Whither the solid tumors. James Ewing lecture

Improvement in survival rates for solid tumors, the cancers of greatest concern to the surgeon, has lagged far behind the dramatic advances that have been made in the treatment of leukemias, lymphomas, and certain childhood tumors. The application of new technical procedures and an aggressive approach to certain metastatic lesions offer chances for improving operative results, but the greatest contribution to curing cancer that can be made by surgeons at this time is the complete removal of the small localized primary tumor. By more active participation in "early detection programs" surgeons can increase their opportunities to treat cancer at this stage. The American College of Surgeons, in consultation with the National Cancer Institute, has conducted a detailed survey that analyzes the lack of surgical participation in clinical trials with a view toward developing a more active surgical interest in evaluating new methods of treatment for the solid tumors. One of the current efforts to improve the outcome of these recalcitrant cancers involves increasing the number of trained surgical scientists in the field of cancer.     

Phantom limb pain: A literature review

Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments.     

Robot-assisted urologic procedures

Surgical robotics, the result of the combined efforts of engineers, computer scientists, entrepreneurs, and surgeons, has enabled the surgeon to execute precise technical maneuvers while seated at a remote console. The capability to perform sophisticated surgical operations by means of a robot is today's reality. The combination of laparoscopy and robotics has the potential to enhance operative performance and the outcomes of laparoscopy, and expand the clinical application of laparoscopy while reducing patient morbidity. In this article, we review initial pioneering and laboratory research, early clinical investigations, and current clinical applications of robotics in urologic surgery.     

Hand surgery training

Training of the hand surgeon HAND SURGEON A CONCEPT: The hand surgeon is supposed to be in charge of all the hand lesions regarding, skeleton, muscles, tendons, nerves and vessels. He has to be able to insure reparation and coverage of all of them. So he is involved in all the structures, which insure integrity and function of the hand. PURPOSE AND WAYS OF TRAINING: To obtain the asked ability, the hand surgeon training has to be global and sustained by two underlying surgical specialities: orthopedic surgery and plastic and reconstructive surgery. From 2000 after many years of dealings, a Right to the Title in Hand Surgery was born. This Right to the Title wants to be the formal recognition of the specific training of the hand surgeon. For the well-recognized ancient hand surgeons they need to be confirmed by one's peers. Now a day the hand surgeon has to satisfy to this specific training: Passed the complete training and exam of the Orthopedic or Plastic surgery board. Spent at least 6 months as resident in the other underlying specialty. Passed a microsurgery examination. Passed one of the four national Hand Surgery diplomas (DIU/Inter-Universitary Diploma). The examinations have been harmonized. A common formation is delivered regarding hand surgery, the way of examination is the same and the formation is 2 years long. The final exam is presented in front of board of examiners where a teacher of one of the other three national diplomas is present. Spent at least 2 years in a formative hand surgery unit, listed by the French College of Hand Surgeons, as senior surgeon. Those requirements are heavy to assume and need a heavy personal involvement. That seems to be necessary to have an ability level as high as possible. Emergency surgery practice is absolutely necessary in this training. All the 17 university formative hand surgery units listed by the French College of Hand Surgeons are members of the FESUM (European Federation of the Emergency Hand Units). Unfortunately it is non-sufficient to train the necessary number of hand surgeons needed in France today. So we try to obtain from the authority the formal recognition of a training period in private practice. Eleven out of the 28 hand units listed as formative by the French College of Hand Surgeons are in private practice and may be recognized as formative in the hand surgeon training. That needs to create an official agreement between university and private Units. This part of the training is yet accepted by the Right to the Title commission for a 6-month training period. But this needs a legal modification or adaptation of the private units legal status so they will be able to offer a quite equivalent conditions of training. Now a days 233 surgeons in France passed the Right to the Title. Among them, the oldest do not have emergency practice any more. So unfortunately, out of 1,400,000 hand injuries a year in France, only few are actually cared by hand surgeons. The emergency training needs at least a three to four senior surgeons team, operating and caring emergencies, 24 h a day, 365 days a year. They need to be surrounded by high-level technical facilities for this type of surgery. Only this type of unit may have a frequent severe hand traumatology practice, especially regarding microsurgery. But on the other hand a less complex hand unit operating only planed surgery and less complicated emergencies, may also be definitively formative. This only depends on the hand surgeon's qualification. It is only with a very demanding and high-level training program that our credibility as hand surgeon may be definitively established. The mainstay of this training is the combined action of the FESUM, the French College of Hand Surgeons and the DIU diploma. The Right to the Title formally confirms that training. For university or private unit, to be a member of the FESUM, must continue to guarantee a high level training regarding emergencies as in number as in complexity. We proposed as minimum level of practice (a year) to be a formative hand surgery unit: 10-15 hand and upper limb replantations; 25-30 very severe hand injuries (revascularization etc.); at least 1000-1500 hand surgery procedures.     

