surgery blog for surgeons
{ Category Archives }
Yesterday I had a patient who had a Mitrofanoff procedure in the past and I decided to take a look at the literature about this interesting approach.
A PubMed search for “Mitrofanoff” showed 416 articles as of today. Among them, a recent educational article gives a nice overview over the topic. Continue Reading »
The initial hype about NOTES is over!
This is such a good news that I couldn’t resist starting with it. :)
I wrote twice about this topic and not only my opinion didn’t change, I noticed that the general perception regarding NOTES is meanwhile clearly negative. Even people who are usually more open to new approaches share this position now.
Surgeons need new challenges though and the Single Incision Laparoscopic Surgery (SILS) is offering some. Recently I was on Grand Rounds where a general surgeon from a private practice shared his thoughts and experience with the auditorium about SILS. I was hoping that he would focus more on review of the (still scarcely) available data. He decided to just present some of his cases though: just cholecystectomies.
Here are my impressions from this talk: Continue Reading »
The introduction of the 80-hours week for the residents in the USA brought a lot of unhappy faces in the faculty members. Ever since then the residents have to listen to “what-do-you-know” and “when-I-was-a-resident” stories on a daily basis. The generation conflict is remarkably expressed in these conversations and it is caused solely by the attending physicians. They urge the residents to protest against these rules arguing that working more than 80 hours per week is essential for a sufficient education. Continue Reading »
Acute anemia is a common reason for transfusion of blood products. The hemoglobin (Hb) threshold for correcting anemia has been a hot topic of discussions for a long time. Here I would like to share my experience and thoughts about this very surgical issue.
About 15 years ago I listened to a talk that was given by a German gastroenterologist who worked at that time in Malawi, a small country in the southern part of Africa. Among other interesting stories, he said that they did not even think about blood transfusion unless there is the number 4 (four!) before the comma in the Hb g/dl level. This was due to a relative lack of blood products but he said also that they never had any problems related to uncorrected acute anemia.
We should assume though, that most of the patients there are generally in a better health that the average patient in the Western world, mostly because of the short life expectancy and very low rate of chronic diseases like Diabetes or Hypertension. Also, as one of my current mentors noted, the rate of patients with sickle cell anemia might be significantly higher there. These patients tend to tolerate much lower Hb levels. Continue Reading »
I have to admit, like many colleagues, I believed for many years that giving Flagyl (Metronidazole) for C. diff. colitis should happen only PO. Now I was corrected.
Recently one of the transplant surgeons in the hospital I work in suggested IV Flagyl for a patient with this diagnosis and I objected. She told me that this is a common mistake and comes most probably with the fact that Vancomycin should be given definitely PO for C. diff. colitis.
When I went home, I couldn’t go to bed until I found some papers about this. Well, of course she was right! :)
Searching PubMed for “intravenous[Title] AND metronidazole[Title] AND clostridium[Title] AND difficile[Title]” gave this result. I pulled the articles from the local electronic database of the hospital and… they convinced me.
Even given PO the drug acts by being first absorbed systemically and its concentration in the mucosa of the bowel is what works then again the bacteria. The PO therapy is cheaper but not superior than the IV one.
Again: Flagyl can be given IV for treating Clostridium difficile colitis!
Good to know!
Thanks to the nice surgeon who pointed this for me! :)
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.
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.
In the beginning of the most medical books, one can read that the medicine (and of course the surgery) is an ever growing field. Now we know that the laparoscopic cholecystectomy is a good idea, whereas the laparoscopic hernia repair is not a good one. The evidence based knowledge doesn’t need much trials. Therefore I dare to share some thoughts about a recent discussions concerning minimizing the “Minimal Invasive Surgery”.