Hippocratic Oath

Trephanation:ancient surgical procedure of operating on the human skull (eg Peru) scraping, chiseling, or cutting bonen  from Philip Schatz,

leonardo di Vinci

Alexander the Great had encouraged his physicians to expand the limits of their science, and from the time of Hippocrates, Greek doctors were recognised as the best in the world. The Romans admired them, too, and when they conquered the Greeks in about 100 BC, the physicians were allowed to continue to practise, now as Roman subjects

In 46 BC, Julius Caesar granted citizenship to all foreigners teaching a liberal art in Rome. This included the Greek doctors, most of whom were slaves or freed men. When, in 23 BC, Antonius Musa, once Mark Antony’s slave, cured the emperor Augustus of a serious illness, he was richly rewarded and won immunity from taxation for all doctors. Later, during the reign of Vespasian (AD 69-79), physicians were also freed from military service.

In the ruins of Pompeii, turned into a time capsule by a volcanic eruption in AD 79, is a house that belonged to a Greek surgeon. It was identified, in 1887, by its large stores of surgical equipment – more than 100 instruments. Since there was relatively little innovation in these tools from the time of Hippocrates in the 5th century BC, instruments like these remained typical of surgical practice for nearly a millennium. In fact, some of them, such as the vaginal speculum, did not change significantly until the 20th century.

The instruments found at Pompeii represent the normal range that a surgeon of the time would have needed. They were mostly bronze, brass or copper, but blades and needles were almost invariably made of iron or steel. Most of the instruments could be heated up and used for cautery. By heating the instruments, the surgeons were, without realising it, sterilising them

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Hernia Repair

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"The pleasure of a physician is little, the gratitude of patients is rare and even rarer is material reward, but, these things never deter the student who feels the call within him"BILLROTH

I know one thing is that I do not know anything

more you you understand more it goes deeper and more you are lost

My curiosity and thrust of knowledge lead me to the wonders of human body and nature

Danil Hammoudi.MD

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Surgery, from the Latin word chirurgia (in turn from the Greek, cheir, hand, and ergon, work), literally means handiwork. Simply put, it's the treatment of disease by use of the hand. Yet the discipline of surgery would be useless if it weren't for the innate ability of human tissue to heal. Imagine for a moment: Without that healing ability, the slightest injury or disease would result, at the very least, in a lifelong defect.

Surgery is not a modern phenomenon but has its roots in the ancient world. Developments in India, Egypt, Greece and Rome many centuries ago meant that operations that are common now were also performed then.

We just reinvinte what ancient where practicing , just compare the gallen intrusment you will see the difference, technological only but not the basic.

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I would like to see the day when somebody would be appointed surgeon somewhere who had no hands,

for the operative part is the least part of the work"

Letter to Dr Henry Christian Nov 20, 1911

Theodor Billroth (42762 bytes)

Theodor Billroth 1892-1894

He is regarded by many as the leading German surgeon of late 19th century. As well an outstanding surgical technician he was able to bring experimental medicine to clinical practice. He had radical ideas for the time on surgical training advocating a prolonged surgical apprenticeship on completion of medical studies consisting of preliminary work in hospitals followed by performing operations on cadavers and experimental animals. This would be followed by a 2-3 year assistantship in a surgical department with studies of the surgical literature and the acquisition of advanced practical skills. His ideas were taken up by many who visited him

In 1855 he wrote a monograph on colonic polyps recognising the relationship between adenomatous polyps and colorectal cancers. He was the first surgeon to excise a rectal cancer and by 1876 he had performed 33 such operations. He carried out the first oesophageal resection in 1872 and the first larnygectomy in 1874. He is best known for the two types of partial gastrectomy that are named after him.

The first Billroth I partial gastrectomy was performed on a 43 year old woman in 1881 for a pyloric gastric cancer. A 14 cm portion of stomach was excised and an anastomosis fashioned with about 50(!) carbolised silk sutures. Billroth wrote 'the operation lasted, including the slow induction of anaesthesia about one and a half hours'

Hugh Owen Thomas (1834-1891)revolutionized the treatment of musculoskeletal injuries and diseases

regarded by many as great pioneer in British orthopaedic surgery

His ideas were published in Diseases of the hip, knee and ankle joints, with there deformities treated by a new and efficient method (1857).

