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”.

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.”

“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.”

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

Paediatric surgery was fun. We had cool stuff happening; gastroschisis, sacro-cocccygeal teratoma, duodenal atresia, colonic atresia and then several boys came in with blunt trauma to pancreas after bicycle accidents. one even had a distal pancreatectomy. Highlight was scrubbing in late night for perf appendix, which i used for my case report.  classic RIF region of maximal tenderness, widespread peritonitis. great thing was, when the paed surg reg, W,  was arranging for an ICU bed, while the pt was having his fluid resus, we students went to grab some Mackers (and offered to get him something too). it was a legendary night that will stay in my memory. (oh, W requested fries and guess what – strawberry milk shake! we teased him a lil about it later, made him all the more self conscious. lol) opreatively, had the suction ready when the peritoneum was next to be cut. frank pus +++.  manual breaking of adhesions in abdo cavity. we had a lili trouble finding the appendix but got it in the end. 

another lap case i watched was a neonate case. lap removal of adrenal ?mass. most likely extra-pulmonary sequestration. 

Oh, and an extremely rare thing i came across at Paed Haem/Onc clinic. 7 month old infant scheduled for orchidopexy for right undescended testes. when testes was brought down, some other tissue was attached to the testicle. it was resected. discharged with no complications. over the next few months, mum noticed lump was getting bigger and when she went back to get it checked out at the same hospital, they dismissed it as scar tissue. she sought a 2nd opinion. the surgeon took it out. pathology came back –> wilm’s tumour, with all the characteristic classical histological features. he had intensive chemo for 5 months. he has to be monitored for mets and any primary occurence in the kidney. thankfully renal US and CXR to date (he is now 3) are clear. saw him at outpatients. 

Interesting / confronting issues: 

Bushfires in Melbourne: When asthma kids come from bushfire-affected areas, i must admit i do not quite know what to say. The doctors are Melbourne-based. They can say the right phrases to display sympathy. They ask the right questions that display practical concern: are you making plans to evacuate? They factored in their empathy whilst explaining the asthma management plans. As we got further away from Black Saturday, residents made comments like “It’s gonna be a smoky day this weekend. More kids will come in. (with a tinge of urgh)”

Childhood obesity: We had a week of lectures as a “Paeds in Sem 1″ Cohort. During this week, we were also supposed to prepare a 10-min presentation on Contemporary Issues in Paediatrics. There were 10, but more interesting to me were things like educating children with disabilities, youth suicide in Australia, immunisation, water fluoridation. My  group was given a science-y topic : childhood obesity. I guess I’m thankful because a topic like “health indicators in indigenous children” or “socioeconomic status and health of Aussie children” will be more difficult, especially in terms of finding information. When i was in 3rd year, my conclusion from dealing with the moderately to super obese was to lap band them, because it is the only thing that works. Educate them it is not a one-stop fix. Involve a dietician. Make them promise (and follow them up) re diet and exercise. Be their partner in health. Banding is the only thing that actually works, as the evidence and literature quite unaminously proves. screw orlistat. Lapbanding helps kick start and continue their lifestyle changes. But how does this change in kids?

We were chatting to a General Paed Surgeon after his list one arvo. He was really nice. He told us one time he attended a Paed Surgical conference and someone presented something on banding. That person was “absolutely lynch-ed”. The anaesthetist chipped in. He had a patient die on him once. There are difficult to intubate, and hard to manage peri-operatively. But he still reckoned it is the only thing that works, at least for adults. 

Obesity is an epidemic in Western societies and considering how a big percentage of the entire world lives in starvation, you cannot help but wonder why. 

New people: i’ve always been a rather introverted person, compensating with a outward show of extroverted-ness. inherently, i am shy. when i tell friends that, some chuckle because i don’t portray that side often. Meeting new people has been interesting. There are still people within my graduating class whom i do not know at all, or very well. Years 4 & 5 will change that as we move around hospitals. Occasionally, an anti-social nonchalant thought creeps in “i’m not gonna stay in Melbourne for good anyway, why bother?” i usually mentally smack myself after.

