Surgery for Surgeons

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 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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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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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 »

A 75 yo, previously completely healthy patient came to my ER and complained about upper GI pain for 3 days, no other complains. The exam showed a very painful and tense abdominal wall upon pressure. Labs got some elevated WBC (11.2 Bil/l) without elevated CRP or any other parameter. The abdominal plain is shown on the right (click the thumbnail for a larger view).

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Yesterday I saw a 20yo female patient who was a driver of a dialysis transport service. It was a very rainy day in Frankfurt and suddenly, in the evening, she slipped with the car (a VW one!) and hit а piller. The airbag opened then against her left forearm which still holded the wheel. Continue Reading »