Thursday, November 29, 2007

The World Famous All Scrubbed Up: "What is THAT?" Competition #3 Part 2 - The Answer!

Congratulations EmergencyEmm!

Human Papilloma Virus is not rare. This guy had an immune deficiency which allowed a fairly common infection (warts) to get out of hand.

An extract from the original article:

After testing samples of the lesions and Dede's blood, Dr Anthony Gaspari of the University of Maryland concluded that his affliction is caused by the Human Papilloma Virus (HPV), a fairly common infection that usually causes small warts to develop on sufferers.

Dede's problem is that he has a rare genetic fault that impedes his immune system, meaning his body is unable to contain the warts.

The virus was therefore able to "hijack the cellular machinery of his skin cells", ordering them to produce massive amounts of the substance that caused the tree-like growths known as "cutaneous horns" on his hands and feet.

Dede's counts of a key type of white blood cell are so low that Dr Gaspari initially suspected he may have the Aids virus.

But tests showed he did not, and it became clear that Dede's immune condition was something far rarer and more mysterious.

HPV is very common. It’s the virus that causes the warts on your fingers and knees as a kid – and yes, it’s the virus that causes genital warts (yech!). All doctors love those.

As long as you all have good healthy immune systems, your wart virus will never get like this.

Without getting overly medical - here's our favourite source - WikiDoc!

Some HPV types may cause warts while others may cause a subclinical infection resulting in precancerous lesions. All HPVs are transmitted by skin-to-skin contact.

A group of about 30-40 HPVs is typically transmitted through sexual contact and infect the anogenital region. Some sexually transmitted HPVs -- types 6, 11, may cause genital warts. However, other HPV types which may infect the genitals do not to cause any noticeable signs of infection.

Persistent infection with a subset of about 13 so-called "high-risk" sexually transmitted HPVs, including types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 — different from the ones that cause warts — may lead to the development of cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), penile intraepithelial neoplasia (PIN), and/or anal intraepithelial neoplasia (AIN). These are precancerous lesions and can progress to invasive cancer. HPV infection is a necessary factor in the development of nearly all cases of cervical cancer.[1]

Another pic:

So - 1 x guest post on offer to EmergencyEmm if he/she wants it!

Monday, November 26, 2007

The World Famous All Scrubbed Up: "What is THAT?" Competition #3 Part 1

This one really got to me. I don't know what it is about us mere non-doctor mortals. SA Doc giggled and said "fascinating". I almost threw up.


Welcome to the WHAT IS THAT COMPETITION PART #3! Guess the medical thingy in the picture and you could win an AMAZING guest post on All Scrubbed Up valued at millions of emotional dollars!

So... Here we go. What is THAT?!


"I've never seen anything like this in my entire career."
- Dr. Gaspari

Thursday, November 22, 2007

GUEST POST: Tough Surgeon (by Bongi)

Second post (in an initial public offering - har har - of 3) by our man with the plan - BONGI!

Enjoy... I didn't. This one was particularly gross for us "mere mortals". Read more of Bongi's stuff here.

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A story that i thought quite funny at the time, illustrating us macho surgeons...

sigmoid volvulus. a wonderful condition which is very common in africa. not the type the textbooks talk about found in institutionalised old folk, but the type found in young black adult males. prevalence highest in uganda, decreasing as one moves south, but still pretty common in south africa. so in my registrarship, i became quite good at detorting the volvulus which is the emergency treatment in casualties. if this doesn't work or on sigmoidoscopy (siggy as we called it) if you see any questionable bowel, immediate laparotomy is performed.

anyway the patient came in and had a clear sigmoid volvulus on examination and x-rays. i got the siggy ready to detort and place a flatus tube. now, for the lay person, in this area of blocked colon, the feces has been rotting. yes rotten feces, the only thing to top regular or garden variety feces. the feces is also under extreme pressure, so as you insert the siggy, it deflates with vigor (explosively). many of my friends got showered with this rotten projectile fecal matter and often in their face when they detorted sigmoid volvulus on more than one occasion. i had evolved a way of doing it that decreased my chances of being the proverbial fan that was just about to get hit. yes, i think i was pretty good at it. in fact the picture above is me with my trusty siggy ready to detort a volvulus.

