Canadian Association of General Surgeons

Background: The prevalence of total knee replacement arthroplasty is raising in number and is interrelated with significant loss of blood, as a consequence raising in number of blood transfusion. Losing blood frequently leads to notable postsurgical anemia predisposing to higher probability for cardiorespiratory problems, Blood transfusion hazards, and elevated medical expenditure. Objectives: To assess the efficacy of tranexamic acid (TXA) in lowering blood loss in total knee replacement arthroplasty . Methods: This interventional prospective study was conducted in between July 2015 and June 2017 in Combined Military Hospital (CMH), Dhaka. 48 patients of both genders with primary advanced osteoarthritis of knee, were participated in this study by giving their informed written consent for total knee replacement and insertion of cemented prosthesis. Two doses of tranexamic acid were given to all patients through intravenous route .First dose(10 mg/kg) was received 10 minutes before tourniquet deflation and second same dose at 3 hours after operation. Results: The patients’ mean age was 62±8.12 years, female with involvement of the left knee were more. The mean blood loss was 368.75 ±46.53 ml in the study group. This result is much lower compairing with other studies what they have mentioned.The mean deduction of haemoglobin concentration (gram/dl) amidst before and after surgery account was 1.66 ±0.27 gram/dl. Conclusion: The administration of tranexamic acid through intravenous route in total knee replacement arthroplasty decreases loss of blood in postsurgical periods. Regarding requiring blood transfusions due to total blood loss and reduction in haemoglobin level, we strongly recommend for the use of tranexamic acid through intravenous route routinely during total knee replacement arthroplasty since it was safe with no extra side effects . Bangladesh Armed Forces Med J Vol 58 No (2) December 2025, pp 29-37

To describe the essential components of well-resourced and high-functioning multidisciplinary networks that support high-quality anesthesia, surgery, and maternity care for rural Canadians, delivered as close to home as possible. A volunteer Writers' Group was drawn from the Society of Obstetricians and Gynaecologists of Canada, the Society of Rural Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, the Canadian Association of General Surgeons, the College of Family Physicians of Canada, and the Association of Canadian University Departments of Anesthesia. A collaborative effort over the past several years among the professional stakeholders has culminated in this consensus statement on networked care designed to integrate and support a specialist and non-specialist, urban and rural, anesthesia, surgery, and maternity work force into high-functioning networks based on the best available evidence. Surgical and maternity triage needs to be embedded within networks to address the tensions between sustainable regional programs and local access to care. Safety and quality must be demonstrated to be equivalent across similar patients and procedures, regardless of network site. Triage of patients across multiple sites is a quality outcome metric requiring continuous iterative scrutiny. Clinical coaching between rural and regional centres can be helpful in building and sustaining high-functioning networks. Maintenance of quality and the provision of continuing professional development in low-volume settings represent a mutual value proposition. The trusting relationships that are foundational to successful networks are built through clinical coaching, continuing professional development, and quality improvement. Currently, a collaborative effort in British Columbia is delivering a provincial program-Rural Surgical Obstetrical Networks-built on the principles and supporting evidence described in this consensus statement.

# 01. The future of general surgery training: a Canadian resident nationwide Delphi consensus statement {#article-title-2} Various pedagogical models have been introduced in an attempt to improve and restructure surgical training, but significant obstacles remain. Before implementing national

Expectations of certainty and confidence in surgical culture are a source of internal conflict for surgeons and learners, with surgeons describing a pressure to project an image that is, at times, inconsistent with how they feel internally. The authors explored surgical residents' perceptions of "impression management" and its effects on surgical judgment and decision making. The authors used a constructivist grounded theory approach to conduct and analyze 15 semistructured interviews with general surgery trainees at an urban Canadian academic health center between 2012 and 2014. Interviews explored impression management in the context of resident learning and performance. Analysis was inductive, whereby emergent themes contributed to a developing conceptual framework, and deductive, using an existing theory of impression management. Residents described sensing an "expectation" to portray an image aligned with the ideal surgical stereotype of confidence and certainty, and shared strategies used to mirror this image. Impression management strategies were used to portray an image of competence, with the aim to improve access to teaching and evaluations. Unintended consequences of impression management on decision making, patient safety, and resident wellness were identified. These findings contribute to a deeper understanding of the potential impact of the sociocultural context on residency training, and provide a language allowing for more explicit discussions about the impact of surgical culture on trainee behaviors. Translation includes formal instruction of these concepts in the curriculum so that trainees better recognize, reflect on, and cope with the pressures to perform in front of others.

