How To Make Projector

colorectal liver metastases

I present the talk I had with residents of my service on the surgical treatment of liver metastases of colorectal origin. I hope you serve as a refresher or update. I hope your comments.

surgical treatment of liver metastases from colorectal

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The "enterao"

The other day I had to go to Barcelona and professional issues and leaving the airport I got in the taxi queue and was assigned as a package, at a taxi in the second row by a guy with a boring face vest -reflective of those who some believe are uniform. The driver in question was about 50 years, the very beginning the "career" began talking with a colleague on the radio. The guy started to criticize Zapatero-calling insult him ignorant, bullshit and other niceties, "went with the speed limit, arguing that the car that consumes less than 140 to 110 - and just keep saying to see if he was dying Rubalcaba , was entered by a urinary tract infection, after the typical way to say about politicians in general: sausages, thieves etc ..., and take it with icing on the Moors and the "blacks."

Your partner should be of the same ilk because he cheered thanks. A rant after ended tried to follow the conversation with me, I really just wanted to take over his speech-I believe that you have not felt so uncomfortable and so eager to tell him he was a jerk. He failed to say anything more than: "It makes me a receipt please?

This situation made me think that in our environment there is much "enterao" about everything and does not know anything. The issues on which there are more "enterao" are soccer, politics and health. As expected, this brought back memories of the "enterao" hospital and I recalled a phrase from Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity"

Who? has not had to deal with the typical family, that after studying the medical encyclopedia or internet consular decides bitterness am getting the smartass with supposedly scientific questions.

Who? have not heard a comment in a waiting room or at the bus stop where a patient says to the other: "You do not pay any attention to medical I had the same and I did ... and I passed. "

Who? has not been submitted in the office for questioning or minioposición, usually by the youngest of the family that has seen many movies doctors.

All these "enterao" I would ask when you're training for something that you may feel that non-experts will give lessons. If the answer is "poor are jerks", apply the story when you go to hospital.

How to handle these situations: in the case of "enterao" pseudo asked: Do you have something to do with healing? Whatever the answer you loose an explanation with technical words can you think of a Latin word made without forgetting, if not the guild does not know anything and if so stay in professional plan.

For "enterao" type interrogator must answer the questions .. and plan to finish in jest ask: What makes me shout? usually remain somewhat puzzled ... then when you say with a smile, a joke!

Read Straight Shotacon Mangas

A surgical nightmare

write yet having recovered from an operation type nightmare of 9 hours without rest or respite. These situations leave you exhausted not only physically but especially from the point of morale. Stand it because you have to finish the job: an operation can not end because you're tired or stressed, or not serve the handover times, or hunger or sleep. There are no excuses that are worth: only worth a job well done.

is a young woman and I say it is my age and that also influences-diagnosed several months ago of a colon tumor with multiple bilateral liver metastases. When diagnosed, the 8 segments of a single liver was not affected by the disease. Presented at the meeting and decided to recommend chemotherapy. After 10 months of chemotherapy was reintroduced in session with an answer-size reduction of metastasis. After careful consideration we decided that if there was a possibility of removing metastases. The surgery meant removing 5 of the 8 segments of the liver to what was necessary to make a left portal vein embolization to achieve the remaining liver to grow enough to allow intervention.

far so perfect. At 9 am we started the incision and from the very beginning we realized that the intervention would be an obstacle: the liver had a dimpling appearance of shape metastases and chemotherapy in addition to adhering to the stomach a previous intervention. After exploring the abdomen and an ultrasound, we were wondering if it was possible resection or not. We knew it was the only chance that the patient is cured or at least got longer survival. The patient had been informed of the risks of surgery and had stated that the assumed. After weighing all the options we decided to go ahead. The resection was extremely complex, but we do it after 6 hours of intervention. When we finished we realized that the arterial blood of the little that we could maintain healthy liver was not suitable. To solve it we had to arterialized the holder to an anastomosis between the hepatic artery and portal vein. Among the above described, to give us hemostasis and close at 6 pm-9 hours of surgery with a break of 15 minutes. After the family informed of the situation patient and high risk for liver-fatal complication in most cases, the mother and father were older and did not understand the extent of their disease and less-technical explanations in these situations is difficult to capture the information. Once the drink is bad news to write the surgical protocol, talking to anesthesiologists and intensive care physicians. Results from the hospital at 7.30, ten hours after the start of the intervention.