E for electives. tweeted a bit about it. plans still uncertain. hope to go to S america. plan to learn spanish. if i master it, then i can speak the 3 most common languages in the world. (english, mandarin). right, as if it was so easy.  though i must admit, when i acted as a mandarin translator at one of the Paeds clinic, i was a lil rusty and struggled a little with medical terminology and sentence structure. parents could tell i don’t speak it everyday, but were nonetheless grateful, as they would have waited ages for the official hospital mandarin translator to come. 

now my 9-week O&G term starts. i will blog and sum up about it when its over again. probably will include things like my 1st pap, vaginal exam, normal vaginal delivery, colposcopy ,etc etc. till then, thanks for listening and dropping by my humble blog.

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

Merriwether (a patient) recently had some lipomas excised and shares his experience and some post-op photos.   

After a colostomy and ileocystostomy, a patient’s daugher (Tiger by the tale) blogs about the aftermath and impending ICU stay. Wish him a speedy recovery.

Neurosurgery

An obese man is being surgically implanted with electrodes inside his brain and exposed to electrical currents trying to make him weight. This is a first of its kind and I leave it up to the reader to comment at the article re: human experimentation. (image credit)

 

Talking about experimenting on humans, this Italian neurosurgeon was certainly pushing the boundaries when he decided to continue surgery on his patient despite suffering from an anginal spasm himself. “I couldn’t leave [the patient] at such a delicate moment… I’m not a hero, I only did my duty.” Read all about it here.

 

A Russian teenager dies after a rare brain stem operation. The father is now suing the Oklahoma City surgeon in a civil lawsuit for medical negligence.

Obstetrics

Some might argue obstetricians are not surgeons. In South Africa, interns perform Caesarean Sections commonly, but before they do, they have to earn a right to do so, just like any surgical procedure. Dr Karen Little (Just Up the Dose) writes about obtaining this license to cut at where she practices medicine – the Crater vs Civilization. (image credit)

Orthopaedic Surgery

An orthopaedic surgeon from the Philippines, Bone MD (The Orthopedic Logbook)addresses a post to young / junior doctors regarding career choices, and how it is OK to be lost. (image credit)

 

A cerebral palsy patient pays an orthopaedic surgeon a visit at his clinic, recounting an awkward moment.

Ophthalmology

Valerian, a recent customer of eye surgery, shares about his PRK experience. 

 

A Repository for Bottled Monsters shares a journal article about eye injuries and prosthetic restoration in the American Civil War years. Cool pictures and great historical information. (image credit)

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

Dr Jeffrey Parks (Buckeye Surgeon) talks about transplant chains, or NEAD (non-simultaneous, extended altruistic) donor chains. He highlights an important issue of moral obligation of those involved to donate their organs to “keep the chain going”.

Diagnostic services

Radiological imaging are sometimes indispensable to a surgeon before he/she takes a patient to surgery. Good ol’ Dr Vijay (Catscanman) has contributed a post full of 3D reformatted images from a post-CABG Coronary CT Angiogram. Check it out; very cool. (image from link above)

Below, articles are not grouped according to surgical sub-specialties anymore. 

The surgical career..

Dr Crippen (NHS Blog Doctor) thinks out loud … “What is a surgeon?“, when a patient of his shows him who did his inguinal hernia repair.

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. 

Surgical training … the tough years ahead. at least for me. Surgical resident Dr Alice (Cut on the dotted line) reflects on why “tough love” is best love for educating interns and medical students.

It is no wonder then, why some surgeons are soooo tired. But is tough surgical training to blame in this following case? A plastic surgeon at Beth Israel Deaconess was so fatigued from previous day’s activities that he dozed off during surgery. Now it is big hoo-ha in the news, at least in Boston. 

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.

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. 

hi all. i am a 4th yr student at Monash Uni. I am currently rotating through Paediatrics, and will next learn about Women’s Health, Psychiatry and finally General Practice before rounding off year 4 with a massive exam they like to call Vertically Integrated Assessment (VIA) which just means they get to test you everything they so wish in a 3-hr long paper. Well i’m just glad i am not taking USMLE Steps 1, 2 CS and CK, YET!

