Top ten US hospitals in 2011 – 2012

Best Hospitals

  1. Johns Hopkins Hospital, Baltimore
  2. Massachusetts General Hospital, Boston
  3. Mayo Clinic, Rochester, Minnesota
  4. Cleveland Clinic, Cleveland
  5. Ronald Reagan UCLA Medical Center, Los Angeles
  6. New York-Presbyterian University Hospital of Columbia and Cornell, N.Y.
  7. UCSF Medical Center, San Francisco
  8. Brigham and Women’s Hospital, Boston
  9. Duke University Medical Center, Durham, N.C.
  10. Hospital of the University of Pennsylvania, Philadelphia

Best Hospitals by Speciality

Cancer:

  • University of Texas M.D. Anderson Cancer Center. Houston, TX
  • Memorial Sloan-Kettering Cancer Center. New York, NY
  • Johns Hopkins Hospital. Baltimore, MD

Cardiology:

  • Cleveland Clinic. Cleveland, OH
  • Mayo Clinic. Rochester, MN
  • Johns Hopkins Hospital. Baltimore, MD

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Ureterolithotripsy

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Basic equipment to perform semi-rigid (endoscopic) ureterolithotripsy for lithiasis of the lower third of the ureter.

We use an ultra-thin uretero-renoscope and a lithotriptor (Swiss Lithoclast 2), the stone is fragmented and extracted from the ureter. Results are excellent.

Soon, I’ll upload a video to show you how it is done.

Recto-Vesical Fistula

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Recto-vesical fistula is an anomalous communication (fistulous tract) between the bladder and the rectum. The common etiologies are diverticulitis, Crohn’s disease, irradiation, traumatic, bladder or colo-rectal cancer and tuberculosis.

Common symptoms of presentation are fecaluria (presence of feces in the urine), pneumaturia (passage of gas in the urine), hematuria (presence of blood or clots in the urine), intestinal symptoms, abdominal pain, and fever/chills.

Evaluation: urine test (urinalysis) shows food fibers, fecal particles, bacteria, white blood cells and red blood cells.

Cystography shows fistulous tract and bladder inflammation, as seen in this picture, which is a diagnostic/evaluation method barely used because of availability of CT scans.

Later I will give you the fast facts about treatment of this condition.

SurgeXperiences 3.23

It’s an honor and pleasure to bring you this new edition of The Best Surgical Grand Rounds Carnival.

FIFA WORLD CUP – SOUTH AFRICA 2010

I would like to express my gratitude to Jeffrey Leow of Vagus Surgicalis (Australian medical student with lots of interest and knowledge of surgery) and the creator of this Great Carnival. Australia is in Group D.

Bongi, a lucky SouthAfrican general surgeon who will host the FIFA World Cup in 12 days, shares a story that will push you to learn Afrikaans. South Africa will be head of the Group A and will play with México, Uruguay and France.

rlbates, my favorite (female) plastic surgeon who lives to sew, wrote an excellent review of Scalp avulsion injuries. USA will play against England, Algeria and Slovenia in Group C.

Techknowdoc, a surgeon part of the Indian Medical Industry, shares his point of view about antibiotics use in abscess drainage. Match ball are made of latex bladder of India.

Julia wrote a comparison between nursing informatics and medical informatics, both are related, they are not exactly the same. Julia is an italian name; Italy is head of the Group F and will play against Paraguay, New Zeland and Slovakia.

Medical Transcriptionist, published an article that states the need for nurses and other medical professionals increase with the demand of elderly health care, as in France. France is part of the Group A and will play with México, Uruguay and the host South Africa.

From DrDJ, a surgical case of a giant condyloma acuminatum (also know as Bushke-Löwenstein tumor) and follow-up. Abraham Buschke was a German dermatologist. Germany is head of Group D.

Agravated DocSurg, wrote his 4th test of OR Rorschach. Very Creative. Hermann Rorschach was a swiss psychiatrist. Swiss is in Group H, with Spain, Honduras and Chile.

From Boobcast; writings of a woman’s bad boob job. Finally she got her nipple reconstruction procedure done which includes a video. She is from US, but in Group C is England.

