Sunday, April 19, 2009

SurgeXperiences 221

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

It is always my pleasure to be the host of SurgeXperiences. I find myself reading and looking for more to bring to you. Let me begin by welcoming Someonetc back from his tour of duty in Iraq. Now maybe he’ll rejoin us in blogging again. I have missed his posts.
I would also like to congratulate Dr Bruce Campbell, Reflections in the Head Mirror, for the recent publication of his essay, The Code, in the April 8, 2009 issue of JAMA. Unfortunately it isn’t open access. Try to get a copy of the issue and read it. Well worth the effort.
Surgeons and Medical Folk
Bongi, other things amanzi, is imparting his wisdom to us in a series of his “surgical principles”:
#1 to swear does in fact help
#2 fear nothing but fear itself
#3 all bleeding stops
#4 enjoy
#5 it is in fact always the surgeon’s fault
#6 take a moment

Buckeye Surgeon gives us some Lap Chole tips.
I love LC. If I had to do 3-4 a day for the next 20 years I would be a happy general surgeon. It's an elegant operation. I haven't done thousands, but I've done enough where it's become almost automatic. I try not to waste any moves. Every act is purposeful. Rarely is there struggling or the sort of futzing around that can occur when doing a laparoscopic colon resection. So here are my tips:
1) Never use a Veress needle. Why blindly stick a needle into your patient's belly? It's ridiculous. I do an open Hasson insertion. It's not slower. It's definitely safer. It's a no brainer……………..
T, Notes of an Anesthesioboist, writes about “Surgeons v Anesthesiologist: Why the Tension?”
…………………On the whole, though, what I typically see is a lot of exasperation from surgeons whenever a medical condition precludes speedy progress to the O.R. – ……………… I always wonder: didn't they look through the chart themselves and see that the lab value was egregiously abnormal, or examine the patient and hear the lung crackles practically from across the room? Surely they, too, did a history and physical, as we're all expected to do?……………….
A good surgeon will also respect an anesthetist's or anesthesiologist’s instructions inside the O.R. when safety is at issue. Rarely have I seen this to be a problem. ………………But I did encounter one surgeon whose behavior I consider among the most appalling I’ve seen. I'll call her Dr. Myrtha Banshee…………
OR nurse Christina, Both Sides of the Mask, writes about her recent experience as a surgical patient in “please tell me”
In surgery, a huge amount of time and attention is devoted to the issue of on-time starts. Extra focus is often placed on the on-time starts for first cases of the day. ……….
When I was scheduled at Giant Hospital for my own surgical experience, I was delighted to get a Tuesday at 9:15am. ………
When the procedure had to be moved to Almost Giant Hospital, I was happy to keep the same day of the week, but obviously the time had to be changed……..
On my surgery day, I lay in the pre-operative area wearing one of those stylish gowns, watching the IV drip, and wishing time would move faster. …………..

A Chance to Cut is a Chance to Cure has returned to blogging and given us a new Tales from the trauma service XIX
Gentleman working on a landscape project. The worker above him falls and drops one of these on him:

And they strike him in the neck. He arrives alert and oriented, but every time he speaks or coughs air comes out of the wound on his neck. Off to the operating room..
More trauma. This tale from Karen Little, Just Up the Dose – Monday, Bloody Monday.
I was driving back to The Crater one Monday morning …….Running towards me from the other direction were a bunch of men in overalls - he'd just flown off the back of a lorry………
This guy was badly hurt. ………………. but as I did this his major injury became apparent. As we carried him, hot, sticky, bright red arterial blood pulsed out of his ear and over my hand - a textbook skull-base fracture, and a massive one at that.
(Via Uveal Blues) Eyeborg Project: An Exciting and Creepy Hack I Hope You Never Try -- Go watch this but remember
It goes without saying that experimenting with your eyesight is neither the easiest hack in the world or the safest, but apparently a few brave souls out there are driven to take it on regardless. The Eyeborg Project is the brainchild of one of those.
Bruce Campbell, Reflections in the Head Mirror, tells us about a patient in “Role Model”
Nothing has come easily. Her cancer was difficult to control and she required radiation and then extensive surgery and more radiation. The side effects led to additional treatments, a feeding tube, and expensive pain medications. ………………..Of course, to hear her tell the story, she is doing fine. She feels well and has adjusted reasonably well. She celebrates her freedom from cancer every single day.
I was worried, therefore, when she arrived for a follow-up visit. She looked distracted. I moved into position to perform the examination.
“What’s this?” I blurted out. “Have you started smoking again?”……………..
KeaGirl, UroStream, talks about “redemption” in her practice.
…………………..And then just yesterday, I had a patient come into the ER with testicular torsion. He was one of the rare patients who presented in enough time for me to swiftly whisk him to the OR and save his testicle! (there is a window of 6 to 8 hours before the testis undergoes permanent damage for lack of blood flow and oxygen, at which point I have to do an orchiectomy). I felt some degree of redemption, and all was right in the world again....
SandnSurf, Life in the Fast Lane, discusses the John Thomas Sign in trauma patients.
The sign tends to be commented on by middle-aged male radiologists and orthopedists suffering from Peter Pan syndrome. Some may even suspect an occult fracture purely based on the observed radiographic penile orientation. While this can clearly be very amusing (in the same way that some people can’t help but laugh when they hear the word “Uranus”) the question remains - is the sign actually of any use?
The Sterile Eye critiques some surgical videos in “10 Gory Surgeries Reviewed -- Part 1/2.” Who better to review the filming than “our own” medical photographer?
WIRED Science has put up an article with “10 Gory Surgical Triumphs on YouTube”. Although their approach is somewhat sensasionalist, the idea to collect surgical videos available on YouTube is good. It has actually inspired me to start a series of posts where I’ll pick a surgical video from YouTube every week and review it.
And here is “10 Gory Surgeries Reviewed – Part 2/2” just in time for this edition!
Scanman’s Casebook: Case 15 --- Really nice films of a “Large Ventricular Septal Defect with Coarctation of Aorta (Tubular Hypoplasia)” Please, go view the films with Vijay as your guide.
Dr Sanjya Gupta’s twitters – check out the x-ray of the spinal fracture! - more from the OR. take a look at this cervical spine CT. can you spot the problem? 7:39 AM Apr 15th
It is teardrop fracture C6. patient ejected from a car through the windshield. now, neurologically normal. tomorrow, will show you post op! 3:43 PM Apr 15th
Check out Buckeye’s string of large bowel obstructions (photo credit).
I've had a run of large bowel obstructions (LBO) lately. ……………... Cancer, volvulus, and hernias are the usual culprits and an operation is often mandated. A colonic obstruction is technically a surgical emergency. …..

Karen Little, Just Up the Dose, makes not one BUT two really nice surgical diagnoses with x-rays in “Best Week Ever.” Go over and see why she has a “big” head (photo credit). Good for you Karen!
A CCLMC medical student writes a post on “Tips for doing well in the surgery rotation.”
I think a lot of people are pretty intimidated by surgery, especially if you don't see yourself as the surgery type. But honestly, surgery is a lot of fun if you work hard and make an effort to learn how to be useful in the OR. Here are my tips for getting more out of your OR experience.
GrrlScientist, Living the Scientific Life, writes about how pioneering stem-cell research in race horses will help people with Achilles tendon injuries.
The move from clinical veterinary to human medicine is inspiring and unusual; we normally see the translation happening the other way around," said Nicola Maffulli, a sports medicine expert and orthopedic surgeon who will help conduct the trial.
More help for humans from our animal friends with a history of xenographs by Chris Sweeney “The Beast Within: Implanting Animal Organs into Humans”
Getting an organ these days is no easy task. Currently, there are more than 100,000 people on waiting lists for organ donations in the United States, but fewer than 30,000 transplants were performed in 2008. The Mayo Clinic estimates that in the United States, 17 people die each day while waiting for a suitable organ to come along………..
Still, the concept of cross-species transplantations is nothing new. As far back as 1889, physicians were shooting up slivers of dog and guinea pig testicles to study “human revitalization therapy.” Through the years, though, there has been significant progress made in the field, and biotech companies have invested heavily in developing transgenic animals and immunosuppressant drugs……………….
A public safety announcement for bloggers from Sheepish, The Paper Mask -- is a Fraudulent Scam. Go read the entire post.
I can't make it much simpler than that, can I?
and another post from Sheepish on Meeting Fatigue