Anyway, the main reason i am writing this is because Dr Cris (also based in Melbourne) has requested us to write something related to “teaching and learning surgery” and then thereafter submit it to her via this form. I decided to play this game and see how we go.

Firstly i start by saying i have limited surgical exposure. So i cannot offer any advice on “teaching surgery”. Even on “learning surgery”, it will just be at an undergraduate level, and even that is many months away. So i will just give some practical tips i learnt in year 3 (2008).

1. Books

Surgical Recall was awesome. Albeit being US-based, it is a fantastic review / revision tool. Divided into 2 column with questions and answers on each side, it covers every possible topic related to surgery. 3 major sections covering background surgical information (e.g. syndromes, most commons, names of procedures, anatomy pearls, common surgical meds, complications, etc etc.), general surgery and then specialty surgery. If you were hardworking and went through the entire book several times, i say you would have no problems acing your surgery rotation.

Core textbooks are essential for understanding. “Textbook of Surgery” is one target written for undergraduate students, written by Australasian surgeons. Good to have. Its quite cool to read a chapter authored by someone you can put a face too. Its almost as if they were speaking to you directly. Except they won’t pause and start pimping you.

Bailey and Love is a good reference text to be used at the library. I know the Yanks use Sabiston, Greendfield, Schwartz etc but i must admit they are a little too advanced for me. They shouldn’t be by the time i graduate or hit yr 5. I have used Zollinger’s Atlas before though. 

2. Where to go

Attend ward rounds, clinics and theatres. Simple. However, students being students lose interest, get bored, have tutorials to get to, lectures to attend, free lunches to go to, and some even have jobs afterhours. So it is essential to work out where you learn best and go for high-yield activities. 

3. What to do

I suppose the next question is what you do once you attend these stuff and how to make them high-yield.

Ward rounds are great to check out how patients do post-op. Post-op care is important, duh. Also, ward rounds are great pimping grounds. But if you have heeded my advice on getting Surgical Recall earlier, then you will have less problems. Some fellow students i speak to tell me that ward rounds are not great for learning surgery. It really depends on the team. 

Clinics are awesome to go for! Now, you can either choose to follow,  or choose to do, or both. Follow consultants to learn direct from the knowledgeable AND experienced. They often have nifty tricks, shortcuts to exams and pearls of wisdoms. Follow registrars/residents who are preparing for surgical exams. They might be free-r to teach as well. I have followed different doctors for surgical outpatients and each time i learn a lot. Participating in clinics are in general a high-yield activity. 

Oh yea, the other option is to “choose to do”. This option depends on the clinic. I have been asked by the consultant to take a room by myself and take the history and/or do an exam and then report back. It is active learning. Not passive watching and following people. This is preferred learning but may not always be possible due to logistical issues like insufficient rooms.

Theatres! (It’s been 1 week in Paeds for me  and i haven’t gone to the OT. I miss blood!) 

Anyway, always find out the patient list from Bookings Office or Pre-Admissions. Find out whose doing the surgery, and ask beforehand if its ok for you to come. its only courteous. Once you are up there on the waiting area before they go under (GA), or before they get rolled into the OT, talk to them. find out why they need the surgery. examine them. elicit the signs. the good student would have read about the procedure the night before, the distinction student would have memorised all the steps. i usually write them down in a little notebook so i dont get lost during the operation! (it can’t be guaranteed that someone will talk you through it; in fact, its v rare that occurs!)

4. What NOT to do

- attend a surgical list, and not having learnt about the patient, the surgical procedure they are going to have, indications, complications, steps (to at least know what they are doing), and some relevant anatomy. 

- steal “surgeries” from fellow students or even residents. i write this because of stories i hear. if students are scheduled by a Clinical Site Administrator, then follow that. if you deviate from the plan, and go along for someone else’s slot, then its plain rude if you just rock up and even take up their chance of scrubbing in. so always ask if they’d be happy. repeated stealing might make fellow students talk about you and they might not like you that much after. 

