Going for Ride with Friends

Going for Ride with Friends

Sunday, September 5, 2010






I have been remiss in not letting you get to view some surgical pathology. I realize that the joy of surgery is the pictures (isn't it?). In a counter-clockwise progression starting from the top left, (1) when you have a huge neurofibroma that is coming of the lower part of your face it is good to have a good surgical head and neck surgeon and blood back-up to remove the mass. The poor boy walked around with a scarf to cover up his lower face as the mass took his lower jaw/lip/face and extended it to the lower chest. (2) Central lines can be used as drainage tubes into the pericardium to diagnose the effusion. The poor boy also has a septic left hip that needs surgery but couldn't breathe well due to the effusion. He has TB. (3) My first Hirschprungs case didn't go as I had exactly hoped. I did a variation on a Duhamel [sic] procedure. The boy had a stoma diversion and is 7 years old. His distal segment was still really dilated, and I couldn't really see the differentiation into the aganglionic segment. The picture does show anatomy well, though. (dilated sigmoid, ureter, bladder reflection, etc) (4) "Big uterus" is becoming my most common diagnosis. Kocher clamps in many sizes and levels of clamp ability, poor lighting, and sometimes doing them with just an inexperienced scrub to assist have all been interesting challenges. (5) Recurrent chest wall neurofibroma that is infected will be a new challenge. The XRay doesn't show any bony involvement so how will I resect this thing and cover the defect in the 11 year old girl? Anyway, don't look if you don't want to see pictures, but do pray that God will continue to give wisdom as many different challenges come along that are new to me. Even if they aren't new, I need lots of God's grace to proceed. dasen

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