Revisions and more revisions...

This Friday's joke is probably something that every PhD student, or all scientific writers for that sake, can painfully relate to: Just when you thought you had it all down and finished your Magnus Opum Academica, ready for submission and done that job... it is returned from your coauthors and supervisor with request for a complete makeover and redo... well, it just exemplifies that writing is something most find difficult and it requires training and adherence to sound advise... hope to be able to share some writing advises on later occasions on this blog. Have a good w/e... and don't despair - you'll get your masterpiece published in the end!!  ;-)

Punctuations...

Communication is everything, yet we communicate in so many ways - physically as verbally.
Todays "lesson" goes with out any further explanations in the era of tweets , blogs and sms communication between supervisor and student... ***smirk***

Improbable research and the Ig Nobel Prize

If you've never heard about the improbable research you should go visit the homepage www.improbable.com. Improbable Research

They award prizes for researcg that first make people laugh, then think. Among the several categories are research iin medicla fields, such as 'anatomy' and 'medicine'.
The 2012 winners in these two categories are:

ANATOMY PRIZE: Frans de Waal [The Netherlands and USA] and Jennifer Pokorny [USA] for discovering that chimpanzees can identify other chimpanzees individually from seeing photographs of their rear ends.

REFERENCE: "Faces and Behinds: Chimpanzee Sex Perception" Frans B.M. de Waal and Jennifer J. Pokorny, Advanced Science Letters, vol. 1, 99–103, 2008.

MEDICINE PRIZE: Emmanuel Ben-Soussan and Michel Antonietti [FRANCE] for advising doctors who perform colonoscopies how to minimize the chance that their patients will explode.

REFERENCE: "Colonic Gas Explosion During Therapeutic Colonoscopy with Electrocautery," Spiros D Ladas, George Karamanolis, Emmanuel Ben-Soussan, World Journal of Gastroenterology, vol. 13, no. 40, October 2007, pp. 5295–8.
REFERENCE: "Argon Plasma Coagulation in the Treatment of Hemorrhagic Radiation Proctitis is Efficient But Requires a Perfect Colonic Cleansing to Be Safe," E. Ben-Soussan, M. Antonietti, G. Savoye, S. Herve, P. Ducrotté, and E. Lerebours, European Journal of Gastroenterology and Hepatology, vol. 16, no. 12, December 2004, pp 1315-8.

BJS celebrates 100 years anniversary

As one of the editors of the BJS (although still a 'freshman') I am proud to be part of along tradition in surgical publishing. Indeed, the BJS celebrates its 100-year anniversary in 2013, a remarkable feat in surgical publishing history! 

This gives opportunities for looking back to the beginning of the BJS and to the several remarkable progresses made over the last century. 

Please click here for free access to the first issue ever published.


This issue also includes an obituary of Lord Joseph Lister (click here to read it). It gives a good opportunity for going back to the early days before asepsis and antisepsis was 'discovered' and applied as we know it in modern surgery.

Modern surgery as we know it today was not able to develop until three great hurdles had been overcome:  

• the control of bleeding, 
• the control of pain, and 
• the control of infection.

The latter is often referred to as "asepsis" or "antisepsis", which are integrated into modern day surgical principles.

While still a student, Lister had decided not just to practise medicine, but also to conduct research to improve medical knowledge. His early investigations explored the action of muscles in the skin and the eye, the mechanism involved in the coagulation of blood, and the role played by blood vessels in the early stages of infection. Lister's research required frequent use of a microscope—a tool very familiar to him because of his father's involvement with it.

In the Edinburgh Hospital where Lister worked, almost half of the surgery patients died from infection. In some hospitals in Europe, as many as 80 per cent died. While surgeons regretted this high death rate, they trained themselves to accept this unpleasant aspect of their work. After all, they thought, nothing could be done about these infections, because they arose spontaneously inside the wound. Lister however, was not convinced of the inevitability of infection (which was also known as sepsis). He began to search for a way of preventing infection—that is, an antisepsis method.

Lister’s first clue as to the cause of infection came from comparing patients who had simple fractures with those who had compound fractures. Simple fractures do not involve an external wound. These patients had their bones set and placed in a cast, and they recovered. Compound fractures are those where the broken bone pierces the skin and is exposed to the air. More than half of these patients died. Lister reasoned that somehow the infection must enter the wound from the outside. But how exactly did this occur? And what could be done to prevent it?