Madoline Hatter presents 50 Great Sites for Menopause Support posted at Nursing School Search Blog. Magdalena is Madoline in Portuguese. Portugal is in Group G, with Brazil.

Dr. Armughan Riaz is a cardiologist from Pakistan; he wrote an article of foods that can lower blood sugar. The Greek term Diabetes, means “one that straddles”. Greece is in Group B.

I have to thank all participants, all publishers and specially all of our readers.

World Cup objectives:

  • Developing the game
  • Touch the world
  • Build a better future

Uric acid nephrolithiasis

Kidney stones (nephrolithiasis or urolithiasis) affect approximately 12% of men and 5% of women during their lifetime. Nearly half of all first time stone formers will have another stone episode within the next four years.

Stones can form when calcium, oxalate, uric acid or cystine are at high levels in the urine.

Uric acid stones represents 5 – 10% of all kidney stones. But they comprise 40% in areas with hot/arid climates where low urine volume and acid urine pH promote uric acid precipitation.
Prevalence:  In patients with gout without antihyperuricemic treatment is 20%. Hundreds-fold greater than healthy adults.

Risk factors: It primarily occurs in patients without abnormality in uric acid metabolism such as: relatively high serum uric acid levels, comparatively low urinary pH, and low fractional excretion of urate. Clinical gout. Hyperuricosuria, chronic diarrhea (bicarbonate loss and dehydration).  Diabetes, metabolic syndrome and overweight.

How it occurs?:  Two major factors contribute uric acid precipitation

  • a high concentration of uric acid in urine
  • acid urine pH

Diagnosis: Is suggested from the acute onset of flank pain, a positive non-contrast-enhanced CT scan, and history of a predisposing disease (gout, cancer, etc). Plain X-ray is not helpful because these stones are not radiopaque. Confirmation of the diagnosis is best made by chemical analysis of a stone that has been passed.

Treatment:

  • Maintenance of the urine output above 2 L/day to diminish the urine uric acid concentration
  • alkalinization of the urine (increase the urine pH) with potassium bicarbonate or potassium citrate (cytra-k; polycitra-k; urocit-k; citro-k) can be given and this regimen can both dissolve preexisting stones and prevent the formation of new ones.
  • Allopurinol (zyloprim; aloprim; atisuril)
  • Reduction in dietary purine intake (protein)
Image courtesy of: Urocit-K

Effectiveness of vasectomy

Around 42 million couples worldwide rely on vasectomy as a method of family-planning.

Every year 800,000 vasectomies are performed in the US.

Recanalisation: 0.5% of all vasectomies (is defined as the presence of any spermatozoa after one or more previously azoospermic samples were properly collected and documented).

Why are doctors sued following vasectomy?

  1. Failure to be sterile (unwanted pregnancy)
  2. Failure to inform regarding positive semen sample post-operatively
  3. Hematoma/infection
  4. Chronic testicular pain
  5. Atrophy or loss of testicular volume

Vasectomy Failure

Can be due to technical errors, recanalization, or unprotected intercourse before azoospermia is documented

  1. Intraluminal needle cautery (vas not transected, no segment removed): Less than 1%
  2. Cautery both ends and fascial interruption: 1.2 % or less
  3. Cautery (prostatic end) only and fascial interruption (clip): 0.02 to 2.4%
  4. Cautery of both ends and excision of a segment: 4.8% or less
  5. Ligation and fascial interruption: 16.7% or less
  6. Ligation and excision of segment: 1.5 to 29%

To confirm sterility: Obtain a semen analysis 3 months on the postop period; the patient should have had at least 20 ejaculates since the time of vasectomy. Azoospermia in a semen sample is definitive evidence of infertility.

Sokal DC, Labrecque M. Effectiveness of Vasectomy Techniques. Urol Clin N Am 36 (2009) 317–329.

Carcinophobia

Fear from cancer

One not uncommon indication for prophylactic mastectomy is carcinophobia (a.k.a. cancerophobia).

Cancerophobia or carcinophobia is an active behavior of extreme fear of cancer that can lead to repeated medical examination without giving full reassurance to the patient. Denial is a mechanism of defense that usually helps the patient to cope with painful, threatening, overwhelming, or awkward thoughts. When it turns out to be ineffective and pathological, it can cause either delay or avoidance in seeking treatment for symptoms relevant for a true malignancy and will lead inexorably to death if not cured. Most people worry about cancer, but those with cancerophobia are unable to perform their activities of daily living.

