Straight Shotocon Mangas

Interview Medical Journal

Alicia Serrano A few days ago I did an interview for the Medical Journal (25-4-2011), I have come to know because it was an interview type written questionnaire but the talks were very cordial. Worst of all was having to pose for the photographer and looking at the photo chosen prefer not to see the rest. What surprised me was that I chose to me considering that there are at least 300 health posts in Spain, the response was that there were few surgeons and created my own opinion. Regarding the first statement is true in general and digestive surgery blogs I can find are those of July Mayol and mine, before starting to write my blog had not looked, do not count those who make propaganda of hospitals or clinics. If someone let me apologize and hope to receive your address.

For the second statement is not my intention to influence opinion in the style of famous gurus or lecturers who have elaborate recipes for all problems, I just want to tell you what worries me about our profession and I have ever heard at any meeting of surgeons. I am also concerned the training of medical students who study "miricina" the new realities facing residents health and without any training other than theoretical and come to our profession in the public health system.

For those who ye curious can read the interview in the Medical Journal or PDF formats - page: 20 -

In the next post I will present the full text of the interview more than anything because it clarifies some of the assertions of the article.

Finally thank you very much to the 625 who visited the blog yesterday, it gives energy to keep

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Parrot Chocolate

In times of cuts and health care has become fashionable to save issue as soon not matter, it appears that healthcare managers and policy makers on duty had not been the subject of saving on your magic-management courses at I say it becomes a simple medical x hours in a manager who gives up his essence. Today I read an interesting summary of the week blog health things input Emilienko on savings on health and I have come forward to participate in the prize paper airplane to the toilet more austere .

Title comes to mind that all cost-saving measures have met in the hospital were based on personal discomfort for the rebound effect, ie it is a contest in which you choose a very cheap surgical mask that had been assessed with a low score. As you begin to use it proves to irritation in the face; result needs to be replaced by another, that being out of competition is much more expensive. This can extend to gloves, suture material, ect ...

But one of the sites where you can save more money, oddly enough, is in the query area . It is not unusual for a patient have to go to consultation with 4 or more specialists and each order your own explorations, some of them very expensive and a little more performance. Example: a patient who underwent colon cancer requiring adjuvant chemotherapy, developed liver metastases and should be operated again. At least it will be seen by: medical oncologists, colorectal surgeons, liver surgeons and gastroenterologists for follow-up colonoscopy. Result: Reviews and multiply quadruple scans. Please note that in digestive tumors systematic reviews address the symptoms only demonstrated survival benefit in the colon.

Another issue is to review patients in the consultation by their health status or your inability will not be candidates for active treatment despite showing a tumor relapse. It is sad that an octogenarian in a wheelchair go to the query, taken from his home by ambulance, to offer you the inconvenience of travel and any return to health, do not forget that being treated by his primary care physician.

My proposal to save is to agree with management a pathology review program and conduct a coordinated multidisciplinary consultation nursing. The savings would be consultations and examinations such as the parrot chocolate. As this is quite complicated for the prize ....

My proposal to qualify for the paper airplane in the hospital is to centralize information for analytical review results and exploration, by phone or e-mai, l which Whereas it may appear this way. The savings would not only be of consultations and only hours of work permits given to attend the consultation.

not forget that for long-term savings are usually to invest!

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Snowflakes and Mexico destination

Yesterday was talking to a good friend about the consequences of our actions and the constant care that is not going to be that the "Karma" will be displayed for payment in accordance with the planted crop. Somehow
touch the subject of the ultimate goal, to that for which we are preparing, for the purpose of life, and I remembered the snowflakes. Why
snowflakes? Ever heard that there are no two snowflakes are identical, and from what I've seen, their structures are symmetrical and beautifully drawn. The most romantic
think that God takes to draw or design them as manifestation of the complex within the imperceptible. The beauty of the details minimum.
But besides being able to contemplate the ephemeral designs of snowflakes, what else is there?
I remembered how to develop our lives as a tangle of details aimed at perfection or a lofty goal.
I personally do not believe in predetermined destiny and I can not explain the similarities or coincidences.
Maybe our lives are like snowflakes, complex, structured, casual, beautiful, sometimes referred to and the most ignored.

