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The annual Presidential Address of the Section of Surgery, of the Manchester Medical Society, was held on Tuesday 18th October 2005 at 8.00 pm in Chancellors Conference Centre, University of Manchester. Prior to the Presidential Address, the Annual General Meeting of the Section was held and the Office-bearer and members of Council were unanimously elected for the 2005/2006 session. The outgoing President, Mr E S Kiff, handed over the Presidential Medallion to the 2005/2006 President, Mr W A Brough (Consultant General Surgeon, East Cheshire NHS Trust) who thanked Mr Kiff for his term of office. Mr Brough then swiftly began his lecture for the evening entitled:- "My heroes in surgery – past and present" Mr Brough began by saying that he had always had an interest in surgical history and that he thought the most exciting period to have lived in surgically was from 1880-1920 because this had seen so many advances in our knowledge of diseases and instrumentation. He then gave brief vignettes on in all 24 surgeons as well as an anaesthetist and a radiologist. From this group a number of interesting stories and comparisons with modern practice emerged. We learned that Billroth’s first few gastrectomies had such a high mortality rate that Billroth although a revered citizen of Vienna was stoned in the streets- an act unthinkable today when the tabloid newspapers can do the job so much more efficiently! Langenbuch who championed cholecytectomy as opposed to cholecystostomy had to wait many years before he was believed. Whipple did his first pancreatectomy on the spur of the moment when the gastric cancer turned out to be pancreatic invading the back wall of the stomach. In these days of super specialisation it appears that Nissen, who now would be chained to the gastro-oesphageal junction, had a picture on his wall of Einstein following his recovery from an aortic aneurism which Nissen had successfully repaired. In the more recent past he paid tribute to his time in Cambridge working with figures like Khan, English and Milstein. Of his time in Manchester both as trainee and Consultant he remembered with affection and gratitude Messrs Stewart, Banciewicz, Scholfield, Tweedle, Bell and Hartley all of whom had provided support and advice together with his colleagues both past and present at Stockport and Macclesfield. The evening would not have been complete without a mention of laparoscopic surgery and his very fruitful association with his friend Chris Royston and finally his great hero John Hunter, who it appears, had some less than complementary things to say about the RCS and the Court of examiners. Mr Brough was commended for his excellent lecture in the form of prolonged applause and a question and answer session took place. The traditional Presidential dinner was held before the lecture in Chancellors Restaurant at 6.30 pm. Fifty-two members and guests enjoyed a three-course meal in a convivial atmosphere and Mr Brough kindly provided the wine.
The second meeting of the Session for the Section of Surgery of the Manchester Medical Society, took place on Tuesday 8th November 2005 at 8.00 pm at Chancellors Conference Centre, University of Manchester. The President of the Section, Mr W A Brough, opened the meeting and welcomed members and guests of the audience. He then introduced the evening’s speaker as follows:- Mr Chris Royston "Is obesity surgery NICE" After briefly talking about his long and fruitful relationship with the president in the field of Laparoscopic surgery Mr Royston began his talk on Obesity surgery. He pointed out that obesity was everywhere in the media now the official definition being a BMI>30-35. He discussed the problems of co-morbidity that arose in particular in relation to diabetic, cardiac, respiratory and joint disorders. Using the NICE guidelines it was estimated that there are 600,000 patients suitable for surgery in the UK and the number of surgeons able to perform it nowhere near adequate. Non-surgical options both mechanical and pharmacological existed but were not very successful. Of the surgical options there were three methods, malabsorptive, restrictive and a combination of the two. He then described the various options and there success or failure. Small bowel bypass had not stood the test of time being associated with significant morbidity. Likewise Vertical band gastroplasties were associated with a 50% failure rate. With the advent of laparoscopic surgery lap bands had appeared. These were not without their problems such as erosion and migration. They had a high maintenance rate and overall only 1/3 of patients had a good result. The current method of choice was a laparascopically performed restrictive operation coupled with a bypass of which he showed a video. The early results were encouraging with a high proportion of diabetic patients improving compared to only 50% of lap band patients, although long term follow up was needed to confirm this success. He concluded by running through the arguments both medical social and economic for obesity surgery but pointing out that training was required and that special centres would need setting up. He finished by saying that just as laparoscopic surgery was best developed by surgeons working in pairs the same was true of obesity surgery. There then followed a lively discussion before the President thanked Mr Royston for coming over. The talk was preceeded by a dinner attended by several members of the section.