Lister began washing his hands before operating, and wearing clean clothes. As the son of a wine merchant, Lister was all too familiar with the problem of wine going bad because of faulty fermentation. Pasteur had shown that the problem was caused by germs which entered from the air, and that organisms did not come to life spontaneously from non-living matter within the wine. Lister immediately recognized the truth and usefulness of Pasteur’s work. If infection arose spontaneously within a wound, it would be virtually impossible to eliminate it. However, if germs entering from the air outside the wound caused infection (in the same way that the wine became contaminated), then those germs could be killed and infection prevented.Pasteur had used heat and filters to eliminate the germs in the wine, but these techniques were not suitable for use with human flesh. Instead, Lister needed to find a suitable chemical to kill the germs. He learned that carbolic acid was being used as an effective disinfectant in sewers and could safely be used on human flesh. Beginning in 1865, Lister used carbolic acid to wash his hands, his instruments, and the bandages used in the operation. Lister also sprayed the air with carbolic acid to kill airborne germs. 

Application of carbolic acid during an operation

After more than a year of using and refining these techniques, Lister had sufficient data to show that his methods were a success. He published his findings in the medical journal, The Lancet, in 1867.Lister was always eager to acknowledge Louis Pasteur’s invaluable contribution. 

In a letter to Pasteur in February 1874, Lister gave him ‘thanks for having, by your brilliant researches, proved to me the truth of the germ theory. You furnished me with the principle upon which alone the antiseptic system can be carried out.’

Listers also gave name to a family of gram-positive bacteria "Listeria monocytogenes" known to cause 'Listeriosis' in cattle and sheep (and one of the reasons why we pasteurize milk products, to get rid of the bacteria - so there is a contribution to both Lister and Pasteur!)

Listeria monocytogenes

Several modern products still carry names with referral to Lister and his techniques for killing germs - among the better known products are probably mouth washes, as displayed from different time periods below.

Antiseptic alcohol

Modern "original Listerine"

Survival differences between colon and rectal cancer

Rectal cancer used to be the "bad boy" of the cancers of the colon and the rectum. As it appears, this may no longer be the case; a number of changes over the past few decades including standardized surgical technique (TME, total mesorectal excision), improved staging (use of magnetic resonance imaging) and careful selection of patients in need of radiotherapy BEFORE surgery, has lowered the rates of local recurrence and improved overall survival. Out group fairly recently published the result from the Norwegian database on colon and rectal cancer and found that rectal cancer survival has now indeed superseded that of colon cancer. Please see the full study published in the BJS:

Nedrebø BS, Søreide K, Eriksen MT, Dørum LM, Kvaløy JT, Søreide JA, Kørner H; 
Norwegian Colorectal Cancer Registry. Survival effect of implementing national
treatment strategies for curatively resected colonic and rectal cancer. Br J
Surg. 2011 May;98(5):716-23. doi: 10.1002/bjs.7426. Epub 2011 Feb 21

In a recently released study available early online in the Acta Oncology we have further explored the survival differences over time. It appears that survival (or more precisely the excess mortality) differes over time during surgery. The clues into this may indeed be the answer to new and more appropriate ways of dealing with these two cancers in the future. Please see the early release in Acta Oncology:

Nedrebø BS, Søreide K, Eriksen MT, Kvaløy JT, Søreide JA, Kørner H. Excessmortality after curative surgery for colorectal cancer changes over time anddiffers for patients with colon versus rectal cancer. Acta Oncol. 2012 Oct 29.[Epub ahead of print]

Scrubs or white coat - what do patients prefer?

Surgeons' attire is important for making a proper impression on the patients - as it goes "you never get a second chance to make a first impression". 

A group of investigators have now investigated the influence of surgeons clothing on the patients' perception on the care they received. 

During a 5-month period, surgeons alternated wearing traditional clothing and surgical scrubs. A total of 612 patients returned the questionnaire.

The conclusion? Surgeon's clothing choice did not significantly influence patient's opinion of the care they received. Patients do not have strong preferences for white coats or more traditional surgical attire.

You may want to read the full paper at Am J Surg, 2012 November issue