A surgeon looks at Rodin's hands

Rodins hands dig preview final

For many years, Stanford University surgeon James Chang has been fascinated by Rodin's hands, sculptures made by the French artist in the 19th century. Chang uses Rodin's hands in what sounds to be a marvelous undergraduate seminar titled "Surgical Anatomy of the Hand: From Rodin to Reconstruction" in which he combines 3D scans of the sculptures, a process seen above, with medical imaging of human bones, nerves, and blood vessels.

Rodins hands dig preview final

Now, Chang has collaborated on an exhibition at Satnford that lies at the intersection of science and art. “Inside Rodin’s Hands: Art, Technology, and Surgery” opens next week at Sanford's Cantor Arts Center.

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A smart knife for surgeons

Researchers at Imperial College London have invented an electric surgical knife that comes equipped with a built-in mass spectrometer. Electric knives cauterize wounds as they cut, which produces smoke. The iKnife will be able to analyze the chemistry of that smoke to determine, for instance, whether the tissue that was just cut was cancerous or not — allowing doctors to make decisions in the OR that would, today, require them to take samples, send those samples to a lab, and maybe schedule a second surgery.

Scientific retraction leads millions of testicles to retract into ribcages

From Retraction Watch: The Indian Journal of Surgery has retracted a 2011 paper entitled "Penile Strangulation by Metallic Rings". The reason: The authors apparently self-plagiarized the report from an earlier 2005 paper. Please insert your own jokes here.

When a patient says "no thanks" to surgery

The Journal of the American Medical Association Internal Medicine has a really interesting essay they've published in full online. It's written by Anna Petroni, a 77-year-old California woman who recently decided against undergoing surgery on her ankles and knees to correct recurrent foot abscesses and arthritis. It's a short, simple piece — just Petroni recounting the story about why she made the decision she made — but serves as a jumping-off point, I think, for several different important discussions about the way we do medicine and the way we make medical decisions.

A couple of things particularly stood out to me. First is the relationships we have with doctors, especially specialists whom we see once or twice and who don't know us very well. Petroni's story suggests that bedside manner is about more than just making somebody feel nice — it can also affect their overall health if the doctor makes decisions related only to their specialty without taking into account the patient's whole story. The second thing I think is really important here is the idea of there often not really being one right answer when it comes to medical decisions. Doctors can say, "we can do this" or "we can fix that", but there's a responsibility on the patient (one we're not usually prepared for or coached through) to decide whether the trade-offs of intervention outweigh the side-effects. And those decisions can vary widely from patient to patient.

I guess I was so shocked when the orthopedist told me I needed to have 4 surgical procedures, I didn't even think about the fact that he did not ask about my cardiac history. But I sure did afterward. I only went in to have my tendons checked. He did not ask how I felt about anything. He just told me what needed to be done.

About a month later, I received a call from the receptionist who asked if I had decided on a date for surgery. I said that I had decided not to go ahead with it. When I feel I can no longer tolerate walking without tendon surgery, I will reconsider my options. Until then, I want to live the best I can with what mobility I have.

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Image: 20090312 - Clint - foot x-ray - left ("good" foot), a Creative Commons Attribution Non-Commercial Share-Alike (2.0) image from clintjcl's photostream

Mustache transplants on the rise

Turkish plastic surgeon Selahattin Tulunay is performing 50-60 mustache implants every month, helping Middle Eastern men achieve thick, full mustaches. The procedure costs about $7,000.

Pierre Bouhanna is a Paris-based surgeon who, for the past five years, has been performing increasing numbers of mustache implants. He says the majority of his patients come from the United Arab Emirates, Iran, Lebanon and Turkey, with men traveling to France to have the surgery performed.

"My impression is more and more they want to establish their male aspect," he said. "They want a strong mustache."

Mustache Transplants on the Rise in the Middle East [KTLA] (via JWZ)

(Image: James and Matthew, with fake moustaches, a Creative Commons Attribution (2.0) image from jonevans's photostream)

An atlas of horrible things that could happen to you in the 15th century

Today, he's known as "Wound Man", but once upon a time this illustration was just one part of a standard medical or surgical text book. You'd get your basic illustrations of anatomy. Then you'd get your Wound Man, to show you all the different, awful things that could happen to that anatomy. A 2009 blog post from the Wellcome Library explains:

Captions beside the stoic figure describe the injuries and sometimes give prognoses: often precise distinctions are drawn between types of injuries, such as whether an arrow has embedded itself in a muscle or shot right through. (The latter is better – the arrowhead can be cut away and the shaft withdrawn smoothly, whilst the embedded arrow will tear the muscle with its barbs when pulled out.)

