Dr Vijay, a practising radiologist from India, has just hosted SurgeXperiences for the 2nd time at his blog “scan man’s notes”. SurgeXperiences 226, is the 50th edition and the final one of SurgeXperiences season 2.
Official SurgeXperiences logo, courtesy of Vitum Medicinus.
SurgeXperiences was set up to be the definitive Surgical Grand Rounds in the medical blogosphere. A surgically focused blog carnival featuring all the best posts related in anyway to the diverse field of Surgery.
SurgeXperiences was first started 1 July 2007. It is hosted by various hosts ranging from surgeons to anaesthesists to radiologists to students! It is on every fortnight and each season lasts approximately a year.
- Season 1 [Jul 2007 - Jun 2008] had 24 editions. An archive can be found here.
- Season 2 [Jul 2008 - Jun 2009] had 26 editions. An archive can be found here.
A big and special thank you to all previous hosts. Your time and efforts do not go unnoticed and i hope the traffic this carnival brings you is sufficient of a motivation to host another time!
Here’s to all 50 and 50 more!
Welcome to the 25th edition of SurgeXperiences – the one and only Surgical “Grand Rounds”, where the best surgical-related posts are gathered into one succinct post every 2 weeks. Thank you for dropping by, and because i’m in exam mode, i shall present this edition in a Q&A fashion; enjoy!
Regular contributors
Q: What is “cell phone elbow”?
A: It is the layman term for “cubital tunnel syndrome”. For a detailed writeup, hop on over to Suture for a Living to have an expert tell you all ’bout it.
Q: We all know experience makes a difference, especially in surgery. But has this ever been validated by a study?
A: Yes! Aggravated DocSurg tells us so, in “I see Jimi in the mirror!“
Q: Who has had an eccentric superior and not know how to react to his comments/jokes?
A: Bongi! He tells us a story about his professor of thoracic surgery.
Q: What is Buckeye Surgeon suggesting over Quality Assurance Committees for physician-initiated healthcare reform?
A: Cost effectiveness! Why? Read here.
Q: What is “Dr Bard Parker’s” take on the working hours limits on surgical trainees nowadays?
A: “kids these days” sums it up. Link on to hear what he’s got to say over at his blog “A chance to cut is a chance to cure”!
Q: How can one cope better with having ‘difficult conversations’ with patients?
A: Find out here as Dr. T (Notes of an Anesthesboist) shares her experience on the recent ‘difficult conversations’ she has had.
Q: Is it possible to be ruthlessly kind, especially in the teaching of medicine?
A: Perhaps, as Bongi (Other Things Amanzi) relates an incident about treating a patient with a 3rd degree circumferential burn.
Newbies
Q: I notice there are not many Australia surgeon bloggers.. Are there any new ones who decided to write about their cool surgical lives?
A: Yes! The diary of a surgeon is revealed! Over at Crikey Bulletin, which features Prof Guy Maddern from Adelaide.
Q: What is it like after vision correction surgery? Is there someone who can tell us about his/her experience?
A: “I was surprised to discover I was immediately able to open my eyes and see normally.” Read all about it from web architect Matt Raible’s blog.
Q: What is the caption for the following advertisement? Who is the advertiser?
A: The caption is “Plastic Surgery Loans“. It is an ad by Fortis Bank.
Q: Speaking about plastic surgery, what is the title of the book Dr Maria Siemionow recently published?
A: Face to Face.
Q: What is this book about?
A: Dr Siemionow recounts her experience of leading a team who successfully performed the world’s first full face transplant at Cleveland Clinic. [link contains an exercept of the book as well]
Special tribute to a great surgeon
Q: What TV show did the late Prof Chris O’Brien (renowned head and neck surgical oncologist) star in?
A: Prof O’Brien was featured in an Australian reality medical TV series called Royal Prince Alfred, which showcases interesting cases and the doctors who work at this top Sydney hospital.
Q: What did Prof O’Brien die of?