François Magendie (1783-1855) and his contributions to the foundations of neuroscience and neurosurgery

Fran?ois Magendie lived during a tumultuous period in French history. Although this early medical pioneer made significant contributions to the fields of neuroanatomy, physiology, and pharmacology, little information is found in the non-French literature regarding this significant person in history. Based on this review, one could also consider this trained surgeon as an early pioneer of neurosurgery. For example, he is known to have used Galvanic current to treat various neuralgias, described a technique for extracting cerebrospinal fluid and quantitated and described its characteristics in normal and pathological specimens, and elucidated the functions of the the cranial nerves using vivisection. Additionally, he accurately described the functions of the dorsal and ventral rootlets using vivisection, and realized that the exposed meninges were susceptible to painful stimuli. Our current knowledge is based on the early contributions of scientists such as Fran?ois Magendie.     

Surgical practice under the recent health insurance system of Japan

Candidates for surgeon have been declining in number for a long time because the labor conditions for surgeon are worse than those for other specialists, especially for internists. In this symposium, we will examine how to improve the present status of surgeons under the totally controlled health insurance system by discussing regarding what is a surgeon, what is a surgeon's work, what is a rational surgical fee, the necessity for surgeon's fees, etc. for the sake of the future development of both clinical surgical practice and research.     

History of Clarke's stereotactic instrument.

The first original stereotactic instrument was designed by the turn of this century by the British surgeon, anatomist, and physiologist Robert Henry Clarke. In 1905 James Swift, in London, constructed the first machine, 'Clarke's stereoscopic instrument employed for excitation and electrolysis'. It was first used in 1906 by Clarke and Victor Horsley to create minute electrolytic lesions in the CNS of animals. The stereotactic apparatus was patented by Clarke in 1914 and cost 300 pounds. Two further instruments were made by Goodwin and Velacott in London and brought to the United States to be used for animal research. The principal of these machines constitutes the basis of modern stereoguides for human use designed after World War II. Clarke's original instrument was last used by Dr Barrington, a genitourinary surgeon in London in the early 1950s. It then disappeared but parts were detected by Dr Hitchcock in 1960 and the complete machine by Dr Merrington in 1970. It can now be found at the museum of University College Hospital in London.     

Victor Horsley, John Marshall, nerve stretching, and the nervi nervorum

In his early professional life, Victor Horsley was registrar and assistant to Mr. John Marshall, anatomist, surgeon, and president of the Royal College of Surgeons. In helping with the research for the Bradshaw Lecture on Nerve Stretching given by Marshall in 1883, Horsley demonstrated changes in nerve fibers due to mechanical stretching of the sciatic nerve, and he also demonstrated small nerve fibers in the sheaths of peripheral nerves--the so-called nervi nervorum. Marshall attributed the benefits of nerve stretching in sciatica to the interference with these nervi nervorum hitherto considered to exist only in the sheath of the optic nerve.     

