Half-life of surgical truth in general surgery

Introduction Karl Popper’s hypothetico-deductive model contends that an assertion is true if it agrees with the facts, and that science progresses via paradigms held to be true until replaced by better approximations of reality. Our study aimed to estimate the half-life of surgical dogma. Methods The first 15 general surgery articles at 5-year intervals were extracted from the British Journal of Surgery since its inception in 1913. A statement summarising each article’s conclusion was formatted, and non-conducive articles were excluded (n=22). A total of 293 article statements were reviewed and marked as true or false by a cohort of 15 senior general surgeons, with a majority positive response denoting a true statement. Regression analysis of the relationship between perceived truth and time was performed. Results Median reviewer positive response rate was 49.5% (range 35.8–64.2%), with over 80% of responders in total agreement regarding 151 statements (51.5%) and deeming 137 (46.8%) currently true. Publication year correlated with percentage of true responses (rho 0.647, p=0.002). Linear modelling of true responses related to 5-year intervals (R2=0.398, p=0.002) estimated the annual rate of loss of truth to be 0.25%, equating to a half-life of 200.0 years. Conclusions Contrary to popular belief, it appears THAT surgical dogma does not lose its lustre for some seven generations. Regression line extrapolation is contentious but would suggest that the current era of surgical knowledge extends from 1769 – the days of John Hunter, the ‘father of modern surgery’ – to 2176, although relative rates of innovation may accelerate and move the nexus point.

Role of FNAC in diagnosis of parotid lesions

Background Salivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions. Results Of the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%. Conclusion The role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.

“The Fantastic Flying Books of Mr. Morris Lessmore” de William Joyce e Brandon Oldenburg: quando o som se mostra dominante na construção de uma narrativa de texto e imagens.

Through the short film “The Fantastic Flying Books of Mr. Morris Lessmore” by William Joyce and Brandon Oldenburg, with music by John Hunter, we intend to realize how this component constructs the poetic and affective imaginary of the work. Facing us with a film without words, we perceive that all the imaginary is constructed in the discourse of images and sounds. We know that the sound component was designed in close collaboration with the filmmakers. In this sense, it comes from a proposal made by William Joyce and Brandon Oldenburg, in the sense that the musical component is based on the song “Pop Goes the Weasel”. The composer, with this information, outlines his work proposal which, in addition to citing the proposed source, calls the “Suite”. In our work, it is our intention to understand how the sound is constructed in order to elucidate these contents, but also the techniques of composition employed. We will look at how the composer integrates the song through the use of intertextuality, as well as how the proper elements of the Suite form are shown. Because Suite is a Baroque form, we will try to understand if its constituents demonstrate the elements present in the Affect Theory, popular theory at the time in the determination with expressive contents of a work. With this film, we realize that music, emphasizing the image, builds another level of meaning, another way of experiencing life and art.

John Hunter (1728 - 1793)

Portrait of anatomist John Hunter

El carácter científico de la Cirugía. Historia y Filosofía

Can we talk about science when we speak about surgery? Not, accordingly to classical epistemology. To consider a discipline as scientific, it must meet certain requirements that surgery would not seem to satisfy: being part of a paradigm and creating scientific knowledge. Therefore, if we want to affirm the scientific nature of surgery, we must investigate the existence of exemplars that could be paradigmatic, since they are the ones that support its epistemic structure. Along with this, we must demonstrate that their practice creates scientific knowledge. We’ve postulated five objectives that surgery had to satisfy. We’ve seen in classic history, that the main characters which are considered founders of modern surgery –Ambrosio Pare and John Hunter– were only able to reach the first three, and as we’ll see, were not enough to consider surgery as part of science. Moving forward in history, we are able to find the first paradigmatic exemplars. The first corresponds to the research work in the animal phase, prior to the first successful human gastrectomy performed by the German surgeon Theodor Billroth, in 1882. The second corresponds to the research in thyroid’s physiology carried out by Emil T. Kocher; thanks to this, he won the Nobel Prize in medicine and phy- siology in 1909. An analysis of the epistemic development of surgery is made from them, and the consequences are analyzed using the concept of the epistemic cycle. Those key hypotheses are important to understand the creation of scientific knowledge in technical disciplines as surgery

**75** Chap. 6.

Barker comments on Cape Elizabeth in 1786–1812 and his visit there in March 1781, to call on the Rev. Ephraim Clark, aged fifty-five, with pneumonia requiring two bleedings. Clark had suffered frequent attacks of pulmonic inflammation which always yielded to bleeding. He continued to preach till the age of seventy-five, when he died of a pulmonic fever. Clark always carried a lancet with him on his parochial visits, as his parishioners were in the habit of being bled, in sickness and in health, as disease prevention. The remainder of this chapter deals with Barker’s patients from ages sixteen to sixty suffering with apoplexy, palsy, hemiplegia, paraplegia, and the apparent successful treatment of bloodletting. He is supported by excerpts on the subject by physicians such as Mathew Baillie and John Hunter; an article by John Collins Warren includes dissections.