23 February 2009

What is a General Surgeon

What is a General Surgeon

A general surgeon is a physician who first completes 4 years of education in medical school. Typically after this training a physician completes a 1 year internship either in his or her desired field or in another field. Next comes 4 or 5 years of surgical residency. In the case of the general surgeon, this time in spent learning both the scientific basis for surgery and medicine, but also the day-to-day practicalities of patient care. For more details about the types of surgeries performed by a general surgeon, visit the Surgery Channel.

A general surgeon trains directly under many surgical attendings in many different areas of specialty. He or she learns both by observing but also by performing operations under the careful eye of the attending surgeon.

The general surgeon performs many operations in many fields before the completion of his residency; the last year is the chief resident year where she is in charge of the day-to-day running of the patients medical and surgical care and also in charge of the more junior residents. In this manner, the general surgeon learns both the science but also the human aspects of surgical care.

Other surgical specialties quickly branch off and narrow their area of surgical practice (for instance an ENT surgeon might only do 1 year of general surgery and a heart surgeon would complete a full 5 years of general surgical training). A general surgeon could still choose to do additional training in Intensive Care Medicine or in trauma surgery for example.

Following 5 years of residency training a general surgeon practices in the community. When he has been established in a community for a period of time, he applies to be a Fellow of the American College of Surgeons. If accepted he becomes a Fellow of the American College of Surgeons (FACS). This is a high honor and verifies that the surgeon is recognized by his peers. (In Indonesia will be FInaCS / Fellow of Indonesian College Surgeon)

The general surgeon practices a broad range of surgeries depending mostly on his or her interest and training. In a large metropolitan area with many sub specialists available at every hospital the range of surgeries performed by the general surgeon would be limited.

However, the skill and broad training of the general surgeon provides a patient with a surgeon with experience in many areas: bowel and intestinal surgery, stomach and chest surgery, skin cancer surgery, breast cancer surgery and lymph node biopsy. Also the general surgeon may have received adequate training in vascular surgery to continue practicing this aspect of surgical care.

Frequently the general surgeon performs the highest number of surgeries at an institution and of course this keeps his surgical skills keen. Thyroid and parathyroid surgery are 2 areas that in a smaller institution away from the large city hospital, the general surgeon provides the comprehensive surgical care.

Complex wound care also falls under the guidance of the general surgeon due to his experience in complex wound care and surgical management.

While the specialist practices a just a few high-volume procedures to hone his or her surgical skills, the general surgeon performs many different procedures in a wide breadth of areas to keep a very diverse knowledge base sharp. Common sense, good bed side technique and a gentle surgical hand in critical.

22 February 2009

Treatment for Benign Prostatic Hyperplasia

Supporting men's health awareness by exploring solutions to the most common health problem for men over the age of 60

MERCER, Pa., Feb. 12 /PRNewswire/ -- The causes and treatments of enlarged prostate will be the focus of a free community seminar on February 20, 2009 at 6:30pm at the Hampton Inn & Suites in Mercer. Also known as benign prostatic hyperplasia (BPH), this non-cancerous enlargement of the prostate affects more than half of all men over the age of 60 and more than 26 million men in the United States each year.

Although BPH is a common health problem, many men lack awareness and understanding about the condition, symptoms, treatment solutions and overall health risks associated with delaying treatment. Dr. Kenneth Hu will be hosting the educational seminar titled "Finding a Satisfying Solution to Enlarged Prostate" and will cover symptoms as well as the range of effective treatment options now available to men who suffer from BPH.

By age 80, about 80 percent of all men have BPH. Symptoms include difficulty in urinating, a reduced urine stream, straining to urinate, frequency of urination, and a feeling that the bladder never completely empties.