A: Glioblastoma multiform, diagnosed in 2006. (source)
Q: What is the title of the book he wrote?
A: “Never say die.” Linked here is a 60-minutes interview with him after he was diagnosed.
Q: Who treated Prof O’Brien?
A: Dr Charlie Teo, a top (and some say controversial) neurosurgeon. When contacted, he said this of his former colleague, “People face death in many different ways but he faced it with such dignity and tenacity … he taught me some great lessons on life….. He knew that he was fighting a formidable enemy and yet he still remained very positive until the bitter end.”
Surgical care
Q: Do doctors really read through the patient notes?
A: Apparently not, as Buckeye Surgeon discovers in a case where he recommended hospice care for a patient, but no one listened!
Q: Is it right for a surgeon to leave post-op care to the hospitalist?
A: No! Certainly not the not-so-Happy Hospitalist, who hears from another hospitalist that an orthopedic surgeon has been doing so and only seeing the patient on the discharge day. To quote, it’s “one of the worst examples of patient abandonment I can imagine.”
Q: How many pounds did Wrexham Maelor Hospital pay for surgical blunders made there over the last 3 years?
A: HALF A MILLION! Read more here.
A pinch of humour
Q: Is there a comic about medieval surgery that could make me laugh?
A: Maybe. Check one out at scanman’s posterous.
Q: What not to do or say when asking for an autograph from a sports star?
A: I’ll leave you to find out from yet another tale from Bongi, entitled “skande“
Some announcements
Q: What is so special about the next SurgeXperience edition?
A: It is the 50th edition!
Q: Who is the lucky blogger who gets to host SurgeXperiences on this very special occasion?
A: Dr Vijay, who blogs at scan man’s notes.. Be sure to submit your posts via this form. SurgeXperiences 226 will be hosted in 2 weeks’ time on 28 June 2009.
Q: Can i subscribe to SurgeXperiences using RSS or email?
A: Certainly! Do so over at this link.
Q: Where can i check out previous editions of this awesome surgical blog carnival?
A: The archives of SurgeXperiences are stored here(Season 2) and here (Season 1). Feel free to check them out!
~ ~ ~
Let’s round up with a joke (that carries a little tinge of politics), courtesy of In From The Night:
“Three Californian surgeons were playing golf together and discussing surgeries they had performed.
One of them said, “I’m the best surgeon in California . In my favorite case, a concert pianist lost seven fingers in an accident, I reattached them, and 8 months later he performed a private concert for the Queen of England.”
The second surgeon said, “That’s nothing. A young man lost an arm and both legs in an accident, I reattached them and two years later he won a gold medal in track and field events at the Olympics.”
The third surgeon said, “You guys are amateurs. Several years ago a woman was high on cocaine and marijuana and she rode a horse head-on into a train traveling 80 miles an hour.All I had left to work with was the woman’s hair and the horse’s ass.
I was able to put them together and now she’s Speaker of the House!”
Fascinating pictures from NY Times’ coverage on Tanzania and its high maternal mortality rate. Ether, if i’m not wrong, is a very old-fashioned way of anesthesia.
One of my clinical tutors at the hospital i rotated for Obstetrics & Gynaecology is semi-retired now; he comes in weekly for an antenatal clinic and gives us weekly tutorials on mainly obstetrics. I can see that is his passion. Often, he goes to sub-sahara Africa for medical missions. He liaises with the government officials and recently i heard him speak at one of the Friday morning CME meetings, where he talked about maternal mortality at Sudan. He reflected about his experiences and how the introduction of misoprostol easily dropped the rates of maternal mortality (hugely contributed by uncontrolled post-partum haemorrhage). According to UNICEF, in Sudan, there is a maternal mortality ratio of 1,107 deaths per 100,000 live birth. In Australia, the rate is 8-10 per 100,000. What a stark contrast eh? Between 1991-96, 1 woman died in Australia of PPH. Most of the 1107 women who die per year in Sudan die of PPH.
