NEWSLETTER > FEBRUARY, 2011
Dr. Saibal Moitra, MD,FCCP
Dr. Debi Dutta, MBBS
Dr. Debi Dutta, MBBS
A middle aged lady got admitted in our hospital with complaints of dry cough and shortness of breath for past 2 n 1/2 years. For this she had initially shown at Medical College Hospital but after few months she was sent to SSKM Hospital, Chest Department, as she was not responding. There she was diagnosed having intertial lung disease and started on oral steroid which she could not tolerate. Her condition remained the same and as she was not getting relieved, she was lately admitted here. When I saw the patient, she was a middle aged housewife, hypertensive, non-diabetic, anxious incessantly coughing and also having SOB due to exhaustion. She was hypoxemic, tachycardiac, tachyspneic, hypertensive, duthermic. There was mild pallor, no icterus, no cyanosis, no clubbing, no dependent oedema, and no lymphadenopathy. Her chest examination revealed diffuse rales. Cardio vascular, abdominal & central nervous system examination was normal. Her Routine investigation revealed: normochromic, n ormocytic anemia, raised ESR, counts were normal, liver function test, blood sugar, renal parameters, thyroid function test were within normal limits. ECG was normal, Echocardiography normal, chest roentgenography reveled by lateral patchy alveolar opacities in middle and lower zones with streakyopacities both lower zones. Arterial bloodgas Analysis revealed type1 respiratory failure. Contrast enhanced CT reveled bilateral scattered alveolits with ground glass opacification and scattered bronchiectasis mostly invoving upper lobes. Patient could not perform pulmonary function testing. There was no sputum. A provisional diagnosis of diffuse parenchymal dry disease was made and blood was sent for al immunological parameters. Patient was put on supplemental moist O2 and other supportive treatment was given. Mantoux test with 5TU PPD was negative. Patient improved symptomatically and a fibrocopic, bronchonoscopy with BAL study was planned. FOB did not reveled any abnormality and BAL fluid was sent for study al ong with Gramstain C/S, ZN stain for AFB and Bactec Culture for M. Tuberculosis. The results showed Smear positive for AFB and M. Tuberculosis grew in Bactec Culture, patient was put on anti-tuberculor drug(RHZE). Though initially she was not tolerating the medicine well, but later she tolerated in. She is still now in the initiation phase. Clinically she has improved and chest x-ray also improved. All immunological parameters were negative.
This case was presented as it shows that tuberculosis can present in any form. Here it presented like an ILD and as the patient was not having the cardinal symptoms like fever, weight loss, family h/o contact. Expectoration and Mantoux was negative. The actual diagnosis eluded her for so long. Henceforth, in India Tuberculosis should be considered as a differential diagnosis in most of the conditions where this is a diagnostic dilemma.
This case was presented as it shows that tuberculosis can present in any form. Here it presented like an ILD and as the patient was not having the cardinal symptoms like fever, weight loss, family h/o contact. Expectoration and Mantoux was negative. The actual diagnosis eluded her for so long. Henceforth, in India Tuberculosis should be considered as a differential diagnosis in most of the conditions where this is a diagnostic dilemma.
Surgery And Some Myths by
Dr. Tapan Mukherjee MS, DNB
Dr. Tapan Mukherjee MS, DNB
We have already stepped in to 21st century. Surgery today has travelled a long path of advancement from days of Susruta, offering our patients a far superior safer technically superb and precise options like minimally invasive surgery, robotic surgery , stereotactic brain surgery; the list is endless and ever-increasing!
But, sadly enough, like the archetypal 'darkness under the lamp', some myths still do affect us, the common man, the patients and the surgeons too are not exempt. A myth is much more serious than the fairy tale and impacts more on the life of humans. Great ancient surgeon William
Stewart Halsted (1852-1922) aptly observed: “It is now as it was then and as it may ever be; conceptions from the past blind us to facts which almost slap us in the face.”
But, sadly enough, like the archetypal 'darkness under the lamp', some myths still do affect us, the common man, the patients and the surgeons too are not exempt. A myth is much more serious than the fairy tale and impacts more on the life of humans. Great ancient surgeon William
Stewart Halsted (1852-1922) aptly observed: “It is now as it was then and as it may ever be; conceptions from the past blind us to facts which almost slap us in the face.”
