“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds. Mr. Jones just had a transhiatal esophagectomy (THE).  The esophagus is the muscular tube that connects the back of one’s throat to their stomach.  It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed. A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up ...

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The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do? According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely. The press release from ...

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Top stories in health and medicine, September 22, 2014From MedPage Today:

  1. UN: Ebola 'Threat to Security'. The West Africa Ebola epidemic is a threat to international peace and security, the United Nations Security Council decided.
  2. Surgical Training Can Be Fun and Games. Make simulation training like a game and surgical residents will want to play, researchers reported in a letter ...

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Risk-adjusted 30- to 90-day outcome data for selected types of operations done by specific surgeons and hospitals are now being publicly posted online by England's National Health Service. According to the site, "Any hospital or consultant [attending surgeon in the UK] identified as an outlier will be investigated and action taken to improve data quality and/or patient care." After cardiac surgery outcomes data were made public in New York, some interesting unexpected ...

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Joan Rivers: Pushing the limits of outpatient care There are minor operations and procedures, but there are no minor anesthetics.  This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers. Ms. Rivers’ funeral was held on September 7.  Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and ...

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Taking lawsuits personally: A surgeons first malpractice case Part 1 of a series. In all my years of practice, my dad called me at the office only twice. The second was to inform me of a horrible family tragedy. The first -- well, I guess in a small way you could say it was the same. "I hear you joined the club," he said. "What?" I had no idea what he was talking about. I'd ...

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A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.” In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care -- the added cost of additional care, additional hospitalizations, and the additional ...

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I opened my obligatory late-afternoon email to find my work schedule for the next morning: three general anesthetics for MRIs. My heart sank. A week before, I had been assigned to the new neurosciences MRI suite for a 6-hour interventional radiology procedure, followed by another intervention in the CT scanner. My first thought: Who is trying to punish me? It's well known in the anesthesiology field that these types of cases ...

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An orthopedist asked me if I could explain why a couple of papers of his did not generate any feedback. He wasn't even sure that anyone had read them. He enclosed PDFs for me. Not being an orthopedist, I cannot comment on their validity. But I think I can explain why the papers have not created much interest. Are you familiar with the term, "impact factor"?

A journal's impact factor is an ...

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I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless: “Modern medicine had to start somewhere.” On the third episode, last Friday ...

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