- attend a surgical procedure more than once. i personally find that having seen one lap appy and one open appy, for example, is good enough. i’m not at the stage of my medical career to be learning HOW to do one. and i don’t think undergraduate medical students are meant to be learning HOW to do surgery.

Finally...

Teaching goes hand in hand with pimping. It is part and parcel of medicine. So rather than whine about it (which i admit i have at times), embrace it. Love it. Take it positively. Learn from it. Because the next time you don’t know an answer, its not just your embarrassment on the line; it’s somebody’s life. (now im banking on someone to quote me on this, hopefully.) 

that is all i’ve got. i reiterate i am just a medical student. i am struggling to get by medical school. im not a whiz kid. the best students (whom you should probably seek advice from) probably don’t waste time blogging. the good ones probably are studying hard and don’t spend much time reading someone else’s blog as well. im just average. so don’t believe everything i say. all the best to you. 

But of course, if you’re a seasoned surgeon or trainee, feel free to share with me what worked for you below in the “comments” section.

related posts:

• Cut on the dotted line >> advice for medical students (surgical resident from USA dispenses great advice)

Thanks to DrCris, a Melbourne-based surgical registrar who is finishing her PhD soon, we now have the Inaugural Australian Medical Blog Awards. Earlier, she had compiled a list of all the Aussie medical blogs. IF you are interested, link on and peruse the blogs, and see which ONE is worthy of your nomination. 

Here are The Rules:

1. Nominations will be taken as comments on this post for two weeks, ending Friday 6th February at 6pm EDST. There is only one category this year - Best Australian Medical Blog. This includes doctors, nurses, ambos, pharmacists, medical researchers and patient blogs, along with many others. You could start with some of the blogs listed at the Australian Medical Blogroll.
2. You may nominate one blog only (preferably not your own - you know it makes you look silly), so choose wisely.
3. The nominations will be scoured by an international panel of bloggers, and a short list of 5 will be chosen
4. Polls (should) open on Monday 9th of February and voting will continue until 6pm EDST on Friday 20th Feb
5. I am the sole organiser of this contest, so this blog, AppleQuack, and my other blog, Scalpel’s Edge are immune to nominations (but chocolates will be accepted).
6. Nominations and votes can come from international people, and non-medical people.
7. It’s just a game, ok, so don’t take it too seriously. There will be another chance next year.

I think Sandnsurf (Life in the Fast Lane), an ED physician,  will win, and he has been kind enough to nominate me! Its a honor to be nominated by the author behind Medgadget’s Best New Medical Blog 2008 and a future winner of the the Australia Medical Blog Awards!

its Lunar New Year here (2 days public holiday in a predominantly Chinese population) in Singapore. Its the Chinese version of New Year, according to their own calendar; where families get together and celebrate the New Year. 

So will be visiting relatives and friends. 

Medical school wise, I start Paediatrics next Monday. 9 week rotation. Followed by a 9 week OBGYN rotation. Its going to be  a hectic time and steep learning curve ahead i reckon.

Blog wise, as i mentioned in my blog round up, i will be posting less and less. trying to maintain SurgeXperiences as well.

Instructions: Scroll down slowly, reading off the bottom of your browser/screen

Jeffrey: Welcome to the 15th edition of SurgeXperiences Season 2. Today we will unveil 2 things. First, as you might already have noticed, is the change of my blog name from “monash medical student” to “Vagus Surgicalis“. Second? I’ll keep you in suspense!

Jeffrey: Let me first introduce to you my co-host for today, Dr. Sanjay Gupta!

Dr Gupta: (mutters under his breath) We’re on air?! Ah, let me put on this suit.

Dr Gupta: Good morning America! As usual, we will be reporting on breaking medical news, regular health and medical updates. 

Jeffrey: (whispers) Psst! Remember what we’re doing today? Not the usual!

Dr Gupta: (embarrassed) Oh yes thank you very much, Jeffrey!! I’m so sorry … today we will highlight this increasingly popular trend we’ve got going ONLINE - blog carnivals! They are similar to a magazine, in that it is dedicated to a particular topic, and is published on a regular schedule, often weekly or monthly [1]. I will cite one example, something close to my profession and my heart. That is…the only surgical blog carnival online – SurgeXperiences. 