Dr. Kenneth Hu
Copyright©2009 PR Newswire.
All rights reserved

Family history of colorectal cancer

Family history of colorectal cancer linked with reduced risk of cancer recurrence

Among patients with advanced colon cancer receiving treatment that includes chemotherapy, a family history of colorectal cancer is associated with a

significant reduction in cancer recurrence and death, with the risk reduced further by having an increasing number of affected first-degree relatives,

according to a study in the June 4 issue of JAMA.
Approximately 16 percent to 20 percent of patients with colorectal cancer have a first-degree relative with colorectal cancer. Beyond rare but highly

penetrant hereditary colorectal cancer syndromes, numerous studies have demonstrated that a history of colorectal cancer in a first-degree relative increases

the risk of developing the disease by approximately 2-fold. However, the influence of family history on cancer recurrence and survival among patients with

established colon cancer remains uncertain, the authors write.
Jennifer A. Chan, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues examined the association of family history of colorectal cancer

with recurrence and survival of 1,087 patients with stage III colon cancer who were receiving supplemental chemotherapy. Patients provided information on

family history of colorectal cancer at the beginning of the study, and were followed up until March 2007 for cancer recurrence and death (median [midpoint]

follow-up, 5.6 years).
Among the 1,087 participants, 195 (17.9 percent) reported a family history of colorectal cancer in 1 or more first-degree relatives. The researchers found

that a family history of colorectal cancer was associated with a significant reduction in the risk of cancer recurrence or death. Compared with patients

without a family history, those with a family history had a 28 percent lower risk for cancer recurrence or death, which occurred in 57 of 195 patients (29

percent) with a family history of colorectal cancer compared with 343 of 892 patients (38 percent) without a family history.
Examining just the risk for cancer recurrence, patients with a family history of colorectal cancer had a 26 percent reduced risk compared with patients

without a family history. Cancer recurrence occurred in 27 percent of patients with a family history of colorectal cancer and 35 percent of patients without

a family history. The reduced risk of death for patients with a family history of colorectal cancer was 25 percent.
The apparent benefit associated with family history was stronger with an increasing number of affected family members. Compared with participants without a

family history of colorectal cancer, participants with two or more affected relatives had a 51 percent lower risk for cancer recurrence or death.
Beyond rare, well-characterized hereditary colorectal cancer syndromes, our data support the hypothesis that a relatively common though less penetrant

genetic predisposition may not only influence colorectal cancer risk but also patient survival. This finding may reflect a distinct underlying molecular and

pathogenic mechanism in cancers that develop in the setting of a common (i.e., sporadic) family history, the researchers write. Further studies are needed to

more fully elucidate potential mechanisms by which a common family history may influence the outcome for patients with colorectal cancer.
(JAMA. 2008;299[21]:2515-2523. Available pre-embargo to the media at www.jamamedia.org)
Editors Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures,

funding and support, etc.
Editorial: Familial Colorectal Cancer - A Genetics Treasure Trove for Medical Discovery
In an accompanying editorial, Boris Pasche, M.D., Ph.D., of the Northwestern University Feinberg School of Medicine, Chicago, and Contributing Editor, JAMA,

comments on the results of the study by Chan and colleagues.
If these intriguing findings are validated in other studies, family history may well become a new prognostic factor in colorectal cancer. Should this be the

case, genome-wide association studies and tumor gene expression profiling studies will be warranted to identify germline and tumor-specific genetic features

associated with a family history of colorectal cancer and favorable outcome following adjuvant chemotherapy.
Over the past 2 decades, some of the first major molecular genetics inroads were achieved through careful study of patients with a strong family history of

colorectal cancer, Dr. Pasche writes. The study by Chan et al suggests that family history of colorectal cancer will lead to the identification of novel

genetic features predictive of response to chemotherapy. Familial colorectal cancer may therefore confirm its role as a genetics treasure trove for medical

(JAMA. 2008;299[21]:2564-2565. Available pre-embargo to the media at www.jamamedia.org)
Editors Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

Contact: Robbin Ray
JAMA and Archives Journals

18 February 2009


Pasiennya Meninggal, Dokter Gigi Ditangkap karena Lakukan Praktik Aborsi Liar PDF Cetak E-mail
Tuesday, 18 November 2008

ImageSeorang dokter gigi di Denpasar, Bali ditangkap setelah ketahuan melakukan praktik aborsi liar. Polisi menangkap I Ketut Arik Wijayanta di tempat praktiknya setelah mendapat laporan beberapa pasien yang sempat ditanganinya meninggal dunia.

