University of Pennsylvania Medical School Spoof 2004 video about the surgery clerkship. In part because of this video, and in part because of too many students failing the shelf (final exam), the clerkship was changed.
over 5 years ago
The oldest descriptions of cancer were written in Egypt as early as 3000 B.C., as part of an ancient Egyptian textbook on surgery. The name, "cancer" comes from the Greek word carcinos, which means crab. Hippocrates used this term to describe the disease because of the projections of a cancer invading nearby tissues. During the 16th century, when the theory of bodily humors prevailed, it was believed that an excess of black bile caused cancer. The renowned anatomist Andreas Vesalius searched diligently for this black bile and ultimately discarded the this theory when he was unable to find it. In 1838 a botanist named Matthias Schleiden and Theodor Schwann, a physiologist, proposed that all living things were composed of fundamental units called cells. Shortly after the introduction of this idea, Virchow (the "father" of pathology) proposed that cells only arose from other cells and that growth could only occur as a result of hypertrophy or hyperplasia. Virchow studied cancers under with a microscope and recognized that they represented hyperplasia in an extreme form that he dubbed "neoplasia."
almost 5 years ago
Good morning all, Being new to blogging, it's surprisingly interesting how difficult it is to start! I recently read Atul Gawande's three best selling books and they were an inspiration. I am sure most medic's will be aware of Mr Gawande (http://gawande.com/), the man behind the WHO safe surgery checklist. If you are not, and you want to read something that will really enthuse you about modern medicine, then please do get his books out from the library. I would recommend starting with "Better". The last chapter of "Better" is what prompted me to write this. Gawande has come up with 5 principles for being a "positive deviant" and 1 of them is - Just Write! He believes that to make our lives as doctors/medical students and the world a better place, we should all write down what we have been thinking about, because we may just come up with something that other people can use or just find others who have similar thoughts and will help us build a sense of community together. Although I have made many previous New Years resolutions to start keeping diaries and to keep journals of thoughts. They have always ended fairly quickly. This time may be different. Hopefully I will come up with some more thoughts that are vaguely worth sharing soon. Final thought for now - "Gawande-ism" = the belief that we can all make self-improvements and improve the world around us, little by little.
over 6 years ago
Why this topic? Why choose this topic? General information Regional anaesthesia and its modes of usage Common anaesthetic agents used How do the an…
over 6 years ago
Each year on the 26th of January, Australia Day, Australians of all shapes, sizes and political persuasions are encouraged to reflect on what it means to be living in this big, brown, sunny land of ours. It is a time to acknowledge past wrongs, honour outstanding Australians, welcome new citizens, and perhaps toss a lamb chop on the barbie (barbecue), enjoying the great Australian summer. It is also a time to count our blessings. Australians whinge a lot about our health system. While I am certainly not suggesting the model we have is anywhere near perfect, it could be a whole lot worse. I recently read this NY times article which talks about the astronomical and ever-rising health care costs in the US and suggests that this, at least sometimes, involves a lack of informed consent (re: costs and alternative treatment options). The US is certainly not the “land of the free” when it comes to health care. There are many factors involved, not least being the trend in the US to provide specialised care for conditions that are competently and cost-effectively dealt with in primary care (by GPs) in Australia. The article gives examples such as a five minute consult conducted by a dermatologist, during which liquid nitrogen was applied to a wart, costing the patient $500. In Australia, (if bulk billed by a GP) it would have cost the patient nothing and the taxpayer $16.60 (slightly higher if the patient was a pensioner). It describes a benign mole shaved off by a nurse practitioner (with a scalpel, no stitches) costing the patient $914.56. In Australia, it could be done for under $50. The most staggering example of all was the description of the treatment of a small facial Basal Cell Carcinoma (BCC) which cost over $25000 (no, that is not a typo – twenty five THOUSAND dollars). In Australia, it would probably have cost the taxpayer less than $200 for its removal (depending on exact size, location and method of closure). The patient interviewed for the article was sent for Mohs surgery (and claims she was not given a choice in the matter). Mohs (pronounced “Moe’s” as in Moe’s Tavern from The Simpsons) is a highly effective technique for treating skin cancer and minimises the loss of non-cancerous tissue (in traditional skin cancer surgery you deliberately remove some of the surrounding normal skin to ensure you’ve excised all of the cancerous cells) . Wikipedia entry on Mohs. This can be of great benefit in a small minority of cancers. However, this super-specialised technique is very expensive and time/ labour intensive. Perhaps unsurprisingly, it has become extremely popular in the US. ”Moh’s for everything” seems to be the new catch cry when