Asistencia Pública. Sala de operaciones de alta cirugía.

En 1927, bajo la dirección del doctor Francisco Guerrini y la órbita de la Dirección General de Salubridad provincial, la Asistencia Pública ocupa la calle 4 y 51. Contaba con dos salas de operaciones, una de ellas para alta cirugía, como lo muestra la imagen, tres consultorios, el de clínica, uno de odontología y otro de otorrinolaringología; sala de primeros auxilios, sala de asepsia, y sala de rayos. Era conocida popularmente como “el dispensario”, pero era mucho más, un centro sanitario pues cumplía una importante labor asistencial.

El anfiteatro endovascular / The endovascular amphitheatre

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ESVS Volodos Lecture: Innovations and the Hippocratic Oath.

This lecture remembers Professor Nicolai Volodos, a pioneer innovator and a giant in vascular and endovascular surgery, who performed the first endovascular repair of a thoracic aneurysm in 1987 and developed a complex endovascular program by the end of the 1980s. The manuscript recalls major innovations and innovators in vascular surgery, examines the challenges innovators and those who adopt innovations face and discusses the modern meaning of the Hippocratic Oath. The author concludes that surgical innovations are essential to advance cost-effective care, and shared decision making on adopting new therapies by an ethical surgeon and a well informed patient is the cornerstone of ethical patient care.

Uncovering the History of Operating Room Attire through Photographs.

BACKGROUND: Although early proponents for each of the four basic articles of operating room clothing--gowns, caps, masks, and gloves--can be identified, it is unclear from historical commentaries when each article achieved general acceptance and was consistently worn by surgeons and by anesthesia providers. METHODS: Historical photographs were identified from the Web sites of the National Library of Medicine, Google, and the archives of the Wood Library-Museum of Anesthesiology for the 11 decades 1860 to 1970. The presence or absence of each article of clothing was then determined for the surgical and anesthesia providers depicted. RESULTS: Over 1,000 photographs were identified and examined. Photographs were then eliminated for repetition, lack of available dating, questionable dating, and poor quality. In 338 remaining photographs that met inclusion criteria, 640 surgical providers and 219 anesthesia providers were depicted and used in the analysis. Statistical definitions for historical terms general acceptance and routine use were proposed. The probability that a surgeon was wearing nonstreet clothes (gown) was 0.66 (95% CI, 0.22 to 0.93) in 1863. The years (95% lower bound to 95% upper bound) associated with a 0.5 probability for wearing cap, gloves, and mask were 1900 (1896 to 1904), 1907 (1903 to 1910), and 1916 (1913 to 1919), respectively. The years associated with a 0.5 probability that an anesthesia provider would be wearing nonstreet clothes (gown), cap, and mask were 1883 (1863 to 1889), 1905 (1900 to 1911), and 1932 (1929 to 1937), respectively. CONCLUSION: Timelines for the adoption of each basic article of surgical attire by surgeons and anesthesia providers were determined by analysis of historical operating room photographs from 1863 to 1969.

Bernoulli in the operating room: from the perspective of a cardiac surgeon.

The Bernoullis were one of the most distinguished families in the history of science. It was Daniel Bernoulli who applied mathematical physics to medicine to further his understanding of physiological mechanisms that have an impact even in today's high-end medicine. His masterwork was the analysis of fluid dynamics, which resulted in Bernoulli's law. Most important for cardiac surgery, it describes how a centrifugal pump works within an extracorporeal circulation, lays the basis for measuring a gradient over a stenotic heart valve, and explains how to measure the transit time flow within a bypass graft.

Supplementing the neurosurgical virtuoso: evolution of automation from mythology to operating room adjunct.

A central concept of scientific advancement in the medical and surgical fields is the incorporation of successful emerging ideas and technologies throughout the scope of human endeavors. The field of automation and robotics is a pivotal representation of this concept. Arising in the mythology of Homer, the concept of automation and robotics grew exponentially over the millennia to provide the substrate for a paradigm shift in the current and future practice of neurosurgery. We trace the growth of this field from the seminal concepts of Homer and Aristotle to early incorporation into neurosurgical practice. Resulting changes provide drastic and welcome advances in areas of visualization, haptics, acoustics, dexterity, tremor reduction, motion scaling, and surgical precision.

[Operating rooms during the second half of the 20th century and its change with surgical advances]. / La salle d'opération durant la 2ème moitie du Xxème siècle et ses remaniements avec les progrès chirurgicaux.

With the rise of new specialities after the World War, the number of OP rooms increases. They became gathered on the basement of buildings near the central sterilisation. To enter the OP room, everyone passes through the dressing "sas". "Slippers", uniforms, gloves and many supplies are now for single-use. Electrified operating tables with their own accessories became very useful. Air conditioning is appreciated too in our countries. The operating microscope for ORL, ophthalmology and neurosurgery is used by every one. In cardiology the coronary revascularisation being common stuff, cardiac transplantation (1967) and open-heart surgery received special attention. Vascular surgeons are dedicated to arteritiden, implants, and aortic aneurysms. Urology is focused on renal transplants (since 1959), and more recently on lithotrity and coelioscopic prostatectomy. The coeliosurgery conquered the abdominal pathology and the endoscopic techniques became current. In neurosurgery, stereotaxy to treat parkinson's disease is not used so often since Levodopa exists. But it is still useful to implant brain-stimulating electrodes for refractory parkinson's cases, some other dyskinesias, mental troubles or epilepsies. The neuronavigation brought new possibilities. At century's end, ambulatory surgery reduces surgical costs. Bigger and multidisciplinary theatres are now preferred. The open-heart surgery assisted by computer and robotics is evolving. Finally, we recall OP room accidents, which are not directly dealing with the operation.