Common myths that our patients happen to share and propagate:
1. You should not take sour food items after a surgical operation! :
It is just the opposite. Most sour food items are citreous fruits and contain vitamin C , which actually help heal our wounds!
2. You should not take a bath for at least a week after surgery, or till the wound heals! :
Wounds start healing immediately after surgery and your skin wound of an operation usually heals enough to become water-tight in 48 hours. A normal gentle soap wash will make it clean and free of contaminating bacteria, thus help actual healing!
3. Older patients need more rest after surgery! :
An important determinant of recovery particularly in elderly patient after a major surgery is the lung function, which a prolonged bed rest will only worsen. Elderly patients should be off the bed faster!
4. Cancer Myths: Surgery opens up the cancer to the air and makes it spread! :
Quite untrue. If there is cancer in other parts of your body after surgery, it is because: the cancer had already spread to other parts of the body before surgery a new cancer has developed or there were cancer cells left behind after surgery or cancer cells slipped into a blood vessel while the surgeon was removing the tumour
Adjuvant therapy, such as radiation, chemotherapy, targeted therapy, or hormonal therapy, can help to eliminate any cancer cells left in the body after surgery.
5. Cancer Myths: Electronic devices, like cell phones, can cause cancer in the people who use them! :
Although very few studies suggest a link between rare types of brain tumours and cell phone use, the consensus among most research is that there is no consistent association between the two. The same goes for microwaves and related appliances that emit low-frequency radiation.
6. Regularly eating Tanduri meats/kebabs won't increase cancer risk! :
Tanduri meats / kebabs creates chemicals linked to cancer in animals, and you can increase your cancer risk by eating too much of it.
7. Bariatric surgery makes weight loss easy and permanent! :
This surgical procedure can help patients lose up to 50 to 66 percent of excess body fat, and patients have a lot of work to do post-surgery. It is possible to gain weight back after the initial loss that results from reducing the size of the stomach. Bariatric surgery is a tool, not a solution.
1. You should not take sour food items after a surgical operation! :
It is just the opposite. Most sour food items are citreous fruits and contain vitamin C , which actually help heal our wounds!
2. You should not take a bath for at least a week after surgery, or till the wound heals! :
Wounds start healing immediately after surgery and your skin wound of an operation usually heals enough to become water-tight in 48 hours. A normal gentle soap wash will make it clean and free of contaminating bacteria, thus help actual healing!
3. Older patients need more rest after surgery! :
An important determinant of recovery particularly in elderly patient after a major surgery is the lung function, which a prolonged bed rest will only worsen. Elderly patients should be off the bed faster!
4. Cancer Myths: Surgery opens up the cancer to the air and makes it spread! :
Quite untrue. If there is cancer in other parts of your body after surgery, it is because: the cancer had already spread to other parts of the body before surgery a new cancer has developed or there were cancer cells left behind after surgery or cancer cells slipped into a blood vessel while the surgeon was removing the tumour
Adjuvant therapy, such as radiation, chemotherapy, targeted therapy, or hormonal therapy, can help to eliminate any cancer cells left in the body after surgery.
5. Cancer Myths: Electronic devices, like cell phones, can cause cancer in the people who use them! :
Although very few studies suggest a link between rare types of brain tumours and cell phone use, the consensus among most research is that there is no consistent association between the two. The same goes for microwaves and related appliances that emit low-frequency radiation.
6. Regularly eating Tanduri meats/kebabs won't increase cancer risk! :
Tanduri meats / kebabs creates chemicals linked to cancer in animals, and you can increase your cancer risk by eating too much of it.
7. Bariatric surgery makes weight loss easy and permanent! :
This surgical procedure can help patients lose up to 50 to 66 percent of excess body fat, and patients have a lot of work to do post-surgery. It is possible to gain weight back after the initial loss that results from reducing the size of the stomach. Bariatric surgery is a tool, not a solution.
