post surgery problems associated with this surgery are loss of bone density for life, Dumping syndrome and anemia.

Roux – en Y gastric bypass is another method. The stomach is either sewn or stapled in the upper half portion in this method thereby creating a smaller stomach above the stomach. The food bypasses here as the intestines are connected to the smaller stomach. The amount of food intake reduces and the weight loss occurs rapidly. This weight loss surgery is more invasive and time to recover is more for the patients. The success rate of this weight loss surgery is stated to be quite high.

Another type of weight loss surgery similar to the above Roux – en Y gastric bypass surgery is the Vertical Banded Gastroplasty. In this method, the upper part of stomach is stapled and the intestines left intact.

In the Lap Band Weight Loss Surgery, a new stomach pouch is produced inside the stomach. This can be done by Laparoscopic method. Patients now prefer this type of surgery, as the post surgery health complications are less.