Har! Har! From AHAJokes...
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Sunday, June 21, 2009
Saturday, January 17, 2009
Monday, June 30, 2008
MindBullet: Take 2 Aspirin and We'll Google You in the Morning...
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.
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.
Tuesday, March 25, 2008
GUEST POST: Lobotomy Revisited (by Brian Carty)
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 were drilled in the skull and a blade was used to cut nerve fibers from the frontal lobes (the front of the brain, just behind the forehead) to the rest of the brain. The term lobotomy came to include a variety of surgical procedures on the frontal lobes which were performed for psychiatric disorders.
An estimated 50,000 lobotomies were performed in the US in the 1930s and 40s. Although electroconvulsive therapy was introduced in the 1930s, it is useful mainly for the treatment of depression. Otherwise, before effective psychiatric drugs were available in the 1950s, the only other treatments for the severely mentally ill were incarceration and physical restraint.
By today’s standards, conditions in the mental hospitals of the time were unimaginable. Many patients were severely agitated, extremely violent, and incontinent. The hospitals were dirty, overcrowded, and understaffed.
Many severely ill patients benefited from lobotomy with decreases in violence and agitation. However, lobotomy often caused serious adverse effects, including disturbances of mood and personality, euphoria, poor judgment, impulsivity, loss of initiative, intellectual deficits, and seizures.
For many patients, however, a decrease in agitation and violence, even when accompanied by neurologic injury from frontal lobe surgery, was understandably considered an improvement. When the first effective antipsychotic drug, Thorazine (chlorpromazine), was introduced in the US in 1954, the number of lobotomies performed plummeted.
Surgery for psychiatric disorders is still performed rarely today. The procedures have become more selective and less extensive and now include deep brain stimulation with implanted electrodes. Similar surgical procedures and deep brain stimulation are sometimes done for movement disorders and chronic pain. Surgery for psychiatric disorders is still controversial and, when performed, is most often used for treatment-refractory obsessive-compulsive disorder (OCD). OCD is a disorder characterized by obsessive thoughts and compulsive behaviors such as repeated hand washing or checking to see if doors are locked. OCD can severely affect functioning and quality of life.
It is worth noting again that surgery for psychiatric disorders must be judged with reference to conditions which existed at the time the procedures were introduced. Although lobotomy is viewed by many as barbaric, the operation gave many patients a limited improvement which was otherwise unobtainable. The wisdom of hindsight should be applied sparingly; newly introduced medical treatments often cause unintended harm. The history of lobotomy should remind us that future generations will inevitably view our current best treatments as primitive.
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 were drilled in the skull and a blade was used to cut nerve fibers from the frontal lobes (the front of the brain, just behind the forehead) to the rest of the brain. The term lobotomy came to include a variety of surgical procedures on the frontal lobes which were performed for psychiatric disorders.
An estimated 50,000 lobotomies were performed in the US in the 1930s and 40s. Although electroconvulsive therapy was introduced in the 1930s, it is useful mainly for the treatment of depression. Otherwise, before effective psychiatric drugs were available in the 1950s, the only other treatments for the severely mentally ill were incarceration and physical restraint.
By today’s standards, conditions in the mental hospitals of the time were unimaginable. Many patients were severely agitated, extremely violent, and incontinent. The hospitals were dirty, overcrowded, and understaffed.
Many severely ill patients benefited from lobotomy with decreases in violence and agitation. However, lobotomy often caused serious adverse effects, including disturbances of mood and personality, euphoria, poor judgment, impulsivity, loss of initiative, intellectual deficits, and seizures.
For many patients, however, a decrease in agitation and violence, even when accompanied by neurologic injury from frontal lobe surgery, was understandably considered an improvement. When the first effective antipsychotic drug, Thorazine (chlorpromazine), was introduced in the US in 1954, the number of lobotomies performed plummeted.
Surgery for psychiatric disorders is still performed rarely today. The procedures have become more selective and less extensive and now include deep brain stimulation with implanted electrodes. Similar surgical procedures and deep brain stimulation are sometimes done for movement disorders and chronic pain. Surgery for psychiatric disorders is still controversial and, when performed, is most often used for treatment-refractory obsessive-compulsive disorder (OCD). OCD is a disorder characterized by obsessive thoughts and compulsive behaviors such as repeated hand washing or checking to see if doors are locked. OCD can severely affect functioning and quality of life.
It is worth noting again that surgery for psychiatric disorders must be judged with reference to conditions which existed at the time the procedures were introduced. Although lobotomy is viewed by many as barbaric, the operation gave many patients a limited improvement which was otherwise unobtainable. The wisdom of hindsight should be applied sparingly; newly introduced medical treatments often cause unintended harm. The history of lobotomy should remind us that future generations will inevitably view our current best treatments as primitive.
Wednesday, March 5, 2008
Tooth gives man his sight back
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 of the jaw.
McNichol's right eye socket was rebuilt, part of the tooth inserted and a lens inserted in a hole drilled in the tooth.
The first operation lasted 10 hours and the second five hours.
"It is pretty heavy going," McNichol said. "There was a 65% chance of me getting any sight.
"Now I have enough sight for me to get around and I can watch television. I have come out from complete darkness to be able to do simple things," McNichol said.
Will have to wait for SA Doc to get back from her managed health care world and explain to me the differences between enamel and eyes. :)
Thanks Toby Shapshak for the story...
Monday, February 4, 2008
Ready! Aim! Operate on my back please!
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 to monetary greed on the part of certain local surgeons (believe me... when we're looking at funding requests, we see large subsets from the SAME neurosurgeons, and the SAME areas of the country). Sniff sniff. I smell a pattern.