A meeting of the Section of Surgery of the Manchester Medical Society, took place on Tuesday 13th December 2005 at 6.30 pm at Chancellors Conference Centre, University of Manchester. The meeting took the form of a debate entitled "From Calman to Calamity Jane in 10 years" and was chaired by the President, Mr W A Brough. Mr Brough introduced the two speakers as follows:- Mr J Black & Mrs L de Cossart Mr John Black opened the debate by accepting that you did not need to be medically qualified to carry out operations, illustrating this point with reference to the Fistula hospital in Adis Ababa. However this was not universally the case studies at Derriford Hospital on hernias finding that only 1 operation had been concluded without Consultant intervention. The conclusions from this study being that nurse practitioners were unlikely to make a major contribution to hernia surgery. Fundamentally there was more to operating than just doing the operation, some of it related to stress and complications which gave him the first opportunity to land the much anticipated controversial comment, namely that when surgeons get a complication they carry on when nurses et one they go of with stress, which produced the desired response from the mixed audience! He went on to look at the reasons for SNP and the drawbacks, two of which were the loss of scales and arpeggios of surgical training and the potential boredom of doing the same operation time and time again. The agenda behind their introduction was multiple, shortage of doctors, EWD and perhaps most sinister and worrying the attempt by all governments in Europe to deprofessionalise medicine. The RCS had not been slow in responding to these moves and had produced a very good consultation document with guidelines for adoption in controlled circumstances which was essentially under the supervision of a Consultant surgeon and in that situation they could play a useful part in the surgical team. Mrs De Cossart started by saying that she was going to raise things to a level of intellectual debate! These changes were not a calamity but needed vision, professionalism and leadership. It was inevitable that over time things change and it was up to surgeons to respond to these challenges positively rather than being reactionary in approach, such attitudes merely fuelled media sceptiscm of the profession. She alluded to the perceived medical models, the restrictive professional who was inward looking with a very narrow view only considering the short term personal interest and the extended professional who was ready to seize new ideas and implement the best, one who looked at the consequences of things outside his own narrow field. SNP could be valuable members of a team helping with training because they were such constant features not just in the theatre but on the wards in terms of pre and post op care. There was now a regulated programme and we as surgeons needed to show courage and accept the contribution that could be made. There followed a predictably lively debate after which dinner, held in Chancellors Restaurant, was enjoyed by several members and guests of the section.
A meeting of the Section of Surgery, of the Manchester Medical Society, was held on Tuesday 10th January 2006 at 8.00 pm in Chancellors Conference Centre, University of Manchester. Mr W A Brough, the President of the Section, welcomed the audience and read the minutes of the previous meeting. He also thanked members and guests for attending the meal held prior to the meeting in Chancellors Restaurant. After the formalities, the President introduced the speaker as follows:- Dr E Dunbar "Infectious disease and the surgeon in 2006" Dr Dunbar began his lecture with some reminiscences of his time in the St George’s Hospital cricket with the President, in particular the dangers of being the wicket keeper if the president had just been hit for a four whilst bowling! Moving on to the academic part of his lecture he first addressed the issue of HIV. He pointed out that all surgeons would operate on somebody who was HIV positive and that by 2050 there would be more HIV positive patients than there were diabetic ones. Manchester had the largest population outside London- which might be regarded as a dubious reason for us to be the second city in the country! However, the good news was that with the advent of new drugs deaths were on the decline, and most deaths these days were from lymphoma. The key to spotting the problem was a low threshold of suspicion, important clews were ,country of origin, sexual history and interestingly whether the spouse had died early. Important laboratory tests were lymphopenia and rising globulins. Moving on from HIV he next considered Hepatitis C which in practice was a bigger problem for surgeons. Needle stick injuries were the major source of infection and because the virus changed frequently it was unlikely there would be a vaccine. Following exposure post exposure prophylaxis reduced infection by 70-80%. Triple therapy was now standard and it was important to start as soon as possible. The final part of his talk considered the problem of the increase in surgical infection related to antibiotic resistant organisms and the value of hyperbaric oxygen. Depressingly he highlighted the fact that we were running out of antibiotics and the fact that we might soon return to an era of uncontrolled sepsis. As evidence C. Difficule was becoming more common and resistant strains were emerging and this was largely due to the indiscriminate use of broad spectrum antibiotics. In anaerobic infections hyperbaric oxygen had a useful and life saving role but the number of places able to offer it was limited. A lively discussion followed the lecture. Prior to the lecture the President, guests and members of the society enjoyed an informal dinner in Chancellors Restaurant.
