Author: Jon Mikel Iñarritu

Older surgeons have higher mortality rates

Like those nice posts of Kidney Notes called Hilarious Journal Articles I have read in the September issue of Annals of Surgery an article wich concludes the following:

For some complex procedures, surgeons older than 60 years, particularly those with low procedure volumes, have higher operative mortality rates than their younger counterparts. For most procedures, however, surgeon age is not an important predictor of operative risk.

In this study, it was used the national Medicare files examining operative mortality in 461,000 procedures. There were three groups of surgeons age 40 years and less, 41 to 50 years, 51 to 60 years, and 61 years and more.

The complex procedures were: esophagectomy, cystectomy, lung resection, aortic valve replacement and aortic aneurysm repair.

Less experienced surgeons (those of 40 years and less) had comparable mortality rates to surgeons aged 41 to 50 years for all procedures. So, why everyone call them unexperienced?

Survival Story (update)

fishermen

Three fisheremen survive nine months at sea.

Salvador Ordoñez Vázquez, Jesús Vidaña López and Lucio Rendón Becerra, are the fishermen who drifted 8,000 kilometres (4,971 miles) across the Pacific Ocean in an open boat for nine months are the toast of Mexico.

They survived rawing fish, seabirds and rain water.

From San Blas, Nayarit (Mexico), to Marshall Islands, Majuro (near Australia) they were found by the Kusskaooss, a ship from a fishing company.

Other related stories:

On 1942, a chinese sailor called Poon Lim survived 4 months on the Atlantic Ocean.

On 1789, the british William Bligh survived 6 weeks.

What a great story, I’m very happy about them.

U P D A T E: They are safe in land

at least

On October 28th, 2005 five fishermen went to hunt sharks. On the very first night, they lost their fishing line. While they looked for this missing line, they exhausted all of their fuel.

During the next few days, to survive, they ate the birds that settled into their boat. They cracked them with a knife, removed their intestines, and used them for food. They walked from one side of the boat to the other trying to fish with hands. They collected gallons of rainwater that slipped into the boat.

One of its more terrible moments was when they shared the night with orcas. They thought that one of them would flip over the small boat. They guarded their fallen companions Juan and “El Farsero” during those three days. Later, they threw their bodies to the sea.

Salvador said: “The day that Juan died, the 20th of January, he called to me and I asked him: ‘What are you trying to tell me, Juanito?’ He looked straight into my eyes and then he died, I will never forget this picture”

They did not want to die, but they let eat, said Lucio, the one from Nayarit. “El Farsero” was the oldest one, but he never wanted to eat, said Jesus. The three assured that the deceaseds were from Mazatlán.

Jesus is the owner of the compass and he frequently let them know that they would eventually arrive in China.
Lucio owned a little Casio watch that prolonged the agony “I had to leave it because each little while they asked me what time was it”.
And Salvador, the master and guardian of the Bible, organized mornings, afternoons and nights of reading.

The mental picture of themselves: Three fishermen on a boat in the middle of the ocean, reading aloud Biblical passages to drive away the fear, the desperation. “He says to God, help yourself that I will help you”.

Nine months and nine tragic days, but on 9th of August, they celebrated when the Taiwanese boat Koo´s 102 found them in the middle of the ocean.

These three men had never had seen such a beautiful dawn in their lives. They were all barefoot, with the swelling in the feet. They were unwell with the marks of the shipwreck in the skin. They saluted. They said that they were well, that they were not scared. They were not cannibals and they didn’t eat their companions as rumored.

The crew of the rescue ship made them put on a T-shirt to take the above picture. These brave men will always remember this journey from the day left the Mexican coast and after more than nine months they appeared in Micronesia. Look out the picture

After 289 days of shipwreck, they said: “We never lost the hope”

Dr. Jon Mikel Iñarritu

FAQ – Necrotizing Enterocolitis

What is this?
Necrotizing Enterocolitis (NEC) is a syndrome wich consists in intestinal infarction.

What part of the intestine is affected?
Terminal ileum and colon, although the entire GI tract is affected in severe cases.

Why is NEC important?
Because NEC is the most common gastrointestinal emergency in the newborn infant and NEC accounts for substantial long-term morbidity in survivors of neonatal intensive care unit.

What are the risk factors of NEC?
Prematurity, milk feeding, circulatory instability, infection, and impaired mucosal defense. NEC incidence is greatest in newborn infants with birth weight less than 1.5 Kg, so prematurity is the most important risk factor.

How can be prevented?
It is well know that avoidance of hypertonic formulas, medications or contrast agents, prompt treatment of polycythemia, and placement of umbilical artery catheters with the tip below the level of the inferior mesenteric artery, prevent this condition.

What are the manifestations of NEC?
There are systemic and abdominal manifestations.

  • Systemic signs are nonspecific and include apnea, respiratory failure, lethargy, poor feeding, temperature instability, or hypotension (in severe cases).
  • Abdominal signs include distention, gastric retention (residual milk in the stomach before a feeding), tenderness, vomiting, diarrhea, and hematochezia (passage of bloody stools through the rectum).

How NEC is diagnosed?
The presence of abdominal distention, hematochezia, and pneumatosis intestinalis confirm the diagnosis of NEC.
We have to perform several studies, including blood analysis, stool analysis, sepsis evaluation, and radiographic studies.
The results of these studies often are nonspecific, although the radiograph may be diagnostic.

What are the findings at the radiograph?
Marked abdominal distention, dilated loops, pneumatosis intestinalis (bubbles of gas in bowel’s wall) and/or free intraabdominal air.

