Presenting at the 2007 meeting of the Society of Surgical Oncology (SSO), Jennifer Gnerlich of the Washington University School of Medicine, St. Louis reports that

Data from an epidemiologic study have provided support for the surgical removal of the primary breast cancer in patients diagnosed with stage IV breast cancer. According to the study, women who underwent surgery were 37% less likely to die than women who did not undergo surgery after controlling for demographic and clinical factors known to affect survival.

Although the current indication for surgery in these patients is to control local wound complications, she suggested that benefit beyond palliation may be possible.

Stage IV breast cancer is one which has evidence of spread to distant sites from the breast. Examples would include lung, liver, bone and brain. Usually these patients would be treated palliatively (meaning, to treat with the aim of comforting the patient rather than to aim for cure). The choice as to whether to perform surgery to remove the tumour or the breast depends on whether it will help to make life more comfortable for the patient.

This report, however, makes the surgical community think again… perhaps operating on the tumour might help some of these patients in terms of survival.

This data was from a retrospective (looking back at patients on record) review of patients who were newly diagnosed with stage IV breast cancers entered into the Surveillance, Epidemiology and End Results (SEER) program database in the US between Jan. 1, 1988 and Dec. 31, 2003. Of the 9,734 patients who met this description, 4,578 (47%) underwent surgery (including mastectomy, complete removal of the breast, and partial excision).

The median survival is longer, averaging 36 months for those who received surgery versus 21 months for those who did not. (Median survival is the length of time that the 50% of the population is still alive from the time of the diagnosis.) It is still contraversial and is not yet clear that it will help until prospective studies address the issue (i.e. studies that follow patients from the time a diagnosis is made, not looking back at records).

This is an issue that, unfortunately, is too commonly seen. When a patient has a breast cancer, she is anxious to do “all that can be done”, even if it is diagnosed in the advanced stage. To most doctors, the quality of life is of primary concern in this situation, and the length of survival has become secondary. Nevertheless, if surgery can prolong good quality survival for advanced breast cancer patients, I don’t see why it should not be offered. I guess we’ll have to wait for other, stronger, evidence to understand whether it should be offered and to whom (what group of patients) it should be offered.

Perhaps those who do not have a taboo against discussing this subject might want offer a glimpse of how you feel about this issue?

General surgery on the net

On the lighter side, I would like to recommend a surgical blog by colleagues from around the globe: Rambodoc. It’s a humerus (sic) look at surgery.

The authors are familiar names on Surginet, a general surgical mailing list where we discuss general surgical issues. Surgeons and trainees will benefit from the discussions on this mailing list on surgical issues and non-surgical issues, some of them hilarious. I personally have been following this mailing list for many years.

I’d recommend a using separate webmail account to receive mail from this list though, ‘cos it’s high-volume and sometimes the busy surgeon could easily get swamped by the sheer volume of the emails. That, of course, is relative :-). Follow the Surginet link above to register.

See what happened yesterday?

Saturday is Boys’ Brigade Day… and today, Joseph’s wearing his new complete Juniors’ uniform…

I stumbled upon this one on Youtube while uploading the video and can’t resist putting it on from dano2607:

A few of my blogging kakis sent me messages, “Bernard, where’s your blog la? There’s another site in it’s place.”

‘Huh?” I went to over to look… “This domain registration has expired..”

“Ohhhh”

… Thus, I remember now that it has been ONE YEAR since I registered my domain name. Happy Anniversary to “BernardChan.Net”! Haha.. I found out the hard way. Thanks guys and girls!

ME passed this contagion to me. I knew I should not have gone to see her that fateful morning, but I expect all sufferers to have an urge to visit a fellow patient’s blog on a regular basis.

I have yet to determine the nature of the organism but it’s clinical effect on infected individuals seems to be an uncanny sensation of being compelled to confess how he or she blogs. Perhaps it might provide an avenue for sufferers of blog-dependency-syndrome for self-examination and liberation from blog-dependency. As to the origin of this contagious factor, I have traced it to our simian cousins.

This illness seems to be a mis-nomer, however, since I have yet to find the anatomy with the name “Blogivum” or “Blogiva” which is the implied inflammed part in the disease called “BlogIVitis”.