The twenty-fifth Michael Boyd Memorial Lecture, of the Section of Surgery of the Manchester Medical Society, was held on Tuesday 14th February 2006 at 8.00 pm in Chancellors Conference Centre, University of Manchester. The President, Mr W A Brough, welcomed the audience and also Professor Sir Netar Mallick, the President of the Society. Mr Brough then gave a brief history of Michael Boyd and introduced the speaker who would be the recipient of the third medal as follows: - Mr John
F Dark "Sixty years of heart surgery – how it developed generally and locally" Mr Dark’s talk initially looked at the largely unsuccessful, earliest attempts to relieve mitral stenosis in the 1920’s. Then the much more successful means, shortly after the last War, of dealing with some congenital cardiac deformities, and again mitral stenosis on a large scale was discussed. Mr Dark outlined the extraordinary growth of open heart surgery world-wide and our own local endeavours, leading on to the treatment of ischaemic heart disease. He then concluded with a short review of heart transplantation, emphasising the programme at Wythenshawe Hospital. Members and guests listened attentively and a spirited discussion took place. Mr Brough gave a vote of thanks to Mr Dark for his excellent lecture, which was echoed by the audience by way of prolonged applause. Prior to the meeting, some forty members and guests enjoyed an informal 3-course dinner held in honour of Mr Dark at Chancellors Restaurant. It was quite an evening to be remembered!
MARCH 2006 The President, Mr W A Brough, opened the meeting and thanked members and guests for attending. He then introduced the trainees and their presentations, who were short-listed from 27 entries, as follows:- J D
Samuel D Speake A Gulati S E
Duff J Barnard Scorecards were issued to all members of the audience and the judges. The results were tallied at the end of the meeting and compared with the adjudicating panel (Section of Surgery Council). Mr Brough thanked all five presenters for the quality and high standards of their presentations and thanked the audience for their participation. He then announced that the winner would be revealed at the dinner following the meeting, which would be held in Chancellors Restaurant. After much deliberation the President announced that the winner of the Trainees’ Prize for 2005/2006 was Mr D Speake who was awarded the prize money of £250.
The last meeting of the current session of the Section of Surgery of the Manchester Medical Society, took place on Tuesday 11th April 2006 at 8.00 pm in Chancellors Conference Centre, University of Manchester. Mr W A Brough, President of the Section, introduced the speaker as follows: Mr H J
Espiner "The surgeon inventor" Mr Espiner came to the UK in 1959 to gain the FRCS, intending to stay for 2-3 years training. After passing the exams he took a research post with Professor Milnes Walker in Bristol for 3 years, then joined the senior registrar rotation and was appointed consultant to the BRI in 1968. His first interest was abdominal and GI surgery with special emphasis on biliary and colorectal surgery. In 1990 he was amongst the first group of surgeons in the UK to develop laparoscopic surgery, which remained his great interest until he retired in 1997. Since then he has remained active in the field forming a company concerned with design and production of surgical instruments. Mr Espiner started by pointing out Manchester’s association with inventors such as Hamilton who developed turbines and jet boats, Pearse who invented powered flight before the Wright brothers and Murdoch who devised the disposable syringe. He went on to talk about his various ventures into invention. These included devices for multiple injections, equipment for isolated limb perfusion in melanoma, a mandrell for anatomises and hernia repairs and most recently various instruments to aid laparoscopic surgery. In all these he pointed out the problems encountered in developing such projects, not all of which in retrospect had been successful. For those with an eye to commerce he explained the costs involved in developing a patent which could run the £15,000- just a day’s work at the Alex for the president! Prior to the meeting, members and guests of the Section attended an informal dinner held in honour of the speaker in Chancellors Restaurant.
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MANCHESTER
MEDICAL SOCIETY
