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.

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).

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.

• 

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.

Lyrical incisions

Many surgeons, anesthetists and nurses like music to be played in the operation theater. It helps them relax and sooth their nerves. It improves the cognitive function of the listeners and creates a sense of well being. Their moods get better.It helps personnel approach surgeries in a thoughtful and relaxing manner.
However, there are contrasting views regarding the role of music in the operation theater. Some people might be sensitive to noise and not like the type of music being played.
What if :

• Some people liked classical music and hated heavy metal?
• The music caused distraction?
• Sudden changes in tempo led to sudden unwanted movements?
• The music affected communication between anesthetists, surgeons and nurses?

It would be a good idea if all the operating theater personnel discussed the type of music to be played while operating. It would save a lot of heartburn among all concerned.

Here is a typical scene from the popular American sitcom 'Scrubs'.

Surgeons' song:-)

Laparoscopy vs Arthroscopy

Laparoscopy and arthroscopy both involve the use of small instruments to look into cavities and perform surgeries. Laparoscopy uses Carbon dioxide to insufflate the abdomen so that the abdominal organs are examined better. Arthroscopy usually involves the use of sterile saline which is pumped into joints at the required pressure using a pump.
Laparoscopy is usually done by trained surgeons or gynecologists while arthroscopy is done by trained orthopaedic surgeons. Joints such as shoulder, elbow, wrist, hip, knee and ankle are most frequently examined and operated with arthroscopic techniques.
Arthritis is an informal way of referring to joint pain or disease and involves many related conditions.
With advances in fiber optics during the 1970s, arthroscopy advanced significantly. The first interventions are credited to the Japanese surgeon Masaki Watanabe. The first arthroscopies were reportedly done with a cystoscope and a thoracolaparoscope.  
The seed for this article came from a walkathon being organised at our hospital on May 21, 2017. Details are given below.

  

The gall of living without a gallbladder

Gallbladder removal or laparoscopic cholecystectomy is one of the most common operations being performed in the world. Usually, the operation is advised for patients with gallstones who develop symptoms of inflammation of the gallbladder. There are several advantages to laparoscopic removal of the gallbladder such as lesser pain, faster recovery and smaller scar.
Many patients ask their surgeons whether removing the gallbladder causes any adverse effects. Many animals do not have gallbladders. Gallbladder is the storage organ for bile which helps in digestion. In people without gallbladders, bile is directly delivered to the intestines. Theoretically, patients may not digest food well but it is found that the body adjusts and most patients are able to consume a normal diet.
Celebrities who have undergone gallbladder surgeries include the Dalai Lama, Eric Clapton and Jack Black.        

Science of a sign

Murphy's sign is a sign elicited by doctors in cases of acute cholecystitis. The doctor keeps his hand below the right costal margin and the patient is asked to take a deep breath. If the patient complains of pain on inspiration, the sign is considered to be positive.This is because the gall bladder, which is inflamed, comes and touches the examiner's fingers.

The sign is named after John Benjamin Murphy, who was called by Mayo as" the surgical genius of our generation". He described innovative procedures in vascular surgery, thoracic surgery, plastic surgery, urology, orthopedics, general surgery and neurosurgery.

Some eponyms related to him are:

•  Murphy’s button- a mechanical device used for intestinal anastomosis

•  Murphy's punch- a punch tenderness at the costo-vertebral angle in cases of perinephric abscess

• Murphy’s test- a test for deep-seated tenderness and muscular rigidity in cases of perinephric abscess

• Murphy drip for administration of fluids by proctoclysis in patients with peritonitis

• Murphy-Lane bone skid-a common commercial steel instrument used for femoral head procedures

He was a founding member of the American College of surgeons and predicted his own autopsy findings ( He died due to aortitis).

The Harmony and the destruction!

This article is about the harmonic scalpel which is an instrument used to cut and cauterize tissues. The instrument uses ultrasound vibrations at a frequency of about 55,00 Hz. At such a high frequency, the molecules are denatured and heated up and die. The instrument is useful in performing advanced surgeries like laparoscopic gastrointestinal surgeries. It is manufactured by ETHICON.
Why is it called 'Harmonic Scalpel'? There is no data available on the origin of that term.
The inventor seems to be Mr Warren Jewett as per patent filing.
   

Colonoscopy- The beginning

It is said that the colonoscopy procedure is as much dreaded by patients as a root canal. Colonoscope is a snake-like instrument that traverses the large intestine from rectum to caecum. The development of colonoscopes was considered a quantum advance in abdominal surgery. It was developed by Dr Wolff, in association with Dr Shinya and Olympus.Their most significant achievement was developing the technique of polypectomy during colonoscopy. They also developed the protocol of using one doctor instead of two for the procedure. Currently, 1.6 million colonoscopies are being performed annually in the USA.

Lap appendicectomy- Patient Info

Laparoscopic appendicectomy- Information for patients

What is appendicitis?

Appendicitis is inflammation of appendix which is a small tubular structure located where large and small intestines meet.

How is appendicitis treated?

The doctor may order some tests to determine if surgery is necessary. If diagnosis is confirmed, the doctor may decide to remove your appendix by doing surgery.

What happens during surgery?

You will undergo general anaesthesia wherein you are put to deep sleep and will not feel pain. The surgery takes approximately an hour. The doctor makes small cuts in your abdomen through which camera and instruments are put and your appendix is removed.

Diet

You can start with clear fluids after about 6-8 hours and resume your normal diet if there is no nausea or vomiting.

Activity

You should not lift heavy weights for 4- 6 weeks. You can gradually increase your walking and activity as directed by your surgeon.

Medications

After surgery, you may be given antibiotics and you should continue taking them as prescribed. You may be given pain medication and you should take them as suggested by your doctor.

Bandages

You may have small bandages over the incisions. Do not be alarmed if a small amount of bleeding is seen. If dressing becomes wet or dirty, it needs to be changed. Do not apply any ointments or creams over the incisions.

When to call the doctor

·         Fever

·         Excessive pain

·         Lot of bright red bleeding

Disclaimer: This is for information only. For queries, talk to your doctor.

Upper GI endoscopy-Patient information

Upper GI endoscopy-Patient information

Endoscopy is a test to look into the esophagus, stomach and first part of small intestine. Endoscope is a thin, flexible tube passed through the mouth and its tip has a camera so that the operator can see inside your gut.

Who undergoes endoscopy?

The doctor may advise endoscopy if you have

·         Heartburn

·         Pain abdomen

·         Vomiting

·         Difficulty in swallowing

·         Blood in vomit

What happens during endoscopy?

The doctor usually sprays the back of your throat with local anesthetic spray to make it numb. You are asked to lie on your side on a couch and put a plastic mouth guard between your teeth. You are asked to swallow the first section of the endoscope which is pushed down your food pipe. The video camera records pictures and sends them to a screen. The doctor may take biopsies of the inside lining of the gut depending on your condition. This is  painless and samples are sent to the laboratory.

What preparation do you require? 

·         You should not eat or drink anything for 4-6 hours before the test as the stomach needs to be empty.

·         If you have a sedative, you may need somebody to accompany you home.

What happens after endoscopy?

Most endoscopies are done without problems and you may have a mild sore throat for a few hours. The doctor may tell you his findings and also give a report. The lab tests if done might take a few days. You can go home after the test if you have not been given a sedative. However, you are required to report to your doctor if you have the following symptoms:

·         Increasing abdominal pain

·         Fever

·         Difficulty breathing

·         Vomiting blood

Disclaimer: This material is for information only. For further details, talk to your doctor.