Under the Knife
Page 32
pH value Chemical expression of the acidity of a liquid: pH7 is neutral, lower is more acidic, and higher is more alkaline. The optimal pH of the human body is 7.4.
Post-natal After giving birth. A post-natal depression is a psychological disorder, a form of depression, suffered by women after they have given birth.
Prevalence The number of cases of a certain disease in a population group at a given moment. Prevalence is mostly expressed as patients per thousand. See Incidence.
Primary See Per primam.
Primum non nocere Basic principle of medicine, meaning literally ‘first do no harm’. At least, do not make a situation worse than it already is. A surgeon sometimes has to make a situation worse, by performing an operation, to ultimately improve it. In such cases, the long-term advantages and disadvantages must be considered. A decision on whether to perform a surgical procedure cannot therefore always be made on the basis of primum non nocere. Surgeons could better work according to the principle of ‘do unto others as you would have them do to you’.
Probe Rod-shaped instrument used to probe the depth of a wound or fistula.
Prognosis Prospect. How an illness will end, the chances that it will end well or badly, the time required for recovery, the symptoms or complications that can be expected.
Prosthesis Temporary or permanent replacement of part of the body by something artificial, for example an artificial leg, false teeth, an artificial blood vessel, artificial ossicles in the ear, an artificial hip or shoulder.
Purgative A laxative to provoke diarrhoea, such as castor oil.
Pus Liquid produced by an infection, comprising dead inflammatory cells (white blood cells), bacteria, tissue and tissue fluid. Different pathogens cause different kinds of pus, with a characteristic smell, colour and texture. A typical subcutaneous abscess (boil) contains creamy, light yellow pus with a slightly cheesy smell. An abscess around the anus will smell strongly of faeces. Teeth abscesses have the most unpleasant smell. See Abscess, Drain.
Radical Literally ‘roots and all’. Always used in surgery in combination with a resection or excision. Means that not only an organ or part of an organ are removed, but also the accompanying lymph nodes. Radical resection is also known as extirpation, which has the same literal meaning. See Total, Metastasis, Lymph nodes.
Regional Relating to a region of the body, i.e. which has its own artery and vein carrying blood to and from the organism. Examples are the upper abdomen, the neck or the lower leg. See Local.
Reposition Surgical action in the case of a dislocated fracture, involving pulling or pushing the fractured bones back into place. A dislocated joint can also be repositioned. A dislocated shoulder can be repositioned using Hippocrates’s method (placing a foot in the armpit and pulling on the extended arm) or the Kocher manoeuvre. See Dislocation.
Resection Literally ‘cut away’ or ‘take away’. In practice, comparable to excision (cutting out).
Resuscitate, resuscitation Literally means ‘revive’ or ‘restore to life’. All the actions required to keep a victim or patient alive in an emergency.
Risk factor A situation that causes a risk of an illness or complication occurring. Malnutrition, obesity, diabetes and smoking, for example, are four important risk factors for bad wound healing.
Scalpel Surgical knife. Formerly a one-piece knife, with blade and handle joined together. Almost completely replaced in modern surgery by a separate handle into which disposable blades can be clicked. See Fleam.
Scar See Wound, Wound healing, Healing.
Scrotum Sac containing the testicles.
Secondary See Per secundam.
Shock See Circulatory system.
Side effect See Complication.
Sign See Symptom.
Sinus A cavity with an opening to the outside. In contrast to a fistula, which joins two openings.
Stenosis Stricture of a bowel, blood vessel or any other hollow structure. Stenosis of an artery leads to symptoms during physical activity. See Arteriosclerosis.
Sterile 1. Not able to produce offspring. 2. Completely free of any pathogens, also known as aseptic. Not to be confused with antiseptic. Surgical instruments, operation jackets and gloves are sterilised with gamma rays or hot steam under high pressure.
Stoma Opening, mouth. Mostly used for an exit from the intestines on the skin of the abdomen. A better name is anus praeternaturalis, literally ‘beyond-natural anus’. A stoma from the small intestine is known as an ileostomy or jejunostomy, and from the large intestine as a colostomy.
Stroke Loss of function of part of the brain due to haemorrhaging or a cerebral infarction. The official medical term is cerebrovascular accident (CVA). See Infarction.
Subcutaneous tissue Also known as the subcutis or hypodermis. The layer of fat and connective tissues immediately below the skin. Obesity in females is typified by an increase in the thickness of this subcutaneous layer (in men, obesity is typified by the accumulation of mainly fat in the fatty tissues in the abdomen around the intestines). Superficial blood vessels, sensory nerves and lymph vessels run through the subcutaneous layer.
