Mihaela Mastacaneanu - Academia.edu (original) (raw)
Papers by Mihaela Mastacaneanu
The FASEB Journal, Apr 1, 2010
Hand surgery and rehabilitation, Dec 1, 2018
Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
Introduction: A computerized system allows the creation of a three-dimensional simulation model o... more Introduction: A computerized system allows the creation of a three-dimensional simulation model of the breast that allows the surgeon to predict the outcome of the intervention based on the tissue characteristics and desires of each patient, making the patient a part of the decision. Aim of study: Although breast augmentation has become lately the most demanded aesthetic surgical procedure of our decade there is no dedicated system that can assist the surgeon in selecting an implant, educating the patient. This is why such a computerized system became mandatory. Material and methods: 869 patients that requested breast augmentation surgery were admitted in our clinic beginning with january 2006; all the patient’s consultations were done using the biodynamic implant selection system. The dimensions measured on the patients were introduced in the software that selected in the end an implant. The simulation of the future breast was done using external sizers and each patient was asked to check the simulation in the mirror. The precision of the system was confirmed postoperatively by 90% of the patients that found that the result was similar to the preoperative simulation. Results and discussions: Using the system is similar to following a script. The patient is informed and educated at every step about the implications and limits of her characteristics and desires. Conclusions: The computerized system in implant selection is a precious tool that assists surgeons in educating patients, implicating them in the final decision and therefore increasing the outcome satisfaction rate.
Introduction: Nowadays, bariatric surgery is the most efficient method in treating morbid obesity... more Introduction: Nowadays, bariatric surgery is the most efficient method in treating morbid obesity. These patients represent a great challenge for the anesthesiologist due to the complex anatomic and functional changes in the obese patient as well as due to the ...
Hand surgery and rehabilitation, Dec 1, 2016
Introduction Les fractures du col du 5 e métacarpien sont fréquentes et représentent 20 % des fra... more Introduction Les fractures du col du 5 e métacarpien sont fréquentes et représentent 20 % des fractures de la main. La technique d'ostéosynthèse en bouquet décrite par Foucher semble s'être imposée comme référence, mais elle reste difficile et parfois laborieuse, due à l'utilisation de broches multiples de faible épaisseur dans un canal médullaire de faible diamètre. Nous proposons une synthèse simplifiée au moyen d'une broche de Kirschner unique de gros diamètre. Technique Une broche de 18 10 e , dont l'extrémité est recourbée, est montée sur un nez à broche. Après incision, nous faisons progresser la broche dans le canal médullaire après trépanation du point d'entrée par la broche elle-même. La réduction s'effectue par manoeuvre de Jahss, puis la broche est enfoncée jusqu'en os sous-chondral. En cas de persistance d'un trouble de rotation, il est corrigé par un mouvement de rotation sur la broche. Une syndactylie associée à une coque de protection en résine est associée. Méthodes Nous avons suivi 30 patients avec un âge moyen de 32 ans. Résultats Au recul de 90 jours, nous observons 100 % de consolidation osseuse et aucun trouble de rotation. La durée opératoire moyenne était de 14 minutes. Aucune complication n'a été retrouvée. Discussion Il s'agit d'une technique simple, efficace, reproductible, rapide et malgré l'usage d'une seule broche, aucun trouble de rotation n'a été répertorié. Cette technique est plus rapide et plus facile que l'embrochage fasciculé par de nombreuses broches. Conclusion Cette technique peut être proposée pour les fractures du col du 5 e métacarpien. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
Hand surgery and rehabilitation, Dec 1, 2018
étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour gui... more étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour guider l'ablation du corps étranger, puis en vérifier la disparition. La nature des corps étrangers était 15 fois végétale, 2 fois en verre, 1 fois un caillou, et 1 fois indéterminée. Leur longueur moyenne était de 4,65 mm (min 1, max 16) et leur largeur moyenne de 1,02 mm. Tous les corps étrangers étaient visibles à l'échographie peropératoire avant ablation et invisibles après ablation. L'échographie peropératoire ayant permis de guider l'extraction de tous les corps étrangers radiotransparents de notre série, elle peut être considérée comme utile à l'extraction de corps étrangers radiotransparents. Déclaration de liens d'intérêts Consultant, expert : oui [newclip technics, Zimmer biomet, Biomodex]. Détention d'un brevet ou inventeur d'un produit : oui [argomedical].