The photographic collection of Charles John Bond (1856-1939

During the history of the Leicester Royal Infirmary from its foundation in 1771, Charles John Bond (1856-1939) emerges as one of the most distinguished members of the medical staff. He was born at Bittesby House in Leicestershire and brought up on his father's farm, where his early interest in natural history was fostered, and was further developed when he want to Repton school, nearby. His medical career began in February 1875, when he was apprenticed to Dr C M Sidley, a general practitioner of Welford Road, Leicester. For a short time he was an "outdoor" pupil at Leicester Infirmary before proceeding to University College London in the following October. He gained gold medals in physiology and anatomy and silver medals in surgery, midwifery, and medical jurisprudence, qualified in 1879 and was appointed house surgeon to Bedford General Infirmary. He returned to London in 1882 to study for the FRCS and shared rooms in Charlotte Street with his lifelong friend Victor Horsley, who in that year was appointed Assistant Professor of Pathology at University College Hospital. In the same year Charles Bond returned to Leicester and became house surgeon to Sir Charles Marriott. He did much to extend the use of Lister's recently introduced antiseptic methods. In the short period of four years he was appointed full surgeon at the Infirmary, and in 1893, because of his distingugished career and wide interests, he was offered the opportunity of joining the staff of University College Hospital. However, he preferred to stay in Leicester in spite of the limited opportunities for scientific investigation and research. In 1890 he married Edith, daughter of George Simpson, a justice of the peace in Derbyshire, and in 1910 they moved to a large Victorian house, Fernshaw, in Springfield Road on the then outskirts of Leicester, where various animals and birds could be kept for use in his experimental work. In this year he took the unusual step of giving up his large private practice to devote more time to study and to his research interests. three years later, at the age of 57, he retired from the staff of the Infirmary, and the governing body made him an honorary consultant surgeon and also elected him a vice president, the only doctor to be so honoured. Thus he retained a close association with his hospital until his death in 1939.     

Tissue engineering in facial plastic and reconstructive surgery

Current biomaterials technology meets some of the needs of the facial plastic and reconstructive surgeon. However, there is a genuine need for improvement in the area of tissue replacement. The principle of tissue engineering provides a natural way to generate needed tissue using the patient's own cells as building blocks, coupled with biodegradable polymers which have been used safely in [figure: see text] patients for decades. This technology enables the creation of complex structures which ultimately have no immunogenicity. Current obstacles to human clinical trials for auricular repair are being pursued for resolution, and the number of new tissues which it may be possible to generate in this fashion continues to expand. Through continued experimentation and collaboration among surgeons, chemical engineers, and materials scientists, we are certain that the barriers to widespread clinical use for this emerging technology will be overcome.     

The use of the Hirsch index in benchmarking hepatic surgery research

Background

The Hirsch index (h-index) is recognized as an effective way to summarize an individual's scientific research output. However, a benchmark for evaluating surgeon scientists in the field of hepatic surgery is still not available.

Methods

A total of 3,251 authors who published between 1949 and 2011 were identified using the Scopus identification number. The h-index, the total number of cited document, the total number of citations, and the scientific age were calculated for each author using both Scopus and Google Scholar.

Results

The median h-index was 6 and the median scientific age, assessed with Google Scholar, was 19 years. The numbers of cited documents, numbers of citations, and h-indexes obtained from Scopus and Google Scholar showed good correlation with one another; however, the results from the 2 databases were modified in different ways by scientific age. By plotting scientific age against h-index percentiles an h-index growth chart for both Scopus database and Google Scholar was provided.

Conclusions

This analysis provides a first benchmark to assess surgeon scientists' productivity in the field of liver surgery.     