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Photos with history, memories that blur the look. Primum non nocere

This new entry photos history is especially hard for me because it brings memories away in time but close the heart. It was a fellow patient who was working at a health center near our hospital. As a result of weight loss and continuous epigastric pain an ultrasound was requested. The finding of a pancreatic mass triggered a study that ended in the operating room and tragedy for the patient, had a pancreatic neuroendocrine tumor occupying the entire gland also invaded the stomach and duodenum in a transmural.

The only surgical solution was the total pancreaticoduodenectomy and total gastrectomy with splenectomy.

first photos intervention

The patient had not complied 40 years and had already passed a traffic accident and viral encephalitis. As a doctor he knew the irreversible consequences that this operation entailed: diabetes difficult to control, severe nutritional problems and a life completely controlled regime, accepted the intervention and was performed without complications. He had the courage and strength to recover and return to work, was a dedicated and devoted care to their patients.

When everything seemed to go well in life and after 42 months of the first intervention, in a routine liver metastases were found 3 that were close to 2 of the 3 hepatic veins. He suggested that the best treatment was the resection but the liver due to nutritional disturbances had undergone degeneration fat with normal liver function that concerned us. Two days before the date of the timing of the surgery came to the emergency department with acute abdominal pain requiring morphine for pain control. Required an emergency intervention was found in the intestinal infarction of venous origin as a result of an internal hernia affecting the entire small intestine. Reduction was chosen, aspiration of intestinal contents and open abdomen. At 6 hours relaparotomy. Fortunately there was a recovery and did not require resection, at 14 days was discharged to be operated on the liver. Once recovered and past 2 months design a conservation strategy parenchyma resection with resection of segment VII and segments II-III and IVA retaining the right and middle hepatic vein.

The initial post was normal but developed an infection of the bed of resection required two reoperations without our being able to control, develop multiple complications and dying after a month and a half died. At all times he was able to convey their desire to live and we encouraged us to continue trying to cure fig. I still remember after more than 5 years my last conversation with her, which sent me your tired in the struggle to live but never lost the will to fight or be resigned, even encouraged us because he saw that we suffered for not being able to master the complications. Only I have the consolation that we offered 3 ½ years of life she intensely enjoyed despite its limitations, yes I have left in the memory.

liver surgery photos

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This aphorism is one of the keys to proceed doctor, or rather should be. Do not know why today I have come to the head, but if this has been the cause of that type on this issue highly topical hackneyed and inconclusive.

When I wrote the entry: "less is more" , and introduced some of the issues as I am more "veteran" on my list: Where has been the sense of As in medicine today. I would like to pose some questions to be answered if we believe that our public health system is financially sustainable, and humane and emotionally by the toilets.

Should we treat all patients with all means at our disposal and as citizens have equal rights?

What is the margin an actual doctor has to adjust or limit the therapeutic effort "when he thinks is best for the patient, in a system like ours," all inclusive "?

Why everyday a doctor has to act against their professional approach pressed by the family, the patient, the system or the fear of claims or complaints?

why when a know that patient has no chance of leaving the hospital continues with active treatment, not to confront the family ?

Why, in short, we have lost our sense of proportion and we are unable to speak clearly with patients and families? I think I have an answer: because we are tired of facing failure, death, lack of understanding of families, citizens and patients, in that order. No doubt there are many other causes, but family pressure is increasing and resources of professionals to deal with it, the interests of the patient-are lower. The helplessness we feel explains why doctors caved-in occasions in the fight against dysthanasia- aggressive therapy -.

I must admit that the whole responsibility is not to relatives, patients or citizens, some colleagues by education, moral or ethical considerations have a vision of medicine in which we must all do never think that sometimes "less is more ."

urgently explain to young people that medicine is not infallible, that our loved ones too sick and die, and that professionals are the ones most experience to make decisions about your treatment. The idea is transmitted to the public-especially young people, is that health is a service to the letter in which they can choose at their discretion. What nobody tells you is that this does not work that way, the citizens can choose between treatments that medical teams proposed as the most suitable for your condition, this is definitely ruled out and choose other alternatives.

I await your responses ... ...