Surgery for Surgeons

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.

The guys of the Mayo Clinic performed an interesting retrospective study about new-onset diabetes as a marker of underlying pancreatic cancer. They found that approxymately 1% of diabetes subjects aged > or =50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes.

Especially in patients with a positive family history for pancreatic carcinoma and a new-onset of DM a suggestion of a follow up would be a good idea.

The day before yesterday I did a cholecystectomy of a patient with a stone passage and elevated transaminases, alcaline phosphatase and bilirubine. At the laparoscopy we saw a liver in an advanced stage of cirrhosis. This explained the preoperative estimated splenomegaly and a consecutive thrombopeny. We discovered that the reason for the liver cirrhosis was a hepatitis C. Neither this condition, nor the cirrhosis or any other finding were known previously. The 46 yo patient lives in Marocco visiting now his brother in Germany and told us that he rarely goes to a physician, who lately (about a year ago) found a diabetes and nothing else (!).

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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 »