Objectives/Interrogation: Carpal tunnel syndrome (CTS) diagnostic is based on clinical symptoms a... more Objectives/Interrogation: Carpal tunnel syndrome (CTS) diagnostic is based on clinical symptoms and physical examination, usually confirmed by electrodiagnostic methods. We wanted to assess the diagnostic value of nerve conduction studies (NCS) and if it can be correlated with intraoperative findings[for full text, please go to the a.m. URL]
Objectives/Interrogation: Nerve conduction studies (NCS) in carpal tunnel syndrome (CTS) stage 4 ... more Objectives/Interrogation: Nerve conduction studies (NCS) in carpal tunnel syndrome (CTS) stage 4 show sensory nerve action potential absent but motor response preserved, distal motor latency to abductor pollicis brevis 4.5 ms to 6.5 ms. After several years of disease evolution, median nerve fibrosis[for full text, please go to the a.m. URL]
Introduction: A computerized system allows the creation of a three-dimensional simulation model o... more Introduction: A computerized system allows the creation of a three-dimensional simulation model of the breast that allows the surgeon to predict the outcome of the intervention based on the tissue characteristics and desires of each patient, making the patient a part of the decision. Aim of study: Although breast augmentation has become lately the most demanded aesthetic surgical procedure of our decade there is no dedicated system that can assist the surgeon in selecting an implant, educating the patient. This is why such a computerized system became mandatory. Material and methods: 869 patients that requested breast augmentation surgery were admitted in our clinic beginning with january 2006; all the patient’s consultations were done using the biodynamic implant selection system. The dimensions measured on the patients were introduced in the software that selected in the end an implant. The simulation of the future breast was done using external sizers and each patient was asked t...
The FASEB Journal, 2010
The main traumatic deformities of the extensor expansion (EE) are the boutonniere lesion (BL) and... more The main traumatic deformities of the extensor expansion (EE) are the boutonniere lesion (BL) and the mallet finger (MF). The classical BL is characterized by flexion deformity at the proximal inte...
Hand Surgery and Rehabilitation, 2018
étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour gui... more étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour guider l'ablation du corps étranger, puis en vérifier la disparition. La nature des corps étrangers était 15 fois végétale, 2 fois en verre, 1 fois un caillou, et 1 fois indéterminée. Leur longueur moyenne était de 4,65 mm (min 1, max 16) et leur largeur moyenne de 1,02 mm. Tous les corps étrangers étaient visibles à l'échographie peropératoire avant ablation et invisibles après ablation. L'échographie peropératoire ayant permis de guider l'extraction de tous les corps étrangers radiotransparents de notre série, elle peut être considérée comme utile à l'extraction de corps étrangers radiotransparents. Déclaration de liens d'intérêts Consultant, expert : oui [newclip technics, Zimmer biomet, Biomodex]. Détention d'un brevet ou inventeur d'un produit : oui [argomedical].
Hand Surgery and Rehabilitation
Introduction: Necrotizing fasciitis is a rare infectious complication of the soft tissues, with r... more Introduction: Necrotizing fasciitis is a rare infectious complication of the soft tissues, with rapid progressive evolution and potentially fatal. Objectives: To present a case of necrotizing fasciitis following abdominoplasty in a patient suffering of morbid obesity. Material and methods: A 43-years old patient suffering of morbid obesity underwent an abdominoplasty, which complicated postoperatively with necrotizing fasciitis. Serial surgical debridment and negative pressure wound therapy (npwt) under self adhesive foil have been performed, associated with prolonged intensive care. Results: The patient has survived, with a complete progressive recovery of the abdominal wall and discharge after 110 days of hospitalization. Conclusions: The therapeutic success in this case is due to the serial surgical debridment, to broad spectrum antibiotherapy and the applying of npwt principles.