Thanks to the use of the 'Thomas splint' the mortality of compound fractures of the femur fell from 80% in 1916 to less than 8% in 1918.

Professor Ait Benamar

Professor in general surgery, clinique des orangers .the only surgeon that I know that can operate without help of no body .

Had been felicitate by his work and theory in the mayart jebule with the famous phrase "thank you Dr Ait benamar to though us how to work"

He was our mentor and is still our friend all what we know and how to think came from him making us one of the best.

One of his phrase that stick in my mind in one of our conversation trying to pouch him to publish " Do not think who do not publish by thousand are nothing, some are the best minded of all time"

Ludwig Courvoisier (1843-1918)

Despite working in such a small hospital his reputation grew and in 1888 the University of Basle recognised his achievements by appointing him Professor of Surgery Extraordinary. It was not until the death of Socin in 1899, when Courvoisier was 57 years old, was he allotted beds in Basle and shortly afterwards he was appointed Professor of Surgery in the University

Courvoisier's most important work concerned surgery to the biliary tract. It was he who developed the operation of cholecystectomy and he was one of the first surgeons to remove a stone from the common bile duct. The well known 'Courvoisier's law' is named after him stating that 'if in the presence of jaundice the gallbladder is palpable, then the jaundice is unlikely to be due to a stone.' This was first proposed by him in his book 'The pathology and surgery of the gallbladder' published in Leipzig in 1890.

Courvoisier was regarded by many as safe rather than brilliant surgeon. He gladly handed over cases to others when confronted with conditions lying outside his experience. He never abandoned his boyhood love of flowers and butterflies and, in addition to his surgical writings, he published 21 papers on entomology. On his death, at the age of 75, he bequeathed his great herbarium to the Botanical Institute and his butterfly collection to the Natural History Museum in Basle..Ludwig Courvoisier

Cushing, Harvey Williams

He was a pioneering neurosurgeon and developed many of the basic techniques and procedures used in neurosurgery today. Amongst his many paper the most important relate to the method of destruction of the trigeminal ganglion (1900), infiltrative analgesia (1902), the function of the pituitary gland (1910), experimental hypophysectomy (1910), the introduction of electrocoagulation (1928) and basophil adenomas of the pituitary gland (1932)

In addition to his clinical writings he was awarded the Pulitzer prize in 1926 for his book entitled the Life of Sir William Ostler. The endocrine disorder named after him is obviously Cushing's Syndrome or Disease. Cushing's Syndrome is the state of prolonged exposure to corticosteroids resulting from either excessive cortisol production or steroid medication. Cushing's Disease is pituitary dependent adrenocortical hyperplasia due to a basophilic pituitary microadenoma. The causes of Cushing's Syndrome are:

  • Cushing's Disease (65%)
  • Ectopic ACTH production (15%)
  • Adrenal adenoma (15%)
  • Adrenal carcinoma (5%)


Ibn Sina (Avicenna) (980-1037) is one of the foremost philosophers of the golden age of Islamic tradition that also includes al-Farabi and Ibn Rushd. He is also known as al-Sheikh al-Rais (Leader among the wise men) a title that was given to him by his students. His philosophical works were one of the main targets of al-Ghazali’s attack on philosophical influences in Islam. In the west he is also known as the "Prince of Physicians" for his famous medical text al-Qanun "Canon". In Latin translations, his works influenced many Christian philosophers, most notably Thomas Aquinas

Avicenna was the greatest of the medieval Islamic physicians, whose work had a direct impact on the Renaissance.
Avicenna was the greatest of the medieval Islamic physicians, whose work had a direct impact on the Renaissance.

Claudius Galen

Claudius Galen (c. AD 130-c. 200), the greatest surgeon of antiquity, would be responsible for huge leaps in virtually every medical discipline.The most famous doctor in the Roman Empire was a Greek, named Galen, born in Pergamum. His parents gave him an education that prepared him to be a philosopher, but at the age of 16, he changed his mind and decided to become a doctor. He studied in Greece, in Alexandria and other parts of Asia Minor and returned home to become chief physician to the gladiator school in Pergamum

Of Galen’s 600 books, for instance, just 20 survive, and those are with us only because they were rescued by Arab physicians. As they conquered the Middle East, the Arabs captured and preserved some ancient medical texts, and from the 9th century, Galen was translated into Arabic on a massive scale.




Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity: A Prospective Randomized Controlled Clinical Trial
Will minigastric bypass prove to be a safer alternative to RYGBP?

Long-term Follow up Results of Intraductal Papillary Mucinous Tumors of Pancreas
Despite improved diagnostic capacity, which is based on clinical presentation and imaging studies, it is still difficult to identify the degree of malignancy for IPMT preoperatively.

New Research Suggests Heart Bypass Surgery Increases Risk Of Alzheimer's Disease

Boston University School of Medicine (BUSM) researchers have discovered that patients who have either coronary artery bypass graft surgery or coronary angioplasty are at an increased risk of developing Alzheimer's disease.

59-Year-Old Man Doing Well After Rare Simultaneous Liver Transplant/Coronary Bypass Surgery (June 10, 1998) -- A 59-year-old patient who underwent a rare simultaneous liver transplant and coronary artery bypass operation a year ago at the University of Illinois at Chicago Medical Center is doing extremely ... full story

First Robot-Assisted Coronary Artery Bypass Surgery In The U.S. Performed At NewYork-Presbyterian Hospital (January 23, 2002) -- A 71-year-old retired businessman from New Jersey is the first patient in the U.S. to receive robotically-assisted coronary artery bypass surgery without a chest incision of any ... full story

New Surgical Bypass Technique Offers Longer-Lasting Bypasses (February 26, 1999) -- A study shows a new surgical technique used for coronary bypasses is safe, effective and, say the study's authors, an improvement on surgical methods currently used for such ... full story

University Of Florida Researchers Report Improvement In The Treatment Of Heart Bypass Patients With Recurrent Problems (October 13, 1997) -- GAINESVILLE, Fla---A minuscule metallic device used to prop open the clogged vessels is better at restoring blood flow than traditional balloon angioplasty -- and does so more ... full story

University Of Florida Researchers Report Improvement In The Treatment Of Heart Bypass Patients With Recurrent Problems (October 13, 1997) — GAINESVILLE, Fla---A minuscule metallic device used to prop open the clogged vessels is better at restoring blood flow than traditional balloon angioplasty -- and does so more safely. > full story

Heart Laser Surgery: An Alternative To Transplantation (April 22, 1998) — Researchers at Temple University Hospital are indicating that the use of heart laser surgery may replace transplantation in certain patients with severe coronary artery disease. > full story

Diabetics At Greatest Risk Of Complications After Re-Opening Arteries (March 7, 2001) — Re-blocking of the artery – a common complication after angioplasty – is a more serious problem for people with diabetes than for non-diabetics, and could explain why they face an increased risk of death following the procedure, researchers report in Circulation: Journal of the American Heart Association. > full story

First Non-Surgical Bypass Successfully Turns Vein Into Artery (May 29, 2001) — A 53-year-old German man became the first person to undergo a new, non-surgical technique that turned one of his coronary veins into a coronary artery to bypass a blockage, according to a special report in Circulation: Journal of the American Heart Association. > full story

Clogged Neck Artery May Warn Of Heart Attack As Well As Stroke (May 7, 1999) — Extensive fatty deposits in the carotid arteries, the blood vessels in the neck that supply blood and oxygen to the brain, may be a marker for coronary artery disease, according to a study in this month's Stroke: Journal of the American Heart Association. > full story

Most Smokers Continue To Light Up After Heart Surgery (November 12, 1998) — Almost three in five smokers who undergo surgery for heart disease continue to smoke after their procedure, according to a study presented at the American Heart Association's 71st Annual Scientific Sessions. > full story

Angioplasty, Robotically Assisted Keyhole Bypass Combo Appears Effective (November 16, 2004) — Combining stented angioplasty and robotically assisted "keyhole" bypass surgery is safe and may help patients with extensive cardiovascular disease, researchers reported at the American Heart Association's Scientific Sessions 2004. > full story