so, getting back to the story; i called the students to see the procedure, because this could be their only chance to see it. i set everything up and started the siggy, with an enterage of students, a house doctor and a rotating medical officer standing to observe. i got to the twist, observed to make sure there was no necrosis and started gently inserting the flatus tube. it slipped easily in. and as usual there was a sudden and massive release through the tube of rotten feces and particularly rancid flatus. i stood there trying to control my gag reflex. it would be considered an acute loss of cool if the tough surgeon was seen to be gaging at anything by his awe struck juniors (tongue in cheek for those who wonder). i just couldn't. i gagged over and over again. now i was struggeling to prevent myself from vomiting. despite this, my prominent thought was that the students would think i was a wimp.

then i looked up. every last one of them had bolted. not one had mannaged to overcome the stench to stay and watch. i laughed. all my ego driven worries about what they would think of me were in vain. obviously if a surgeon nearly gagged then mere mortals (tongue in cheek, flamers) like medical students and doctors would obviously not be able to be in the near vicinity of such a thing.

the patient did well, got his elective colectomy the next week and went on his merry way.

Monday, November 19, 2007

GUEST POST: Fashion Statements (by Bongi)

Ladies and Germs ... Please give a hearty, clinically clean, surgically scrubbed welcome to our first guest poster - Bongi from Other Things Amanzi! Welcome my man...

This is part of a drive to get more contributions to All Scrubbed Up. We're about a year old now and readership is growing rapidly. More content for you, our medically minded audience.

This is part 1 of a 3 post series. If you like Bongi's work - TELL US! It's a fascinating insight into Mpumalanga medicine (and this time, what they wear!)

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Fashion Statements

sometimes we as surgeons are restricted by the most mundane of things. back in my kalafong days, more often than my first world visitors could imagine, entire theater lists would get canceled because of lack of theater attire (scrubs). this gave rise to a funny story and, indirectly to a more recent and somewhat more serious story.

story one.

i arrived in theater one morning in kalafong, ready and eager to operate. there were no theater pants, only tops. i quickly found out there were none available and the matron was on the verge of canceling my list. i checked my gas monkey (anaesthetist). he got one of the last pairs and was dressed for action. the sister was also appropriately attired. it was just me that couldn't enter the theater complex.

not to be blocked by such a minor thing, which was anyway an administrative error and therefore, i reasoned, should not disrupt theater lists, i made a plan. i took a sterile drape and wrapped it around my waist like a sarong and strutted out into theater.

my fashion statement it would seem was too much for the matron, because before i had made even 5 meters, she came rushing up to me with a clean pair of theater pants (she had apparently just created them from subatomic particles using a process of fusion) and insisted i go back to the change room to make myself decent. no fashion sense it seems.

the second story was more recently.

i was called to the theater at the local provincial hospital in the early hours of the morning. it seems they started a laparotomy for a gunshot abdomen and were now in deep water. i dived into my car (i reasoned i would soon be diving into their deep water with them and i wanted to get my eye in) and raced to the hospital, trying to fully wake myself up as i went. i parked and charged to theater.

there i encountered obstacle number one. the change room door was locked. no problem, i would just go in through the main door.

obstacle number two was the main theater doors had been locked using a piece of wood wedged through the door handles. i shouted into theater, but there was no reply. i reflected that, although they had called me in at some ungodly (but not unsurgical) hour, they had not allowed easy access. the telephone call had lead me to believe that the situation was critical. i could not let a mere locked door get in my way. i broke it down. inside i found one of the sisters sound asleep. my supplications to open the door as well as my violent attack on said door had, luckily, not disturbed her no doubt well deserved rest.

obstacle number three awaited me in the change room. there were no shirts. at this stage i was feeling slightly less than my usual cheery self. i was in no mood to waist more time. i dressed in theater pants and entered theater with a naked torso.

there was stunned silence. the medical officer was speechless. he started explaining his operative dilemma, but as he looked up and saw me he went quiet. if i wasn't in such a bad mood i'm sure i would have laughed. i started scrubbing. (i suppose i should say something like my godlike torso faintly illuminated by the one light in the scrub room, but that is implied, of course).

soon i was donned with the operating gown and got to work. no longer blinded with jealousy, no doubt, the medical officer found his voice again and could explain to me the situation. my mood also improved and soon the normal intraoperative banter was being exchanged as if it wasn't 3o'clock in the morning and as if the consultant hadn't just turned up half naked after breaking down the theater door and of course as if there wasn't someone whose life hung in the balance.

