surgery blog for surgeons
This is the third part of the posting series “The process of organ procurement”. Please start with the first and second part if you have not done so.
The cold dissection is the part with the most surgical variants and I want to stress again the fact that the described way is the one that I use, well knowing that this is only one of many possible ways to perform an organ procurement in general and a cold dissection in particular.
This is the second part of the posting series “The process of organ procurement”. Please start with the first part if you have not done so.
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The preparation in the OR includes placing of two electrosurgery (”Bovie”) pads and two suction lines.
I usually fixate both arms next to the body unless the anesthesia colleagues have a good reason for extending one or both of them. Shaving and decontamination of the skin I perform only in a line about 5-10 cm on both sides of the midline as I never make lateral incisions.
There are many ways performing most of the surgical procedures. Everyone of the surgeons has established a way to go for a particular surgery that s/he is most familiar with and trusts the most. In this series of postings (”The process of organ procurement”) I will describe the way I perform the liver and kidney procurements in a Standard Criteria Donation (SCD) situation.
Continue Reading »
Recently I had an interesting case with a weird behavior of a suspected metastasis after resection of the primary tumor.
Description
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 3rd 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.
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.
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!
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.! :)