A review of the impact of exercise on fall rates among community-dwelling older adults.

Background: The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives.

Exploring the umbilical and vaginal port during minimally invasive surgery.

This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site.

A pleasant dilemma to have: to treat the HCV patient on the waiting list or to treat post-liver transplantation?

New and relatively well-tolerated medications to treat hepatitis C virus (HCV) infection have presented an opportunity for hepatologists to eliminate HCV in liver transplant (LT) candidates prior to transplantation. While concern for causing decompensated liver disease in the sickest subset of pre-transplant patients makes some clinicians reluctant to offer treatment, we believe that several advantages of early HCV eradication appear to shift the debate in favor of using anti-HCV agents before LT. There are encouraging safety data for new HCV medications in cirrhotic patients, and given the limited supply of donor livers available, delaying or possibly preventing the need for LT by treating HCV can offer significant benefit.

Bladeless direct optical trocar insertion in laparoscopic procedures on the obese patient.

Background: Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women.

Objectives: A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women.

Methods: Two types of surgical techniques were blindly applied in 224 obese reproductive-age women with benign neoplastic diseases of ovary and uterus.

Transvaginal liver surgery using a tethered magnet and a laparoscopic rein.

Introduction: A novel technique was used to remove a large liver cyst via culdolaparoscopy.

Case Description: We used laparoscopic instruments, a gastroscope, a laparoscopic rein, and magnets. The magnets consist of an external magnet and a specially modified tethered neodymium internal magnet, safe for use in transvaginal endoscopic surgery.

Fatal streptococcal toxic shock syndrome from an intrauterine device.

Background: The occurrence of toxic shock syndrome from an intrauterine device (IUD) is very rare.

Objectives: To raise awareness of the risk of toxic shock syndrome caused by an IUD, to educate others about when to suspect this complication, and to provide treatment recommendations.

Case Report: A 49-year-old woman presented to the Emergency Department in septic shock after complaining of 5 days of nausea, vomiting, and diarrhea.

Transabdominal wall deployment for instruments, lights, and micromotors using the concept of secured independent tools.

Use of secured independent tools (SIT) is changing the laparoscopy paradigm, which involves the use of instruments inside the abdominal cavity that are operated via a port that is larger in diameter than the instrument itself. However, in SIT instead of ports we used filaments or cables. Here we describe a modified SIT for use in the introduction of sutures or cables inside the peritoneum.

Laparoscopy and natural orifice surgery: first entry safety surveillance step.

Background And Objective: We are sharing information regarding the surveillance of the first entrance port in laparoscopic and natural orifice transvaginal endoscopy surgeries. However, we are not analyzing techniques or other surgical findings.

Method: In this study, 160 women with previous abdominal pelvic surgeries underwent laparoscopic surgery, 145 patients underwent transvaginal Minilaparoscopy Assisted Natural Orifice Surgery (hybrid), and 3 patients underwent pure natural orifice transvaginal endoscopic surgery (pure).

Laparoscopy rein and a backward needle entrance.

Since the awakening of single-port laparoscopy and culdolaparoscopy and with the increased interest in minilaparoscopy-assisted natural orifice surgery and pure natural orifice peritoneoscopy, laparoscopists are in pursuit of techniques with less percutaneous assistance. We made a rein using a 6-cm straight cutting edge needle in a 2-0 nylon suture with a large clip tied near the end as stoppage. We are also presenting an optional technique of placing the 6-cm straight needle backward, when the diameter of the cannula does not allow the parallel passage of the needle holder.

Secured independent tools in peritoneoscopy.

Background And Objectives: Secured independent tools are being introduced to aid in peritoneoscopy. We present a simple technique for anchoring instruments, powered lights, and micro machines through the abdominal wall.

Methods: We used a laparoscopic trainer, micro alligator clips with one or two 2-0 nylon tails and cables for engines and lights.

Postoperative patient attitudes and perceptions of transvaginal cholecystectomy.

A survey was conducted in order to dispel misconceptions about natural orifice transvaginal cholecystectomy. Forty-two patients were surveyed after having undergone that procedure. Those patients were asked questions related to 1) patient satisfaction, 2) whether they would recommend the procedure to others, and 3) dyspaurenia.

Minilaparoscopy-assisted natural orifice surgery.

Background And Objectives: New technology has allowed us to perform major abdominal and pelvic surgeries with increasingly smaller instruments. The ultimate goal is surgery with no visible scars. Until current technical limitations are overcome, minilaparoscopy-assisted natural orifice surgery (MANOS) provides a solution.

Efficacy of concentrated autologous platelet-derived growth factors in chronic lower-extremity wounds.

The efficacy of concentrated autologous platelet-derived growth factors in the healing and closure of chronic lower-extremity wounds was evaluated in 24 patients with 33 lower-extremity wounds treated previously for at least 6 months using traditional methods. Surgical wound debridement was performed to convert chronic ulcers into acute wounds. Concentrated autologous platelet-derived growth factors and thrombin were applied to the wound bases and protected with a nonadhering compression dressing that remained intact for 7 days.

Neurothekeoma in the foot: a rare occurrence.

Neurothekeoma is a benign cutaneous neoplasm of nerve sheath origin. This seldom-seen entity is especially rare in the foot. We provide an overview of neurothekeoma and describe a patient with an occurrence in the foot that was effectively treated by complete excision of the mass.

Chigger mite infestation.

This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in South America. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained.

Culdolaparoscopic cholecystectomy during vaginal hysterectomy.

Background: Exploration of the abdominal cavity is routinely performed during abdominal and laparoscopic hysterectomies. The visualization of the abdomen during vaginal hysterectomy, however, is not usually done. During a vaginal hysterectomy, after the uterus is removed, an opening is present in the cul-de-sac, which offers a unique opportunity for the performance of not only exploratory but also concomitant surgeries, such as a cholecystectomy.