Canadian Researchers Call For More Angiograms (July 13, 2005) — More tests need to be prescribed to save and prolong the lives of Canadians living with coronary artery disease, says a study released today from the University of Alberta. > full story

Risk Factors For Women Remain High One Year After Heart Surgery (June 16, 1999) — A Johns Hopkins study of women who had coronary bypass surgery found that a year later, a majority of them continued to have the same significant risk factors that brought them to the operating room in the first place. > full story

Second Generation Of Radiation Devices Being Tested To Treat Restenosis (March 14, 2001) — Cardiologists at Rush-Presbyterian-St. Luke's Medical Center in Chicago have begun treating patients with a new catheterization procedure that might eliminate restenosis in arteries previously clogged from scarring or arteriosclerosis. > full story

Restoring Flow To All Blocked Areas Of The Heart Improves 5-year Survival Rate, Study Says (June 21, 2005) — When a patient has several coronary arteries blocked, heart surgeons should attempt to restore blood flow to all affected areas of the heart, and they should use arteries, not veins, to serve as conduits. These factors significantly impact long-term survival rates, according to a new study. > full story

Adrenal Insufficiency and the Intensive Care Unit
Lynn Loriaux, MD, PHD, MACP
Oregon Health & Science University School of Medicine
The incidence of adrenal insufficiency in medical and surgical intensive care units (ICUs) is rising.

Abdelrahman A. Nimeri, MD
Washington University School of Medicine
L. Michael Brunt, MD, FACS
Washington University School of Medicine
Anatomic considerations, preoperative evaluation, operative planning, operative technique, troubleshooting, postoperative care, complications, and outcome evaluation are described.

Prevention of Postoperative Infection
Jonathan L. Meakins, MD, DSC, FACS
University of Oxford
Byron J. Masterson, MD, FACS
University of Florida College of Medicine
Operations classified as infected are those in which infected tissue and pus are removed or drained, providing a guaranteed inoculum to the surgical site. The inoculum may be as high which may already be producing an infection.

Postoperative and Ventilator-Associated Pneumonia
Craig M. Coopersmith, MD, FACS
Washington University School of Medicine
Marin H. Kollef, MD
Washington University School of Medicine
Outline of an evidence-based strategy for initiating antimicrobial therapy in patients with ventilator-associated pneumonia.

This Month's Algorithm
Diagnosing Hollow Viscus Injury After Blunt Trauma

Injuries to the Stomach, Small Bowel, Colon, and Rectum
Jordan A. Weinberg, MD, FRCSC
University of Tennessee Health Science Center College of Medicine
Timothy C. Fabian, MD, FACS
University of Tennessee Health Science Center College of Medicine
Determination of the need of operation and operative management of injuries to the gastrointestinal tract are described.

Sample Chapter

Minimally Invasive Esophageal Procedures
Marco G. Patti, MD, FACS
Associate Professor, Department of Surgery, University of California, San Francisco, School of Medicine, Director, Center for the Study of GI Motility and Secretion, University of California, San Francisco, Medical Center
Minimally invasive esophageal procedures have continued to evolve, thanks to better instrumentation and improved surgical expertise.

Academy of Surgical Research :: Advancing Medicine Through Information Exchange

Founded in 1982, the Academy of Surgical Research promotes the advancement of professional and academic standards, education and research in the arts and sciences of experimental surgery.

The Academy interfaces with medical and scientific organizations, and governmental agencies in establishing and reviewing ethics, theories, practices and research pertaining to surgery and promotion of the results for clinical application


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ACS Surgery: Principles and Practice, an official publication of the American College of Surgeons, is the ONLY online comprehensive, continually updated reference and continuing education service in general surgery. Noted for its problem-solving approach and numerous well-drawn, clean, simple four-color illustrations, ACS Surgery is geared to the surgeon in practice. Its prominent Editorial Board and 200 contributors represent current leaders in general surgery and related subspecialties who bring both scholarship and practical, clinical expertise to its pages. An integrated CME program permits subscribers to earn up to 120 Category 1 credits. It is available by subscription in both online and print formats



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