The other interesting thing about this illustration: It's also an example of how the early printing industry worked. According to the Bernard Becker Medical Library at Washington University, there were several different versions of the Wound Man, but the same version would show up in multiple books — a result of surgeons and printmakers literally carrying the same wood blocks from one printing press to another.

Read more about surgery and medicine during this time period by visiting the excellent history of science blog: The Chirurgeon's Apprentice

Wound Man via David Ng

Scenes from a heart surgery

This is absolutely wonderful, and absolutely not for the squeamish.

Defective Heart Girl Problems is a blog where physicist Summer Ash has blogged her experience with finding out that she has a defective heart valve and getting treatment to deal with that defect. The image above shows her scar from her recent surgery.

Ash went through surgery to repair her heart on July 18th. Here's how she explains the problem:

I recently discovered that I was born with a congenital heart defect known as bicuspid aortic valve disease (BAVD). It’s not a disease, per se, so much as a defect. Most people (roughly 99% of them) are born with a tricuspid aortic valve. I am the lucky 1% born with a bicuspid valve. (I am the 1%!)

As a bonus, being born with this genetic mutation also means the lower part of my aorta, the part that connects to the aortic valve and helps channel the flow of oxygenated blood into the arteries, has less fibrillin-1 – a protein that helps to maintain the structural integrity of the aortic wall. This means that my aorta is prone to “stretching out” and even the normal stress of blood flow coming out of the heart and being channelled to the rest of the body is enough to cause it to start ballooning outward.

The nominal course of BAVD usually entails the aortic valve calcifying and stiffening later in life (60s – 70s), ending in valve replacement surgery. Some people will also need the root of their aortas replaced at this time, some may not. My problem is that my aorta is jumping the gun; it’s already stretched out to the point where it’s considered an aortic aneurysm. I like to imagine it as a hipster, dilating before it’s cool to do so.

On July 29, she posted the full story of her surgery, including photos of her visible heart and really clear, well-written explanations that describe what her surgeon's did while they were rooting around in her chest cavity. It's graphic. And it's not for everybody. But it's also extremely powerful storytelling about both medical science, and the experience of having something go wrong with your body that you can't control. Highly recommended.

Read Summer Ash's description of her surgery

(Via Jennifer Ouellette)

Horror stories from the history of surgery

Sometimes, it's a little mind blowing when you remember just how recently medicine passed from the world of art/magic/tradition and into the realm of science. There's plenty of reason to argue that the transformation still isn't complete today, but I'm really mesmerized by stories from the 19th century, when every surgery was something of an experiment and the same, cutting-edge doctor could vacillate between modern techniques and medieval bio-alchemy in his treatment of the same patient.

Until that time, the prevalent method of cataract treatment was “couching,” a procedure that involved inserting a curved needle into the orbit and using it to push the clouded lens back and out of the line of sight. Warren's patient had undergone six such attempts without lasting success and was now blind. Warren undertook a more radical and invasive procedure—actual removal of the left cataract. He described the operation, performed before the students of Harvard Medical School, as follows:

"The eye-lids were separated by the thumb and finger of the left hand, and then, a broad cornea knife was pushed through the cornea at the outer angle of the eye, till its point approached the opposite side of the cornea. The knife was then withdrawn, and the aqueous humour being discharged, was immediately followed by a protrusion of the iris."

Into the collapsed orbit of this unanesthetized man, Warren inserted forceps he had made especially for the event. However, he encountered difficulties that necessitated improvisation:

"The opaque body eluding the grasp of the forceps, a fine hook was passed through the pupil, and fixed in the thickened capsule, which was immediately drawn out entire. This substance was quite firm, about half a line in thickness, a line in diameter, and had a pearly whiteness."

A bandage was applied, instructions on cleansing the eye were given, and the gentleman was sent home. Two months later, Warren noted, inflammation required “two or three bleedings,” but “the patient is now well, and sees to distinguish every object with the left eye.”

That's from an amazing essay on the history of surgery published last month in the New England Journal of Medicine.

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LAPD probing Lap-Band weight loss surgery provider after patient deaths

Billboards for weight loss surgery provider "1-800-GET THIN" were ubiquitous around LA freeways until recently; the company has since come under scrutiny by the FDA, consumer affairs watchdogs and Consumer Reports for sketchy business practices. Now, the Los Angeles Police Department is investigating the firm over the recent death of a patient. Snip from LA Times report:

In a civil lawsuit, two former surgery center workers alleged that a series of medical gaffes contributed to [55 year old patient Paula] Rojeski's death. That lawsuit, filed in January, said an intravenous line was not properly inserted into Rojeski's arm during surgery, causing solution to pool on the floor of the operating room. Former surgical technicians Dyanne Deuel and Karla Osorio also said in the lawsuit that the anesthesiologist forgot to turn on the oxygen tank before surgery.