Pihak kepolisian mendapat informasi tentang adanya seorang korban yang tewas setelah melakukan pengguguran kandungan, langsung terjun ke lapangan melakukan penyelidikan. Demikian disampaikan oleh Kapoltabes Denpasar Kombes Pol Drs Alit Widana, di Denpasar, Senin (17/11).

Alit Widana menyebutkan, bermula dari adanya korban tewas akibat malpratik seperti itu, akhirnya petugas menemukan pelakunya, yakni tersangka Arik, yang dalam praktiknya juga mengaku dokter spesialis kandungan dan genekologi (SKG).

Padahal, kata petugas pada Polsek Denpasar Selatan menambahkan, singkatan SKG yang terdapat di belakang nama Arik tersebut, sesungguhnya adalah kepanjangan dari Sarjana Kedokteran Gigi.

Arik memang seorang dokter gigi yang lulusan Universitas Mahasaraswati Denpasar dengan gelar SKG, ujar petugas.

Dikatakan, selain telah merenggut seorang korban tewas, tersangka yang pada 2005 ditangkap dalam kasus serupa, tercatat telah menggugurkan ratusan kandungan pasiennya secara gelap.[ihsan/ant/www.suara-islam.com]

17 February 2009

Kalender PABI

Sudahkah sejawat bersiap siap ?

Rencana P2B2 PABI VII akan diselenggarakan di Pekanbaru, Propinsi Riau pada tanggal 4 sampai 8 Mei 2009.

Tema yang akan diusung kali ini adalah :Patient and Doctor Safety on Excelent Surgery Services. dengan subtema : Regional Distribution of Surgeon Services and Safe Community.

Diselenggarakan di Hotel Grand Labersa Pekanbaru. Untuk menghubungi sekretariat panitia silahkan kirim e-mail di : p2b2pabipku@yahoo.co.id

Selamat berjumpa di Pekanbaru

New therapy for B cell NHL

ASH 2008: Novel Therapy Shows Promise in B Cell Non-Hodgkin's Lymphoma

Roxanne Nelson
Information from Industry
FEMARA® (letrozole tablets) - Important Trial Results
Learn more about an important trial with patients in the early adjuvant setting. Click here.
Safety Information and Prescribing Information.

December 7, 2008 (San Francisco, California) — An investigational drug with a novel mechanism of action has shown promising activity in leukemia and lymphoma patients who were resistant to other therapies in a phase 2 study highlighted here at the American Society of Hematology (ASH) 50th Annual Meeting and Exposition. Fostamatinib disodium is the first drug to target the protein spleen tyrosine kinase (SYK), and is under development by Rigel Pharmaceuticals, Inc.

Fostamatinib produced significant responses in patients who had failed standard therapies for diffuse B cell lymphoma, chronic lymphocytic leukemia, and small lymphocytic lymphoma (CLL/SLL). It also prolonged stable disease in patients with follicular lymphoma, Jonathan W. Friedberg, MD, from the James P. Wilmot Cancer Center, University of Rochester, in New York, reported at a packed plenary session.

These results look promising, J. Evan Sadler, MD, PhD, from the Division of Hematology at Washington University, in St. Louis, Missouri, commented to Medscape Oncology, and this drug offers hope of very specific targeted therapy. One of the great success stories in recent years has been imatinib (Gleevec), which is a "beautiful example of a targeted therapy that is terribly effective, and now we are all looking for the next one," he said

"What is most exciting about this type of targeted therapy is that it confirms the laboratory findings about this B cell receptor and that inhibition of this signal does result in tumor responses and disease stability in a large number of patients," he said.

The future of this drug is going to be 2-fold, he said. "First, we are going to confirm our results in additional trials and, equally important, we are going to be doing laboratory investigations to see if we can predict which tumors are the most sensitive to this drug."

Certain normal and malignant B cells rely on "tonic" B cell receptor (BCR)-mediated survival signals, which induce the phosphorylation of the associated Ig alpha and beta proteins. It also induces the recruitment and activation of SYK, which then initiate downstream events and amplify the original BCR signal. A subgroup of diffuse large B cell lymphomas exhibits the overexpression of BCR pathway components, including SYK, and also relies on tonic BCR signaling.

