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Leonid Rogozov: The Surgeon Who Operated On Himself And Lived

In April, 29th, 1961 a doctor of the 6th Soviet Antarctic expedition Leonid Rogozov aged 27 felt pain in a right lower belly and fever. The next day brought only exasperation. Having no chance to call a plane and being the only doctor at the station “Novolazarevskaya”, at night, in April, 30th the surgeon made an appendix removal operation on himself using local anesthesia. He was assisted by an engineer and the station’s meteorologist. 
 
In 1959 Leonid Rogozov graduated from the Institute and was immediately accepted to the surgery clinical residency. However, his studies at the residency were broken off for some time due to Leonid’s trip to Antarctica in September, 1960 as a doctor of the 6th Soviet Antarctic expedition to Novolazarevskaya station. 
During this expedition there happened an event that made a 27-year old surgeon world-famous. 
In the 4th month of the wintering, in April, 29th, 1961, Leonid showed disturbing symptoms: weakness, nausea, fever and pain in a right iliac region. The following day his temperature got even higher. Being the only doctor in the expedition consisting of 13 people, Leonid diagnosed himself: acute appendicitis. There were no planes at any of the nearest stations, besides, adverse weather conditions would not allow to fly to Novolazarevskaya anyway. In order to save the sick member of a polar expedition there was needed an urgent operation on site. And the only way out was to operate on himself. 
At night, on the 30th of April, 1961, the surgeon was being helped by a mechanical engineer and a meteorologist who were giving him the medical instruments and holding a small mirror at his belly. Lying half bent on the left side, the doctor made a local anesthesia with novocaine solution and made a 12cm incision in the right iliac region with a scalpel. Either watching in the mirror or by touch he removed an inflamed appendix and injected antibiotic in the abdominal cavity. In 30 or 40 minutes from the beginning of the operation there developed a faint and giddiness and the surgeon had to make pauses for some rest. Nevertheless, by midnight the operation lasting 1 hour and 45 minutes was over. In five days the temperature normalized, in two days more – the stitches were taken out. 
In the St. Petersburg Museum of the Arctic and the Antarctic there is an exposure of surgical instruments that Leonid Rogozov applied for this uneasy operation. 
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Leonid Rogozov: The Surgeon Who Operated On Himself And Lived

In April, 29th, 1961 a doctor of the 6th Soviet Antarctic expedition Leonid Rogozov aged 27 felt pain in a right lower belly and fever. The...

26 organisations team up to fight Antibiotic Resistance

Better coordination is needed to ensure that antibiotics remain effective in treating common infections, experts say. 
 
