Quotes of the Month
I purposefully delayed last month's letter so I could report on the Texas Surgical meeting, which just took place on April 3-5, 2003. The host city was Dallas but the Westin Stonebriar Resort in Frisco, Texas was the meeting site.
Dr. Eric Fonkalsrud from UCLA was the guest speaker. He spoke on the surgical correction of chest deformities and the use of subtotal colectomy for the treatment of ulcerative colitis and other benign diseases of the colon. Pectus excavatum, a congenital deformity of the chest where the center is concave, occurs about one in 400 births. Of course there are varying degrees of deformity but in its most severe form the sunken breastbone causes significant pressure on the underlying heart and lung, resulting in compromised physiologic function. Fortunately this is correctable surgically and Dr. Fonkalsrud outlined the procedure which has, in his experience, given the best results. He also described in detail the results his surgical service has obtained by treating benign debilitating diseases of the colon with subtotal colectomy, preserving the function of the anal sphincter by the use of a small bowel pouch to replace the excised rectum.
I was impressed by the quality of the papers presented at the meeting. There are 7 allopathic medical schools in Texas and surgeons from their faculties are well represented in the Texas Surgical Society. In addition Baylor University Hospital in Dallas has a surgical training program and members of its faculty have always been leaders in the Society and contributors to the scientific presentations. The Texas Surgical Society is fortunate to have the members of the various surgical programs in the state present their results and experience rather than reserve it for national presentation. In addition the Texas Surgical Society allows its members from small communities to have a forum for the presentation of their surgical experiences to their peers. The technological and therapeutic advances were quite impressive, so I am going to summarize some which I think will be of interest.
Dr. Joseph Zwischenberger from UT Medical Branch Galveston presented a paper which demonstrated that in many cases sophisticated imaging studies could diagnose lung nodules so that invasive needle biopsy was not necessary. Dr. Kenneth Benson, a new member from Lubbock, discussed nephron-sparing surgery for cancer of the kidney. This technique removes a portion of the kidney rather than the whole organ. It is only useful for small tumors and provides similar results as a nephrectomy in the treatment of kidney cancer. The increased use of thoracic CT scans as screening methods for coronary artery disease has discovered asymptomatic small kidney neoplasms, which are amenable to nephron sparing surgery.
Atrial fibrillation after coronary artery bypass surgery has been a disturbing postoperative problem. Dr. Richard Wood from Baylor University Medical Center in Dallas described a technique that many of the cardiac surgeons at Baylor have been using to effectively treat this problem. They leave a small wire loosely attached to the surface of the heart and this wire catheter exits through a tiny opening in the chest. If the patient goes into atrial fibrillation post op then the heart can be converted to a regular rhythm by an electrical shock administered via the catheter. When the patient has recovered then the catheter is simply removed by gentle traction.
I was impressed by a presentation entitled Kyphoplasty for the treatment of osteoporotic compression vertebral fractures; given by Dr. John Reeves from Wichita Falls. Compression vertebral fractures influenced by osteoporosis are common and cause a significant health and economic problem for the elderly patient. Surgical correction for these fractures is generally not done because the porotic soft bone does not lend itself to conventional orthopedic fixation utilizing screws and other hardware. Dr. Reeves used a technique that consists of percutaneously inserting a balloon canula into the compressed vertebrae and inflating the balloon to elevate the compression and thereby restore the normal vertebral height. X-rays demonstrate whether the anatomy is satisfactory or if further elevation is required. Once the orthopedic surgeon is satisfied with the result then an acrylic substance is injected through the canula to maintain the fracture reduction and then the balloon and canula are removed. Dr. Reeves reported satisfactory short-term results that are certainly encouraging for the correction of this significant health problem. Time will tell whether the results are lasting.
Dr. Brunicardi from Baylor University Medical School in Houston reported the preliminary results of a clinical trial that attempts to achieve insulin independence in type 1 diabetics by transplanting pancreatic islet cells into the patient's portal vein. The unique aspect of this trial is that the pancreases are obtained in Texas from deceased donors then sent to a center in Miami where the islet cells are extracted. Successful extraction of these cells is difficult and the establishment of an extraction center is costly. The results of this trial demonstrated that geographically located centers can be established around the US and these centers could serve the transplant programs thus allowing them to operate without a costly extraction laboratory.
Other papers covered topics such as: Robotics for cardiac surgery, laparoscopic colectomy techniques, the use of heated chemotherapeutic agents for the intra-peritoneal treatment of wide spread malignancies, the use of endoscopy for the retrieval of radial arteries for coronary artery bypass grafting, and a sutureless technique for aortic-coronary artery anastomoses in non pump cardiac surgery.
I thought it was a successful meeting. The next one will be in October and it will be located in El Paso. The Society is studying the development of a web site that could be accessed by both patients and physicians. Successful establishment will preclude the reporting of results in a medium such as The Webletter.
QUOTES OF THE MONTH
"Give me a firm place to stand, and I will move the earth."Take care until next time,
Richard J. Turner, III, M.D., F.A.C.S.
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