Call for Submissions - Grand Rounds Vol. 6 No.36

Hey!

First of, I would like to thank the creators of Grand Rounds for such a wonderful feat and giving me the honour to host this next edition.

With the last edition topping the charts at 33 Charts I would certainly have to pull my socks up and pull of the rounds with at least 50% near perfection that Dr. V did.

Without further ado, lets get into submission mode. I'd like to keep the theme for this edition as Humour in Medicine. This may not have to be restricted to doctor patient but may extend to anything happening in and around medicine with a funny end to it!

Submission can be made either here at the comments section or at my email - Techknowdoc

I am on twitter with the handle (Techknowdoc) and would accept DM's there too

Deadline for submissions would be 30th May - Sunday!

Looking forward to hosting a colourful and hopefully smiling edition!

Cheers

Follow up of the Condyloma Accuminata

In continuation with my previous post about the giant anal wart that turned out to be cancerous, this is the same patient after 10 days follow up post surgery.

In case you are wondering what it looked like before the surgery, you can check out the photo here or go through my last post Giant Condyloma Accuminata!

That is a pretty descent job if I may say so myself. The only thing is to now, somehow, convince him that radiation is absolutely necessary for complete cure of the carcinoma. He is quite reluctant though. Also, e had about 50 smaller finger sized warts on his bodice and neck and face which he now wanted removed because he was afraid he would get cancer in them too. Took about 1 hour but we got them all!!

He's about ready to go home in a week or so to consider radiotherapy.
Until I hear more from him....

Giant Condyloma Accuminata

For all the non-medical readers, the title is not something I made up just to arouse your curiosity. Unfortunately, we had a patient of middle east descent recently who presented to us with a large growth in his perineal area (close to the anus).

He had been harbouring it for 10 years. When it started it was about the size of a pea. At present it was about the size of a soccer ball. This is the actual photo. No kidding! What must have started at the anal region as a simple wart was now extending upto the anal cleft behind and the groin in front! What provoked the man to keep it in hiding for all this time eludes even his brain. Somewhere in this mass was his anal opening. Can you even imagine the logistics of hygiene!

Well, we had the honour of having to operate on it and excise what we could while trying to save his sphincter functions. No sooner had we started that we realised that this most likely has undergone malignant change (become cancerous). Every portion we touched would bleed like crazy. The condyloma had become so vascular that it was very like that it had progressed to squamous cell carcinoma as is bound to happen after such a long period of having it. We excised what we could and tried to suture his skin back in place while sending the specimen for histopathological examination.

As it turned out, it was squamous cell carcinoma but the margins could not be identified, meaning we didn't know if we got all of it or was some element left in situ. We asked him to go for an Oncologists opinion for radiotherapy.

He refused! He still is resistant to go there and is thinking of going back to his home country.

God help him!

How soon can we drink after surgery?

Modern medicine has been breaking bounds in the new era. Every year we come up with new and fantastic methods to fast track recovery after a surgical procedure. The entire day care surgery concept is based on this fact. Sometimes, however, our patients push us to the limit.

The gentleman we were operating upon for a bilateral hernia under day care surgery was a very good candidate for surgery. Medically fit, cooperative, not pain sensitive, motivated for day surgery, ready to walk back to his hotel room in the evening after surgery. He was given local anaesthesia in the inguinal region and we were operating upon him. We finished the Right side and went on to the left. All was going well until suddenly the patient decides to ask us a very interesting question.

"Can I have a beer as soon as the surgery is done?"

We were quite shocked and asked him to say that again. I think he realised what he said because he then tried something else. " I can smell beer in the OT. Can I have some. I can smell it in the oxygen tube" Maybe he thought it was an excellent way to recover early from surgery?

Now wouldn't that be a novel way to get drunk. Inhale some alcohol vapours! Superb absorption!

Abscess Drainage without Antibiotics?

I just read a paper this morning that gave conclusive evidence that antibiotics do not work after an Incision and Drainage procedure for an Abscess. That was rather surprising to me. How can a cavity that's filled with pus (essentially teeming with bacteria and what not) not respond to the very things that were invented to destroy said bacteria and what not!

The data suggested that there was no difference in the healing process in the placebo group and the group that received the antibiotics. They also report that the incidence of further infection was not affected by the antibiotics. So, 7 days after the incision, patients were no better no worse. I'm not so sure thats a good thing!

Taking this scenario and applying it in India would be akin to shutting your practice down. Why? Simple. Your patients will think you've lost it! "My doc is so stupid he didn't even prescribe me antibiotics". In a country that is widely known for abusing over the counter drugs, we have our chemist friends that happily dispense all antibiotics over the counter as well and almost no one I know asks for a prescription. Knowing this, do you think that even if I don't prescribe an antibiotic, I won't be asked for it? Wouldn't it just be bought anyway to 'be safe'?

Pharma companies - Lets not even get started there. They must already be conduction 'trials' to disprove this theory. Be realistic, if you won't prescribe antibiotics for an infection, what else is left??? (Of course, I'm generalising!)

                                                          

How about you? Would you feel comfortable not taking any antibiotics after getting a surgical procedure on your body to remove pus from an abscess cavity?? 

I want comments on this one!

Ice Ball Surgery.

In continuation with my anal surgeries experience the novel concept of freezing someone's ass off captured my interest yesterday!

Cryosurgery is one of the accepted methods of treating Piles. Why, I will never understand? Is it because in this heat its something to cool off with? Is it because thats the only way to send gas back up the ass? Is it because its convienient? I have no answers. I personally don't like it as a form of treatment, but nevertheless it is used, so here we go!

 What you do is first identify the pile mass, take the cryotip which is a nice rounded metal tip and apply that to the mucosa and let the freezing gas go through the tip to form a nice snowball over the mass!

Over to the left is the cylinder with the application tip attached.

The ice balls thus formed actually look like this but are stuck to the pile mass so the one's on the right are merely descriptive! The gas from the cylinder makes a godaweful noise when applied and the handle gets really cold too, so I imagine the patient is having an internal cooling like no airconditioner can provide (probably why this method is popular in the summers).

The question remains, with better and better methods of treatment including the Infrared photocoagulator (painless, anaesthesialess, 10 minute and out procedure which I use at my clinic) and the HAL doppler coming in will the ice balls survive!

Question 2: Can we use it to cool ourselves down in the summer anyway??