韦伯斯特与中国整形外科的蕴育

目的 研究美国医生韦伯斯特在中国整形外科早期发展过程中所扮演的角色和所起的作用.方法 通过查阅哥伦比亚大学图书馆馆藏档案资料、检索相关文献、资料分析并辅以口述历史的研究方法.结果 获得了韦伯斯特两次来华的经历资料和1948年上海整形外科学习班的细节.了解了参加过这次学习班的中围医生以后所从事的工作,特别是朱洪荫、汪良能和张涤生.客观评价了韦伯斯特在中国整形外科学的发展上所起到的作用.结论 韦伯斯特于20世纪20年代较早地在北京协和医院开展整形外科临床实践,后又通过上海整形外科学习班启发了中国最早一批专门从事整形外科的医生.

Abstract：

Objective To investigate the role of American plastic surgeon Jerome P. Webster in the history of plastic surgery in China. Methods The archives stored in J. P. Webster' s library and documents are analyzed and information is also collected by interviewing some senior plastic surgeon ( oral history). Results The experience of Webster in China for two times and the documents about the Shanghai plastic surgery course in 1948 were acquired. The doctors who participated the Shanghai plastic surgery course were studied for their career, especially Hongyin Zhu, Liangneng Wang, and Disheng Zhang. The role of Webster in the development of plastic surgery in China was evaluated objectively. Conclusions Webster started his career in Peking Union Medical College at early 1920s, who went back to China in 1948 to enlighten the first group of Chinese plastic surgeon in Shanghai plastic surgery course.     

The history of research training and career awards in urological science supported in the National Institute of Diabetes and Digestive and Kidney Diseases.

Urology research and training grants were placed into a separate research program in 1979. Research emphasis and the context of training programs have changed from a focus on urolithiasis in the 1970s to a broader range of urological disorders in the 1980s. From 1977 to 1990, 49 applications were submitted by 47 applicants for research training/career development support and 39% of the applications were successful. From 1977 to 1987 medical doctors applying for research/career training had a 75% success rate in subsequent National Institutes of Health research grant applications, and basic scientists had a 67% success rate. Of the 33 former trainees supported on institutional training grants during the last 14 years 76% were medical doctors and 24% were basic scientists. From 1977 to 1987, no former medical doctors or basic scientists from institutional training grants have a record of applying to the National Institutes of Health for research grant support. The urology community needs to capitalize on the available opportunities to expand the training programs to increase the number of physician and urological research scientists.     

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Appropriate Clinical Management of Adult-Acquired Flatfoot Deformity

This clinical consensus statement of the American College of Foot and Ankle Surgeons focuses on the highly debated subject of the management of adult flatfoot (AAFD). In developing this statement, the AAFD consensus statement panel attempted to address the most relevant issues facing the foot and ankle surgeon today, using the best evidence-based literature available. The panel created and researched 16 statements and generated opinions on the appropriateness of the statements. The results of the research on this topic and the opinions of the panel are presented here.     

A cumulative analysis of an individual surgeon's early experience with elective open abdominal aortic aneurysm repair

BACKGROUND: Several studies have reviewed the role of hospital and surgeon case volumes in determining early mortality after elective open abdominal aortic aneurysm (AAA) repair. Few, however, have analyzed this relationship at the individual surgeon level. The purpose of this study was to display the usefulness of a unique statistical tool as a form of an ongoing practice audit. METHODS: All patients who underwent an elective open AAA repair by an individual surgeon at a university-affiliated medical center over a 5-year period were analyzed. The cumulative sum failure method was used to analyze the results over time. Failure was defined as the presence of early mortality, myocardial infarction, or a complication resulting in another surgical procedure or prolonged hospitalization. A target failure rate of 10% was chosen, and 80% alert and 95% alarm boundary lines were established. RESULTS: One hundred thirty-eight patients underwent elective AAA repair by this surgeon over a 5-year period (1998-2003). There were 5 early mortalities (3.6%), 15 myocardial infarctions (10.9%), and 3 major morbidities (2.2%). These results were plotted on a cumulative sum curve as an example of an ongoing practice audit. CONCLUSIONS: The cumulative sum failure method provides a tool whereby a surgeon can prospectively audit his practice and recognize trends in performance before their recognition by standard statistical tools.     

