All Scrubbed Up

Har! Har! From AHAJokes ...

Yikes. Click on the image to enlarge.

Excellent MindBullet from MindBullets.net . They're weekly doses of futurism - health related in this instance... SA Doc's analysis . It could happen - give it a couple of years. In South Africa, we're in a little bit of a pickle though. No online consultations are allowed - HPCSA law dictates you have to "touch" a patient in order to provide a medical service.

The second guest post from Brian Carty of Hot Medical News , covering the... well, less-covered side of medicine! Enjoy "the history of the lobotomoy"! There's a great video that goes along with this post. Watch it here . By Brian Carty, MD, MSPH March 25, 2008 Do you remember Rosemary Kennedy, John F. Kennedy's sister? Maybe not, since she spent most of her life hidden away in an institution in the Midwest. She had a lobotomy, a brain operation for mental illness, in 1941 when she was 23. Her father, Joseph Kennedy, arranged the operation. The procedure left her mentally incapacitated. Whether she was mentally ill, mentally retarded, or both, is unclear, but her disruptive behavior led to the operation and its unfortunate outcome. She died of natural causes on January 7, 2005 at the age of 86. The lobotomy, also called leucotomy, was devised in 1935 by the Portuguese neurologist Egas Moniz for the treatment of various psychiatric disorders. In this procedure, holes w...

HUH? Wat die donder? 27/02/2008 21:16 - (SA). AFP Dublin - An Irishman blinded by an explosion two years ago has had his sight restored after doctors inserted his son's tooth in his eye, he said on Wednesday. Bob McNichol, 57, from County Mayo in the west of the country, lost his sight in a freak accident when red-hot liquid aluminium exploded at a re-cycling business in November 2005. "I thought that I was going to be blind for the rest of my life," McNichol told RTE state radio. After doctors in Ireland said there was nothing more they could do, McNichol heard about a miracle operation called Osteo-Odonto-Keratoprosthesis (OOKP) being performed by Dr Christopher Liu at the Sussex Eye Hospital in Brighton in England. The technique, pioneered in Italy in the 1960s, involves creating a support for an artificial cornea from the patient's own tooth and the surrounding bone. The procedure used on McNichol involved his son Robert, 23, donating a tooth, its root and part o...

Working for a managed care company, I am observing the high number of spinal surgeries that take place in the market (and just think that, what a funder sees is only a fraction of what is actually happening in South Africa...) South Africa is known to have a low threshold for doing spinal surgery. In the UK, you would have to go through a lot of conservative therapy and years of waiting... AND have severe disease in order to get an op. Here, we see many neurosurgeons going in to do fusions or disc replacements sometimes without severe disease, sometimes even without conservative treatment! Is this due to the patients who put so much pressure on surgeons to do something about their pain? Sometimes I think these people fit into their own subset, and should be defined by psychiatry for a new personality disorder. We get a constant stream of calls - all exactly the same personality types - fighting tooth 'n nail to get a surgery for disease that is very mild on their MRI. OR. Is it due...

Read an article on the front page of the Citizen , about Discovery Health (Bongi's favourite) refusing to fund a liver transplant on what seems like suspicion of alcohol abuse. So I want to debate transplants. And the ethical eligibility to receive one. Liver transplants spring to mind. Many conditions cause end-stage liver disease that would then require a liver transplant for survival. Livers are a scarce resource that do not become available everyday. For instance, in the UK, 17000 people are waiting for a liver transplant. If you're lucky, between 50 and 200 become available every year. So, how do you allocate organs appropriately and fairly? Do you want to give a liver to a person, who through large consumption of alcohol caused cirrhosis? Or do you want to give it to a child, who through no fault of their own, has biliary atresia. Or to a woman who developed auto immune hepatitis? Most international guidelines say that for a person who has alcohol-induced liver failure t...

Is it just me? Or is that thing beatin' fast!?

Who would've thunk it? The world's video viewing spot of choice, YouTube, has live surgery. Lock away the kids!

