Surgery for Surgeons

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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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.! :)

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”.

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A very interesting trial was published in the current issue of “Archives of Surgery“. The clear conclusion is: “Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.”

In discussions with colleagues we compared many times the endoscopy (gastroscopy and colonoscopy) with a video game. The students found this talks very funny. Now we have the “proof”! :)

So, dear surgeons: take a good computer machine and play! Play for the sake of your patients! :)

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 »

First results of the EVA-3S trials were recently published in the NEJM. The conclusion is clear: “In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.”

OK, I am a surgeon and have the thinking of a surgeon. I always had a bad feeling regarding the carotid stents. The idea of a uncovered stent, pressed against the plaques on the carotid bifurcation, made me feel uncomfortable.
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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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Once again a mid 2004 multicenter trial but very interesting because of the high relevance in the daily practice of surgery.

The conclusion is straight and clear: “..for primary hernias, the open technique of tension-free repair is superior to the laparoscopic technique, both in terms of recurrence rates and in terms of safety.”

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This is a somehow old (mid 2004) but nevertheless very important multicenter trial which aroused my interest due to the fact that I do laparoscopically (hand)assisted colectomies.

The conclusion is: “..the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer”.

Though, “no advantage of laparoscopically assisted surgery was evident with respect to either all stages of cancer or high-risk subgroups”. The collecting of data for the trial began 1994. Therefore the new, hand assisted approach in the laparoscopic surgery, could not be considered.

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A recent publication from the laboratory institute in the university clinics in Hamburg, Germany discusses a new approach to diagnosing colorectal carcinoma: detection of tumor DNA in stool samples. Here is the abstract of the publication in the german “Aerzteblatt”:

Detection of tumour DNA in stool is a new screening approach aimed at improving the early diagnosis of colorectal cancer. DNA from colorectal adenomas or carcinomas can be detected using specific mutations or methylation patterns. Altered DNA can in principle be detected in a high excess of normal DNA with high sensitivity, but low cost routine screening assays have yet to be developed. The combination of markers and methods must be refined to detect early stage tumours reliably. Only a test with high sensitivity could replace colonoscopy as the recommended screening method in the future.