Surgeon Literally ‘hand-worker’, also chirurgeon (archaic). Medical specialist qualified to treat patients by performing operations. Restricts himself to diseases and disorders that can be treated surgically. Surgical specialisations are known as the ‘cutting’ disciplines.
Surgery ‘Hand-work’, from the Greek words kheir (hand) and ergon (work). Also the art of healing. Historically, strictly separated from medicine, which restricts itself to curing diseases without using the hands. In modern medicine, surgeons are of course also physicians and non-cutting doctors also use their hands. The difference between curing and healing, however, maintains the difference between the two approaches (cutting and non-cutting). See Healing.
Symptom A change in the body’s normal functions noticed by a patient. A doctor cannot thus observe symptoms, but can only be told about them by the patient. Asking about the nature, seriousness and development of the symptoms is the first stage in the doctor’s examination of the patient. This stage is known as anamnesis. Any abnormalities that the doctor observes or invokes in the patient are known not as symptoms but as signs. Identifying signs is the second stage and is known as the physical or clinical examination.
Syn- or sym- Prefix meaning ‘together’ or ‘at the same time’. Symposium means literally ‘drinking together’. Syndrome is the continual coincidence of different abnormalities and illnesses.
Syphilis Sexually transmitted chronic infection. Caused by the bacteria Treponema pallidum. Causes tissue destruction, for example, in the face, and eventually of the central nervous system. This wasting disease was ubiquitous in the nineteenth century and could not be effectively treated until after the Second World War with antibiotics.
Thoracotomy Cutting open the thoracic (chest) cavity. Another procedure for accessing the thoracic cavity is thoracoscopy, keyhole surgery in the chest. See -tomy, Thorax.
Thorax Chest. See Thoracotomy.
Thrombosis Formation of a clot in a blood vessel. Thrombosis in a vein (venous thrombosis) leads to accumulation of tissue fluid, which is obstructed from flowing away. Thrombosis in an artery can lead to gangrene or an infarction.
Tissue A group of cells that all have the same function. Individual tissues have specific structures, functions and properties and usually have their own blood vessels to supply them with oxygen and nutrients. A body part usually consists of different kinds of tissue, such as skin, subcutaneous tissue, connective tissue, muscle tissue, nerve tissue, gland tissue, bone and cartilage.
-tomy The suffix -tomy means ‘cut’. A laparotomy entails cutting open the abdomen, a thoracotomy the chest (thorax) and a craniotomy the head (cranium). The suffix -ectomy means ‘cut out’. A tumourectomy is the cutting out of a tumour. A parathyroidectomy is removal of a parathyroid gland. Try saying that ten times in quick succession!
Total Complete. In surgery, this means includ
ing the outermost margins. See Radical.
Tourniquet A band tied tightly around a limb. If the pressure it creates is higher than the blood pressure, all bleeding from the limb will be stopped. If the pressure is low, the blood will be dammed up in the limb and the tourniquet can be used to facilitate the tapping of blood from a vein. See Bloodletting.
Transplantation Transfer of tissues by detaching them completely from the body. See Transposition.
Transposition Surgical method of transferring tissues without completely detaching them. See Transplantation.
Trauma Injury or wound (from ancient Greek) caused by an external impact. This is always taken literally in surgery. A car crash, a fall, a blow, a bullet, a knife or a punch are all examples of trauma. Traumatic thus means ‘causing an injury or wound’. Surgical tweezers have small pointed ends designed to grip the tissue firmly without bruising or crushing it, and are consequently called ‘atraumatic tweezers’. Traumatology is the branch of surgery concerned with wounds caused by trauma.
Triad Fixed combination of three symptoms or signs that can predict a certain diagnosis. The triad for a bad surgeon, for example, is firstly blaming complications on circumstances and not on his own (lack of) talent, secondly giving his own experience priority over scientific evidence, and thirdly, not showing respect for his operating team.
Tumour Literally a growth or a swelling. Can in theory refer to any swelling, but is in practice now only used for abnormal tissue growth. This can be benign (non-cancerous) or malignant (cancerous). A tumourectomy is the removal of a tumour. See Cancer, Resection, Excision, Total, Radical.
Urinary catheter See Drain.
Urologist Medical specialist concerned with the surgery of the kidneys, the urinary tracts, the bladder and the male genitals.