Correspondence to: Dr, P. Matusz, Departamentul de Anatomie, Universitatea de Medicinã oi Farmaci... more Correspondence to: Dr, P. Matusz, Departamentul de Anatomie, Universitatea de Medicinã oi Farmacie "Victor Babeo", Timiooara, Str. Col. Enescu nr. 2, Timisoara SUMMARY: Information about the lymph node status is an important prognostic factor, influencing breast cancer staging and treatment options. The primary tumor drains along a lymph trajectory in a first regional lymphatic node, called sentinel node (SN), which captures the disseminated tumoral cells. Breast’s lymph drainage is complex; together with the main axillary drainage pathway there are also secondary pathways, with significant practical importance in case of breast cancer. The study material was represented by 35 female patients, aged between 31 and 74 years, with palpable breast malignant tumor. We analyzed primary tumor size and location, and injected radiopharmaceutical (RP) substances. The RP substances used were 99mTc–Hepatate and 99mTc–Nanocoll, in doses of 15-30 MBq, by intradermal or peritumoral injec...
Datorită frecvenței crescute și a impactului funcțional, traumatismele mâinii au o serie de conse... more Datorită frecvenței crescute și a impactului funcțional, traumatismele mâinii au o serie de consecințe sociale și economice importante, atât pentru pacienți, cât și pentru societate. In ciuda faptului că in multe țări europene (Franța, Belgia, Elveția, Luxemburg) există preocupări mai vechi, iar in altele (Turcia) mai noi privind dezvoltarea unui sistem organizatoric eficient de prevenție și asistență a traumatismelor mâinii, România se confruntă incă cu multe probleme din acest punct de vedere. Vom incerca să evaluăm locul actual al traumatologiei mânii in țara noastră, sugerând principalele direcții pe care trebuie acționat in viitor. Cuvinte cheie: traumatisme ale mâinii, prevenție, tratament, costuri
REZUMAT Introducere: In prezent, chirurgia bariatrică este considerată cea mai eficientă metodă p... more REZUMAT Introducere: In prezent, chirurgia bariatrică este considerată cea mai eficientă metodă pentru tratamentul obezităţii morbide. Acesti pacienţi reprezintă o provocare pentru medicul anestezist, datorită complexelor modificări anatomice si funcţionale ale organismului pacientului obez, precum si datorită comorbidităţilor asociate. Articolul prezintă experienţa noastră in managementul anestezic al unui grup de pacienţi operaţi in Spitalul Clinic Judeţean de Urgenţă Timisoara. Material si metodă: Am analizat retrospectiv o serie de 18 pacienţi care au fost supusi gastrectomiei longitudinale laparoscopice intre decembrie 2006 si mai 2009. Toţi pacienţii au fost operaţi in anestezie generală monitorizată. Am analizat morbiditatea preoperatorie, managementul anesezic si evoluţia postoperatorie imediată. Rezultate: Lotul de studiu a cuprins atât bărbaţi (10) cât si femei (8), cu indicele mediu de masă corporală (BMI) de 48,05 kg/m 2 . In ambele grupuri au fost prezente multiple como...
REZUMAT SINGLE STAGE ACHILLES TENDON COVERAGE AND RECONSTRUCTION Mihaela Mastacaneanu1, Zorin Cra... more REZUMAT SINGLE STAGE ACHILLES TENDON COVERAGE AND RECONSTRUCTION Mihaela Mastacaneanu1, Zorin Crainiceanu1, Shruti Kaushal1, Adriana Opris1, Adrian Tirla2, Alina Helgiu1, Alina Cradigati3, Mirela Sarandan3, Adrian Caramida1, Tiberiu Bratu
The need for medical resources is unparalleled by the resources availability, thus the allocation... more The need for medical resources is unparalleled by the resources availability, thus the allocation should be fair and effective, respecting medical and ethical criteria. While macro- and meso-allocation are beyond the reach of the individual doctors, the microallocation entitles doctors to treat patients using the local limited resources and following the ethical guidelines, to the patients’ best interest. The herein case discussion shows the use of a single operating microscope in a department of plastic surgery, for concomitant elective and emergency operations, the ethical criteria, and the algorithm for solving the competing claim and the implications thereunder, as well as guidelines for improvement. The appropriate allocation of the microscope requires an efficient coordination of elective operations and emergency patients, medical staff and infrastructure in order to maintain the standard of treatment despite material limitations. Surgeons should be proficient in using the mic...