My 9-week Obstetrics & Gynaecology rotation ended today. I clearly remember attending one labour ward night shift (9pm to 7am). I was quite happy because one of the ladies consented to having me around, watching and learning. It was indeed a privilege to attend their birthing process. The lady was in stage 1 labour, so nothing much was happening. The midwife was checking some of the drugs and preparing them. She taught me as she did – syntocinon, ergometrine, misoprostol … we use this if there is PPH. sync is to help the uterine contract.. in the event of a PPH, we might use ergo, miso PR, etc.
If only the women in Sudan had access to these drugs …
My time in O&G land was an eye-opening experience. I attended many theatre sessions; that was where i could do Vaginal Examinations under Anaesthesia! Women really didn’t care what happened when they’re knocked out. Most threw in that comment when i asked them as they waited in the pre-surgical area. It’s weird though, most had no palpable pathologies. I did feel a couple of retroverted uteruses though. No adnexal masses. I stopped doing them when i hit the minimum of 5. We have a logbook to sign off. One of which was to watch 1 hysteroscopy. I ended up watching like 3o or sth. I can almost do one if they asked me to. Just have to know how to fiddle and connect the hysteroscope and attach the Hartman’s bag.
I loathed Obstetrics. That’s because as a student, you follow the midwife. No offense to midwives, but i don’t find their job very interesting. I admire their patience and preserverance in sticking around with a women for her labour. Gawd its long and boring. I would much rather be a resident, who usually only comes in a couple of times to pop their head in and check how the woman is progressing. And they come in for the final crowning bit. Push! Damnit woman push!*
* ok, not they don’t say that.
Gynaecology is so much more interesting. In fact i like it. I scrubbed in for 2 total abdominal hysterectomies, one for a uterine myosarcoma and another for a massive 10cm fibroid.
Another cool pic i had from my iPhone was that of a dermoid cyst. Now to understand this, you have to know that dermoid cysts can have ectodermal derivatives in them – epithelial tissue, hair, skin, even teeth! Too bad this one had no teeth!
So anyway, that’s that. We also had a week where u follow a private consultant and experience the life of a specialist. He practises mainly obstetrics. He tells me an average OBGYN does about 120 deliveries a year, he does about 3 times of that. A quick search of his name yielded recommendations on Bubhub, and other mummy forums. its nice that he can see sisters of sisters, friends of friends who all like him so much, and even a GP who refers her patients to him for specialist care! he provides her complimentary antenatal and obstetric care! he made me reconsider obstetrics, but warned me of potential lifestyle issues. and oh, the malpractice coverage is huge! but i think if i ever stepped down that path, i might focus more on gynaecology, particularly gynae surgery, e.g. oncology, or endometriosis interest, etc.
that’s O&G in a nutshell. my exams are next friday 12 june and the OSCEs are on 16 june!
it seems that top individuals in their field are more inclined to be engaged in some sort of controversy, like it or not. Recent events in the Paediatric Surgical community here in Melbourne has prompted this post.
Is Paddy Dewan, a renowned paedatric urologist, a saint or sinner? The Age, Melbourne’s newspaper, reports back in 2003.
“There were charges of intimidation, protracted and ugly contract negotiations, complaints by Dewan about serious errors and patient deaths, and untold instability and upset on all sides.
Finally, the hospital’s chief executive, Kathy Alexander, recommended Dewan be sacked for disrupting the surgical department and effectively compromising patient care. The hospital board, after examining acidic statements by at least 14 surgeons, endorsed the highly unusual move.”
What exactly did this high profile surgeon do to incur the wrath and prompt “acidic” comments from 14 other surgeons? The reporter enlightens us:
“Dewan reported a total of 26 incidents to the Department of Human Services, the Australian Medical Association, the Medical Practitioners Board and even the Coroner. The incidents involve most of the 12 surgeons in the hospital’s department of general surgery. Surgeons see this as a personal attack.
However, Dewan says he went outside the hospital because he was not satisfied with the response of its patient safety committee, where he referred two incidents. “I was not being heard,” he insists.”