Barry, An Explorer’s View of Life, describes his “First Meeting with the Surgeon”
This is a preliminary meeting he tells us. He would just like to go over the probable fate that awaits me, but the specific plan will have to wait for the results of the CT scan on Monday.
The usual course of treatment involves 3 months of combined chemo and radiation therapy at Princes Margaret Hospital to shrink the tumor in my throat followed by the removal of half my esophagus and half my stomach. They will use my stomach to rebuild the missing esophagus because it is composed of the same material as my throat. The surgery will require me to be in hospital for ten days to two weeks followed by five to six weeks recovery at home.
I will need five months off work. If all goes well.
Linda has turned pale at the mention of the removal of half my stomach and I can only wonder what my face looks like.
Follow up with these posts by Barry:
* Immediately (Part 2) And Then Then News
* Answers (Part 2) And A Big New Question
* My Decision and Why I Made It

Surgeon Heals Patients and Their Violent Ways
Dr. Carnell Cooper, a Baltimore surgeon, is saving lives inside and outside the operating room.
Dr. Carnell Cooper's Violence Intervention Program provides training and support to trauma victims.
Since becoming a trauma surgeon 16 years ago, he has dedicated himself to treating the many young African-American men who've been shot, stabbed or beaten, only to see them return to the ER with another severe injury just months later…………..
“Finders Keepers”, a story about a little boy who is going to have heart surgery.
Tomorrow morning,” the surgeon began, “I’ll open up your heart…” “You’ll find Jesus there,” the boy interrupted.
The surgeon looked up, annoyed. “I’ll cut your heart open,” he continued, “to see how much damage has been done…” “But when you open up my heart, you’ll find Jesus in there.”
The surgeon looked to the parents, who sat quietly. “When I see how much damage has been done, I’ll sew your heart and chest back up and I’ll plan what to do next.” ……………………

Surgical Humor
Why it’s past time for GPS in the OR (via Book of Joe)
The Mechanic vs the Heart Surgeon (via Jeffrey, Vagus Surgicalis)
Cast Anatomy (via Street Anatomy) with explanation here. You really must go see these casts. It’s enough to make you wish you had a broken arm!

News Items
* Double Hand Transplant Awakens Brain Control --
The brains of patients who've received double hand transplants can recreate lost neurological control systems, according to new brain data from a French surgical team.
* Kuwaiti surgeon succeeds in neurosurgery operation implanting two batteries in the spinal cords of patients who have difficulty in walking.
* Second U.S. Face Transplant Performed in Boston on a man who lost the middle of his face in a freak accident.
* SoCal Docs Help Woman With Severe Deformity: Rodarte's face covered in tumors
At an early age, tumors began to grow on Ana Rodarte's face. By age 25, her advanced neurofibromatosis had deformed the left side of her face, leaving her homebound and unable to see out of one eye.
* That’s Sp-early Got to Hurt
Docs had to remove a SIX INCH fishing spear from this clumsy fisherman's brain after he managed to fire it into his own head.
* Yemeni surgeon to leave Gitmo
Ayman Batarfi, 38, told a military review panel that he was a humanitarian worker who found himself at the battle of Tora Bora while Osama bin Laden was in the area, according to a Pentagon transcript. He was captured in Afghanistan and sent to the prison camps here in 2002.
* 5 cm. fir tree removed from patient’s lung (photo credit)
A five-centimeter fir tree has been found in the lung of a man who complained he had a strong pain in his chest and was coughing blood.
The 28-year-old patient, Artyom Sidorkin, came to a hospital in the city of Izhevsk in Central Russia last week,
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SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit. The next edition will hosted by Bongi, other things amanzi, on Sunday, May 3rd. The deadline for submissions will be midnight on Friday, May 1st. Be sure to submit your post via this form.
Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.


Anonymous said...

Nice edition, as always! Thanks for including me!

Karen Little said...

Nicely done! Thanks for including me as well :)

Christina said...

Terrific collection, Ramona. Thank you very much for including my post!

Jeffrey Parks MD FACS said...

best one I've seen done. Great work, Ramona