The LA Times report goes on to list four additional patient deaths. (photo: LA Times)

Wide awake during brain cancer surgery

This fascinating video from the Mayo Clinic explains how 28-year-old Mary Meixner went through "awake surgery" during which surgeons used an intra-operative MRI to target her brain tumor.

At the end of the operation, she slept. Then, she says, "I woke up and I was so excited, and I was like, yes! I'm not dead! I can talk! I can think! Because you never know, right?"

Transcript here (PDF).

(via @thespeachgal)

An anesthesiologist's view of the human heart

This is a really fascinating entry in The Guardian's multi-video package about heart health and medicine. Bruce Martin, a British anesthesiologist, talks about his job, anesthetizing patients for heart surgery. If this doesn't make your job seem less stressful by comparison, then you're probably a fighter pilot or something.

Via Ed Yong

Man undergoes extensive plastic surgery to look like Superman


A Filipino man named Herbert Chavez has undergone extensive surgery to make himself look like Superman: a nose job, a chin implant, collagen in his lips, and (randomly) hip implants.

Pinoy goes under knife to look like Superman

(via Neatorama)

How To: Remove a bladder stone in the days before anesthesia

The Chirurgeon's Apprentice is an entire blog dedicated to eye-witness accounts of surgery in the days before anesthesia. Oh, Internet. Thou art wonderful and horrible.

Collected by University of London medical historian Lindsey Fitzharris, the stories come from well-documented sources, from the 17th century onward. Part of the goal here is to follow the path of surgery as it really started to become its own profession ... separate from that of barber. Yes, this is going to be every bit as gory as you imagine. I'll start looking for a unicorn now.

If you visit the Gordon Museum at Guy’s Hospital in London, you will see a small bladder stone—no bigger than 3 centimetres across. Besides the fact that it has been sliced open to reveal concentric circles within, it is entirely unremarkable in appearance. Yet, this tiny stone was the source of enormous pain for 53-year-old Stephen Pollard, who agreed to undergo surgery to remove it in 1828.

Although the operation itself lasted only a matter of minutes, lithotomic procedures were painful, dangerous and humiliating. The patient—naked from the waist down—was bound in such a way as to ensure an unobstructed view of his genitals and anus [see illustration]. Afterwards, the surgeon passed a curved, metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once he had located it, his assistant removed the metal tube and replaced it with a wooden staff. This staff acted as a guide so that the surgeon did not fatally rupture the patient’s rectum or intestines as he began cutting deeper into the bladder. Once the staff was in place, the surgeon cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used a probe to widen the hole, ripping open the prostrate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder.

Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators.

Via Ed Yong

Image: Ouch, again., a Creative Commons Attribution (2.0) image from rberteig's photostream

Image shows a kidney stone. Kidney stones and bladder stones are basically the same thing, though. Their names signify where the stone formed. Either way, they're made of the same stuff. And more people post images of their kidney stones to Flickr.

Makers and surgical trainee team up to improve prototyping bones from CT scans with 3D printers


Mark Frame, an orthopedic surgical trainee at Scotland's Monklands Hospital, 3D printed a model of a bone from a CT scan, as preparation for surgery. Rather than using the local rapid prototyping shop at a university (where such an operation might cost $1200 for a miniature model), Frame modelled the bone himself and had it printed at Shapeways for £77. The Shapeways community gave him feedback and help as he worked through the process, using free software tools to make the model. I love how networked maker communities help people who have specific, interesting problems to solve them for themselves. I also love 3D printed bones -- as you might remember, my wife surprised me with a 3D print of my femur after my surgery this year. When I showed it to my surgeon (a man of heroic reserve and calm) he practically flipped his lid and I practically had to pry it out of his fingers.
I used OsiriX, a well known open source medical imaging package for mac OS to open the CT scan images and produce a surface render (mesh of points) and export it in a format I could manipulate and make compatible for the printers at Shapeways. I exported the files as .obj files and opened them in a recommended manipulation program called MeshLab. This, another free open source application for mac osx. The aim of this application is to close any holes in the meshes and to delete any artifact produced in the scans. These were then exported as .stl files ready for printing.

I uploaded them to Shapeways through my account and they were almost instantly verified as printable and Shapeways began processing the images. The total cost for both bones in white flexible plastic only came to a tiny £77. The bones were in our hands in 7 days to the UK. The resultant models were amazing! We verified them and found them to be virtually identical copies of the bones on the CT scans. The white plastic was a great material to machine and use our normal orthopedic drills and saws and screws on to practice the operation.

3D Printing Bone on a budget!