After generating sufficient drama at RCH, more ensues this day at Sunshine Hospital! Now the Professor of Paediatric Surgery over there, he has accused staff at Sunshine Hospital of manipulating surgery waiting lists to encourage patients to pay for private services.
“In a scathing submission to a parliamentary inquiry into hospital performance, Professor Dewan has also alleged the hospital’s suspension of his services in recent years meant children with appendicitis and twisted, dying testes did not get timely treatment.”
The drama never ends! Now patients, or rather, their appreciative parents, are rallying to support their beloved surgeon (source: The Wee Kids).
Professor Paddy also volunteers with overseas missions for underserved paediatric populations with an organisation he set up – Kind Cuts for Kids. This included a trip to Gaza. Apparently Sunshine Hospital – his current employer – isn’t too pleased by his frequent trips overseas for these missions.
I cannot help but wonder, are highly achieving, perfectionist individuals who care nothing but ensuring optimal care for their patients, bound to rub the wrong shoulders and cause undue friction amongst colleagues? Is Dewan a victim of the system, which to him doesn’t seem to value transparency as much as he does? Or is he a self-made timebomb of overflowing self-righteousness who is an inappropriate whistle-blower?
I suspect only individuals who have worked directly with him or are involved in this entire saga can make an accurate assessment. But what do you think? Also, have you come across such individuals at your work place?
that’s my bro, doing his 5th desert at Namibia. as part of the Racing The Planet series. its currently the main photo on the 4Deserts : Namibia 2009 main page!
“SCUT… Forgive me for this; I HATE this word. Ward work is patient care. It’s the work of Angels and Saints. It is a privilege to do. It’s fun. It is necessary to the care of patients. If you call this patient care scut, you (and your proteges) won’t do it. If you call an admission a ‘hit’, you won’t take care of them. Your language defines your feelings. Your feelings determine what you have energy for. I get energy from getting a patient a cup of coffee, drawing their blood well, and closing their skin in a nice manner……… as much energy as I gett from transplanting their hearts and lungs, and bypassing their vessels. I can’t do what I don’t have energy for.”
Curt Tribble, M.D.
Professor and Chief
Division of Thoracic and Cardiovascular Surgery
Vice Chairman, Department of Surgery
University of Florida College of Medicine
Gainesville, Florida
(from cover of Advanced Surgical Recall”
Following a retrospective cohort study on over 19,000 patients who have had bariatric surgery in the USA in 2005, Dr. Edward H. Livingston concluded the following:
“It has been shown that the minimal annual procedure volume required to be designated as a center of excellence [125 cases per year] does not necessarily result in better outcomes, and that the minimum volume requirement is not evidence-based. Most importantly, this volume criterion significantly restricts access for bariatric surgery care,”
“Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted,”
This led me to wonder the question as stated in this blog post’s title: Being a student at a Centre of Excellence – does it make a difference? Does rotating through a COE ensure one learns from the ‘very best’ in the field, assuming more of them are gathered there? How does it affect a student’s choice on which hospital he/she will choose to work at upon graduation from medical school?
Dr Livingston’s article can be found in the April issue of Archives of Surgery. .
- Contrary to what Hollywood scriptwriters may think, to do most operations properly, probably requires no more than average manual dexterity. In the author’s opinion, anyone who can write neatly probably has enough manual dexterity to do most surgical operations. The qualities that distinguish a superior surgeon from an average one are far more subtle, reside in the cerebral cortex rather than the cerebellum, and mainly involve complex decision-making and judgement
Addenum [15/4/09]
- The ANZ Journal of Surgery published a special edition in March 2009 (Vol. 79, Iss. 3) on surgical education.
- An article seems to portray differing opinions from Mr Whalan.
Gallagher, Leonard and Traynor wrote about the “Role and feasibility of psychomotor and dexterity testing in selection for surgical training”.