it comes to skin cancer treatment in the US. In the past two years, working very part time in skin cancer medicine in Australia, I have diagnosed literally hundreds of BCCs (Basal Cell Carcinomas). The vast majority of these I successfully treated (ie cured) in our practice without needing any specialist help. A handful were referred to general or plastic surgeons and one, only one, was referred for Mohs surgery. The nearest Mohs surgeon being 200 kilometres away from our clinic may have something to do with the low referral rate, but the fact remains, most BCCs (facial or otherwise), can be cured and have a good cosmetic outcome, without the need for Mohs surgery. To my mind, using Mohs on garden variety BCCs is like employing a team of chefs to come into your kitchen each morning to place bread in your toaster and then butter it for you. Overkill. Those soaking up some fine Aussie sunshine on the beach or at a backyard barbie with friends this Australia Day, gifting their skin with perfect skin-cancer-growing conditions, may wish to give thanks that when their BCCs bloom, affordable (relative to costs in the US, at least) treatment is right under their cancerous noses. Being the skin cancer capital of the world is perhaps not a title of which Australians should be proud, but the way we can treat them effectively, without breaking the bank, should be. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Dr Genevieve Yates
over 5 years ago
When you think of the term 'bacteria', it immediately conjures up an image of a faceless, ruthless enemy-one that requires your poor body to maintain constant vigilance, fighting the good fight forever and always. And should you happen to lose the battle, well, the after effects are always messy. But what some people might not know is that bacteria are our silent saviours as well. These 'good' bacteria are known as probiotics, where 'pro' means 'for' and 'bios' is 'life'. The WHO defines probiotics as "live micro-organisms which, when administered in adequate amounts, confer a health bene?t on the host". Discovered by the Russian scientist Metchnikoff in the 20th century; simply put, probiotics are micro-organisms such as bacteria or yeast, which improve the health of an individual. Our bodies contain more than 500 different species of bacteria which serve to maintain our health by keeping harmful pathogens in check, supporting the immune system and helping in digestion and absorption of nutrients. From the very first breath you take, you are exposed to probiotics. How so? As an infant passes through it's mother's birth canal, it receives a good dose of healthy bacteria, which in turn serve to populate it's own gastro-intestinal tract. However, unfortunately, as we go through life, our exposure to overly processed foods, anti-bacterial products, sterilized and pasteurized food etc, might mean that in our zeal to have everything sanitary and hygienic, we might be depriving ourselves of the beneficial effects of such microorganisms. For any health care provider, the focus should not only be on eradicating disease but improving overall health as well. Here, probiotic containing foods and supplements play an important role as they not only combat diseases but also confer better health in general. Self dosing yourself with bacteria might sound a little bizarre at first-after all, we take antibiotics to fight bacteria. But let's not forget that long before probiotics became a viable medical option, our grandparents (and their parents before them) advocated the intake of yoghurt drinks (lassi). The fermented milk acts as an instant probiotic delivery system to the body! Although they are still being studied, probiotics may help several specific illnesses, studies show. They have proven useful in treating childhood diarrheas as well as antibiotic associated diarrhea. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn’s disease and the recurrence of pouchitis (a complication of surgery during treatment of ulcerative colitis). They may also help to maintain a healthy urogenital system, preventing problems such as vaginitis and UTIs. Like all things, probiotics may have their disadvantages too. They are considered dangerous for people with impaired immune systems and one must take care to ensure that the correct strain of bacteria related to their required health benefit is present in such supplements. But when all is said and done and all the pros and cons of probiotics are weighed; stand back ladies and gentlemen, there's a new superhero in town, and what's more-it's here to stay!
over 5 years ago
A new bionic eye lens currently in development would give humans 3x 20/20 vision, at any age. The lens, named the Ocumetics Bionic Lens, was developed by Dr. Garth Webb, an optometrist in British Columbia who was looking for a way to optimize eyesight regardless of a person’s health or age. With this remarkable lens, patients […]
about 4 years ago
Although used less commonly than knee or hip replacement, shoulder replacement surgery removes diseased or damaged bone in the shoulder and replaces it with an artificial joint. If arthritis pain is unrelieved by other methods, you may need replacement surgery.
over 3 years ago
This is a PowerPoint presentation I made whilst on my surgery rotation that I received several compliments for. I have just re-discovered it and found it useful for revision, so maybe you will too! It covers the basics of: - Aortic anatomy - What is an aneurysm? - Risk factors - Ruptured aortic aneurysms - Surgical repair: Open & EVAR - Main complications of surgery
almost 7 years ago