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Surgical stories

Surgeons have successfully recreated a patient's thumb after it had been crushed in an accident. One surgeon sewed the remains of the original thumb to the patient's chest to keep it alive, while another sculpted a thumb bone from coral to use as a scaffold and then 'seeded' it with bone cells from the man's forearm. The thumb bone was then attached to the man's hand and covered with flesh grown from the skin of the original thumb. The surgeons' hope that bone cells will ultimately replace the gradually dissolving coral and that blood vessels will form in the new thumb. It is hoped that the eventual consequence of this procedure will be the creation of replacement hips, joints, heart valves, livers, nipples and other body parts.

A woman's life has been saved by the first use in the UK, and the first successful use in the world, of a metal heart implant. Ms Mills was suffering from a rare heart virus, viral myocarditis. This caused inflammation and swelling of the heart muscle which then blocked the blood vessels. The device works by being hooked up to the main arteries supplying the heart, pumping blood around the body. This allows the heart to be kept alive but without having to do any work, so it can recover independently. It does not mimic the rhythm of the heart by but circulates blood in a continuous flow unlike other artificial devices. After 6 days the patient showed marked signs of improvement and the device was removed. She has now recovered to full health. The cardiac specialist leading the intervention said, 'The most exciting concept this has shown is that if you rest a sick heart, even if it has reached an advanced stage of deterioration it can recover'.

The National Confidential Enquiry into Perioperative Deaths, established earlier this year to review surgical and anaesthetic practice, has suggested that surgeons may be performing unnecessary cancer surgery. It recognised that doctors needed to keep abreast of new developments and learn new skills, but emphasised that surgery cannot solve every problem. Consideration of the additional stress this may cause the patient and their family, as well as affording the patient dignity, had to be of prime concern.

New league tables have been published by the government, which list how much it costs to carry out the same sort of operation in different local hospitals. They cover over 500 surgical procedures which involved £5 billion of NHS spending and provided almost 5 million episodes of care of patients. They reveal that surgical operations in England's most expensive hospitals are 58 percent more costly than in the least expensive. Ministers also intend to collect and publish more cost information for all hospital procedures. Later this year there will be new performance league tables and new clinical indicators to give a properly rounded assessment of how individual hospitals are performing in terms of both efficiency and quality of care. NHS regional offices are being asked to investigate and re-set targets where there are huge unexplained variations in cost.

Sources: Times 2 November; Guardian 2 November; BBC Online; Press release (DoH)

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