Jeffrey: Now tell us more about this unique name – SurgeXperiences. What does it mean?

Dr Gupta: SurgeXperiences actually stand for Surgical Experiences. It is an all-inclusive blog carnival about surgical blogs, wherein surgical eXperiences are shared. It is open to all (surgeon, nurse, anesthesia, patient, radiologist, pathologist, etc) who have a surgical blog or article to submit. I’ve heard they even got their very own logo!

Jeffrey: That’s right. We’ll bring that up right now… 

Jeffrey: There seems to be some technical difficulty. Our guys will be sorting this out, but we’ll come back to that in a while. Meanwhile, Dr Gupta, perhaps you could tell us, exactly what kind of articles they feature.

Stories

Dr Gupta: It is my pleasure. Original articles from established surgical bloggers are most welcome. Some are excellent story tellers. One of them is a general surgeon hailing from the South African province of Mpumalanga. Dr Bongi  2 stories for us regarding post traumatic stress. Dr Bongi (Other Things Amanzi) recalls an incident when he was the junior on a cardiothoracic service receiving a gunshot heart. With a 2nd article, he highlights the aftermath of losing a patient and the effect it can have on the doctors involved… 

Jeffrey: It certainly isn’t easy to be a doctor, having to deal with patients lost, and the duty of care to the next patient with little/no time for themselves to recover.

Dr Gupta: Exactly. We wash our hands off the previous (now dead) patient and then literally wash our hands. Today in the 21st century, we have this established practice of hand washing, kudos to a 19th century Semmelweiss. Dr Vitelli, who authors Providentia, gives a historic account of this Austria doctor. 

Jeffrey: Wow, that was interesting. Here, let us feature a funny story from MudPhudder, talking about his worst day in the O.R.

Dr Gupta: Ah… (full of reminiscence)…  those medical student days… Now let us present some bloggers who blogged certain viewpoints about certain issues:

Blogger Viewpoints

• Suethsayings: Dying for a surgery which might not work  (Obesity surgery: disadvantages/complications and the importance of patient selection) 

“…giving people false hopes about surgery which may not even help them (and may cause their death), can we really say anymore that “no one is being hurt”?”

• Dr Sharma’s Obesity Notes: Obesity in 2009 (5 predicted trends in obesity treatment)

Overall, I look forward to an exciting 2009 in which obesity will remain at least as, if not even more, important than it was in 2008.

• Philadelphia Inquirer: When doctors clash, patients are the one who suffer (turf wars in the medical profession)

“Even now, with rigid licensure laws in place, many people don’t know the difference between an ophthalmologist and an optometrist, let alone who is the best surgeon for a specific operation.

Patients need all the help they can get. Let ophthalmologists and optometrists work together to diagnose and treat eye problems. And let’s keep surgery in the hands of surgeons.”

• Synapse: An Apple a day (Apple CEO’s health and speculation regarding cause)

• Synapse: Anaes-ethic (substance abuse in medical professionals)

“… I have had the aquaintance of anaesthetists who speak of drug use, both prescription and illicit, in a recreational context. However, I also know medical students and doctors in other specialties who have also used such substances…. “

• Buckeye Surgeon: Rural Surgery (It takes more than money to recruit a surgeon to a rural area)

“… You may find you are only doing 5 or 6 cases a week without a reasonable expectation of growth (given the population) and your income falls by 50% or more. It happens. And the hospitals don’t care because they’re still racking in the procedural profits from the cases you do book … “

• To London and Back: Smiley faces advertising pain (personal experiences with surgical / medical instruments)

“… Dental instruments. Dreadful. Vaginal speculum is a big no-no. Don’t even try. Nasal speculum. Not any better. Surgical instruments: scalpels, knives, forceps, tenaculums etc. Under anesthesia one does not much care, but seeing the instruments and their cold lifeless skin on the table in the morning sun is not at all uplifting. Scissors, dilators, kidney basins, hooks, retractors, screws. Are these for used for torture? … “