- “knowledge, judgement and good technical skills will no longer be enough to safely practice surgery and interventional procedures” and that
- other “fundamental abilities (e.g. psychomotor skills, visuospatial ability and depth perception) are critically important for catheter-based interventions, NOTES, robotic surgery and other procedural interventions of the future.”
To be honest, if they struggle during surgical training, its fair game. But thereafter in surgical practice? Wouldn’t that reflect so badly on the teaching hospital, superiors, mentors, and ultimately the governing body for that country’s surgeons (e.g. American College of Surgery, Intercollegiate Royal College of Surgeons, Royal Australasian College of Surgeons, Academy of Medicine Singapore, etc.)? Is it possible that training can overcome such “deficits” in innate fundamental abilities? Can surgical skills be imparted REGARDLESS of innate talent?
They go on to attempt to compare surgery to other professions. “In contrast to other high-skill professions/industries (e.g. aviation) we do not have a tradition of testing prospective surgical trainees for abilities/attributes that we now recognize as being important for surgical practice. Instead, we continue to rely on surrogate markers of future potential (e.g. academic record)”
Then they attempt to push their case further. “… many studies have shown that psychomotor ability is an important predictor of both learning rate and performance for complex laparoscopic tasks. Psychomotor skills, visuospatial ability and depth perception can all be tested objectively by validated tests.”
Finally they reveal what is done at the Royal College of Surgeons in Ireland. “… all short-listed candidates for Higher Surgical Training now undergo formal testing of both technical skills and fundamental abilities (psychomotor skills, visuospatial ability and depth perception). Reports on each candidate’s performance are supplied to the interview committee. Furthermore, a prospective database is being kept for correlation with future surgical performance. We believe that selection into surgical training should take account of attributes that we know are important for safe and efficient surgical practice.”Grantcharov and Reznick
, in their article entitled “Training tomorrow’s surgeons: what are we looking for and how can we achieve it?”, states their assertions clearly.“Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon.”
Traditionally speaking, those whose manual dexterity are superior (e.g. being able to pick up rice grains with chop sticks, or can cross stitch, or knit very quickly and skilfully) are touted as the “future surgeons” by casual observers. Will these talented individuals have a substantial competitive advantage?
he wasn’t the most talented student at musical school
what he lacked in natural ability, he made up in discipline
he practiced
all the time
all the time he practiced
Paediatrics has just finished. I should talk about it
I discovered i am not a natural with babies/toddlers, in terms of rapport establishing, etc. I guess i lack the experience with limited interaction with my cousins/nephews/nieces. I tried, but I am not a natural. If I am to be blessed with a wife and children in the future, then these 9 weeks of experience with kids might come in handy… but as they grow older, its easier; you can ask them about school. who’s your favourite teacher? who’s your best friend at school? what’s your favourite subject? what do you wanna be when you grow up? etc etc read more…
A mechanic was removing a cylinder head from the motor of a Harley motorcycle when he spotted a well-known heart surgeon in his shop. The surgeon was there, waiting for the service manager to come and take a look at his bike.
The mechanic shouted across the garage, “Hey, Doc, can I ask you a question?” The surgeon a bit surprised, walked over to the mechanic working on the motorcycle.
The mechanic straightened up, wiped his hands on a rag and asked, “So Doc, look at this engine. I open its heart, take valves out, fix ‘em, put ‘em back in, and when I finish, it works just like new. So how come I get such a small salary and you get the really big bucks, when you and I are doing basically the same work?”
The surgeon paused, smiled and leaned over, and whispered to the mechanic… “Try doing it with the engine running.”
(source: somewhere on the net 
)
Welcome to SurgeXperiences – the one and only surgical blog carnival in the medical blogosphere. Today I will be your host for the 20th edition of the 2nd season.
SurgeXperiences logo created by vitum of vitum medicinus.
