Osler and his thoughts for us in 1991

Article Abstract:

Sir William Osler, called the Goethe of medicine, was born in Canada in 1849. He perceived medicine as a discipline and physicians its caretaker. Although the method of medicine he practiced is now outdated, his concepts of the role of the physician and the practice of medicine are not. The words of Osler are used to address issues occurring in vascular surgery today. The medical profession makes promises to patients that cannot be forgotten. The complex problems of clinical medicine require the physician to keep up with changes; this can only be done by regular reading and attending meetings. There is controversy over the indications for performing carotid endarterectomy (removal of the cholesterol plaque-thickened inner lining of a carotid artery, one of the arteries providing the main blood supply to the brain). The published evidence clearly shows the indications for and results of this operation, yet case reviews point out many examples of surgery performed for inadequate indications and associated with high rates of complication and death. The question is asked, 'Can't these surgeons read?' Yet, carotid endarterectomy is a good operation; it has been proven superior to aspirin in treating narrowing of the carotid artery that is 70 percent or greater. Maybe vascular societies should confront the issue of outcome and help set standards. Another example is that of laser-assisted balloon angioplasty, which has been found to be no better than standard balloon angioplasty. Use of unproven methods has produced predictable results and the image of the medical profession has suffered. Economic payback for the physician is seen as being the driving force of medicine rather than patient welfare. Osler asked physicians to first master the field and then spend the rest of their lives maintaining their proficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

History, Biography, Beliefs, opinions and attitudes, Speeches, lectures and essays, Blood vessels, Graduate medical education, Vascular surgery, transcript, Postgraduate medical education, Osler, Sir William

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Carotid eversion endarterectomy revisited

Article Abstract:

This study evaluated eversion endarterectomy of the carotid artery, the main artery of the head and neck. In this procedure blockage (stenosis) of the carotid artery is removed by turning the vessel inside out and removing the blocking material (i.e., the blocking material of atherosclerosis or hardening of the arteries). The results of technique to date have been good, as evidenced by lack of permanent neurological complications or deaths in 98 surgical procedures. Preliminary clinical and x-ray findings suggest that there is significant reduction in both continuing technical problems and in closing of the vessel. The author concludes that long-term clinical and laboratory study will be required to show the value of this procedure.

Atherosclerosis, Carotid artery, Carotid arteries

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Eversion of difficult ileostomies by guy rope suture technique

Article Abstract:

The surgical creation of an artificial opening in the wall of the ileum, the last section of the small intestine, through which fecal material may be emptied, is known as ileostomy. Usually a section of the inside of the bowel is pulled through the opening (eversion) to form a nipple onto which an appliance for the removal of waste can be attached. Turning a normal segment of the intestines inside out may not be a problem, but forceful attempts to manipulate a diseased section of intestine may damage that tissue. To prevent this, a technique was developed according to the guy rope principle to evert the intestine. This technique can also be used to evert healthy sections of intestine in creating a permanent ileostomy.

Analysis, Ileostomy, Intestine, Small, Small intestine, Ileum

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