• Medical Economics Blog: Heart problems and surgery teach doctor difficulty of navigating the medical system (as title suggests)

• Field Notes Blog: Race you to the bottom (A missionary surgeon at Kijabe Hospital in Kenya shares his personal reflections)

… just as quickly as a Heimlich maneuver can open an obstructed airway, acknowledging our need is the first step in opening up the floodgates holding back God’s grace…

• Julie’s Life experiences: Changes in 2009 (surgical floor RN blogs about the new year)

• Edmund’s Blog: Investigation of patients treated by an HIV-infected cardiothoracic surgeon (as title suggests)

Dr Gupta: (amazed) Those are some intriguing articles that I could spend an entire day reading! Seems like this SurgeXperiences blog carnival is really cool! If only i had a blog.. i would contribute every fortnight!

Jeffrey: Well its never too late to start one to chronicle your life! 

Dr Gupta: (chuckles) I’ll think about it. Now we move on to some technological updates in the surgical field! 

Tech updates

• Fully integrated voice controlled OR in Naval Medical Centre, San Diego (Journal Abstract)
• Eye-See-Cam: See what the surgeon sees, exciting applications (Medgadget Blog)
• Heart valves implanted without open-heart surgery (e! Science News)
• New surgical adhesive SurgiSeal approved by FDA (Medgadget Blog)
• Doctor places first next-gen REALIZE Band, also known outside the US as ‘the Swedish Band’.(Biomedicine Blog) - Advantages over LAGB® are technical. All seem to be as effective in treating morbid obesity. 
• Step one in your surgery: Swallow the microscopic hands (Discover Blog) – left picture below
• Swallow your surgeon (Medical Quack) – right picture below

Jeffrey: Alrightey. Let’s take a break for the advertisements!

~ ~ ~

This is a familiar tune, but actually is “a spoof video made for one of our anesthetists who retired in March & this was played at his retirement party..”

~ ~ ~

Dr Gupta: Thank you for joining us back on our unique coverage of SurgeXperiences – the one and only surgical blog carnival in the world.

Jeffrey: (serious tone) Today, we want to also  feature an open letter from Orac, a surgical oncologist who blogs frequently about psuedoscience and quackery. He addresses this letter to Seth Aronson who lost a loved on to breast cancer and plans to make a movie/documentary about it. 

Dr Gupta: As I understand, this project is entitled “Walk Through Fire” . As Seth himself describes it, i quote: “it is a documentary about the epic struggle to save my soulmate Audrey from breast cancer, and the aftermath of my failure to do so. All footage shot while she was alive will be shown in color, everything shot after she died will be black and white. The b&w footage will include interviews with nurses, healers, oncologists and patients, talking philosophically and realistically about the potential possibility of curing cancer, as well as Audrey’s family and friends reminiscing about her life.” Here’s a sneak peek:

Jeffrey: This is indeed a heart wrenching story. The response from Orac has been termed by some as “touching, reasoned, and rational”, “outstanding”, “heartfelt”, and “pitch-perfect”. You must CHECK IT OUT. 

I’m very, very sorry for your loss. Believe me, I am. Like you, I have been touched by breast cancer in my family… 

Regardless of your personal tragedy and apparent anger at the medical system, what I do have a problem with in your clip is your apparent belief that there is a cure, specifically the Hoxsey therapy, that could have saved Audrey and is being hidden from the American public by the medical profession.

You keep saying, “There’s got to be a better way.” You’re almost certainly correct. Do you really think that oncologists haven’t asked themselves that very question time and time again? Do you really think they enjoy giving cytotoxic drugs and seeing people die when they can’t save them? Do you really think they would “suppress” a cure if one was found…

Patient news and stories

Dr Gupta: Moving on, we also have some news and stories about patients and from patients. For once, we will take the limelight off sportstars having surgery, and instead focus on the common folks and their lives.

