I just shook hands with a face transplant patient and did not know it

January 21, 2015- By Steven E. Greer, MD

I was in the process of being given a personal tour of the new facilities of the NYU Institute of Reconstructive Plastic Surgery when the doctor interrupted and introduced me to a patient. The adult male was Read more »

Drug-coated balloons to treat fem-pop disease

April 27, 2014- Interviewed by Steven E. Greer, MD

At the Charing Cross symposium in London, Medtronic reported results of the IN-PACT trial of their paclitaxel balloon. 12-month patency rates were 82%, compared to Read more »

Atul Gawande’s surgical checklist fails in real world study

March 15, 2014- By Steven E. Greer, MD

In 2009, Atul Gawande, MD, MPH and his large international team published in the New England Journal of Medicine (NEJM) an observational study that showed a significant reduction of death and “complications” after non-cardiac surgery. The World Health Organization (WHO) created the checklist used in the NEJM paper. After this non-randomized, non-controlled, observational study was published, entire nations adopted the surgical checklist system.

Now, in 2014, a population study drawing from Ontario surgical patient data, published in the NEJM, showed no significant benefit from the widespread adoption of the same WHO surgical safety checklist that Dr. Gawande popularized. This study was also observational, but it was stronger than the 2009 Gawande study in that it included the entire population within a region.

What went wrong? Read more »

NEJM letter casts doubt on original Gawande checklist paper

June 11, 2014- By Steven E. Greer, MD

When the recent Canadian studied published in the NEJM failed to show any benefit from the WHO surgical checklist championed by Atul Gawande, The Healthcare Channel pointed out that the original Gawande paper was possibly the problem. It was designed poorly, and collected data from non-U.S. countries with little oversight.

Now, in the current online NEJM, letters to the editor are coming in. One writer echoes our concerns about the original Gawande paper. Read more »

The Massachusetts General trauma response to the Boston bombings

Interviewed by Steven E. Greer, MD

Paul Biddinger, MD, Medical Director for Emergency Preparedness, Massachusetts General Hospital and also Chairman of the Massachusetts Medical Society’s Committee on Preparedness, discusses how his hospital, and all of Boston, responded to the several hundred severely injured patients after the Boston terrorist bombs. Lesson from the battlefield helped saves lives, as did the fact that Boston possibly has more Level 1 trauma centers than any other city in the world.

Reliable gun violence statistics

February 12, 2013 By Steven E. Greer, MD

In the wake of the Newtown, Connecticut massacre of 20 first graders and six brave adults, the debate over gun control is the main topic of the news. Consequently, both sides of the debate are using statistics to support their arguments. However, gun violence statistics are quite often inappropriately cited by untrained “pundits” or lobbyists.

A summary of some of the most important evidence and data: Read more »

Long-term outcomes for AAA repair

Frank Lederle, MD, discusses the NEJM paper he authored that studied long-term outcomes of endovascular repair of abdominal aortic aneurysms versus open surgical repair. This study adds to the body of evidence because of the long-term nature, use of more modern devices, and use of more reliable North American patient cohort data.

Mark G. McKenney, M.D.: Advances in trauma care

Tremendous advances have been made over the last two decades in the way that trauma patients are handled in the OR and ICU. The ongoing wars have contributed much. Survival rates in the theater are now approaching 90%, compared to 70% decades ago. Mark G. McKenney, M.D., Chief of Trauma at the University of Miami and Co-Director of the Ryder Trauma Center discusses some of the most important developments in sepsis care, artery embolization, fluid resuscitation, and medical imaging using portable ultrasound.

The stages of wound healing in time lapse

(Best viewed in full screen 1080iHD)

Surgery residents might find it interesting to watch this time lapse video of wound healing and correlate it with the basic science chapters in all text books. Note the peripheral radial contraction patterns of the intact skin caused by fibroblasts migrating and pulling using integrin molecules, the color changes of the granulation tissue, the migration of the epithelial cells inward, the final reduction in erythema after the epithelium covers the granulation tissue, etc.

For a thorough discussion of wound healing biology that is on display in the video, refer to this chapter from The Handbook of Plastic Surgery edited by Greer et al

Thomas Brott, MD: Review of the CREST trial of carotid stenting

The CREST trial, published earlier this year, was the latest large-scale, randomized, controlled trial to test the safety and efficacy of carotid artery stenting versus standard open CEA surgery. Divisions of the HHS and medical societies might next make changes to reimbursement and clinical guidelines based on the trial. The PI and lead author, Thomas Brott of the Mayo Clinic in Florida, discussed the paper. Topics discussed include:

• The results which met the primary endpoint: a composite of death, stroke, or MI
• Were the periprocedural minor strokes caused by the stents releasing debris
• Were the greater number of myocardial infractions seen in the CEA surgery group significant Q-wave MI’s or just enzyme bumps?
• The other carotid stenting trial from the ICSS group that showed in a subset of patients MRI evidence of stroke more often with the stent group than CEA