Vein Blood vessel that transports blood to the heart. The adjective is venous. In anatomy books, veins are depicted in blue. The oxygen-poor blood is a dark-red colour, which has a blue tint when seen through the thin wall of a vein. Veins have venous valves, to stop the blood from flowing back downwards. Pulmonary veins are special blood vessels that also transport blood to the heart but, because this blood comes from the lungs, it is oxygen-rich. The portal vein carries blood from the intestines to the liver, not the heart.
White blood cells Leucocytes – collective name for different cells that can be active in the blood and outside the blood vessels, where they can move to any tissue of the body.
Wound Open breach of a barrier in the body. An opening in the skin is usually referred to simply as a wound; an opening in mucous membrane is referred to as an ulcer. A wound has edges and a wound bed. The healing of a wound depends on the presence of bacteria in the wound, the amount of dead tissue, the supply of blood to the edges of the wound and the wound bed, and the patient’s nutritional condition. A healed wound leaves a scar, as extra connective tissue is required to bridge the opening.
Wound healing The recovery of a wound, leaving a scar. Primary wound healing is bridging the wound opening with connective tissue. It can only occur if the wound is clean, the edges of the wound are sufficiently pressed together for several days, and there is an adequate supply of blood to the wound bed and the edges of the wound. In the case of secondary wound healing, the wound initially remains open and will gradually fill up with new tissue known as granulating tissue. The skin or the mucous membrane will then close over this new tissue. See Wound.
X-ray image intensifier Fluoroscopy. Method that uses X-ray imaging to show fractures live on a monitor. The X-ray machine can be used during an operation. Those present in the operating room will then have to wear lead jackets to protect themselves from the radiation.
Bibliography
General Publications
Altman, Lawrence K., ‘Doctors Call Pope Out of Danger; Disclose Details of Medical Care’, supplement to the New York Times, 24 May 1981
Conan Doyle, Arthur, Sherlock Holmes’s Greatest Cases (Crime Masterworks) London: Orion, 2002
Dekker, Pauline, and de Kanter, Wanda, Nederland Stopt! Met Roken, Amsterdam: Uitgeverij Thoeris. www.nederlandstopt.nu, 2008
Ellis, Harold, Operations that Made History, Cambridge: Cambridge University Press, 1996
Farley, David, An Irreverent Curiosity: In Search of the Church’s Strangest Relic in Italy’s Oddest Town, New York: Gotham Books, 2009
Hartog, J., History of Sint Maarten and Saint Martin, Philipsburg, NA: Sint Maarten Jaycees, 1981
Haslip, Joan, The Lonely Empress: Elizabeth of Austria, London: Phoenix Press, 2000
Herodotus, The Histories (ed. John M. Marincola, trans. Aubrey de Sélincourt), London: Penguin Classics, 2003
Hibbert, Christopher, Queen Victoria: A Personal History, London: HarperCollins, 2000
Cento Anni di Chirurgia: Storia e Cronache della Chirurgia Italiana nel XX Secolo. Eugenio Santoro, Edizioni Scientifiche Romane, 2000
Lifton, David S., Best Evidence: Disguise and Deception in the Assassination of John F. Kennedy, New York: Macmillan, 1980
Matyszak, Philip, Ancient Rome on Five Denarii a Day: A Guide to Sightseeing, Shopping and Survival in the City of the Caesars, London: Thames & Hudson, 2007
Men Who Killed Kennedy, The, History Channel, A&E Television Networks, 1988
Mulder, Mimi, and de Jong, Ella, Vrouwen in de heelkunde: Een cultuurhistorische beschouwing, Overveen/Alphen a/d Rijn: Uitgeverij Belvedere/Medidact, 2002
Norwich, John Julius, The Popes: A History, Chatto & Windus, 2011
Nuland, Sherwin B., Doctors: The Biography of Medicine, Amsterdam: Uitgeverij Anthos, 1997
Pahlavi, Farah Diba, An Enduring Love: My Life with the Shah – A Memoir, New York: Miramax, 2004
Pipes, Richard, The Unknown Lenin: From the Secret Archives, New Haven/London: Yale University Press, 1996