The FASEB Journal, Apr 1, 2010
Hand surgery and rehabilitation, Dec 1, 2018
Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
Introduction: A computerized system allows the creation of a three-dimensional simulation model o... more Introduction: A computerized system allows the creation of a three-dimensional simulation model of the breast that allows the surgeon to predict the outcome of the intervention based on the tissue characteristics and desires of each patient, making the patient a part of the decision. Aim of study: Although breast augmentation has become lately the most demanded aesthetic surgical procedure of our decade there is no dedicated system that can assist the surgeon in selecting an implant, educating the patient. This is why such a computerized system became mandatory. Material and methods: 869 patients that requested breast augmentation surgery were admitted in our clinic beginning with january 2006; all the patient’s consultations were done using the biodynamic implant selection system. The dimensions measured on the patients were introduced in the software that selected in the end an implant. The simulation of the future breast was done using external sizers and each patient was asked to check the simulation in the mirror. The precision of the system was confirmed postoperatively by 90% of the patients that found that the result was similar to the preoperative simulation. Results and discussions: Using the system is similar to following a script. The patient is informed and educated at every step about the implications and limits of her characteristics and desires. Conclusions: The computerized system in implant selection is a precious tool that assists surgeons in educating patients, implicating them in the final decision and therefore increasing the outcome satisfaction rate.
Introduction: Nowadays, bariatric surgery is the most efficient method in treating morbid obesity... more Introduction: Nowadays, bariatric surgery is the most efficient method in treating morbid obesity. These patients represent a great challenge for the anesthesiologist due to the complex anatomic and functional changes in the obese patient as well as due to the ...
Hand surgery and rehabilitation, Dec 1, 2016
Introduction Les fractures du col du 5 e métacarpien sont fréquentes et représentent 20 % des fra... more Introduction Les fractures du col du 5 e métacarpien sont fréquentes et représentent 20 % des fractures de la main. La technique d'ostéosynthèse en bouquet décrite par Foucher semble s'être imposée comme référence, mais elle reste difficile et parfois laborieuse, due à l'utilisation de broches multiples de faible épaisseur dans un canal médullaire de faible diamètre. Nous proposons une synthèse simplifiée au moyen d'une broche de Kirschner unique de gros diamètre. Technique Une broche de 18 10 e , dont l'extrémité est recourbée, est montée sur un nez à broche. Après incision, nous faisons progresser la broche dans le canal médullaire après trépanation du point d'entrée par la broche elle-même. La réduction s'effectue par manoeuvre de Jahss, puis la broche est enfoncée jusqu'en os sous-chondral. En cas de persistance d'un trouble de rotation, il est corrigé par un mouvement de rotation sur la broche. Une syndactylie associée à une coque de protection en résine est associée. Méthodes Nous avons suivi 30 patients avec un âge moyen de 32 ans. Résultats Au recul de 90 jours, nous observons 100 % de consolidation osseuse et aucun trouble de rotation. La durée opératoire moyenne était de 14 minutes. Aucune complication n'a été retrouvée. Discussion Il s'agit d'une technique simple, efficace, reproductible, rapide et malgré l'usage d'une seule broche, aucun trouble de rotation n'a été répertorié. Cette technique est plus rapide et plus facile que l'embrochage fasciculé par de nombreuses broches. Conclusion Cette technique peut être proposée pour les fractures du col du 5 e métacarpien. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
Hand surgery and rehabilitation, Dec 1, 2018
étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour gui... more étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour guider l'ablation du corps étranger, puis en vérifier la disparition. La nature des corps étrangers était 15 fois végétale, 2 fois en verre, 1 fois un caillou, et 1 fois indéterminée. Leur longueur moyenne était de 4,65 mm (min 1, max 16) et leur largeur moyenne de 1,02 mm. Tous les corps étrangers étaient visibles à l'échographie peropératoire avant ablation et invisibles après ablation. L'échographie peropératoire ayant permis de guider l'extraction de tous les corps étrangers radiotransparents de notre série, elle peut être considérée comme utile à l'extraction de corps étrangers radiotransparents. Déclaration de liens d'intérêts Consultant, expert : oui [newclip technics, Zimmer biomet, Biomodex]. Détention d'un brevet ou inventeur d'un produit : oui [argomedical].
