Quotes of the Month


     I know it has been some time since I have written a Webletter and I apologize for my tardiness but it seems like 2004 has been unusually busy-at least for me and my family. Two new female grandchildren, christenings, travel, and other writing projects have kept me busy.

     In February, I attended the North Texas Chapter of the American College of Surgeon's meeting in Dallas. One of the highlights of the meeting was a talk by Dr. Donald Palmisano who is a New Orleans surgeon and the current president of the AMA. He had a great deal to say about the medical malpractice crisis in the United States and places the blame squarely on the frivolous litigation by plaintiff's attorneys. I refer you back to a February Webletter where I discussed other aspects of the problem. He is so confident of his stand that he will debate a trial attorney anywhere and any time, using statistics, which he has researched, that refute their standard arguments.

     In April, I attended the spring meeting of the Texas Surgical Society. The meeting was held in Houston and the scientific session was held in the beautiful new Denton Cooley Building at the Texas Heart Institute. Dr. Cooley presented a paper on the 50 year history of the Institute, and outlined 105,000 cardiac cases done at the Institute's various locations. 105,000 cases is mind boggling for one institution. In 2003 alone they did over 7000 cases. I am not aware of that volume at any other place in the world.

     I don't have a planned subject for discussion so I am going to present a number of "Medical One Liners" from the current literature. I have borrowed most of these from Dr. Stephen Eppstein's e-mails. Dr. Eppstein is a well known Fort Worth Internist who practiced at the late Lorimer Clinic for many years. Prior to his retirement he was a mainstay at The Medical Clinic of North Texas. He currently provides their continuing medical education and sends comments on current medical literature to his many physician friends and colleagues by e-mail.

     TRAVELLERS DIARRHEA - Quinolones (Cipro, Levofloxacin, etc) are the current drugs of choice for treating traveler's diarrhea. For individuals on steroids, there is an increased risk of Achilles tendon rupture during athletic endeavors. Quinolones are also contraindicated in pregnancy and in children.

     ED: I, and many others, take Cipro prophylactically while traveling to high risk areas(Mexico, tropics).

     CORONARY ARTERY STUDY - Dr. N.E. Khan et al, New England Journal of Medicine 2004,350:21-8. Patients who underwent coronary artery bypass surgery were studied by comparing those done "off pump" and "on pump." There were no deaths in either group but at 3 months the graft patency rate was significantly higher in those patients done "on pump."

     ED: I think the rate for "off pump" cases will improve as more sophisticated instrumentation is developed so surgeons can easily operate on the beating heart. My cardiac surgeon friends tell me that they can hardly tell any difference when using these newer instruments.

     SMOKING AND CORONARY ARTERY DISEASE (CAD) - Smoking is a risk factor for developing CAD and for sudden death if you have CAD. Smoking cessation reduces the risk of sudden death to the same risk as a never smoker. The number of cigarettes smoked daily is not a factor, reducing the number does not reduce the sudden death risk. Smoking cessation is the goal.

     ED: This risk is probably due to carbon monoxide in the smoke as a product of combustion.

     MAMMOGRAPHY - In asymptomatic women breast augmentation reduces the sensitivity of detecting breast cancer. It was 45% with augmentation vs. 66.8% without. The specificity is not changed.

     ED: Radiologists have recognized this and have developed techniques of positioning, etc. but apparently they are not perfect enough to overcome the effect of the implant on the imaging.


     I am in the process of publishing a children's book. It is entitled Hello My Name Is Tiff. It is an autobiography written by our late Lhasa Apso from her vantage point in Heaven. When it is ready and priced, it will be for sale on this web site. I have two essays available for sale .They are $10.00 each. They are on historical medical events. One is on President Grover Cleveland's secret operation and the other is on the assassination of Senator Huey P. Long from Louisiana.

     I also am organizing some Irish Poetry which I composed on our trip last year and these will be available and for sale.

Too many people in the modern world view poetry as a luxury,
Not a necessity like petrol. But to me it is the oil of life.
     - John Betjeman (1906-84), British Poet, The Observer, 'Sayings of the year'

Poetry makes nothing happen, it survives
In the valley of its saying.
W.H Auden (1907-73), British Poet, In Memory of W.B. Yeats
Take care until next time,
Richard J. Turner, III, M.D., F.A.C.S.

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     Trip to Ireland
     Texas Surgical Society Meeting Notes
     The Malpractice Crisis
     Treatment and Prevention of Malignant Disease
     West Nile/Cancers/Discontent with American Healthcare/Prescriptions
     History of Preventive Medicine
     Smoking Risks/Depression/The Western Diet
     Food Consumption/Cancer and Treatment Relationships
     Notes from the Spring Texas Surgical Society Meeting
     Alternative Medicine
     Breast Cancer Symposium
     Vitamin B, Passive Smoking, Statin Therapy, Common Cough