The metal organic series in Southern Jiangxi is the series of W & U deposits closely related with the Late Yanshanian granite within the South China fold system and the uplift belt. The host rock of W mineralization is fine or medium-fine grained biotitic granite of Early Yanshanian period, subordinated with Late Yanshanian granite The time initial of uranium concentration span from 103-70Ma. Vertically the mineralization zone of tungsten is above that of uranium, however horizontally it is in the center and that of uranium outwards. To the west of Wuyi tectonic belt, distinctly the uranium mineralized posterior to the tungsten, however to the east of Wuyi tectonic belt, the W-Mo-bearing grease negation quartz vein let remarkably cut off the U-bearing silicified fractured zone.

This research studied spatial relationship between groundwater resource-function and sensitivity by statistical analysis in HuFu Plain. The results indicated that groundwater resource function was classified as middle, while groundwater sensitivity was classified as middle and lower in HuFu Plain. The area , groundwater resource function is classified as rich or poorer and richer or poor, where groundwater sensitivity is higher or lower respectively. At last analyzing the mechanism of multicorresponding relationship based on the same factors that they have.

O aspecto ultra-sonográfico dos hamartomas dos ductos biliares pode variar, sendo importante reconhecer suas diferentes formas de apresentação, para que possam ser lembrados no diagnóstico diferencial de lesões focais hepáticas. Neste trabalho, os autores apresentam um caso desta afecção em que foram identificados inúmeros nódulos hiperecogênicos dispersos pelo parênquima hepático, com os maiores atingindo 1,6 cm, sem produzir reverberação sonora posterior.

Estudo conduzido com o objetivo de avaliar a confiabilidade, acurácia e dificuldades do exame de congelação, utilizando-se pequenos fragmentos de tumores mamários obtidos com a biópsia histológica por agulha grossa (bioptycut). Durante 13 meses, 37 pacientes foram submetidas ao Bioptycut (pistola BIP 2.2 ou Promag 1.2, agulhas l4G), sendo que, de cada uma delas, foram retirados no mínimo dois fragmentos, um a fresco para congelação e outro submerso em formol para inclusão posterior em parafina. O estudo de congelação constituiu-se de exame citológico do "imprimir" da peça e de exame histológico usando cortes através de congelação. Os cortes foram feitos usando criostato e micrótomo, com cortes de 8µ. O tamanho do tumor puncionado variou de 1cm a 12cm (média 4,8cm). A congelação foi conclusiva em 33 casos (89%), sendo trinta carcinomas e três benignos, e inconclusiva em quatro casos (11%). A obtenção deste dia:nóstico se deu pelo "imprint" e corte em 29 casos (78%), só pelo "imprint" em quatro casos (11 %), em dois casos tanto o corte quanto o "imprint" foram inadequados e dois não foram descritos. Posteriormente foram obtidas peças por exérese da lesão (até a análise) em 28 casos, dos quais 25 carcinomas e três tumores benignos (11 %). Houve um caso de congelação conclusiva de benignidade, em que a exérese posterior revelou se tratar de carcinoma (falso-negativo). Não houve falsos-positivos. A sensibilidade foi de 96% e a especificidade de 100%. Assim, conclui-se que o exame por congelação, usando-se peças obtidas com bioptycut se mostrou confiável, evitando biópsias abertas em 81 % dos casos, garantindo rapidez e melhor preparo das pacientes para terapêutica definitiva.