• Rotorhead has got colorectal cancer. Read about how the doctors came to the diagnosis. He will be having neo-adjuvant chemo-radiotherapy over the following weeks. God-speed. 
• “I was 1st man to be treated by my surgeon for breast CA” (hard news for a patient to take)
• Numerous surgeries, skin grafts await Tega Cay burn victim Connor …
• Man Who Had OCD Surgery 8 years ago Dies (WPRI.com)
• Best Medical Blog finalist Kevin MD gives us a heads up on a patient who tweets his vasectomy. This is not the first. 
• Sour relations between ex-es. “NY Surgeon to Ex: You Owe Me for My Kidney.”
• I just had Cataract Surgery !

Surgeon General Coverage

Jeffrey: Next we move on to cover a little on who the next Surgeon General for the USA might be and we feature some opinion from the blogs. 

Dr Gupta: Due to conflicting interests, I shall abstain from reporting.

• NY Times Politics Blog “The Caucus” reports “CNN Medical Correspondent/Neurosurgeon as Surgeon General?“
• Busy Gupta performs brain surgery, reports for CNN 
• Sanjay Gupta as Surgeon General? (Women’s Health News)
• Advice and viewpoints are rife regarding the election of the future Surgeon General. 
• A topic of interest is whether the new one will be for or against universal healthcare. 
• Steven Milloy thinks its time for a Surgeon General-ectomy. In his own words, 

“So over the last 96 years, the Surgeon General has gone from working on genuine public health problems (infectious disease, clean water and sanitation) to advocating golf, Mickey Mouse-less food and beverage containers and video exercise games as public health measures.”

• Healthcare at Change.Org suggests some candidates; a welcome break from the limelight on rockstar Gupta.
• MD$alaries clarifies the role of a Surgeon General in USA and compares the salary this office entitles to that of physician executives at insurance companies

Orbituary

Dr Gupta: (solemnly) We have had fantastic surgeons who lived and it is only right we pay tribute to their lives and dedication to what they did. Today we feature 2 outstanding individuals whom many will remember for many years to come.

• 25 Dec 2008: Dr Nedret Mujkanovic, a surgeon and war hero, is remembered over at the Srebrenica Genocide Blog.

As the only surgeon in the besieged town, Dr. Mujkanovic performed 1,390 operations, 100 amputations and four Cesarean sections – many times without anesthetics. In 1993, he was featured in NY Times. 

• 27 Dec 2008: Colleagues of Chris (Made A Difference) are remembered as New Jersey surgeon Dr Pryor is laid to rest.

Dr. Pryor was a Major in the Army Reserves and it was his second tour in Iraq. He was killed when a mortar struck near his quarters in Mosul. He was 42 years old. His service in Iraq wasn’t the first time he answered the call. He also reported to the World Trade Center after the bombing in 2001.

Jeffrey: Lastly, we have lined up for you some fun stuff too!

• Neo-Conduit: The Surgeon Song – features music and lyrics by UK doctors The Amateur Transplants
• Surgeon Tee shirts for Thee? – Check them out!
• Frankie’s Hideout: Frankie the Fattie
• Some lawyer blog: A great DUI lawyer is like a surgeon (humorous) 
• Interested in a different kind of surgery? a mac fan? check out some pictures here!
• Oh! the iPhone can do LASIK and whiten your teeth. Really?

Announcements

Dr Gupta: That’s funny. I especially like the one by Frankie. I’ve heard of him somehow! Correct me if I’m wrong, but I think he’s the next host!

Jeffrey: That’s spot on Gupta. The next edition of SurgeXperiences (216) will be hosted at Frankie’s Hideout 2 weeks from now on 1 Feb 2009. You can submit your articles via this form.

Dr Gupta: Earlier we said we were going to show you the 2nd surprise. Now, thanks to Vitum, we have SurgeXperiences official logo! 

Here it is!

Dr Gupta: Looks great. Really reflects well on the blog carnival. You can check out past editions here. 

Dr Gupta: Well, thank you for joining us. It’s been my pleasure being the guest host. If you want to host SurgeXperiences, just like i did, feel free to contact Jeffrey who is the main coordinator.

i’ve been advised to include this:

Disclaimer: the above is entirely fictional and imaginary. they do not in any way reflect the views of the real Dr Sanjay Gupta.