 
By CAROLYNE KRUPA, amednews staff. Posted Nov. 26, 2012. 
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Antibiotic resistance has been a growing health concern for decades. But 26 organizations are joining together to highlight the increasing urgency of the problem and protect the effectiveness of antibiotics for future generations. 
The Centers for Disease Control and Prevention, American Academy of Pediatrics, Robert Wood Johnson Foundation and Center for Disease Dynamics, Economics & Policy are among the 26 organizations that announced the effort on Nov. 13. By signing a joint statement, the groups agreed to better coordinate efforts to fight antibiotic resistance, support related research, improve surveillance and raise awareness. 
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“Antibiotic resistance has become one of the world’s most pressing health problems,” said Brian C. Quinn, PhD, senior program officer and team director of the Robert Wood Johnson Foundation’s Pioneer Portfolio, which is aimed at driving social change to improve health. “Antibiotics continue to be overused at alarming rates across the country. This problem is far too widespread to be handled alone.” 
In conjunction with the statement, the CDDEP’s Extending the Cure project released its latest data about antibiotic use in different states. The five states with the highest rates of antibiotic use in 2010 were Kentucky, Louisiana, Mississippi, Tennessee and West Virginia. The states with the lowest use were Alaska, California, Hawaii, Oregon and Washington. 
“The threat of antibiotic resistance returns again and again, and the threat of untreatable infections looms,” said Arjun Srinivasan, MD, associate director for Healthcare Associated Infection Prevention Programs with the CDC Division of Healthcare Quality Promotion. “There are patients in hospitals in this country that have infections that we cannot treat with any of the antibiotics that we have.” 
Growing urgency 
Antibiotic resistance is making some of the most common infections difficult to treat, said Clara Filice, MD, MPH, MHS, pediatric environmental health and food policy fellow with the AAP. A lot of the pathogens that cause infections — such as ear and skin infections — have become resistant to commonly used antibiotics. 
“It is a growing public health crisis,” she said. “It’s something that most, if not all, physicians who are practicing are experiencing.” 
More than 70% of bacteria that cause hospital-acquired infections are resistant to one or more antibiotics used to treat them, according to the National Institute of Allergies and Infectious Diseases. 
Urinary tract infections are the second most common infection in the U.S., accounting for about 8.6 million patient visits annually, the CDC said. If they go untreated, UTIs can develop into serious bloodstream infections. But they are becoming harder to treat with the available arsenal of antibiotics, said CDDEP Director Ramanan Laxminarayan, PhD, MPH. Resistant bacteria that cause UTIs increased more than 30% between 1999 and 2010. 
70% of bacteria that cause hospital-acquired infections are resistant to one or more antibiotics. 
“These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective,” he said. “New drug development needs to target the types of drug-resistant bacteria that cause these infections.” 
There has been some progress. Overall, the percentage of antibiotic prescriptions filled nationwide has dropped 17% since 1999. Use of fluoroquinolones, which are commonly used to treat respiratory infections such as pneumonia, decreased 24% between 2007 and 2010. Deaths related to methicillin-resistant Staphylococcus aureus also have declined. 
Health care professionals and organizations need to work together to improve antibiotic stewardship and reduce unnecessary use, Dr. Srinivasan said. 
“It has reached a point of urgency,” said Henry “Chip” Chambers, MD, chair of the IDSA’s Antimicrobial Resistance Committee and chief of infectious diseases at San Francisco General Hospital. “We can’t invent ourselves out of this mess with new drugs. We are going to have to figure out how to save the ones we have.” <div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKhI91926XwA1-kR_sQrBXZ6NvcKQyypB8na0PHqkG095LCnRe0Pt8twZL2GNHp2ygsFsJ-Vo6xIDIm9kWGxIh4iB6W5jvonfyvTe_rFKSFd_L5gHL-0AazfzPmrwtLsio6w2nVC_kTV4/s640/blogger-image-336202440.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKhI91926XwA1-kR_sQrBXZ6NvcKQyypB8na0PHqkG095LCnRe0Pt8twZL2GNHp2ygsFsJ-Vo6xIDIm9kWGxIh4iB6W5jvonfyvTe_rFKSFd_L5gHL-0AazfzPmrwtLsio6w2nVC_kTV4/s640/blogger-image-336202440.jpg" /></a></div>

26 organisations team up to fight Antibiotic Resistance

Better coordination is needed to ensure that antibiotics remain effective in treating common infections, experts say. By CAROLYNE KRUPA,...

Surprising Hurdles to Quitting Smoking for Cancer Patients

Megan Brooks 
 
Why do most cancer patients keep smoking after being diagnosed with cancer? The answer is far from simple, according to a new study. 
 
 
Dr. Sonia Duffy 
The "multitude of issues" that cancer patients face when tackling their smoking habit surprised us, Sonia Duffy, PhD, RN, FAAN, a researcher at the University of Michigan School of Nursing in Ann Arbor, told Medscape Medical News. There are "so many variables affecting why they don't get treatment, and if they do get treatment, why they may not respond," she explained. 
 
"Nicotine addiction, health issues, emotional issues, psychological issues, and system-level issues are all in the way," Dr. Duffy noted. 
 
Other obstacles include lack of access to smoking-cessation programs, doubts about whether they can quit, lack of social support, sleep deprivation, poor nutrition, low activity, and low socioeconomic status. After back-to-back appointments and grueling chemotherapy or radiation protocols, many cancer patients simply lack the time or energy to attend quit-smoking programs, Dr. Duffy said. 
 
Depression is another huge barrier that keeps many cancer patients from kicking the habit. Although depression rates are lower than 10% in the general population, they are as high as 58% in cancer patients. 
 
Dr. Duffy and colleagues conducted a literature review of relevant studies on smoking by cancer patients. The results appear in the November issue of Community Oncology. 
 
This is the first comprehensive review to examine the reasons the very cause of the cancer — smoking — in many cases isn't treated, Dr. Duffy said. She admitted she wasn't prepared to find so many hurdles hindering smoking cessation in cancer patients. 
 
Ducking an Obligation? 
 
"There is a growing consensus about the obligation to provide state-of-the-art smoking cessation interventions for cancer patients," she and her colleagues write. However, research suggests that only 56% of family physicians recommend that their smoking oncology patients quit smoking, and most oncology providers do not provide smoking interventions beyond advice to quit, they note. 
 
"For busy oncology providers, even brief advice coupled with medication therapy (nicotine replacement therapy, bupropion, or varenicline) can help smokers quit," Dr. Duffy told Medscape Medical News. 
 
At the very least, she said providers can refer patients to the 1-800-QUIT-NOW help lines available in all 50 states; they provide telephone counseling and sometimes medications to those without insurance. 
 