The symptoms of this condition, in my humble opinion more aptly named “Blog Dependency Syndrome”, is manifested in me in the following ways:

1. The first chance I get to log on to my PC every morning, I hurry to take a look at the dashboard of my wordpress blog. My mind seems to be wondering whether there would be any new comments. Finding interesting comments seems to be followed by a feeling of euphoria. Understandably, however, the lack of comments invokes a dysphoric emotion. The euphoric factor might be calculated by a yet-to-be-discovered formula. It is, nevertheless, known to be directly proportional to the number of comments, visitors and relevance of comments; and inversely proportional to … err…. so far no factor has yet been found.

2. I feel an urge to visit the blogs on my blogroll. Some blogs more than others, but the urge is persistently present. Particularly if I had left a comment on the blog, I find myself inexplicably clicking on the blog’s links in increasing frequency to see whether the comrade had replied or updated. This is especially acute if the blog-companion is one who frequently updates the blog or can be expected to reply to comments.

3. Another related symptom is the strange urge to know what is happening in other individuals’ lives and families. Facts and tidbits of info that I would not have excited me or piqued my curiousity in the first place if I didn’t have this contagious condition. The local term for this condition is “Kaypohchee”. I wonder whether it has to do with the fact that sufferers band together and form cliques that share thoughts and talk so much so that the “Kaypohchee” centre of the brain has been enhanced in its keenness.

4. When a friend or relative complains that, “You haven’t been been in touch lately;” my thoughts are, “Haven’t you been reading my blog?” I regrettably find that I began expecting my great-grand-auntie to learn how to use the PC if she wants to know anything about me and Joseph.

5. Whenever I take photographs, I begin having thoughts how I’m going to put those in my blog. Those photos will remain in “My Pictures” folder until they get into the blog before being transferred to it’s proper folder. “My pictures” is getting too heavy. It is being filled to its capacity already. I m u s t do something to relieve the obstruction downstream…

6. Occasionally I see an emotional patient. I think… “Hmm… sounds like that … so-and-so blogger… sooo ‘emo’ one.” Or I look at the bank officer. I think… “Hmm… looks like that … so-and-so blogger… the lengjai/lenglui one.” Blogging personalities become the point of reference. I am still amazed at how this happens.

7. To put ME’s fears at rest, fortunately I do not think, “How shall I put this on my blog?” when I operate or scope. I do think that, however, when I come across any myths or disinformation that patients carry with them. I cannot resist the urge to highlight that to readers. Also, coming across “interesting”, sometimes “gross” tidbits of info or illustrations in my surgical or medical e-newsletters makes me want to share them with my blogger friends.

Here is DSM IV’s (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) definition of substance dependency:

The DSM-IV-TR identifies seven criteria (symptoms), at least three of which must be met during a given 12-month period, for the diagnosis of substance dependence:

Tolerance, as defined either by the need for increasing amounts of the substance to obtain the desired effect or by experiencing less effect with extended use of the same amount of the substance.

Withdrawal, as exhibited either by experiencing unpleasant mental, physiological, and emotional changes when drug-taking ceases or by using the substance as a way to relieve or prevent withdrawal symptoms.

Longer duration of taking substance or use in greater quantities than was originally intended.

Persistent desire or repeated unsuccessful efforts to stop or lessen substance use.

A relatively large amount of time spent in securing and using the substance, or in recovering from the effects of the substance.

Important work and social activities reduced because of substance use.

Continued substance use despite negative physical and psychological effects of use.

Although not explicitly listed in the DSM-IV-TR criteria, “craving,” or the overwhelming desire to use the substance regardless of countervailing forces, is a universally-reported symptom of substance dependence.

The DSM is a collection of criteria to make diagnoses of mental disorders. They are internationally agreed upon criteria in order to help doctors talk the same language when they communicate to each other about mental disorders. I suppose Blog Dependency Syndrome might be classified as DSM IV 304.90.

However, since this contagion must be passed on, in goodwill… I shall, in goodwill, pass it on to:

1. Yenjai… whose perspective would be greatly appreciated.

2. Jimbo… a medical consult should help define the condition more clearly.

3. Kucau… would you care to chip in your thoughts from the the Frontal Lobe?

4. Chen… is there any imaging method to make a diagnosis? Or IMAGINARY methods?

5. Sweetpea… is there anything you can dispense for our poor souls suffering from this, or are you in the same boat?

6. Pelf… does this condition affect those in the East Coast as well? Do they affect chelonians?