To a medical student like me, the field of surgery is very intriguing, to say the least. The daily working life of a surgeon, or even that of a surgical trainee, can be jam-packed full of action, blood, guts and gore. Dull moments in surgery are hard to come by. Surgeons are able to test their hypotheses and see rapid, graphic results from their work. Students are often awed by this process. What also draws me to surgery is the immense satisfaction of being able to completely excise a cancer (hence providing a definitive cure), or relieve the pain of an intra-abdominal catastrophe, e.g. perforated appendix.
General Surgery
Neurosurgery
Obstetrics
Orthopaedic Surgery
Ophthalmology
Peri-operative medicine
Dr Bates (Suture for a Living) reviews an article on the requirement of perioperative stress doses of corticosteroids.
Plastic surgery
Plastic surgeon Dr Ramona Bates (Suture for a Living) educates us on medical lasers and the law after reading an article from a “throwaway” journal “MedEsthetics”. (image credit)
Sometimes, veterinary surgeons can take pointers from their counterparts who operate on real human beings, just like a certain Dr Michael Pavletic. This vet, faced with a tumour on a cat’s face, turned to an older human reconstructive surgery textbook that suggested a simple skin flap might do the trick. He took what was a routine technique in human surgery and tailored the procedure for a cat. It worked. Today, he is a pioneer in veterinary reconstructive plastic surgery. Read about him here.
Moving back our focus to human surgery, chronic refractory pilonidal disease can result in an undesirable cosmetic effect after multiple incisions and drainages. Dr Lisa Marcucci (Inside Surgery) describes a commonly-used technique “Z-plasty” to overcome this problem.
Although cosmetic surgery is only a part of plastic surgery, it is very prominent in the community and considerable attention is dedicated to who had it, should you have it, and the like. I thought i might throw in something since everyone knows about this former King of Pop. Apparently he is having some cosmetic procedures to “doll up” before his return to stage.
Well it seems that some ‘doctors’ have also jumped onto the bandwagon and pretend to be plastic surgeons when they are not. Adventures in Plastic Surgery reports.
Trauma surgery
Dr Parker (A Chance to Cut is a Chance to Cure) is back with a shout with a continuation of his “Tales from the Trauma Service” series at XVIII.
Transplant surgery
Diagnostic services
The surgical career..
Regarding inter-profession relations, Dr Parker (A Chance to Cut is a Chance to Cure) updates us on some of the drama that has been going on, and what he reckons, in R-E-S-P-E-C-T — parts ONE and TWO.
Advances in surgery
The Medical Quack reports that the world’s first robotic distal pancreatectomy was performed at Fox Chase Cancer Centre via the VikY system.
Over at Abu Dubai, a surgeon performs the first telesurgery at UAE in front of various colleagues.
Surgical media
Oystein (The Sterile Eye) is a medical videographer from Norway. He has the following articles/media links to contribute.
- Of background music in surgical videos. What do YOU think?
- The National Museum of Health and Medicine are digitizing their vast archive of meical photos. Check it out.
- He also recorded a video of a laparoscopic liver resection, with a brief summary.
- Lastly, a video of ERCP.
Gabrielle Eden has a short write up on the background of the famous picture of a foetus grabbing onto a neonatal surgeon’s hand. It is entitled “The Hand of Hope“.
Will you be in Italy from Oct 27 to Nov 8? If so, you could join in the Vesalius Trust Art and Anatomy Tour – a tour of wax anatomical models at several anatomical museums. Even if you can’t go, the spine-chilling pictures at Morbid Anatomy might suffice. Here’s a preview:
That rounds up this edition of SurgeXperiences. What i lack in terms of humour or expertise in commentary, i hope i have made it up with the images i included.
Next edition will be hosted on 19 Apr at Suture for a Living.
You can submit your blog posts via the carnival submission form, and check out all the previous editions. You can also subscribe to SurgeXperiences via RSS feed or email.
If you would like to host a future edition, don’t hesitate to contact me.
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This Sunday (29 Mar), SurgeXperiences will come back to where it started from for its 20th edition of the 2nd season. Nothing’s special is gonna happen; just another good ol’ biweekly catch-up of the best surgical posts of the medical blogosphere.