Nurses to the Rescue 
 
Nurse-led interventions might be a good option to get more cancer patients to quit smoking. One review concluded that, in general, nurse-administered programs are more effective than nonnursing interventions ( Cochrane Database Syst Rev. 2004;1:CD001188). 
 
"Oncology nurses are ideally positioned to deliver cessation interventions," Dr. Duffy and her colleagues point out. Why? Because they are "educated in patient education, psychosocial interventions, and physiological interventions; they have access to and immediate rapport with patients, as well as respect from patients' physicians; they understand the patients' medical conditions, can read their charts, and write nursing notes; and they constitute a much larger workforce than oncology physicians." 
 
In addition, physician time is at a premium, which makes nursing interventions more cost effective. 
 
It is estimated that smoking is behind 30% of all cancer deaths and 87% of all lung cancer deaths, yet 50% to 83% of patients keep smoking after being diagnosed with cancer. 
 
Dr. Duffy said her next project will focus on ways to specifically design smoking-cessation programs for nurses to deliver to cancer patients. 
 
The study was supported by the Department of Veterans Affairs and the National Institutes of Health through the University of Michigan's Head and Neck Specialized Program of Research Excellence (SPORE). The authors have disclosed no relevant financial relationships. 
 
Community Oncol. 2012;9:344-352. Abstract 
 
 
Medscape Medical News © 2012 WebMD, LLC 
 
Send comments and news tips to news@medscape.net. 
 
Cite this article: Surprising Hurdles to Quitting Smoking for Cancer Patients. Medscape. Nov 29, 2012.q <div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaVp1e_U3E2ixPjjbewHh33ktm4WkyO7WxjhPk_iMOG4Q7YYUPCj8RPu0SkBuCGsRDHzlbTVGhT_eytTB0OkIRuZhqoKhVvlAPzTMELmYVJ5NocHFw3GMrv4Hm8bzbNJLJDN7kplqcrrg/s640/blogger-image-1880565552.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaVp1e_U3E2ixPjjbewHh33ktm4WkyO7WxjhPk_iMOG4Q7YYUPCj8RPu0SkBuCGsRDHzlbTVGhT_eytTB0OkIRuZhqoKhVvlAPzTMELmYVJ5NocHFw3GMrv4Hm8bzbNJLJDN7kplqcrrg/s640/blogger-image-1880565552.jpg" /></a></div>

Surprising Hurdles to Quitting Smoking for Cancer Patients

Megan Brooks Why do most cancer patients keep smoking after being diagnosed with cancer? The answer is far from simple, according to a ne...

Ninth Café

Amazing café on 5th floor of Siam Discovery. Food was great. <div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg46QJhd8uyw38OsfIA6gGwcBl3sPk1W_jaIky-8JXTITqjAztIdArX_Tdru0n-WJxQiMktMawThPtw49NV6Tqw_4LKM-PXkDdEin96bxaAYEyTR76D18N_fBgn-XXCcOvmEhgwt2tyarE/s640/blogger-image--667843763.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg46QJhd8uyw38OsfIA6gGwcBl3sPk1W_jaIky-8JXTITqjAztIdArX_Tdru0n-WJxQiMktMawThPtw49NV6Tqw_4LKM-PXkDdEin96bxaAYEyTR76D18N_fBgn-XXCcOvmEhgwt2tyarE/s640/blogger-image--667843763.jpg" /></a></div> <div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNn3fZFX5qNec8ItHX_azBVisvFMIEwUl6jgUxXf88fM1aXxU5ikpha2DL21zDUB0qSO0WtwiymE8ZiGW-S2ux-Yd9inwJ8u9S-TIOOr_P10VMA15JBNCo-oh0CUjhAFXO0Gvd9DOYrWI/s640/blogger-image-1424159503.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNn3fZFX5qNec8ItHX_azBVisvFMIEwUl6jgUxXf88fM1aXxU5ikpha2DL21zDUB0qSO0WtwiymE8ZiGW-S2ux-Yd9inwJ8u9S-TIOOr_P10VMA15JBNCo-oh0CUjhAFXO0Gvd9DOYrWI/s640/blogger-image-1424159503.jpg" /></a></div> <div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBPWCOUQUWCyXSrgSCFvUPee6iPgQGv_2h1KT6R4Hdwv1aPBHax0Mb23bY9qty07RR8oSbXNApytWyvefHqNKm7C1lEKic9BxrjskGEwBfrTCwNbTV-CFrdUygrqhDcDdk21k5lcXDlGc/s640/blogger-image--1036999253.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBPWCOUQUWCyXSrgSCFvUPee6iPgQGv_2h1KT6R4Hdwv1aPBHax0Mb23bY9qty07RR8oSbXNApytWyvefHqNKm7C1lEKic9BxrjskGEwBfrTCwNbTV-CFrdUygrqhDcDdk21k5lcXDlGc/s640/blogger-image--1036999253.jpg" /></a></div>

Ninth Café

Amazing café on 5th floor of Siam Discovery. Food was great.

