Thursday, July 12, 2018

About biceps- Two heads are better than one!

Let me be frank. I am a scary dude because I have two heads. I swear it’s not my fault as I was born like this. My second name is brachii. That makes me Biceps brachii.

Each of my heads arises from the scapula and gets inserted into the humerus. To get along well with my colleagues (tendons and bones), I have several coverings-bicipital aponeuosis, bicipitoradial bursa . I am forced to get along well with them to help in smooth functioning of my host. 

I rank higher than the two muscles lying below me, coracobrachialis and brachialis. I am run by musculocutaneous nerve and cervical nerves. I am fed by the brachial artery. I flex the elbow, flex and abduct the shoulder and also help in supinating the forearm. My chief antagonist is triceps muscle.

If you have read enough, let me go on to some interesting facts.  When I flex, I look like the back of a mouse. This made the humans (living in Rome) call all the muscles as muscles  because musculus means ‘ little mouse’ in Latin. You can’t call me bicep because it is considered incorrect.

Between 1505 and 1510, there was an artist named Leonardo Da Vinci who drew my portraits and explained my functions. He was not believed because he was not an anatomist. Two hundred years later, I was rediscovered by William Cheselden and Guillaume Duchenne.

Another interesting fact is that because of me, horses can rest and sleep while standing.

Monday, July 9, 2018

Fistula - A brief history

The barber and the surgeon

During 17th century lived King Louis XIV. In the year 1685, he developed a swelling in his bum which became an abscess and finally a fistula.

The king was rumoured to have bathed only twice in his lifetime because water was supposed to cause infections! In desperation, the services of the barber- surgeon were sought.

Barber surgeons were barbers who performed minor operations. Charles- Francois Felix, who was the barber surgeon, prepared for 6 months and developed tools for his tryst with glory or despair.

He operated on the king in November 1686 and the operation was a success. The surgeon became famous and also prosperous. The courage of both the king and the barber gave a new respectability to surgeons and eventually led to the establishment of the royal academy of surgery.  

( An anal fistula is an abnormal communication between the anal canal and the skin. It occurs due to infection of anal glands.)

Wednesday, July 4, 2018

Jeep bottom!

Imagine that you were a driver in the World war. You drive a jeep, fight for your country and do all that is required of you and make yourself feel proud. You are tired at the end of the day and just want to take rest. Suddenly you find that fluid is leaking from the base of your spine and it is foul smelling. You think that it is just sweat, forget all about it and take rest.
In a few days, the fluid leak increases and then suddenly it becomes an abscess (pus filled). It is throbbing, painful and unbearable. You take some antibiotics and forget all about it.  It keeps coming back again and again and then you decide to do something about it. You don’t know which doctor to consult. You search the internet and think that it is ‘piles’.
I met a patient a few days ago in my clinic who did not know which doctor to approach for a pilonidal sinus. He knew the diagnosis because he had done a little bit of research on the internet. That made me dive headlong into the topic.
Pilus means hair and nidus means nest and pilonidal sinus means nest of hair. Pilonidal sinus disease was first described in 1833 and attained fame due to its presence in soldiers during World War II. During this time, it was known as “Jeep Disease”. Hair goes through the skin, forms a track and stays until it is removed.
There are several treatments for this condition. It can be excised and left to heal by itself or it can be closed primarily. Several types of flaps can be planned for the primary closure.
Since the disease happens in young individuals, cosmesis has to be considered. Time away from work or school also plays a role.

Saturday, September 9, 2017

Varix- Where did the word come from?

I was just wondering about the origin of the word 'varices' and how it arose. Online search revealed that the word came from Latin 'wer' which means highland or high. As surgeons, we encounter them usually as esophageal varices or varicose veins. Esophageal varices look like this.

Bleeding from esophageal varices is a significant cause of mortality in patients with portal hypertension. Currently, esophageal variceal ligation remains the treatment of choice to treat patients with esophageal varices.
It is exciting to read about the history of treatment of a particular condition and the difficulties faced by the inventors of the methods that are currently in use.
The story of esophageal variceal banding is closely linked to that of portal hypertension. The idea of a banding device for varices originated from the device that was being used for hemorrhoids. Initial devices were single shot devices and had to be reloaded each time after application of the band. Currently, multi-band ligation has made the life of both the surgeon and patient far easier.

Saturday, July 29, 2017

Uffs and butts- A tale of asstronauts!

As surgeons, we often encounter patients with anorectal problems. They can be a source of great discomfort and cause loss of work and expenditure to patients. Some common problems faced by patients include hemorrhoids or piles, fissures, fistulas and pilonidal sinuses.

Although hemorrhoids don't deserve a treat, they sometimes require treatment. Hemorrhoids are often referred to as piles. This word is derived from the Latin word 'pila' which means ball which might have referred to the globular form of external hemorrhoids.
Fissures are tears in the anal canal and cause a lot of pain. The word fissure is derived from the Latin word 'fissura' which means 'to split'.
Fistulas in the anal canal cause a lot of embarrassment to the patients because of the pus discharge and are difficult to treat if they are complex. The word fistula is derived from Latin which means 'pipe'.
Pilonidal sinus is a discharge from the gluteal cleft and the term was first used in 1880 and meant pilus (hair) + nidus (nest).

Monday, June 26, 2017

He fed fevers!

Robert James Graves was an Irish surgeon who described a case of exophthalmos with goiter in 1835. The disease was named after him and is commonly referred to as Graves' disease and is the commonest cause of hyperthyroidism. Less commonly it is also known as Begbie's disease, Parry's disease, Flajani's disease, Marsh's disease etc. Signs and symptoms of hyperthyroidism may include muscle weakness, weight loss, diarrhea, fast heartbeat, poor tolereance of heat etc.
Some interesting facts about Robert James Graves :

    • He had a gift for languages. He was thought to be a German spy and arrested for travelling without a passport as the authorities could not believe that an Irishman could speak German so fluently.
    • He introduced new methods of clinical teaching which are followed to this day.
    • He introduced the timing of pulse by watch.
    • He was the first to introduce the practice of giving food and liquids to patients with fever instead of withholding it. He jokingly suggested an epitaph for himself " He fed fevers"!
    • He is the uncredited inventor of the second-hand on watches.
Some notable cases of Graves' disease include
  • George H.W. Bush and Barbara Bush
  • Gail Devers,American sprinter
  • Marty Feldman, a British comedian, who used his bulging eyes as part of his act.

Monday, June 12, 2017

Hashimoto- A town doctor

June 20 is known as Hashimoto's thyroiditis awareness day. I was able to do armchair research and glean out some information about Hashimoto from Wikipedia.
Hakaru Hashimoto was a Japanese medical scientist born in 1881. He studied in Japan, Germany and England and returned to his hometown, Imaguchi, where he practised as the town doctor till his death in 1934.
He published a report on lymphomatous goiter in 1912 which was evaluated years later by English and American researchers and the disaese that he described was recognized as an independent illness and named as ' Hashimoto's thyroiditis'.
Hashimoto's thyroiditis is an autoimmune disease in which the thyroid gland is gradually destroyed leading to hypothyroidism and in some cases, thyroid lymphoma. A relapsing encephalopathy occurring in association with Hashimoto's thyroiditis is known as Hashimoto's encephalopathy.