Dealing with Evidence!
You have probably heard about EBM (Evidence Based Medicine), and those of you who are not doctors probably presume that a lot of what we do is based on Evidence..... NOT SURE! There is a lot more of the other EBM - Eminence Based Medicine, that gets used. How do we as cardiothoracic surgeons deal with evidence? Lets take a simple example - use of multiple arterial grafts in Coronary Artery Bypass Graft (CABG) surgery. Bypass surgery started off as a method of providing an ad
Just a small hole in the groin!
If one was given the choice between a small hole in the groin, compared to a great big crack down the middle of the chest, there is no contest. I remember the early descriptions of successes in percutaneous coronary artery intervention - with stents in the early 1990s: I was training in cardiothoracic surgery and my learned superiors dismissed the notion out of hand. The common refrain - "Can you imagine showing a metal spring or coil into an artery?" We all had come to appre
Not splitting the chest!
The late Dr Louis Cohen was a delightful man, and an incredibly caring cardiologist with a passion for squash, who was very well known at the University of Chicago for his dedication to his patients. A large, luxuriant and very prominent white beard graced his face. As a fortunate collaborator of his, I was the beneficiary of many entertaining stories and some interesting, high profile Chicago faculty members as patients. His refrain about the sternum - "every one of these w
Plating the rib?
Yes, why not? Every other bone that is broken in the body is internally fixed with plates and screws. I am sure the medical members of the audience will remember mention of flail chest or painful rib fractures. In the "old days", the standard treatment for both was conservative with some shaking of the head and trying to control the pain. Both of these can be addressed very effectively with plating of the ribs. Dr Sylvana Marasco, from the Alfred Hospital, Melbourne is a very
Closing the chest
Lets continue... The median or midline sternotomy was first studied and shown to be effective in goats in 1897. It was another 50 years before Dr Ormand Julian at Rush Presbyterian Medical Center popularized it. The sternotomy is the most commonly performed bone-breaking procedure or osteotomy in world today. At that stage, bone was lashed together with heavy suture or twine - and the technique was called cerclage. As I mentioned in the previous blog, wire closure is not eff