In surgery

In surgery

Bangkok

Bangkok

Maldives

http://youtu.be/ZbWGsUfiG6w

Orange Juice Can Trigger Dangerous Syndrome

Fran Lowry 
 
ANAHEIM, California — Food protein-induced enterocolitis syndrome (FPIES) was triggered by orange juice in a 2-year-old boy, according to a poster presented here at the American College of Allergy, Asthma & Immunology 2012 Annual Scientific Meeting. 
 
FPIES and its triggers (most commonly cow's milk, rice, and soy) can be difficult to diagnose, lead researcher Tara Federly, MD, a fellow at the Children's Mercy Hospital and the University of Missouri in Kansas City, told Medscape Medical News. 
 
FPIES is not mediated by immunoglobulin (Ig)E, "so it's not the immediate hypersensitivity reaction that you see with peanut or milk or other allergy," Dr. Federly explained. "The exact mechanism is not known, but it's basically an inflammation of the GI tract that is triggered by certain foods. The interesting thing is that it happens hours after ingestion, instead of being a more immediate IgE-mediated reaction," she said. 
 
In the case reported by Dr. Federly and her colleagues, which they describe as the first report of orange juice being the causative agent in FPIES, a 2-year-old boy presented with lethargy and severe vomiting that required hospitalization and the administration of intravenous fluids. This occurred on 5 occasions. 
 
The episodes occurred without associated rash, angioedema, respiratory symptoms, fever, or contact with other sick children. 
 
Each time, "the emergency department thought that he had viral gastroenteritis, and he returned to normal after intravenous fluid replacement," Dr. Federly reported. 
 
On further questioning, the child's mother implicated orange juice as an apparent trigger because the reaction usually occurred a couple of hours after he drank it. 
 
The possibility of an IgE-mediated food allergy was ruled out on the basis of negative skin-prick testing to orange extract and fresh orange juice. In addition, IgE specific to orange was less than 0.1 kU/L, Dr. Federly said. 
 
The researchers performed an FPIES oral food challenge, using the recommended total challenge dose of 0.06 g of protein/kg divided into 3 feedings over 45 minutes. 
 
The intended duration of observation was 4 hours, but within 90 minutes of the final dose, the child began vomiting every 10 to 15 minutes for 2 hours. He did not develop urticaria, rhinorrhea, wheezing, or other symptoms of anaphylaxis. 
 
His absolute neutrophil count was elevated, from 1920 cells/µL to 3420 cells/µL. 
 
The child became tachycardic and lethargic after his vomiting episodes and was given normal saline. After vigorous hydration, he responded very well and returned to normal. 
 
Other Fruits Implicated 
 
"This response goes along with FPIES," Dr. Federly said. 
 
"Other fruits have been implicated in FPIES, such as apple, pear, and banana, but not orange juice. When he stopped eating oranges, he had resolution of his vomiting episodes," she explained. 
 
The message for physicians is to think about the possibility of FPIES when a child comes in with recurrent episodes of vomiting and dehydration, she said. 
 
Again, "the most typical triggers would be milk, soy, and rice, but you need to think of unusual cases, such as fruit and more solid foods. These kids should be seen by an allergist.... Doing a challenge in the clinic is the best way to determine if it is really FPIES," she noted. 
 
"Not an Allergy" 
 
Jay Portnoy, MD, professor of pediatrics at the University of Missouri and Mercy Children's Hospital, who was not part of the study, told Medscape Medical News that FPIES is a relatively new syndrome. 
 
"Kids can die from [FPIES]. The reaction is delayed. It happens an hour or 2 after eating the food, so the parents don't always know what food it was; they don't even associate it with a food. It usually happens in children less than 1 year of age, young infants, so this might be responsible for crib death," Dr. Portnoy said. 
 
"The important thing is that allergy testing doesn't help identify FPIES because it's not an allergy; it's something else, but we don't quite know what it is. It is important to be aware that this syndrome exists and that unusual foods not usually linked to food allergy can be associated with it," he said. 
 
Dr. Federly and Dr. Portnoy have disclosed no relevant financial relationships. 
 
American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual Scientific Meeting: Abstract P261. Presented November 11, 2011. 
 
 
Medscape Medical News © 2012 WebMD, LLC

Orange Juice Can Trigger Dangerous Syndrome

Fran Lowry ANAHEIM, California — Food protein-induced enterocolitis syndrome (FPIES) was triggered by orange juice in a 2-year-old boy, ...