Quotes of the Month
Spring Texas Surgical Society Meeting
Recently I attended the spring semi-annual meeting of the Texas Surgical Society, which was held in Tyler, Texas. The azaleas and dogwoods were in full bloom and the setting was magnificent. Fortunately the rains did not come until Sunday when the members were leaving to return to their homes scattered over all parts of the Lone star State. The Texas Surgical Society was founded in 1915 and its membership comprises the leading surgeons from large cities and small communities of Texas.
The invited guest speaker was Dr. Richard W. Hobson, II who is an internationally acclaimed Vascular Surgeon from the University of Medicine and Dentistry of New Jersey. The meeting content was heavily weighted toward vascular surgery probably because of Dr. Hobson's expertise in this field.
There were papers presented on pediatric heart transplant, parathyroid surgery, burn scar correction, plastic surgical correction of post mastectomy defects, problems associated with surgical training, and the Texas A and M bonfire catastrophe besides the papers on vascular surgery.
Dr. Coselli from Houston presented his experience with surgery for aneurisms that involved the aorta (large artery) both in the chest and in the abdomen. His series consisted of over 1600 cases. This is truly amazing since these aneurisms are not common. The surgery is very difficult and Dr. Coselli has developed techniques that minimize some of the treacherous complications such as paralysis of the lower extremities due to clamping of the aorta while the various branches of the aorta are sewn to the prosthetic graft. Houston has always been a center for complicated vascular surgery since surgical pioneers like the late Dr. Stanley Crawford and the current Dr. Michael Debakey started the programs following World War II.
Dr. Clifford Buckley from the Scott and White Clinic in Temple, Texas spoke on the problems associated with the development of an endovascular aortic aneurysm treatment program. This is a technique used on poor risk patients who have a large and potentially fatal abdominal aortic aneurysm. The patients were compromised by associated illnesses that made them a serious risk for a general anesthetic. The endovascular technique allows the surgeon to insert the specially constructed graft through an artery in the leg and manipulate it into a position within the inside of the aneurysm. The grafts are hand made and very expensive averaging about $10000 apiece. Small hooks attach the prosthetic graft at the upper portion of the aorta and the two limbs of the lower portion of the graft insert within the iliac arteries, which lead to the legs. Patients who have their aneurisms repaired by this technique must be followed for the remainder of their life since there are many potential complications associated with the procedure. The longevity of the graft is not known since the procedure is so new. This type operation is a perfect example of a problem previously addressed in the Webletter. The problem is that the remuneration for the procedure hardly covers the expense of the new technology and hospitals risk losing money when their vascular surgeons decide that a patient should have this type repair. When a patient is a fair surgical risk the conventional open aortic aneurysm repair is currently far superior. Only time and refinement of the endovascular techniques will determine whether it will be appropriate for all patients with this vascular problem, which is usually a complication of arteriosclerosis and is potentially fatal if it ruptures. The risk of rupture of an aortic aneurysm is directly related to its diameter. Patients whose aneurisms are 6 centimeters (2. 5in.) and over are considered to be at risk and are candidates for surgical repair. As I said earlier the technique recommended will be determined by the patients co-morbid medical illnesses.
Dr. Hobson, the distinguished guest speaker, delivered an excellent paper on catheter balloon dilation and stenting for narrowing of the carotid (large artery in the neck) arteries. The carotid arteries (2) are the major blood supply to the brain and can have narrowed segments usually due again to that egregious vascular problem, arteriosclerosis. If the narrowing of the blood vessel exceeds 70% of the diameter of the lumen then the patient is at risk for a stroke. As in the previous technique of endovascular surgery, the use of this technique is determined by the physical condition of the patient. Currently only surgeons who are certified to participate in clinical trials that are evaluating this procedure can perform this operation and receive remuneration for it. The FDA has not approved the device, which is inserted in the blood vessel above the narrowed area and utilized for trapping debris that may dislodge as a result of the balloon dilation. This debris can migrate to the small arteries of the brain and cause a stroke, which is one of the most serious potential complications of this type surgery, both when done by the open technique and by the catheter route. If all of these problems are worked out then the catheter procedure may be the preferred method for all patients and the standard of care in the future.
Dr. Steven Blackwell from Galveston presented a very interesting paper on the use of Suave hair conditioner for use in wound cleansing. They happened on this product serendipitously when a patient told him she used it to remove dried blood from her hair because the hydrogen peroxide that she was instructed to use did not work. Dr. Blackwell and his group did a scientific evaluation of the product and determined that it prevented bacterial growth and did not harm normal cells. It is inexpensive and readily available. Their plastic surgery service is currently using Suave to remove adherent dressings especially in pediatric patients and clean and debride painful wounds and ulcers in all patients. It sounds too good to be true but their extensive evaluation was certainly convincing. I can think of many other potential uses for this product and look forward to trying it.
QUOTES OF THE MONTH
"If anything is sacred the human body is sacred."Take care until next time,
Richard J.Turner, III, M.D., F.A.C.S.
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