Back surgery is dangerous... not necessarily curative, and often leads to repeat surgeries. Yet in South Africa, it's itchy trigger fingers all round. I think South Africa (neurosurgeons, medical schools and possibly funders) need to have a serious look at the indications for doing back surgery.
Or before long, we'll set a precedent that could rather have been controlled by Celebrex.
(PS. The surgeons in this picture were ripped straight off the Internet and have NOTHING to do with this article! If you're a back surgeon, send All Scrubbed Up your picture... We'll post your picture up with dollar signs. For free.)
Sunday, January 27, 2008
The ethics of liver transplants for alcoholics...
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 to become eligible for a transplant, they need to have shown a period of abstinence and/or a period of rehabilitation. Usually 6 months.
After this period - does that make them deserving of a liver transplant? Should the guidelines be abolished as people who are alcoholics have a disease "that they are not in control of"? Even if you will continue to drink and destroy your new liver?
Should self-induced liver disease be deserving at all (taking into account the more deserving children and adults out there, who have had no control of the cause of their liver failure)?
What do you think?
Personally, I will tell the Organ Donation Society NOT to give my liver / organs to anybody who has not been substance abuse rehabilitated. Full stop.
Saturday, January 26, 2008
Wednesday, January 23, 2008
Live Surgery #1 - Open Heart Surgery
Who would've thunk it? The world's video viewing spot of choice, YouTube, has live surgery.
Lock away the kids!
Lock away the kids!
Thursday, December 6, 2007
GUEST POST: Superhero Surgeons - It ain't all Sex, Drugs & Rock 'n Roll (by Bongi)
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 stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.
then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.
the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...
“colon? yes. cut? no”
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 stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.
then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.
the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...
“colon? yes. cut? no”
Monday, December 3, 2007
Designer Surgical Masks
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
Headgear #2
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.
- - - - -
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.
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 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.
Tuesday, November 13, 2007
The World Famous All Scrubbed Up: "What is THAT?" Competition #2 Part 2 - The Answer!
SA DOC:
(Yech! - Andy)
It's a teratoma!
Great definition from Wikipedia..
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).
- - - - -
CONGRATULAIONS to EVERYONE. You're all bloody funny!
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).
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?
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?
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:
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!)
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!)
Update: ANSWER HERE!
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!
Monday, August 6, 2007
Pregnancy without a Uterus?
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.
And the point of the tale...
It just proves that you don't need to have a uterus to have a pregnancy... You know it's coming! Next post...
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.
And the point of the tale...
It just proves that you don't need to have a uterus to have a pregnancy... You know it's coming! Next post...
Tuesday, July 3, 2007
The price of life…
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 hospital – just for a few months. Remember, you don’t just skip out happy the next day – it takes TIME to recover from hefty procedures.
I’d rather take my wealth and spend it lavishly to live my remaining days on a deserted island somewhere.
So I told the surgeon…”If you ever open me up, and see the pancreatic tumour, please close me back up and send me packing to the Bahamas!”.
I don’t know if I’m right. But it sure got me thinking.
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 hospital – just for a few months. Remember, you don’t just skip out happy the next day – it takes TIME to recover from hefty procedures.
I’d rather take my wealth and spend it lavishly to live my remaining days on a deserted island somewhere.
So I told the surgeon…”If you ever open me up, and see the pancreatic tumour, please close me back up and send me packing to the Bahamas!”.
I don’t know if I’m right. But it sure got me thinking.
Tuesday, June 12, 2007
SA Doc stuck in a WHIPPLE...
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 the Whipple surgery, the experience of the center and the surgeon is important. At USC, Dilip Parekh M.D. has performed more than 100 consecutive Whipple type of procedures over the past 9 years with good outcomes.
What is a Whipple operation?
In the Whipple operation the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed. Occasionally a portion of the stomach may also be removed. After removal of these structures the remaining pancreas, bile duct and the intestine is sutured back into the intestine to direct the gastrointestinal secretions back into the gut.
Shudder. I hope the poor guys duodenum isn't useful! More info here.
PS. Took a flyer on the picture. SA Doc can confirm the gory truth tomorrow.
Monday, June 4, 2007
Med student dissecting kit. Buy now!
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 # 38|
- Teasing needle straight with metal chuck | Part # 37 |
- Iris scissors fine point 4.5" | Part # 9 |
- Surgical scissors 5.5", one point sharp and one point blunt | Part # 5SB |
- Cartilage knife | Part # 26 |
- 1 x 2 Teeth tissue forceps 4.5" | Part # 13-T |
- Scalpel handle # 3 | Part # 27 |
- Scalpel blade # 10, pack of 10 blades | Blades for handle # 3 |
- Mall probe chrome plated | Part # 36 |
- Hemostatic forceps 5", Curved | Part # 45CD |
- Ruler 6" plastic ( Part # 30)
Buy it here, if you dare.
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 # 38|
- Teasing needle straight with metal chuck | Part # 37 |
- Iris scissors fine point 4.5" | Part # 9 |
- Surgical scissors 5.5", one point sharp and one point blunt | Part # 5SB |
- Cartilage knife | Part # 26 |
- 1 x 2 Teeth tissue forceps 4.5" | Part # 13-T |
- Scalpel handle # 3 | Part # 27 |
- Scalpel blade # 10, pack of 10 blades | Blades for handle # 3 |
- Mall probe chrome plated | Part # 36 |
- Hemostatic forceps 5", Curved | Part # 45CD |
- Ruler 6" plastic ( Part # 30)
Buy it here, if you dare.
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