Welcome to the third, in an initial series of 3 guest posts by our Mpumalanga HeavyWeight... Bongi. He's witty, he's irreverant - he's a little whack. But it's all in the name of demystifying the doctor. Or not. Enjoy SUPERHERO SURGEONS - It ain't all Sex, Drugs & Rock 'n Roll! If you like Bongi's work - visit him here ! Wear a glove. Spread the love. - - - - - yes i have an alter ego. yes, i dress in funny clothes with a cap covering my head and a mask covering my face. and yes, dressed as such i try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). i am ... a superhero. but there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people. a common cold behind a theatre mask is no small thing. remember you can’t blow your nose. sniffing loudly only works for a while and attracts all sorts of strange star...

What will they come up with next? I must say, I fear any surgeon more interested in the effect of his headgear than my gaping wound. Headgear #1 Headgear #2

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 . - - - - - 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 ...

SA DOC: 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, thyr...

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?

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!)

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!) Update : ANSWER HERE !

When I was still in medical school we had a very unusual case come to Groote Schuur Hospital . A woman had an ectopic preganancy in her liver. Tasty. Now for those of you who don't know... or for some sicko Intern-like reason, are interested... An ectopic pregnancy simply means a pregnancy that occurs outside the uterus. Almost 100% of these will never survive as most ectopics implant into the tiny fallopian tube. At 8 weeks, the fallopian tube bursts as it cannot contain the growing fetus. Then, it's surgery and the usual save-her-life type stuff. Remove the tube, decrease fertility - but keep the patient. A delicate balancing act, no? But, there is an exception every rule - sometimes - very rarely, the egg retrogradely moves out the fallopian tube into the abdomen and implants itself onto the bowel or peritoneal lining or, in this case, the liver... This woman, with the help of some amazing Obstetricians and surgeons (to save her life and stuff) delivered a healthy baby girl...

I’m back! Article about flying patients around soon. With photographic evidence… But first. Helping with the Whipples the other day got me thinking. The patient in question has a really bad Pancreatic Carcinoma and has quite severe abdominal pain. The prognosis is poor. Probably 3 months. By doing this palliative whipples (you can do the op for other reasons) - she will first need to recover, but then should have less pain. The catch is - she is still going to die. We have not solved her cancer problem. We have probably extended her life by 9 months. Here’s the second catch. She has no medical aid. All the theatre costs, ICU, ward stay, doctor and anaethetist will be paid out of her pocket! It could come to a quiet R100k. Now is that worth it? Many would say yes. You can’t put a price on life can you? But I’m skeptical. If I had pancreatic cancer, and I had 3 months to live, I wouldn’t want to spend my money having a huge operation, whiling away the time, drugged up in hos...

Hehe. Just phoned SA Doc, only to have a scrub sister (I think they're called that) answer the phone. SA Doc, apparently, has her hands so deep inside someone the phone would surely get lost. It's a whipple... that's been going on for 8 hours. I don't even know what a whipple is! Sounds dangerous. When in doubt, Google it. As long as its not a symptom, remember... The Whipple operation was first described in the 1930’s by Allan Whipple. In the 1960’s and 1970’s the mortality rate for the Whipple operation was very high. Up to 25% of patients died from the surgery. This experience of the 1970’s is still remembered by some physicians who are reluctant to recommend the Whipple operation. Today the Whipple operation has become an extremely safe operation in the USA. At tertiary care centers where a large numbers of these procedures are performed by a selected few surgeons, the mortality rate from the operation is less than 4%. Studies have shown that for good outcomes from...

I'll never understand these bloody med students. They're quite serious about selling you the following piece of hardware. And I say hardware because, well, you kind of expect this to come out in a movie like SAW . Feast your eyes on the cold steel available for just under $30! AMA-approved anatomy dissection kit for first year medical students! The American Medical Association (AMA), America�s most prestigious medical organization, worked in conjunction with DR Instruments, professors, and medical students to design this kit for first year medical students. The 10GSM kit contains the most widely used dissection tools for first year anatomy classes. DR Instruments offers over 125 dissection tools including a wide range of dissection kits for medical school anatomy classes. To purchase additional or replacement tools, please click on the part number for more information and to place your order!! 10GSM kit contains following tools: - Teasing needle bent with metal chuck | Part # 3...