Flashback to “Salty“….
Here’s something sweet:
G-5 : this is not a collection of the most elite countries in the world. Hehe.
G-5 : it’s glucose 5% iso-osmolar solution for IV injection a.k.a. “sugar drip” 
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G-10 : this is for the extra sugar boost.
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Dextrose 50% : the mother of all IV sugar boosts.
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.
Here are my operating theatre shoes… a bit stained, I know… with “you know what”.
These shoes aren’t made for walking. They’d give you aches if you walked very far in them. They’re made for comfortable standing for long periods. And the toe box is very tough… so that the occasional accidental drop of the business-end of the knife might not cut the surgeon’s toes. ;-).. hopefully.
Photo Hunters : “Art”
While I’m on a roll…. here’s the “ART” of HANDWASHING.
Click to see bigger picture.
Semmelweiss would have been proud of this. He is the doctor who first advocated the widespread practice of handwashing in clinical practice and reduced death by infection in post-delivery mothers just by that simple method.
Photo Hunters : “Colourful”
And something colourful to feast your eyes upon:
The sutures cabinet in operating theatre. Imagine what colours we put into the body when we’ve finished with the operation.
Seriously though, they are colour-coded to help identify the type of suture in the packs. Some ARE the colours shown on the packs, but others aren’t, e.g. “Mersilk” is black and “Monosyn” is colourless.
This is what I meant by “The key will be to identify what sub-population (which group of people) will benefit from it….” in the previous post on the protective effects of aspirin.
A study published in the New England Journal of Medicine yesterday compared patients with colorectal cancer who took aspirin with those who didn’t. It turns out that there IS a subgroup of people who benefits more: those who over-express (means “to have an excess of”) COX-2.
What’s COX-2? It’s an enzyme (rings a bell?) that promotes growth of blood vessels in tissues. It is possible that this is the mechanism that leads COX-2 to promote the progression of colorectal cancer.
At the moment, this information is not usable yet in clinical medicine, but this is one road that could lead to better understanding of development of cancer and its prevention.
David Aspirin
versus
Goliath COX-2