'Family-centred care' in American hospitals in late-Qing China.

Today, patients' families in the West are regaining the access to hospitals that they lost when hospitals emerged as the primary site for medical treatment, research and training at the beginning of the twentieth century. In China, however, families were never excluded from American mission-run hospitals, in fact, they were indispensable. Families were in the waiting rooms, consulting rooms,wards and operating theatres. They provided more than reassurance and comfort: they fed and nursed their sick relatives, acted as advocates and middlemen and may even have lowered the incidence of cross-infection, the scourge of the contemporary hospital in the West.

Los cirujanos generales frente a la cirugía de las varices / General surgeons and varicose vein surgery

La insuficiencia venosa crónica es una enfermedad muy prevalente, de una gran relevancia sanitaria y económica, y en la que en los últimos años se están produciendo importantes novedades terapéuticas. Aunque en la mayoría de los hospitales públicos su asistencia recae sobre los cirujanos generales, éstos no disponen de una formación continuada adecuada y continúan realizando habitualmente una cirugía clásica. Además, su presencia en el ámbito científico, organizativo y formativo es casi nula. Presentamos una actualización sobre las novedades en flebología y, aprovechando los resultados preliminares de una encuesta nacional, reflexionamos sobre la situación actual de la flebología y el futuro que los cirujanos generales tienen en este campo (AU)

Chronic venous insufficiency is a highly prevalent condition, with significant health and economic repercussions. Although important therapeutic developments have been introduced in recent years, the majority are dealt with by general surgeons in national health hospitals. These surgeons do not have the required and continuous training, and continue to perform classic surgery techniques. Also, their presence at scientific, organisational meetings and training is almost nil. We present an update on developments in phlebology, and tapping into the preliminary results of a national survey, we reflect on the current status of phlebology and beyond for those general surgeons who should have a role in this field (AU)

La urología preilustrada. De la urología del Real Colegio de Cádiz a la de la Veneranda Tertulia / Urology before illustration. From the Urology of the Royal College of Cadiz to that of the «veneranda» gathering

El estudio de la actividad urológica del occidente andaluz se encuentra contenido en las «Observaciones» impresas y manuscritas de las Memorias de la Regia Sociedad de Medicina Sevillana y en aquellas pertenecientes al Real Colegio de Cirugía de Cádiz. Comprende un período que abarca desde 1693 hasta el primer tercio del siglo XVIII. Se consolida la Veneranda Tertulia, Felipe V concede «Cédula Real»; es el 1º de Octubre de 1701. Inicia su andadura Médico-Quirúrgica la «Regia Sociedad de Medicina y demás Ciencias de Sevilla». Hay que recordar que toda la cirugía andaluza y especialmente la de Cádiz (a través del Real Colegio de Cirugía) estuvo presente en la Regia Sociedad. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili y otros muchos fueron fundacionales de este extraordinario acontecimiento. La formación quirúrgica y, por ende, la urológica tenía su raíz y fundamento en los anfiteatros anatómicos, (Sevilla 1731) y (Cádiz 1728) definidos «impíos» por la Iglesia. José Celestino Mutis (1750-53) y Pedro Fernández Castilla (1741) aíslan a la Universidad de este nuevo movimiento. Hubo una intensa relación entre Cirujanos de la Armada y la Regia Sociedad, siendo socios desde su fundación: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). Siendo el principal protagonista Luis Montero, verdadero paradigma con proyección hacia la centuria siguiente, de influencia netamente francesa junto con Ramos, ambos alumnos de Beaumond, anatómico de reconocido prestigio (AU)

The study of the urological activity in the Andalusian occident is contained in the printed and handwritten «Observations» of the records of the Royal Society of Medicine of Seville and the Royal College of Surgery of Cadiz. They encompass the period from 1693 to the first third of the 18th century. By the first of October 1701, the «Veneranda» gathering consolidates and Philip V gives the «royal warrant». The «Royal Society of Medicine and Other Sciences of Seville» starts its medical-surgical path. It should be reminded that all the Andalusian surgery and specially the one from Cadiz (through the Royal College of Surgeons) was present in the Royal Society. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili and many others were founders of this extraordinary event. Surgical training and, by extension, urological training had their root and basement in the anatomical amphitheaters (Seville 1731 and Cadiz 1728), which were considered ungodly by the Church. José Celestino Mutis (1750-53) and Pedro Fernandez Castilla (1741) excluded the university from this new movement. There was and intense relationship between Navy surgeons and the Royal Society, being members since its foundation: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). The main protagonist was Luis Montero, real paradigm with projection to the next century, having a neat French influence altogether with Ramos, both of them being Beaumond's alumni (an anatomist of recognized prestige) (AU)