Some common myths that some surgeons themselves believe:
1. The duration of an operation does not matter.
2. Debulking of advanced tumors improves survival and quality of life.
3. Simple adhesions cause pain; adhesiolysis alleviates pain.
4. Incisions heal from side to sidenot from end to endthus length does not matter.
5. The bigger the incision, the greater the surgeon.
6. Midline incisions are the best.
7. Layered abdominal closure is better.
8. Subcutaneous sutures improve wound healing.
9. Subcutaneous wound drains prevent wound infections.
10. Stapled anastomoses are better than hand-sutured anastomoses.
11. A two-layered intestinal anastomosis is safer than a single-layered anastomosis.
12. Interrupted rather than continuous suture technique results in a better intestinal anastomosis.
13. Routine use of nasogastric decompression after laparotomy is beneficial.
14. The nasogastric tube protects the downstream anastomosis.
15. The T-tube has to be inserted after common bile duct exploration.
16. Feeding the postoperative patient should be accomplished gradually.
17. Irrigating the peritoneal cavity after any type of operation is beneficial.
18. One should remove all visible peels of fibrin during operations for peritonitis.
19. Postoperative fever is an ominous sign that should be treated.
20. Antibiotics should be continued after operations for peritonitis as long as the patient is febrile or his white cell count is elevated.
21. The stronger and more modern the antibiotic agent, the better.
22. Modern, high-tech, expensive wound care is better than soap and water.
1. The duration of an operation does not matter.
2. Debulking of advanced tumors improves survival and quality of life.
3. Simple adhesions cause pain; adhesiolysis alleviates pain.
4. Incisions heal from side to sidenot from end to endthus length does not matter.
5. The bigger the incision, the greater the surgeon.
6. Midline incisions are the best.
7. Layered abdominal closure is better.
8. Subcutaneous sutures improve wound healing.
9. Subcutaneous wound drains prevent wound infections.
10. Stapled anastomoses are better than hand-sutured anastomoses.
11. A two-layered intestinal anastomosis is safer than a single-layered anastomosis.
12. Interrupted rather than continuous suture technique results in a better intestinal anastomosis.
13. Routine use of nasogastric decompression after laparotomy is beneficial.
14. The nasogastric tube protects the downstream anastomosis.
15. The T-tube has to be inserted after common bile duct exploration.
16. Feeding the postoperative patient should be accomplished gradually.
17. Irrigating the peritoneal cavity after any type of operation is beneficial.
18. One should remove all visible peels of fibrin during operations for peritonitis.
19. Postoperative fever is an ominous sign that should be treated.
20. Antibiotics should be continued after operations for peritonitis as long as the patient is febrile or his white cell count is elevated.
21. The stronger and more modern the antibiotic agent, the better.
22. Modern, high-tech, expensive wound care is better than soap and water.
It was Rudyard Kipling (1865-1936) who said: “We think so because all other people think so; or because we think we in fact think so; or because we were told to think so, and think we must think so.”*(p62) Obviously, the average human, surgeons included, finds comfort under the sheltering wings of dogmatism wrapped in myths. Well-entrenched myths are notoriously resistant to rational critique and even evidence just look at the thousands of years required to dismiss the great therapeutic values attributed to bloodletting by world leaders of medicine and surgery. But try we must, and this list represents a modest effort. Scrutinize it and then reflect on the many myths to which you are enslaved personally. As time goes by, new myths will appear and old myths will disappearalbeit very slowly. Let us try to hasten the latter.
Acknowledgement:
*Moshe Schein, MD, Attending Surgeon, Department of Surgery, Bronx Lebanon Hospital Center Bronx, NY, Common myths in surgery; Surgical Rounds , January 2004.
*Schein M. Aphorisms and Quotations for the Surgeon. United Kingdom: TFM Publishing; Shrewsbury, UK, 2003.
*Breastcancer.org / treatment / surgery / expectations / myths.jsp, January 2004.
*Moshe Schein, MD, Attending Surgeon, Department of Surgery, Bronx Lebanon Hospital Center Bronx, NY, Common myths in surgery; Surgical Rounds , January 2004.
*Schein M. Aphorisms and Quotations for the Surgeon. United Kingdom: TFM Publishing; Shrewsbury, UK, 2003.
*Breastcancer.org / treatment / surgery / expectations / myths.jsp, January 2004.
Best Employee January
Mr. Subrata Koley (Floor Manager)
Mr. Subrata Koley (Floor Manager)
Floor Of The Month January
5th Floor
5th Floor
Best Employee 1st runner up January
Mr. Tapas Deb Sharma(Medical Transcriptionist)
Mr. Tapas Deb Sharma(Medical Transcriptionist)
Best Employee 2nd runner up January
Mr. Manas Saha(Incharge Laboratory)
Mr. Manas Saha(Incharge Laboratory)