Tuesday, November 13, 2007

The World Famous All Scrubbed Up: "What is THAT?" Competition #2 Part 2 - The Answer!


Easy one? Last time I saw one of these I was a student... They're nice and rare... but GREAT to look at!

(Yech! - Andy)

It's a teratoma!

Great definition from Wikipedia..

A teratoma is a type of neoplasm (specifically, a tumor). The word teratoma comes from Greek and means roughly "monstrous tumor". Definitive diagnosis of a teratoma is based on its histology: a teratoma is a tumor with tissue or organ components resembling normal derivatives of all three germ layers. Rarely, not all three germ layers are identifiable. The tissues of a teratoma, although normal in themselves, may be quite different from surrounding tissues, and may be highly inappropriate, even grotesque (hence the monstrous): teratomas have been reported to contain hair, teeth, bone and very rarely more complex organs such as eyeball, torso, and hand. Usually, however, a teratoma will contain no organs but rather one or more tissues normally found in organs such as the brain, thyroid, liver, and lung.

Next time you feel a lump in your groin (and it's helluva painful) - it's more likely to be a ovarian torsion or appendicitis than a teratoma. Don't fret! Teeth and hair are probably NOT growing inside your groin (for men - the pain would occur in your testes - and then NO, it's not appendicitis).

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CONGRATULAIONS to EVERYONE. You're all bloody funny!

Friday, November 9, 2007

THe World Famous All Scrubbed Up: "What is THAT?" Competition #2 Part 1

Right. Next one!

THE CASE: 24 year old female presents with a lump in her right groin. Pain.

HINT: This "thing" can also occur in males.

Pretty, ain't it?

Wednesday, November 7, 2007

He drank so much - his liver split in half!

Spotted on Digg recently...

A young father who drank up to 15 bottles of wine a day died of cirrhosis so bad his liver had split in half, his family revealed yesterday.

Steven Massey, described as a 'Jack the lad', would drink his favourite Cassini sparkling perry 'just like he was drinking pop'.

The 21-year-old's death has devastated his parents and four older siblings, who hope his story will send out a shocking message about the perils of boozing.

I CANNOT believe that a 21-year-old could drink themselves to death!? Where the hell were the parents? Don't you think it's disgusting that you get first world countries where people are dying from social diseases.

Then I read a little further on, and this kiddie, Steven Massey, already has THREE CHILDREN! I ask again, where were the parents with the sex education (or at least a fuckin condom!). Bloody hell.

Split in half is fairly melo-dramatic. I guess it was so fragile, it just kinda fell apart. Lovely.

SA DOC's THOUGHT OF THE DAY: Social disorders are the hardest thing to deal with in society. You can't stop people drinking, having sex or taking drugs by reprimanding them. It takes a mindset shift. It takes a social change. And I hope to God first world countries out there (especially the ones who have a superiority complex over us third worlders) are doing something to fix this shit. Ahem. England.

Sorry about the anger, but I thought we only joked about towns where there was nothing to do except drink and have sex?

Tuesday, November 6, 2007

THe World Famous All Scrubbed Up: "What is THAT?" Competition #1 Part 2 - The Answer!

Ladies and Germs. I'm proud to announce the winner of the first World Famous "What is THAT?" Competition - ... BONGI! Nice one gal!

SA DOC says:

It's a multifibroid uterus. And yip, the story is true (some details have been changed to protect the patient). I'm not so sure why SA Surgeon (his alias) was so keen to take it out - usually gynae territory apparently.

Next competition coming soon!

(PS. Bongi - if you want your picture on the blog - drop your email in the a comment. AND... as a BONUS PRIZE - you get to write a guest post on SA's biggest medical blog. Keen? Drop us a line!)

Saturday, November 3, 2007

The World Famous All Scrubbed Up: "What is THAT?" Competition #1 Part 1

So here's an idea for the medics and non-medics amoung you. Welcome to the first installation of the All Scrubbed Up "What is THAT" Competition. From time to time, we'll post something up that I've either removed during a surgery - or that we've happened on across the medical web. Your job? Tell us what it is!

WARNING: The following images may not be suitable for children under the age of 16 - and squirmish males.

CLUE: 42 year old woman presents with growing mass in her abdomen for three years.

What is THAT? (Please post your answers as comments - winner gets... uh... their picture on the blog!)