Objectives/Interrogation: Carpal tunnel syndrome (CTS) diagnostic is based on clinical symptoms a... more Objectives/Interrogation: Carpal tunnel syndrome (CTS) diagnostic is based on clinical symptoms and physical examination, usually confirmed by electrodiagnostic methods. We wanted to assess the diagnostic value of nerve conduction studies (NCS) and if it can be correlated with intraoperative findings[for full text, please go to the a.m. URL]
Objectives/Interrogation: Nerve conduction studies (NCS) in carpal tunnel syndrome (CTS) stage 4 ... more Objectives/Interrogation: Nerve conduction studies (NCS) in carpal tunnel syndrome (CTS) stage 4 show sensory nerve action potential absent but motor response preserved, distal motor latency to abductor pollicis brevis 4.5 ms to 6.5 ms. After several years of disease evolution, median nerve fibrosis[for full text, please go to the a.m. URL]
Introduction: A computerized system allows the creation of a three-dimensional simulation model o... more Introduction: A computerized system allows the creation of a three-dimensional simulation model of the breast that allows the surgeon to predict the outcome of the intervention based on the tissue characteristics and desires of each patient, making the patient a part of the decision. Aim of study: Although breast augmentation has become lately the most demanded aesthetic surgical procedure of our decade there is no dedicated system that can assist the surgeon in selecting an implant, educating the patient. This is why such a computerized system became mandatory. Material and methods: 869 patients that requested breast augmentation surgery were admitted in our clinic beginning with january 2006; all the patient’s consultations were done using the biodynamic implant selection system. The dimensions measured on the patients were introduced in the software that selected in the end an implant. The simulation of the future breast was done using external sizers and each patient was asked t...
The FASEB Journal, 2010
The main traumatic deformities of the extensor expansion (EE) are the boutonniere lesion (BL) and... more The main traumatic deformities of the extensor expansion (EE) are the boutonniere lesion (BL) and the mallet finger (MF). The classical BL is characterized by flexion deformity at the proximal inte...
Hand Surgery and Rehabilitation, 2018
étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour gui... more étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour guider l'ablation du corps étranger, puis en vérifier la disparition. La nature des corps étrangers était 15 fois végétale, 2 fois en verre, 1 fois un caillou, et 1 fois indéterminée. Leur longueur moyenne était de 4,65 mm (min 1, max 16) et leur largeur moyenne de 1,02 mm. Tous les corps étrangers étaient visibles à l'échographie peropératoire avant ablation et invisibles après ablation. L'échographie peropératoire ayant permis de guider l'extraction de tous les corps étrangers radiotransparents de notre série, elle peut être considérée comme utile à l'extraction de corps étrangers radiotransparents. Déclaration de liens d'intérêts Consultant, expert : oui [newclip technics, Zimmer biomet, Biomodex]. Détention d'un brevet ou inventeur d'un produit : oui [argomedical].
Hand Surgery and Rehabilitation
Introduction: Necrotizing fasciitis is a rare infectious complication of the soft tissues, with r... more Introduction: Necrotizing fasciitis is a rare infectious complication of the soft tissues, with rapid progressive evolution and potentially fatal. Objectives: To present a case of necrotizing fasciitis following abdominoplasty in a patient suffering of morbid obesity. Material and methods: A 43-years old patient suffering of morbid obesity underwent an abdominoplasty, which complicated postoperatively with necrotizing fasciitis. Serial surgical debridment and negative pressure wound therapy (npwt) under self adhesive foil have been performed, associated with prolonged intensive care. Results: The patient has survived, with a complete progressive recovery of the abdominal wall and discharge after 110 days of hospitalization. Conclusions: The therapeutic success in this case is due to the serial surgical debridment, to broad spectrum antibiotherapy and the applying of npwt principles.