Experience gained by basic surgical trainees in varicose vein surgery over a 15 year period - has it changed?

OBJECTIVE: The aim of this study was to see if the training provided for Basic Surgical Trainees (BST's) by one consultant vascular surgeon has changed over a 15-year period. METHOD: From a computerized database we have a 15-year record of varicose vein operations identifying the first and second surgeon. We have analysed cases involving the BST and those in which the consultant operated alone. In such instances training opportunities were lost. RESULTS: No change was found in the total number of cases performed, the number of operations carried by the BST as the first surgeon, or the cases performed by the consultant operating alone. The number of operations performed by a BST annually correlated positively with the total number of cases. A BST was named as first surgeon in 39% of cases (632/1622). CONCLUSION: This study has shown no definite evidence to support the view that training in varicose vein surgery has deteriorated.     

从外科医师到外科学家

一名刚完成接受外科专业培训,考试合格的外科医师,他的前面有两条路可供他选择：坏的道路和好的道路。如果向坏的道路走,他可以到达两个终点。（1）不良外科医师：这些医师以医学知识来欺骗病人钱财,或夸大病情,从中获利;（2）低劣外科医师：他们使用不达标或已淘汰的知识和技术治疗病人。另一条道路是向好的道路,但走这条道路是要不断进行终身学习和评核。最终能否成为一名合格或优秀的外科医师,主要靠的是自己的天赋和个人所付出的努力。一名优秀的外科医师如果只是通过手术,他的一生只能造福有限的病人。但是如果一名外科医师通过医学研究,找出一套新学说、新技术,就可使更多的病人受益。能够称为外科宗师,要求能把新学说发扬光大,成家成派。更要有高尚人格和品德,令人敬佩。     

Advances in the treatment of early- to late-stage colorectal cancer: 20 years of progress

Background: Numerous scientific and clinical advances have made significant changes in our understanding of the etiology of colorectal cancer and in the diagnosis and treatment of patients with large bowel malignancy or its precursor lesions. Methods: A personal view of 20 years of progress was presented at the Commission on Cancer lecture during the 1993 Clinical Convocation of the American College of Surgeons. Results and Conclusions: Improvement in the diagnosis and treatment of early bowel cancers, significant benefit from multimodality therapy of more advanced resectable bowel cancers, and better articulated selection criteria in patients with recurrent colorectal cancers are reviewed. Most importantly, both physical and emotional consequences of our therapies are shown to have diminished without sacrificing the ability to cure. Perhaps the next major challenge is for the general surgeon to assume responsibility as the primary medical manager of any patient with gastrointestinal cancer from the time of diagnosis onward.     

�����ҽʦ�����ѧ��

??From a surgeon to a master surgeon Lau W.Y.Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China Abstract Facing a surgical specialist after he has finished with his surgical training are two roads that he can choose to follow.If he chooses to follow the road of the evils, he can arrive at one of the following two points:- a bad doctor or a poor doctor.A bad doctor is someone who uses his professional knowledge or skills to cheat or to take advantage of his patients. Essentially, this is a bad doctor doing bad things with evil intention.A poor doctor is a doctor who is poor in knowledge or skills. The doctor’s intention might be good but because he is applying outdated knowledge or skills in treating his patients, his patients suffer. On the other hand, the doctor can choose to follow the road of the good, but he needs to spend efforts in updating his knowledge and skills by doing continuing medical education and auditing. Whether at the end this doctor becomes a qualified surgical specialist or a good surgical specialist would depend on how much efforts he has spent, and how talented he is.Without research, a good surgical specialist can never become a master surgeon. If a surgeon just performs operations, the number of patients who can benefit from him is limited. However, if the surgeon can, through his research, come up with a new knowledge or a new treatment which other surgeons can follow, the number of patients who can benefit would be many folds more.A master of the master surgeons is someone who comes up with a revolutionary idea in surgery that changes the conventional thinking. He also has to process the high ethics and personality that everybody would admire.