Surgery for Surgeons

Recently I had an interesting case with a weird behavior of a suspected metastasis after resection of the primary tumor.

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A 43 years old male came in July 2008 to the Medical Service with nausea, vomiting and abdominal pain. The workup showed a tumor in the 3^rd portion of the duodenum as well as a big mass in the right liver lobe, so the IM guys asked us to take a look. They performed two attempts to biopsy the masses which showed no tumor. This was the reason for the decision to resect the tumor.

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Michael DeBakey died at the age of 99.

This surgeon published his first invention in 1933 and had an office at the Baylor College in Houston until his death yesterday (In Memoriam, Baylor College of Medicine).

My former chief retired about a year ago and at the same day I left also the Medical Center where he and Dr. Thorsten Morlang made me a surgeon. At a ceremony because of his retirement Dr. Wolf J. Stelter (1994 president of the Michael E. DeBakey International Surgical Society) showed then pictures of his own chiefs through the years in different medical centers in Germany and in the United States. He started talking about them saying that of all these men, only Michael DeBakey is still alive. …And I was happy that my chief is alive.

Until some hours ago Michael DeBakey was a living legend… I can’t write anything more about this.

Rest in peace, Dr. DeBakey! Rest in peace, Michael!

About a year ago I wrote about a transgastric approach in some gastroenterological experiments. What happened in this year? Well, there is a development! Let us take a look at a paper published last year in Nature Clinical Practice Gastroenterology & Hepatology - a magazine belonging to the Nature publishing group. This publication is a review of the still veterinary experiments concerning the “natural orifice transluminal endoscopic surgery” (NOTES).

This time the paper is written better. The authors are IM guys who are obviously still in the euphory in front of the possibility to perform “operations” as endoscopists. Though they started thinking about things like indications, complications and techniques.

For me the interest in NOTES-publications remain still in the question about the indication and the risks of this experiment. Therefore I don’t want to discuss the other parts of the paper. Also, I will compare the transluminal with the laparoscopic approach only and not with the open surgery, because the laparoscopy is what NOTES compete with. Continue Reading »

Every abdominal surgeon has patients with peritonitis. In severe cases, a “second look” should be planned. At least this is the common opinion.

A  group from Holland published a randomized trial about this topic. Surprisingly the results did not show higher morbidity in the “on-demand” group. Continue Reading »

Since the end of the 70-ies, as the radioiodine therapy was initiated, the prognosis of the well-differentiated thyroid carcinomas improved like no other. Despite the success of the therapy, about 30% of the papillary thyroid carconimas show a recidive. Therefore the question about the followup of these carcinomas is quite interesting.

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A recent case in my ER offered a very interesting finding. A 1930 born woman from Egypt got an CXR. Among the common findings in the CXR of an elderly woman, a couple of breast implants could be seen. The collegue who had the case did not came to the idea of investigating the breast of the woman. All of us were somehow upset seeing the implants. I first saw the date she was born and noticed that I did never see breast implants in a woman of this age. But the real surprise was that the patient is of Egyptian origin who did never live outside Egypt, being only a visitor in Germany.

Who could imagine that behind the traditional Muslim dress of a 77yo woman with a headscarf, a couple of 2 big breast implants could be find? Wilhelm Conrad Röntgen made it possible. :)
Take a look at the pictures!

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The title of a paper published in the British Journal of Surgery is “Influence of sex on expansion rate of abdominal aortic aneurysms.” This paper describes a trial with a very interesting conclusion: “The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.”

The cutoff size for AAA is in Germany 50mm. I know that the NHS in the UK makes possible the treatment of such aneurysms until they reach 55mm. Since years the head of our vascular surgery considers treating of female aneurysms of 45mm. I have to tell him about this nice paper.

Thanks, Dr. Mofidi et al.! :)

In the beginning of the most medical books, one can read that the medicine (and of course the surgery) is an ever growing field. Now we know that the laparoscopic cholecystectomy is a good idea, whereas the laparoscopic hernia repair is not a good one. The evidence based knowledge doesn’t need much trials. Therefore I dare to share some thoughts about a recent discussions concerning minimizing the “Minimal Invasive Surgery”.

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A very interesting trial was published in the current issue of “Archives of Surgery“. The clear conclusion is: “Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.”

In discussions with colleagues we compared many times the endoscopy (gastroscopy and colonoscopy) with a video game. The students found this talks very funny. Now we have the “proof”! :)

So, dear surgeons: take a good computer machine and play! Play for the sake of your patients! :)

In the last Friday a patient was brought to my ER from the airport. He was previously reported by the control point as a cerebral commotio. He was a man in the 4 decade who flew from a big city in the USA to Europe accompanied by his wife. It was interesting that he is a nephrologist and his wife is a general surgeon. Continue Reading »