Fostamatinib disodium inhibits SYK, is currently being developed for the treatment of rheumatoid arthritis, and has demonstrated significant in vitro activity against BCR-dependent non-Hodgkin's lymphomas. A phase 1 trial of 13 patients evaluated the efficacy of 2 dose levels (200 and 250 mg twice daily) and, based on those results, the 200 mg dose was selected for the current phase 2 trial.

"We tested 2 doses based on prior experience with rheumatoid arthritis patients, and we agreed the safe dose was 200 mg," said Dr. Friedberg. "The phase 2 component was the more important part of the trial."

Dr. Friedberg and colleagues assessed the efficacy of fostamatinib in 68 patients with relapsed or refractory non-Hodgkin's lymphoma in 3 separate disease cohorts: diffuse large B cell lymphoma (n = 23), follicular lymphoma (n = 21), and other B cell non-Hodgkin's lymphoma (n = 24), including SLL/CLL (n = 11), mantle cell lymphoma (n = 9), marginal zone/mucosa-associated lymphoid tissue (MALT) (n = 3), and lymphoplasmacytic non-Hodgkin's lymphoma (n = 1). The median age of patients was 61 years, and they had received a median of 5 previous therapies, including autologous stem-cell transplantation (n = 16) and radioimmunotherapy (n = 8).

Treatment with fostamatinib produced a complete or partial response in 22% of patients with diffuse B cell lymphoma (4 partial responses and 1 complete response) and in 55% of patients with CLL/SLL (6 partial responses and 0 complete responses). Among patients with follicular lymphoma, 10% of patients (n = 2) achieved a partial response, and there was 1 partial response observed in the MALT subgroup.

Stable disease was observed in an additional 23 patients, including 12 with follicular lymphoma, 4 with diffuse B cell lymphoma, 4 with mantle cell lymphoma, 2 with CLL/SLL, and 1 with MALT. The median progression-free survival among all patients was 4.5 months, but 16 patients received treatment for more than 200 days, and 14 remain in the study. Of the cohort, 4 patients with diffuse B cell lymphoma succumbed to their disease, and 1 patient with CLL died of infection after treatment.

The researchers found that, overall, fostamatinib was very well tolerated. "The patients were heavily pretreated, and they had few other therapeutic options," said Dr. Friedberg. "We have to put side effects into the perspective of patients who have had a lot of prior therapies and other chemotherapies. Very few patients experienced the typical chemotherapy side effects, such as nausea and fatigue."

There were 4 reported cases of febrile neutropenia and 8 patients requiring a dose modification because of neutropenia, hypertension, mucositis, or liver-function-test abnormalities.

This agent, Dr. Friedberg concluded, represents a safe and novel therapeutic approach that should be further developed for the treatment of B cell non-Hodgkin's lymphoma.

"The next 10 years in cancer research are going to be important," said Owen A. O'Connor, MD, PhD, associate professor of medicine at Columbia University Medical Center, in New York City. "New technology is going to be able to help us understand cancer — not just genes turned on and genes turned off, but complex signaling networks."

"It's the next wave of understanding cancer biology, so we can develop new targeted drugs," said Dr. Owen, who introduced the study when it was presented at the plenary session. "This is a nice example of how we can actually [transfer] laboratory-based work into the clinic relatively quickly."

Dr. Friedberg and most of the coauthors have received research funding from Rigel.

American Society of Hematology (ASH) 50th Annual Meeting and Exposition: Abstract 3. Presented December 7, 2008

16 February 2009

Selamat Datang

Assalamu'alaikum wr wb.
Selamat datang di blog saya, di sini sejawat dokter spesialis bedah bisa saling kenal, menyambung tali silaturahim, saling bertukar informasi dan pengalaman selama mengabdikan ilmunya di tengah masyarakat.
Kepada pembaca pada umumnya, kami persilahkan untuk berkonsultasi tentang penyakit dan persoalan kesehatan lainnya, terutama yang berhubungan dengan penyakit bedah.
Sumbang saran juga kami harapkan dari pembaca, baik mengenai design blog maupun tehnis medis, dan kami harapkan sumbangan artikel lainnya.
Selamat bergabung dan semoga bermanfaat.
Wassalamu'alaikum wr wb