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OCTOBER 2001 The outgoing President, Mr I MacLennan handed over the Presidential Medallion to the incoming President, Mr D Allan (Consultant Surgeon, Furness General Hospital), who thanked Mr MacLennan for his hard work in putting together an excellent programme for the past session. Mr Allan then proceeded to give his Presidential Address entitled:- "Bridging the gap" This title covered several themes. The first of these was penetrating wounds. He described a series of 83 such cases that he had managed at Furness General Hospital. These were mainly knife wounds sustained during an assault. The majority were abdominal wounds but the series included 17 chest wounds, 16 head & neck wounds and 9 multiple wounds. Such a series would be expected to have a high mortality, yet there were only 7 deaths. For cardiac injury he commended the use of midline sternotomy and Foley catheters to effect rapid control of bleeding. For liver injuries he had found vascular graft material ideal for buttress sutures. Not surprisingly an independent review of the 83 cases concluded that had they all been transferred to the nearest large centre, the mortality would have been nearly three times greater. This led to the second theme; namely that those responsible for shaping surgical services for the future have failed to address how the isolated DGH would deal with the wide range of emergencies coming through its doors. He concluded by exposing the gaps in current surgical training the product of which is a relatively inexperienced specialist who would be ill equipped to deal with cases he had just described. The audience was left in no doubt that Mr Allan was not only a gifted surgeon, but also a product of a surgical training system that was once the envy of the rest of the world. An informal dinner was held in honour of Mr Allan in Chancellors Restaurant before the address at 6.30 pm when he was joined by members and guests of the Section. The Society and Section gratefully acknowledge the generous support of Janssen Cilag.
Mr D Allan, President of the Section, was in the chair and introduced the speaker for the evening Mr R J Watson. Mr Watson spoke on "Gastric stapling – does size matter?" Mr Watson introduced his topic by pointing out the rising prevalence of obesity in the Western world and the medical conditions associated with it. He described the evolution of operations for obesity and why the Margenstrasse and Mill operation was his procedure of choice. He described the indications for surgery and went on to relate his experience with the procedure in 31 patients where a mean starting weight was 22 stones. A mean weight loss of seven stones was achieved, there were few complications and in many cases a marled improvement in associated medical conditions. Patient satisfaction was high with this procedure and abdominoplasties which some went on to have. He emphasised the importance of a team approach in managing these patients and in particular the important role of the anaesthetist. A lively question and answer session ensued what was an extremely interesting lecture and Mr C Ball gave the vote of thanks. An informal dinner was held prior to the meeting in honour of Mr Watson, in Chancellors Restaurant, when he was joined by members and guests of the Section.
The Guest Lecture and Annual Dinner is a light-hearted, social evening. This year’s speakers were both members of the Section and spoke on interests outside of surgery as follows:- Mr E S Kiff (Consultant Surgeon, Wythenshawe Hospital) "Table talk" Mr Kiff introduced the topic of woodwork by reviewing what initially got him interested in it followed by a survey of the raw material, the tools and the techniques used. He recommended buying tools as a form of therapy. He looked at some of the techniques of construction using examples of his own creations including a beautifully constructed bench. He then reviewed some of the works of his friend Richard of North Wales. He looked at some of John Makepeace’s works at Parnham. A brisk discussion followed led by some budding carpenters. Mr B Hancock (Retired Consultant Surgeon, Wythenshawe Hospital) "Astro photography" Mr Hancock introduced the concept of astro photography demonstrating that due to earth’s rotation a prolonged photographic exposure is dependent on the camera rotating also. The pole star is used as a reference point. Brian then illustrated light pollution with photographs at different sites along with a night time photo of Europe. This showed how France was cautious to avoid light pollution. The Algarve and Tenerife were suitable places for enthusiasts. He showed excellent photographs of Mars, Jupiter’s moons, Saturn, comets and lunar and solar eclipses. The President thanked both speakers for a thoroughly enjoyable and informative evening. After the meeting a wine reception was held followed by the annual dinner in Chancellors Restaurant whereby speakers, members and guests continued their jolly evening.