Could you show me a radiograph with this findings?
Yes, here you can see marked abdominal distention, dilated loops, pneumatosis intestinalis (bubbles of gas in bowel’s wall)
NEC

What is the treatment of this condition?
It depends on the stage of the disease. Medical managemente is appropiate in most cases, but in those patients with advanced NEC and bowel perforation we have to perform surgical intervention.

What are the complications?
The acute complications are infectious and hematologic. The late complications are intestinal narrowing or stricture formation and short bowel syndrome.

What is the prognosis?
Due to advances in neonatal intensive care, agressive treatment, potent antibiotics and earlier diagnosis, approximately 70% to 80% of infants who have NEC survive, and approximately 50% of these are normal. The mortality rate is higher in infants who require surgery for NEC.

Dr. Jon Mikel Iñarritu

First Laparoscopic Liver Surgery

(via)
The first laparoscopic liver surgery in a child, was performed in Mexico.

Mark Thomas, a pediatric surgeon performed the world’s first laparoscopic liver surgery in a pediatric patient. The procedure was on May 24 at the National Medical Center, La Raza in Mexico City. The patient is 2 years old and has liver cancer, on the postop the patient is doing well.

By now, there aren’t published reports of liver resection in pediatric patients with cancer.

Thomas said: “Only a handful of centers in the world perform the number of specialized laparoscopic liver surgeries that we do in Cincinnati”

Dr. Jon Mikel Iñarritu

Surgery Simulator

Via Wired News

Is it possible to train yourself in a virtual patient?

A short answer is Yes.

In India, Professor Suvranu De is developing a surgery simulator with help of this couple of devices:

cyberglove phantom
Cyberglove & Phantom devices

Sounds nice, but… I personally believe that you cannot train yourself in a virtual environment because there are not virtual patients nor virtual diseases. There are certain things that cannot be learned that way. Human body and human organs manifest in different ways in disease and wellness, as the number of people on earth.

Here is an example of the SimSurgery:

Have you ever seen a virtual fever or cancer? I don’t.

The basics of minimally invasive surgery skills could be learned in virtual environments (like learn for the first time the spatial skill in angle laparoscopes). From there to the point of learn certain procedure in a simulator, it’s a long way.

Perhaps this kind of technology can have some applications, but we don’t have to hurry and change what it has been proven for years… although somebody call us old fashioned.

What do you think about surgery simulators?

Dr. Jon Mikel Iñarritu

Top Ten causes of death in Mexico

Several times, some people have asked me what causes death to mexicans.

On the last mortality statistics (2004) of general population, the main causes of death were [independently of sex]:

  1. Heart disease – 16.4%
  2. Complications of Diabetes Mellitus – 13.1%
  3. Cancer – 12.9%
  4. Traumatic injuries – 7.4%
  5. Liver disease (alcoholic and non-alcoholic) – 6.2%
  6. Stroke – 5.7%
  7. Perinatal complications – 3.5%
  8. COPD – 3.0%
  9. Pneumonia & influenza – 2.6%
  10. Kidney failure – 2.0%

References:

INEGI

State-Of-The-Art Surgery

From Medical News Today

Medical Center Accreditated by the American College of Surgeons:

The Beth Israel Deaconess Medical Center’s Carl J. Shapiro Simulation and Skills Center has been formally accredited as a Level 1 facility by the American College of Surgeons (ACS), the first in Boston and New England – and one of only six inaugural certified centers in the United States – to provide simulation-based skills training to health care students and professionals from all medical and surgical disciplines.

I would love to get that training.

Dr. Jon Mikel Iñarritu

Screening Measures for Cancer

Elisa Camahort wrote at Healthy Concerns a Frequently Asked Question: What are the best preventative screeinngs -of cancer- we all should do?
By now, there is evidence for three types of cancer, the recommendations of the US Preventive Services Task Force are the following:

Breast Cancer

  • Screening mammography, with or without clinical breast examination, every 1-2 years for women aged 50 and older.
  • Discusse with women in their 40s.
  • Women should be screened until their predicted life expectancy is less than 10 years.
  • Women with a strong family history should receive counseling for several options, which may include genetic testing for BRCA-1 and BRCA-2 and more intensive screening for breast cancer.
  • Regular clinical breast examinations.

Cervical Cancer

  • Target sexually active women with an intact cervix, starting three years from age of onset of sexual activity or at age 21.
  • Screening is routinely done by cytological examination.
  • Among women with repeatedly negative findings, screening more often than every three years rarely detects important conditions.
  • Screening women with previous negative findings every three years is a reasonable approach.

Colorectal Cancer

  • Target patients over age 50 years: Annual FOBT (Fecal Occult Blood Test) plus flexible sigmoidoscopy every five years OR colonoscopy every 10 years.
  • Patients should be asked about first and second degree relatives who have had colorectal cancer (number of relatives and age of diagnosis).
  • In order to screen high risk patients, ask the following questions starting at age 30 and update every 5 years: Have you ever had colorectal cancer or an adenomatous polyp? Have you had inflammatory bowel disease (ulcerative colitis or Crohn’s disease)? Has a family member had colorectal cancer or an adenomatous polyp? If so, how many, was it a first-degree relative (parent, sibling, or child), and at what age was the cancer or polyp first diagnosed?.
  • Patients at high risk should have screening colonoscopy starting at age 40 years, or 10 years younger than the earliest diagnosis in their family, whichever comes first, and repeated every five years.

Other Types of Cancer

  • There are not evidence to recommend screening.

Regards,

Dr. Jon Mikel Iñarritu