I’m thinking of grouping the posts according to surgical specialties, so if you want to see yours included, be sure to submit something related!
How to submit: via this form
Deadline: Friday, 27 Mar
[image credit]
Hereditary diffuse gastric cancer. To put this in context, it is thought to represent 1% of all gastric malignancies.
A definition is available:
Hereditary diffuse gastric cancer (HDGC) is defined in members of a family with (1) 2 first- or second-degree relatives with diffuse gastric cancer, one of whom is diagnosed before the age of 50 years; or (2) 3 or more first- or second-degree relatives with diffuse gastric cancer, irrespective of age at onset [1]
Germ-line truncating mutations of the E-cadherin (CDH-1) gene are detected in 50% of diffuse-type gastric cancers and families that harbor these mutations have an autosomal dominant pattern of inheritance with a very high penetrance. [2]
Was highlighted in Grey’s Season 5 Episode 17. The girl highlighted in the picture has the CHD1 gene mutation and is discussing with her brother who is freaking out about one of the complications of gastrectomy. (dumping syndrome)
Prophylactic gastrectomy is only curative management, genetic counselling is strongly recommnded; even yearly endoscopies will not suffice. I quote,
Unfortunately, close endoscopic surveillance with random yearly biopsies has not been proven effective in increasing survival. Typically, when these biopsies return positive, patients are found to have advanced disease, with very poor prognosis.[3] Therefore, prophylactic gastrectomy is the only reliable preventive treatment for patients with CDH-1 gene mutations. (image credit)
Not a good cancer to get. QOL substantially affected even after prophylactic gastrectomy at young age. A central database should be created to ascertain an accurate value for the incidence and prevalance, at least starting in the States. Maybe Japan.
Addenum:
For more information on HDGC, and gastric cancer in general, please go to “Be Strong Hearted” – a network for gastric cancer patients, survivors and families.
References (quite proud i actually did this for a blog post lol)
[1] Caldas C, Carneiro F, Lynch HT, et al. Familial gastric cancer: overview and guidelines for management. J Med Genet. 1999;36:873-880.
[2] Guilford P, Hopkins J, Harraway J, et al. E-cadherin germline mutations in familial gastric cancer. Nature. 1998;392:402. [Medline].
[3] Lewis FR, Mellinger JD, Hayashi A, et al. Prophylactic total gastrectomy for familial gastric cancer. Surgery. 2001;130:612-619.
Five surgeons were taking a coffee break and were discussing their work. It was an interesting conversation.
* The first surgeon said, “I think accountants are the easiest to operate on. You open them up and everything inside is numbered.”
* The second replied, “I like to operate on electricians. You open them up and everything inside is color-coded.”
* The third added, “I think librarians are the easiest to operate on. you open them up and everything inside is in alphabetical order.”
* The fourth one boasted, “I like to operate on lawyers. They’re heartless, spineless, gutless, and their heads and their butts are interchangeable.”
* Fifth surgeon said, “I like Engineers. . . they always understand when you have a few parts left over at the end…”
ah ok. so it seems that “The list of nominees has been scrutinised by a team of international experts and they have selected a shortlist (in alphabetical order):”
and yay! i made it to among a group of 5 Aussie bloggers. I am however, not an Australian by nationality. i just study medicine at an Australian medical school. 3 years in Melbourne and i’m loving it.
Voting is open to everyone – you need not be Australian, you need not be medical, you just need to have an opinion. Polls close on the 20th of February, so get your votes in before then.
I havent seen AEQ and Prn Penguin before, so its good reading time! Degranulated is a pharmacist / medical student / outdoor guy. I might vote for him. I figure Life in the Fast Lane is way ahead.
Self promotion?
well, first of all, u can VOTE HERE!!
and for a selection of popular/good posts, check out my “blog round up” and see how far my blogging has come along. gee i talk abt it as if it was CV-able.
take it easy and have fun reading the great blogs. Even the nominated ones.
the nominated blogs for Aus Med Blog Awards 09
