Fear from cancer

One not uncommon indication for prophylactic mastectomy is carcinophobia (a.k.a. cancerophobia).

Cancerophobia or carcinophobia is an active behavior of extreme fear of cancer that can lead to repeated medical examination without giving full reassurance to the patient. Denial is a mechanism of defense that usually helps the patient to cope with painful, threatening, overwhelming, or awkward thoughts. When it turns out to be ineffective and pathological, it can cause either delay or avoidance in seeking treatment for symptoms relevant for a true malignancy and will lead inexorably to death if not cured. Most people worry about cancer, but those with cancerophobia are unable to perform their activities of daily living.

For example, cancerophobics believe that a simple headache is a symptom of brain cancer/tumor or dysphagia is a symptom of gastric cancer.  This patients need psychological intervention.

In a female patient cancerophobia with a strong family history of breast cancer and a benign tumor in her breast and if psychological intervention doesn’t help her and she still over-anxious, prophylactic mastectomy is indicated.

The Best U.S. Hospitals for 2009

1. Johns Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. Ronald Reagan UCLA Medical Center, Los Angeles
4. Cleveland Clinic
5. Massachusetts General, Boston
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. University of California-San Francisco Medical Center
8. Hospital of the University of Pennsylvania, Philadelphia
9. Barnes-Jewish Hospital/Washington University, St. Louis
10. Brigham and Women’s Hospital, Boston &  Duke University Medical Center, Durham, N.C.
11. University of Washington Medical Center, Seattle
12. UPMC-University of Pittsburgh Medical Center
13. University of Michigan Hospitals and Health Centers, Ann Arbor
14. Stanford Hospital and Clinics, Stanford, Calif.
15. Vanderbilt University Medical Center, Nashville, Tenn.
16. New York University Medical Center
17. Yale-New Haven Hospital, New Haven, Conn.
18. Mount Sinai Medical Center, New York
19. Methodist Hospital, Houston
20. Ohio State University Hospital, Columbus

Top Hospitals by Specialty in the U.S.

• Cancer: M.D. Anderson Center, University of Texas, Houston
• Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
• Digestive disorders: Mayo Clinic
• Ear, nose, throat: Johns Hopkins Hospital, Baltimore
• Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
• Gynecology: Brigham and Women’s Hospital, Boston
• Heart and heart surgery: Cleveland Clinic
• Kidney disorders: Brigham and Women’s Hospital
• Neurology and neurosurgery: Mayo Clinic
• Ophthalmology: Bascon Palmer Eye Institute, University of Miami
• Orthopaedics: Mayo Clinic
• Psychiatry: Massachusetts General, Boston
• Rehabilitation: Rehabilitation Institute of Chicago
• Respiratory disorders: National Jewish Hospital, Denver
• Rheumatology: Johns Hopkins Hospital
• Urology: Johns Hopkins Hospital

REFERENCES:

• News release, U.S. News & World Report.
• U.S. News & World Report: “America’s Best Hospitals.”
• Avery Comarow, health rankings editor, U.S. News & World Report.

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image under Creative Commons license

As in Marvin L. Corman’s book (Colon & Rectal Surgery) quotes:

Man should always strive to have his intestines relaxed all the days of his life and that bowel function should approximate diarrhea. This is a fundamental principle in medicine, that whenever the stool is withheld or is extruded with difficulty, grave illnesses result.

Maimonides: Mishneh Torah

Rectal prolapse (a.k.a. Procidentia) is one of the most fascinating surgical pathologies because its complexity in treatment. In 1912 Moschcowitz proposed an herniation of Douglas pouch as a cause for rectal prolapse. Another cause was proposed by Broden and Snellman with the help of defecography described a full thickness rectal intussusception.

Rectal prolapse is 6 times more common in females (as males) aged 50 years or older. Many of male patients has a past medical history of psychiatric disorders. Chronic or lifelong constipation with straining is present in more than 50% of patients.

Patients describe a mass or bulge that they have to push back in after defecation. Often, presentation of rectal prolapse can be dramatic when the prolapsed segment becomes incarcerated below the level of the anal sphincter as in this clinical case and emergency surgical therapy was indicated.

More than fifty types of procedures for repair rectal prolapse have been described, but the treatment is always surgical.

Hand reconstruction

Lakshmi Tatma is a girl who is two years old but she was born with 8 limbs, because she is joined at the pelvis to what is, in fact, a headless, undeveloped twin (parasitic twin or to be more specific, ischiopagus cojoined twin).

This is surely an abnormal feature and it has attracted media attention worldwide.

The 24-hour-long surgery to remove the extra limbs of this Indian girl born with four arms and four legs was a success, doctors announced Wednesday.

A team of more than 30 physicians removed Lakshmi’s extra limbs, salvaged her organs, and rebuilt her pelvis area, Dr. Sharan Patil said from a hospital in the southern Indian city of Bangalore, India.

The organs of a pig are placed within the model.

The model is intubated with an “orotracheal” tube

Abdominal view

Thoracic view

Laparoscopy view

Note the color of the skin and the emphysema

Note the color of the skin and the emphysema

Note the changes in the color of the skin

Images courtesy of Mariana Herrera Guerrero, M.D.

More of Subcutaneous emphysema here.

The english organization Marie Stopes International maintains a campaign to alert british citizens on the risks of acquiring venereal diseases or non-wished pregnancies when traveling to Mexico.

