There are things in medicine that we knew nothing about and often we are surprised at how some very basic scientific principle is behind some apparently strange conditions.
Panama reminds me of my friends visit. I have not seen him for years as we went our separate ways as he children were growing up. He was a sporty person and played rugby to a professional level. Here is the blog:
© Am Ang Zhang 2011
Did you enjoy your Cruise?
Sure!
So you can get away from blogging and from Medicine.
I got away from blogging but then it was only the slowness of the Internet that was prohibitive.
Then I realised that perhaps we doctors never could get away from medicine and in a sense I did not want to either.
Medicine has become a hobby.
Cruising is an interesting way to have a holiday, you do not have to pack everyday and you get to meet some really interesting people.
On our Cruise we had dinner with an eminent professor and his wife.
Tribology!!!
Yes, a world class Medical Engineer and all I might want to know about hip and knee replacements.
Wow!
A friend came to our tropical resort to play golf with me.
He was walking a bit funny on the golf course.
“I used to hit 250 yds.”
“What happened”. He now hits 160 yds if he is lucky.
“Bilateral hip replacements.”
Good old rugby.
But that was not all. A year before he had bladder cancer that was diagnosed and luckily it was caught early.
“It was painful but the BCG treatment was good!”
So perhaps my professor was wrong: one patient one disease.
He obviously had hip problems from rugby and then bladder cancer.
So I asked my new found friend.
“There is a theoretical risk as the cobalt in the alloy in particular could be a problem. Check out the Swedish research.”
I told him about my friend and my professor.
“Interesting approach!”
“I know. But it concentrates the mind.”
Lisa B. Signorello et al
In summary, overall cancer risk among hip implant patients was close to expectation. However, we observed these patients to have a statistically significant excess of melanoma and prostate cancer and, after a latency of 15 years or more, of multiple myeloma and bladder cancer.
In contrast, we noted a statistically significant deficit of stomach cancer and suggestive evidence for decreased colorectal cancer risk. The incidence of bone and connective tissue cancers was not statistically significantly higher than expected for either sex in any follow-up period.
Further evidence suggesting an antibiotic effect comes from a study in Denmark (14), where a lowered risk of stomach cancer was found among patients with osteoarthritis who underwent hip implant surgery (presumably exposed to both NSAIDs and antibiotics) but not among those who did not have surgery (presumably exposed only to NSAIDs).
However, because this investigation provided the first opportunity to adequately evaluate the long term cancer-related effects of hip implants, the associations that we observed with bladder cancer and multiple myeloma, while also potentially attributable to chance or bias, should be considered carefully and require further in-depth study.
J Natl Cancer Inst 2001;93:1405–10
A year later my friend called me:
A year later my friend called me:
"But Cockroach Catcher, you wrote about it in July of last year! Some even had bladder cancer!"
I suppose Medicine is still of great interest to me and one should never accept what is known now as the whole truth. Medicine cannot stagnate nor should we forget basic principles.
The Telegraph:
One of the participants in the trial, David Jose, 51, from Clifton, near Bristol, had a hip "resurfacing" operation in 2007, a year before retiring as a police officer.
The father of two had been suffering hip pain from playing football and rugby.
In May last year he was told that the tests had found atypical cells which were not at this stage cancerous.
He saw Angus Maclean, an orthopaedic surgeon at Southmead Hospital involved in the study, who said that the trial had established three cases in which patients had developed bladder cancer, and 14 more including Mr Jose who had changes to their chromosomes.
The doctor told him researchers "could not believe" what had been found, describing the findings as "shocking".
Not as shocked as my friend.
Feb 4, 2012
Tribology: Hip Replacement & Cancer
My golfing friend wrote to me asking if I have read the latest in The
Telegraph.
"But Cockroach Catcher, you wrote about it in July of last year! Some even had bladder cancer!"
I suppose Medicine is still of great interest to me and one should never accept what is known now as the whole truth. Medicine cannot stagnate nor should we forget basic principles.
To remember our eminent yet formidable Professor of Medicine, Professor MacFadzean: One Patient One Disease.
I would like to pay tribute to our eminent yet formidable Professor of Medicine, Professor MacFadzean, 'Old Mac' as he was 'affectionately' known by us. He taught us two important things right from the start:
First - One patient, one disease. It is useful to assume that a patient is suffering from a single disease, and that the different manifestations all spring from the same basic disease.
Second - Never say never. One must never be too definitive in matters of prognosis. What if one is wrong?