The feeling of physical fatigue, stress accumulated frustration at failing to perform surgery without technical problems, the conversation with the family, explain to the rest of the companions, and in short, the feeling that all that effort was in vain and that the patient's hopes had been frustrated, got to be a day really hard, do not forget that, of those who leave scars and torn pages of the calendar. By now the patient is well, but with data from liver dysfunction, as expected.

Inside A Womens Viginia

Photos with history: an alien of 25 kilos. The doctor patient

Patient over 70 years since the last fifteen to the doctor for increased progressive abdominal girth. He carried out several tests and concluded that he had a large retroperitoneal tumor and recommended surgery. The patient did not accept because he was well and had to take care of their 6 children. Throughout this period the abdominal mass was growing slowly, despite the progressive deterioration of their quality of life, the family was unable to persuade her to return to the doctor.

few weeks before coming to our hospital the patient could not get out of bed, I could barely eat and had a progressive respiratory distress that prevented him from lying. I had to sleep sitting up. Cuando llegó a la consulta estaba en una fase preterminal. Le planteamos que la única solución era intentar quitarle la masa que medía unos 80x90 cm y que se originaba en el retroperitoneo izquierdo. La paciente aceptó la intervención-no tenía alternativa-sabiendo que podía morir en el quirófano. Cuando le pregunté por qué no había querido operarse antes, me contestó: “De algo hay que morirse doctor y yo ya soy muy mayor”. Supongo que al ver la muerte más cercana cambió de opinión: ¡quién no lo hubiera hecho!

Las imágenes que se presentan a continuación no son agradables. Recomiendo a las personas impresionables no see them. In any case that is under your responsibility to see

Image 1 appearance of the abdomen of the patient with marked incision.

Image 2 image of the tumor once the incision by holding the abdominal wall.

Image 3 tumor occupying the entire abdomen before removing.

Picture 4 beginning of the removal performed by four surgeons.

Picture 5 pulling the mass to gain access to the pelvis for its removal.

Picture 6 the tumor once removed of its size and weight (25 kilos) did not fit into any container, we had to use a container.

Picture 7 the abdomen of the patient once the intervention.

The patient was discharged without complications at 12 days was necessary to remove a muscle and a nerve root that has to do with the mobility of the left leg. Currently leading a normal life with a sequel in motion.

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Today I started on Monday in the worst way possible: talking with a partner, become a patient. One is used to talking to all kinds of patients, delivering bad news, talking about cancer, to talk about life, quality of life and death: what is used is to give bad news to a person which is every day is like you, who understands your problems, with which you identify yourself, you appreciate but never would have thought that one day would be your patient.

It all started 4 days ago with severe abdominal pain which resolved spontaneously. My partner went to hospital and underwent an ultrasound that showed a cystic lesion in the pancreatic head. This morning he has a scanner and have confirmed the worst suspicions. At 8.30 pm I received a call telling me the case and digestive've come to see the scan is clear about the diagnosis, no data because I do not want anyone to even suspect whom I am speaking. Accompanied by my colleague Gastrointestinal we went to talk to him and we have informed our suspicions and treatment options, as with any other patient, with the important difference that if I knew that we were talking about a disease with a cure unlikely.

The conversation was friendly and without tension, without awkward questions, in short, has made us very easy, this has been what has moved me most: his generosity, his empathy by putting over his anguish, his tragedy, concern for us pass this bitter pill with the best of their smiles. I wish I could fit so news like integrity, in a manner so natural and so calmly plated!

Thanks mate for your example. We will see in the operating room if all goes well.

For those partners or other persons who have been patient with cancer I recommend reading this interview of a patient's medical .