“What is more embarrassing, his hat or what he might give you? Make sure don’t come home with any unwanted holiday souvenirs”

This poster is very offensive and annoying. It’s an insult for my Country and it will frighten tourists. MFs, try to think before offend.

Welcome to the third edition of SurgeXperiences, the first carnival of surgery. I’m honored to bring you this surgical carnival.

This will be a practical and concise edition. The objective of blogs (in my point of view) is to answer questions as quickly as possible, so lets start with the HOW-TOs. Enjoy.

• How to classify fingertip injuries and amputations and how to treat them? This is a nice abstract in where we will learn how to close the wound, maximize sensory return, preserve length, maintain joint function, and achieve a satisfactory cosmetic appearance. This is a Must Read!
• How to survive surgical training when your boss is really mean? A touching and insightful story. Luckyly those times are changing.
• How must be your surgeon? How to make the perioperative experience a smooth one for patients, nurses and surgeons? Great tips for all of us. Don’t lose the floor.
• What are the complications of Mitral Valve Replacement? An excellent reminder.
• How to choose a rehabilitation center? What are their services, facilities, costs and credentials?
• How is the clinical presentation of severe pancreatitis? I love hard cases as this one.
• How much farther have we advanced in medicine since the days of trepanation? Do you know that people had holes drilled in their heads voluntarily and they state that this results in more energy and an increased feeling of consciousness and lessens repression?
• How a prosthetic robotic arm works? Nice videos!
• How a simple procedure (lateral sphicterectomy) can lead to a satisfyingly outcome for both the patient and the surgeon?
• How to interpret the new article that assures the relationship between breast implants and suicide rates?
• How to be thankful to a surgeon and how a surgeon can change your life? Charming story that guides me to always give the best of me.
• How an amebic brain abcess looks like? You will never forget to keep it as a differential.
• How a simple order can trigger a defense mechanism? Try to not give orders to therapydoc.
• Should mesalamine be stopped prior surgery? Why?
• How to manage those the difficult situations involving CPR? A very insightful view and nicely written.
• How to back in time for 3 decades and deny the link between AIDS and VIH? Do you think that the truth may prevail?
• What kind of role a military surgeon play in war zone? Sharing his thoughts and feelings about Air Force training.

Thank you for your time and participation. Make sure you read the next edition of SurgExperiences, created by Jeff Leow

Please feel free to post about anything related to surgery, like surgical procedures, mistakes during surgery of your training, lessons learnt, and tips, first operation done solo, memorable operations, memorable patients, jokes. I also accept patient posts.

You can send me your article via:

Blog Carnival Submission Form
Regular e-mail to: j o n m i k e l ( AT ) g m a i l . c o m.

On physical examination we found Grade IV hemorrhoidal disease.

We decide to perform a PPH procedure with an hemorrhoidal circular stapler (33 mm) kit.

Note the tissue removed.

This donut confirms the circular and complete resection of the defect.

On the postoperatory period the patient was in excellent condition without pain and without bleeding.

On the physical exam, we found a 10×15 cm tumor in the left upper quadrant. The tumor is not fixed, it feels solid and well delimited. We did not find any other important data.

Lab work beteween normal ranges. We ordered plain abdominal film, chest x ray and later an abdominal ultrasound and a CT scan.

Rx

Ultrasound

CT Scan

With these findings, we decided to perform an exploratory laparotomy (left subcostal incision) and tumor resection.

Look the size of the tumor and its characteristics.

Note the splenic vein.

The tumor arises from the tail of the pancreas. It was impossible to dissect the spleen, so we had to cut it.

Pathology

Final diagnosis: Benign Solid Pseudopapillary Tumor of the Pancreas of 14 cm, and 1.66Kg.

Solid-pseudopapillary tumor (SPT) of pancreas is a very rare (about 450 cases have been described in the world literature) neoplasm of low malignant potential and unknown origin. It generally occurs in young women and the prognosis is usually good after complete surgical removal.

SPT is also know as Fratz’s tumor

The patient was alert, very anxious, and in severe pain.
blood pressure of 160/120; pulse of 126; respiratory rate of 24; normal temperature; SatO2 of 96% without O2 supplement.
She had a distended upper abdomen and epigastric tenderness without rebound or guarding.

A plain film of the abdomen was ordered and showed gas-filled, grossly dilated stomach.

Pass of nasogastric tube was unsuccessful.

A laparotomy was mandatory.

The patient survived the surgery but 6 months later, she died by causes nonrelated to the surgery

In 1904, Borchardt described the classic triad of gastric volvulus: severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube.

On January 25th, a car crash took place in Nebraska and Shannon Malloy (a previously healthy 30 year old woman) was seriously injuried. Her skull became separated from her cervical spine, this is what is called internal decapitation.

“I remember the impact and then I had no control over my head… I wasn’t focused so much on the pain. I just kept thinking, ‘I have to stay alive,’” said Shannon.

5 screws were drilled into Shannon’s neck and 4 more were drilled into her head to keep it stabilized. Then a thing called a halo (rods and a circular metal bar around her head) was attached for added support. It’s not exactly a pain-free procedure.

Shannon Malloy still has a long, costly recovery ahead. A fund has been set up in Malloy’s name at Wells Fargo banks. You can make donations at any location under the “The Benefit of Shannon Malloy.”

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