Archive for the “Surgery” Category

Posted on 04 Aug 2012
Surgery

Decortication Surgery

Decortication is a medical procedure that entails surgical removal of the exterior layer, membrane, or fibrous covering of an organ. The procedure is generally carried out when the lung is covered by a thick inelastic pleural peel impeding lung expansion. In a non-medical sense, decortication is the removal of the bark, husk, or an outer-most layer of an object. It is also used in the treatment of chronic laryngitis.

When performing a decortication of the lung, which is the most ordinary form used, the patient is under general anesthesia and the chest cavity is broken open as it is during open-heart surgery. The surgeon studies areas of the pleural membrane (a kind of enclosure that surrounds the lungs) to find areas that have gotten fibrous and scarred, and removes them. The next step is to close the surgical opening and bring the patient out of anesthesia. This is major surgery, it is invasive and the patient needs several days of monitoring in a hospital to establish that the patient is healing as he/she should.

When the pleura are thickened, it usually causes pain and discomfort for the patient. If the pleura are left to thicken more, it can lead to a problem such as making it difficult for the patient to breathe. Also, since the lung that is involved may find it difficult to reinflate, it cannot push the pleura out of the way. As the patient struggles with lack of oxygen, this can lead to shortness of breath and other serious medical issues.

Pleural mesothelioma is caused by exposure to asbestos and develops when the deadly asbestos fibers become trapped in the space between the mesothelial cells. When they are trapped in the mesothelium, the fibers automatically cause the cancerous cells to divide irregularly causing severe thickening of the pleural membrane. This may cause fluid build-up called pleural effusion. The fluid then puts pressure on the lungs and the breathing (respiratory) system preventing regular breathing.

A pleurectomy is a surgical procedure to remove part of the pleura, the lining around the lungs. This is one kind of surgery done to treat mesothelioma, which is a rare kind of lung cancer often connected to asbestos exposure. The surgeon removes the pleura, which is the area where most of the malignant tumor is usually located. If the cancer is in an extremely early stage, doctors deem a pleurectomy as a potential curative remedy or treatment. Other patients in the later stages of the cancer receive the surgery as a palliative kind of treatment to help alleviate symptoms.

Then there is the empyema, or infection within the pleural area. These are usually caused by pneumonia in the patient. Many patients that have pneumonia develop a plural effusion. Normally, the pleural effusion clears up when the pneumonia is treated. Often, in other patients, the infusion does not disappear, but becomes infected. An infected pleural infusion is known as an empyema. An empyema will generally not respond to antibiotics, nor will they clear on their own. Most of these infections will require surgical exploring and drainage.

Posted on 28 Apr 2011
Surgery

Hiatal Hernia – My Experience Of Surgery

I first realized that something was wrong about three years ago when the symptoms first appeared. I did not know it at the time but I had got hiatus hernia, a malfunction of the digestive system. I experienced a terrible burning pain, which started in the chest and radiated outwards to the neck and throat. I did not know this sensation was caused by the regurgitation of gastric acid, commonly called gastric reflux.

I explained all this to the local pharmacist and, although she adopted a pose of caring and sympathy, it seemed that she was only equipped to give quick answers to stock questions. She advised Antacids, which can be bought over-the-counter and are available in liquid or tablet form. I tried some of these and some of them worked for a while, but the pain came back and I tried some others and in larger doses and in the end I tried everything on the pharmacist’s shelf and nothing solved the problem.

So I thought I needed to see the doctor. I don’t often see a physician except when it is very serious so the doctor looked at me quizzically. He questioned me about the symptoms and then announced that I had gastric reflux. He then pondered sagely for a while and, as if in a fit of inspiration, proclaimed that he would prescribe the perfect solution to the problem. He wrote out the prescription and I rushed out to have it dispensed.

What he had given me were what I now know to be proton pump inhibitors, which are intended to stop acid production and are therefore supposed to be completely effective in relieving symptoms. At first they relieved the symptoms, not completely but they had some effect, and then the symptoms came back as bad as ever. I went to see the doctor once more and he explained that all I needed to do was to up the dosage. I should take twice the previous amount and if that failed increase it to three times. This I did and, guess what, it didn’t work either, so it was back to the surgery.

This time the doctor gave me the impression that his life would have been far easier if he didn’t have difficult patients to deal with! He issued a prescription for another remedy which he said, with an air of certainty, “was sure to do the trick”. This particular prescription, I later discovered, was a gastric H2 receptor blocker, an antihistamine, which they say can reduce gastric secretion of acid. Again I tried this prescription and at first it reduced the symptoms, not completely, but made me feel somewhat better.

And then one day I had what I thought to be a heart attack. The ambulance was called and the paramedics rushed me off to the infirmary. There I saw another doctor, a young man with a much more sincere and less casual air about him. He assured me that this was no heart attack but a continuation of the stomach problem and that I had a hiatus hernia and recommended surgery as the only way it could be fixed.

So I had the surgery done, which I should have done in the first place, and this time it worked. After a few days, I was as good as new. All those pills were just a waste. This is just my experience. Other people might have different experiences of this problem, but I thought you might like to hear mine.