The speaker Mr S Payne, Consultant Urologist, gave his lecture entitled: "Clinical governance and working practice: can the NHS afford it?" Mr Payne opened his lecture by defining Clinical Governance and identified risk management as its most important function. He went on to discuss the reasons why clinicians make mistakes, pointing out that a medical accident is a consequence of either an error, or a violation and is often the result of a combination several unforeseen circumstances. Patient expectations were ever increasing, but the resources to deliver the expected quality of care were often lacking in the NHS. In order to deliver on Clinical Governance, we need to demonstrate excellence, evolve an open culture and be cost efficient in our delivery of care. We need to document what we do and the outcomes of our clinical actions more accurately; the current measures being wholly inadequate. To achieve this, we need to define data sets, evolve user-friendly coding systems, and have access to Information Technology and employ data clerks. He described how his department had gone about this and how this had resulted in being able to demonstrate to the PCT with robust data, the need for an additional Consultant. Risk equates to litigation, the cost of which is rising steeply in the NHS. Clinical Governance is aimed at reducing risk. The question wasn’t whether Clinical Governance was affordable, but whether we could afford not to do it. There followed a lively discussion and Mr Blower gave a vote of thanks. An informal dinner was held prior to the meeting
in honour of Mr Payne, in Chancellors Restaurant, where he was joined by members and
guests of the Section.
FEBRUARY 2002 Mr Allan introduced Mr W V Humphreys, Consultant Vascular and General Surgeon at North West Wales NHS Trust, who gave the 19th Michael Boyd Memorial Lecture entitled: "Aggressive vascular reconstruction for limb Mr Humphreys explained that he was one of Michael Boyd’s last House Surgeons and recounted how he had been offered the post during finals examinations. He described Michael Boyd’s career, from a Field Hospital in Cairo where he developed an interest in unusual pets, to Manchester. Michael Boyd had a particular interest in the follow-up of patients with limb ischaemia, publishing on the natural history of arteriosclerosis of the lower extremities. These publications are still quoted in journals today. Mr Humphreys described the population of North West Wales for whom he has provided a vascular service since 1984. In conjunction with Bangor University, he set up a database to prospectively audit all limb salvage and amputation procedures and follow-up. He presented a large series of patients undergoing 1220 operations for limb ischaemia. He showed that length of survival and graft patency were related to the extent of tissue necrosis at presentation. The series had a limb salvage rate of 80%, which was associated with a better quality of life than major amputation. The cost of limb salvage was explained and shown to be considerably less than the cost of primary amputation, although the cost of unsuccessful limb salvage was high. In patients over 80 years the graft patency and quality of life was comparable with younger patients, although survival time was shorter. In light of the suggestion that vascular reconstructions may be centralised, Mr Humphreys posed the question whether patients over 80 years would be transferred and treated. He concluded that arterial reconstruction for critical limb ischaemia is worthwhile. There followed a question and answer session during which several members of the audience recounted tales about Michael Boyd and how he would have appreciated Mr Humphreys lecture. Mr Abraham thanked Mr Humphreys on behalf of the Surgical Section. Prior to the meeting, members and guests attended a pleasant, informal dinner in Chancellors Restaurant where for the first time, they had a choice of menu for each course.
MARCH 2002 This year the audience was also given scorecards to evaluate the presentations. These were handed in at the end of the meeting and compared with the judges' decision. Mr D Allan, President, was in the chair and introduced the trainees as follows:- Mr J Hardman Mr D A Luff Mr M Moran Miss K Telford Mr Allan emphasised how well presented the papers were and thanked the presenters for the interest they had generated. After the meeting at 8.00 pm an informal dinner was held to which the four presenters for the annual Astra/Zeneca Trainees Prize attended and were joined by members and guests of the section. During coffee the judges announced that the winner of the Astra/Zeneca Trainees Prize was Mr D A Luff who will receive a cheque for £250.
APRIL 2002 Mr D Allan, President of the Section, was in the chair and introduced the speaker for the evening, Mr A Bianchi, who is a Consultant Specialist Paediatric & Neonatal Surgeon and works for the Manchester Children’s Hospitals NHS Trust. Mr Bianchi’s lecture was entitled:- Conjoined twins: ‘To do or not to do’ Mr Bianchi started by describing the different types of conjoined twins and explaining the background to the case. One twin is always weaker, and it is the anatomy that determines which twin will die. He described the case of Mary and Jody and so provided a remarkable insight into the ethical, moral and medical dilemmas of this case, which received widespread press coverage at the time. He elegantly discussed the dilemmas faced by the parents and the medical team that led to the case being considered by the High Court. The planning, preparation and the operation to separate the twins was then described, and Mr Bianchi emphasised the important contributions of all his colleagues, not least the two teams of anaesthetists, the orthopaedic and the neurosurgeons. The weaker twin unfortunately, but as expected, died, but the stronger twin made an excellent recovery. He concluded with a fascinating discussion of the legal arguments and rulings behind the case and the principle of double reasoning. The handling of this case by Mr Bianchi and his team epitomised the qualities of communication, humility, sensitivity, judgement, skill, courage and team work. This was an excellent lecture that stimulated much discussion and then a vote of thanks was given. Before the meeting, at 6.30 pm, an informal dinner was held at Chancellors Restaurant in honour of Mr Bianchi and he was joined by members of the Section and their guests.
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