Report of the President’s Commission on the Assassination of President John F. Kennedy, Washington, DC: United States Government Printing Office, 1964
Santoro, Eugenio, and Ragno, Luciano, Cento anni di chirurgia: Storia e cronache della chirurgia Das Wiener Endoskopie Museum: Schriften der Internationalen Nitze-Leiter-Forschungsgesellschaft für Endoskopie, vols 1 and 3, Vienna: Literas Universitätsverlag GmbH, 2002
Scott, R. H. F., Jean-Baptiste Lully, London: Peter Owen, 1973
Sedgwick, Romney (ed.), Lord Hervey’s Memoirs, London: William Kimber and Co., 1952
Service, Robert, Lenin: A Biography, Cambridge, MA: Belknap Press, 2000
Szulc, Tad, Pope John Paul II: The Biography, London: Simon & Schuster, 1995
Tanner, Henry, ‘Pope’s Operation is Called Successful’, supplement to The New York Times, 6 August 1981
Tulp, Nicolaes, De drie boecken der medicijnsche aenmerkingen. In ’t Latijn beschreven. Met koopere platen. Tot Amstelredam, voor Jacob Benjamyn, boeck-verkooper op de hoeck van de Raem-steegh achter d’Appelmarck, 1650
Tulpii, Nicolai, Observationes medicae. Editio Nova, Libro quarto auctior et sparsim multis in locis emendatior, Amsterdam: apud Danielem Elsevirium, 1672
Tumarkin, Nina, Lenin Lives! The Lenin Cult in Soviet Russia, Cambridge, MA: Harvard University Press, 1997
Vospominaniya o Vladimire Il’iche Lenine, vols 1–8, Moscow, 1989–91
Wilkinson, Richard, Louis XIV, Abingdon/New York: Taylor & Francis, 2007
Worsley, Lucy, Courtiers: The Secret History of the Georgian Court, London: Faber & Faber, 2010
Medical Publications
Aucoin, M. W., and Wassersug, R. J., ‘The Sexuality and Social Performance of Androgen-Deprived (Castrated) Men Throughout History: Implications for Modern Day Cancer Patients’, Social Science & Medicine, December 2006, 63(12): 3162–73
Beecher, H. K., ‘The Powerful Placebo’, Journal of the American Medical Association, 1955
Bergqvist, D., ‘Historical Aspects on Aneurysmal Disease’, Scandinavian Journal of Surgery, 97, 2008: 90–9
Bernstein, J., and Quach, T. A., ‘Perspective on the Study of Moseley et al.: Questioni
ng the Value of Arthroscopic Knee Surgery for Osteoarthritis’, Cleveland Clinic Journal of Medicine, May 2003, 70(5): 401, 405–6, 408–10
Bretlau, P., Thomsen, J., Tos, M., and Johnsen, N. J., ‘Placebo Effect in Surgery for Ménière’s Disease: A Three-Year Follow-Up Study of Patients in a Double Blind Placebo Controlled Study on Endolymphatic Sac Shunt Surgery’, American Journal of Otolaryngology, October 1984, 5(6): 558–61
Brewster, D. C., et al., ‘Guidelines for the Treatment of Abdominal Aortic Aneurysms: Report of a Subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery’, Journal of Vascular Surgery, 2003, 37(5): 1106–17
Chandler, J. J., ‘The Einstein Sign: The Clinical Picture of Acute Cholecystitis Caused by Ruptured Abdominal Aortic Aneurysm’, New England Journal of Medicine, 7 June 1984, 310(23): 1538
Cohen, J. R., and Graver, L. M., ‘The Ruptured Abdominal Aortic Aneurysm of Albert Einstein’, Surgery, Gynecology & Obstetrics, May 1990, 170(5): 455–8
Dudukgian, H., and Abcarian, H., ‘Why Do We Have So Much Trouble Treating Anal Fistula?’, World Journal of Gastroenterology, 28 July 2011, 17(28): 3292–6
Eastcott, H. H. G., Pickering, G. W., and Rob, C. G., ‘Reconstruction of Internal Carotid Artery in a Patient with Intermittent Attacks of Hemiplegia’, Lancet, 1954, 2: 994–6
Francis, A. G., ‘On a Romano-British Castration Clamp Used in the Rights of Cybele’, Proceedings of the Royal Society of Medicine, 1926, 19 (Section of the History of Medicine): 95–110
García Sabrido, J. L., and Polo Melero, J. R., ‘E = mc2/4 Men and an Aneurysm’, Cirugía Española, March 2006, 79(3): 149–53
George Androutsos, G., ‘Le phimosis de Louis xvi (1754–1793) aurait-il été à l’origine de ses difficultés sexuelles et de sa fécondité retardée?’, Progres en Urologie, 2002, vol. 12: 132–7
Gilbert, S. F., and Zevit, Z., ‘Congenital Human Baculum Deficiency: The Generative Bone of Genesis 2:21–23’, American Journal of Medical Genetics, 1 July 2001, 101(3): 284–5