Correspondence to: Dr, P. Matusz, Departamentul de Anatomie, Universitatea de Medicinã oi Farmaci... more Correspondence to: Dr, P. Matusz, Departamentul de Anatomie, Universitatea de Medicinã oi Farmacie "Victor Babeo", Timiooara, Str. Col. Enescu nr. 2, Timisoara SUMMARY: Information about the lymph node status is an important prognostic factor, influencing breast cancer staging and treatment options. The primary tumor drains along a lymph trajectory in a first regional lymphatic node, called sentinel node (SN), which captures the disseminated tumoral cells. Breast’s lymph drainage is complex; together with the main axillary drainage pathway there are also secondary pathways, with significant practical importance in case of breast cancer. The study material was represented by 35 female patients, aged between 31 and 74 years, with palpable breast malignant tumor. We analyzed primary tumor size and location, and injected radiopharmaceutical (RP) substances. The RP substances used were 99mTc–Hepatate and 99mTc–Nanocoll, in doses of 15-30 MBq, by intradermal or peritumoral injec...
Datorită frecvenței crescute și a impactului funcțional, traumatismele mâinii au o serie de conse... more Datorită frecvenței crescute și a impactului funcțional, traumatismele mâinii au o serie de consecințe sociale și economice importante, atât pentru pacienți, cât și pentru societate. In ciuda faptului că in multe țări europene (Franța, Belgia, Elveția, Luxemburg) există preocupări mai vechi, iar in altele (Turcia) mai noi privind dezvoltarea unui sistem organizatoric eficient de prevenție și asistență a traumatismelor mâinii, România se confruntă incă cu multe probleme din acest punct de vedere. Vom incerca să evaluăm locul actual al traumatologiei mânii in țara noastră, sugerând principalele direcții pe care trebuie acționat in viitor. Cuvinte cheie: traumatisme ale mâinii, prevenție, tratament, costuri
REZUMAT Introducere: In prezent, chirurgia bariatrică este considerată cea mai eficientă metodă p... more REZUMAT Introducere: In prezent, chirurgia bariatrică este considerată cea mai eficientă metodă pentru tratamentul obezităţii morbide. Acesti pacienţi reprezintă o provocare pentru medicul anestezist, datorită complexelor modificări anatomice si funcţionale ale organismului pacientului obez, precum si datorită comorbidităţilor asociate. Articolul prezintă experienţa noastră in managementul anestezic al unui grup de pacienţi operaţi in Spitalul Clinic Judeţean de Urgenţă Timisoara. Material si metodă: Am analizat retrospectiv o serie de 18 pacienţi care au fost supusi gastrectomiei longitudinale laparoscopice intre decembrie 2006 si mai 2009. Toţi pacienţii au fost operaţi in anestezie generală monitorizată. Am analizat morbiditatea preoperatorie, managementul anesezic si evoluţia postoperatorie imediată. Rezultate: Lotul de studiu a cuprins atât bărbaţi (10) cât si femei (8), cu indicele mediu de masă corporală (BMI) de 48,05 kg/m 2 . In ambele grupuri au fost prezente multiple como...
REZUMAT SINGLE STAGE ACHILLES TENDON COVERAGE AND RECONSTRUCTION Mihaela Mastacaneanu1, Zorin Cra... more REZUMAT SINGLE STAGE ACHILLES TENDON COVERAGE AND RECONSTRUCTION Mihaela Mastacaneanu1, Zorin Crainiceanu1, Shruti Kaushal1, Adriana Opris1, Adrian Tirla2, Alina Helgiu1, Alina Cradigati3, Mirela Sarandan3, Adrian Caramida1, Tiberiu Bratu
The need for medical resources is unparalleled by the resources availability, thus the allocation... more The need for medical resources is unparalleled by the resources availability, thus the allocation should be fair and effective, respecting medical and ethical criteria. While macro- and meso-allocation are beyond the reach of the individual doctors, the microallocation entitles doctors to treat patients using the local limited resources and following the ethical guidelines, to the patients’ best interest. The herein case discussion shows the use of a single operating microscope in a department of plastic surgery, for concomitant elective and emergency operations, the ethical criteria, and the algorithm for solving the competing claim and the implications thereunder, as well as guidelines for improvement. The appropriate allocation of the microscope requires an efficient coordination of elective operations and emergency patients, medical staff and infrastructure in order to maintain the standard of treatment despite material limitations. Surgeons should be proficient in using the mic...