For example, cancerophobics believe that a simple headache is a symptom of brain cancer/tumor or dysphagia is a symptom of gastric cancer.  This patients need psychological intervention.

In a female patient cancerophobia with a strong family history of breast cancer and a benign tumor in her breast and if psychological intervention doesn’t help her and she still over-anxious, prophylactic mastectomy is indicated.

2009 Best Hospitals in the US

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The Best U.S. Hospitals for 2009

  1. Johns Hopkins Hospital, Baltimore
  2. Mayo Clinic, Rochester, Minn.
  3. Ronald Reagan UCLA Medical Center, Los Angeles
  4. Cleveland Clinic
  5. Massachusetts General, Boston
  6. New York-Presbyterian University Hospital of Columbia and Cornell
  7. University of California-San Francisco Medical Center
  8. Hospital of the University of Pennsylvania, Philadelphia
  9. Barnes-Jewish Hospital/Washington University, St. Louis
  10. Brigham and Women’s Hospital, Boston &  Duke University Medical Center, Durham, N.C.
  11. University of Washington Medical Center, Seattle
  12. UPMC-University of Pittsburgh Medical Center
  13. University of Michigan Hospitals and Health Centers, Ann Arbor
  14. Stanford Hospital and Clinics, Stanford, Calif.
  15. Vanderbilt University Medical Center, Nashville, Tenn.
  16. New York University Medical Center
  17. Yale-New Haven Hospital, New Haven, Conn.
  18. Mount Sinai Medical Center, New York
  19. Methodist Hospital, Houston
  20. Ohio State University Hospital, Columbus

Top Hospitals by Specialty in the U.S.

  • Cancer: M.D. Anderson Center, University of Texas, Houston
  • Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
  • Digestive disorders: Mayo Clinic
  • Ear, nose, throat: Johns Hopkins Hospital, Baltimore
  • Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
  • Gynecology: Brigham and Women’s Hospital, Boston
  • Heart and heart surgery: Cleveland Clinic
  • Kidney disorders: Brigham and Women’s Hospital
  • Neurology and neurosurgery: Mayo Clinic
  • Ophthalmology: Bascon Palmer Eye Institute, University of Miami
  • Orthopaedics: Mayo Clinic
  • Psychiatry: Massachusetts General, Boston
  • Rehabilitation: Rehabilitation Institute of Chicago
  • Respiratory disorders: National Jewish Hospital, Denver
  • Rheumatology: Johns Hopkins Hospital
  • Urology: Johns Hopkins Hospital

REFERENCES:

  • News release, U.S. News & World Report.
  • U.S. News & World Report: “America’s Best Hospitals.”
  • Avery Comarow, health rankings editor, U.S. News & World Report.

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image under Creative Commons license

Rectal Prolapse – NSFW

Rectal prolapse Rectal prolapse Rectal prolapse

As in Marvin L. Corman’s book (Colon & Rectal Surgery) quotes:

Man should always strive to have his intestines relaxed all the days of his life and that bowel function should approximate diarrhea. This is a fundamental principle in medicine, that whenever the stool is withheld or is extruded with difficulty, grave illnesses result.

Maimonides: Mishneh Torah

Rectal prolapse (a.k.a. Procidentia) is one of the most fascinating surgical pathologies because its complexity in treatment. In 1912 Moschcowitz proposed an herniation of Douglas pouch as a cause for rectal prolapse. Another cause was proposed by Broden and Snellman with the help of defecography described a full thickness rectal intussusception.

Rectal prolapse is 6 times more common in females (as males) aged 50 years or older. Many of male patients has a past medical history of psychiatric disorders. Chronic or lifelong constipation with straining is present in more than 50% of patients.

Patients describe a mass or bulge that they have to push back in after defecation. Often, presentation of rectal prolapse can be dramatic when the prolapsed segment becomes incarcerated below the level of the anal sphincter as in this clinical case and emergency surgical therapy was indicated.

More than fifty types of procedures for repair rectal prolapse have been described, but the treatment is always surgical.