Welcome to the third edition of SurgeXperiences, the first carnival of surgery. Iâ€™m honored to bring you this surgical carnival.
This will be a practical and concise edition. The objective of blogs (in my point of view) is to answer questions as quickly as possible, so lets start with the HOW-TOs. Enjoy.
How to classify fingertip injuries and amputations and how to treat them? This is a nice abstract in where we will learn how to close the wound, maximize sensory return, preserve length, maintain joint function, and achieve a satisfactory cosmetic appearance. This is a Must Read!
How much farther have we advanced in medicine since the days of trepanation? Do you know that people had holes drilled in their heads voluntarily and they state that this results in more energy and an increased feeling of consciousness and lessens repression?
I am pleased to announce that the new edition of SurgeXperiences is going to be hosted here at Unbounded Medicine next week. I’ll be accepting ALL your submissions.
Please feel free to post about anything related to surgery, like surgical procedures, mistakes during surgery of your training, lessons learnt, and tips, first operation done solo, memorable operations, memorable patients, jokes. I also accept patient posts.
A previously healthy 27 years old female came to the emergency department with a chief complaint of one-month diffuse and intermitent abdominal pain, transitory relief with bowel movements, nausea without vomit, early saciety, postprandial fullness and weight loss of 4 kilos in 1 month.
On the physical exam, we found a 10×15 cm tumor in the left upper quadrant. The tumor is not fixed, it feels solid and well delimited. We did not find any other important data.
Lab work beteween normal ranges. We ordered plain abdominal film, chest x ray and later an abdominal ultrasound and a CT scan.
With these findings, we decided to perform an exploratory laparotomy (left subcostal incision) and tumor resection.
Look the size of the tumor and its characteristics.
Note the splenic vein.
The tumor arises from the tail of the pancreas. It was impossible to dissect the spleen, so we had to cut it.
Final diagnosis: Benign Solid Pseudopapillary Tumor of the Pancreas of 14 cm, and 1.66Kg.
Solid-pseudopapillary tumor (SPT) of pancreas is a very rare (about 450 cases have been described in the world literature) neoplasm of low malignant potential and unknown origin. It generally occurs in young women and the prognosis is usually good after complete surgical removal.
A 68 year old female patient came to the E.D. with a chief complaint of sudden, severe epigastric pain, retching without vomitus and distention of the upper abdomen.
The patient was alert, very anxious, and in severe pain.
blood pressure of 160/120; pulse of 126; respiratory rate of 24; normal temperature; SatO2 of 96% without O2 supplement.
She had a distended upper abdomen and epigastric tenderness without rebound or guarding.
A plain film of the abdomen was ordered and showed gas-filled, grossly dilated stomach.
Pass of nasogastric tube was unsuccessful.
A laparotomy was mandatory.
The patient survived the surgery but 6 months later, she died by causes nonrelated to the surgery
In 1904, Borchardt described the classic triad of gastric volvulus: severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube.
On January 25th, a car crash took place in Nebraska and Shannon Malloy (a previously healthy 30 year old woman) was seriously injuried. Her skull became separated from her cervical spine, this is what is called internal decapitation.
“I remember the impact and then I had no control over my head… I wasn’t focused so much on the pain. I just kept thinking, ‘I have to stay alive,'” said Shannon.
5 screws were drilled into Shannon’s neck and 4 more were drilled into her head to keep it stabilized. Then a thing called a halo (rods and a circular metal bar around her head) was attached for added support. It’s not exactly a pain-free procedure.
Shannon Malloy still has a long, costly recovery ahead. A fund has been set up in Malloy’s name at Wells Fargo banks. You can make donations at any location under the “The Benefit of Shannon Malloy.”
Neurosurgery is about to change with the arrival of Neuro Arm, a new robot system developed by specialists of The Calgary University.
This device was designed by Garnette Sutherland, a neurosurgeon who worked the last 6 years to make the device that frees the surgeons of the possible faults caused by the human hand.
â€œMany of our microsurgery techniques come from the 60s, and have put to the surgeons the lack of the exactitude, precision, skills and resistance,â€ explained the professor of neurosurgery.
“Neuro Arm shows a spatial resolutions that allows neurosurgeons to operate with such precision tha we could speak of a cellular level.”
It is designed to be operated by a neurosurgeon from a workstation, the robot operates with a system of realtime images, offering a detail without precedent, and a better control of the equipment.
The surgical tests of Neuro Arm in the human patient are in process, and we hope that the first surgery with this device could be this summer,â€ added Sutherland.
This surgical device was designed and made in collaboration with MDA, a well-known company to participate with the NASA in the development of the robotic arm Canadarm2, used in the space shuttles. The project began in 2001, had a cost of 2 million dollars, mainly provided by B.J. and Don Seaman.
â€œThe best surgeons can work in a space of 1/8 of inch, whereas this robot does possible to work in a space of the wide one of a hair,â€ explained Don Seaman.