Historical Review

Hashimoto thyroiditis (HT) is part of the spectrum of autoimmune thyroid diseases characterized by the destruction of thyroid cells by various cell- and antibody-mediated immune processes. It was first described by the Japanese surgeon Hakaru Hashimoto (1981-1934). It was not until 1956 when a link between antibodies to thyroid cells present in the serum of patients and HT was made. Over time, our understanding of the immunologic pathways involved in HT has evolved. We now recognize the association of this disease with other autoimmune diseases and thyroid cancer. The increasing use of the needle biopsy and serologic tests for antibodies have led to much more frequent recognition, and there is reason to believe that it may be increasing in frequency. It is now one of the most common thyroid disorders. This chapter gives a historical overview of Hashimoto's disease.

A Case of Corrosive Esophagitis in Lao People's Democratic Republic

Introduction: Corrosive esophagitis is often caused by the intake of alkaline or acidic substances. Esophageal stenosis is the most important late complication of corrosive esophagitis. In Laos, where Western medical care is available in few locations, treatment for esophageal stenosis is challenging. We report on a patient who was treated in Laos. Case Presentation: In Laos, an 18-year-old woman attempted to commit suicide by drinking an acidic detergent. Sixteen months later, she consulted a district hospital in Laos, which is supported by a Japanese nonprofit organization, with a chief complaint of dysphagia. An upper gastrointestinal series demonstrated severe stenosis of her thoracic esophagus. She underwent open laparotomy for gastrostomy with a urinary catheter to improve her nutritionally poor condition; the operation was performed by a Japanese surgeon with Lao medical staff. Through the gastrostomy, she injected liquid food by herself. Gradually she became unable even to drink water. Because we could not obtain any devices for esophageal dilatation in Laos, balloon dilatation catheters were donated from Japan. Twenty-three months after the injury, the endoscopic balloon dilatation for esophageal stenosis was performed by a Japanese physician, who also taught local physicians how to use the device. The patient's esophagus was as narrow as a pinhole at 20 cm from the incisors. Repeated balloon dilatation by local physicians enabled her to consume solid food orally. Conclusion: Corrosive esophagitis combined with stenosis is often difficult to treat. The Lao patient was successfully treated by a combination of local and foreign medical staff.

Journalism and Academic Surgery: The Denver Post and the American Surgeon

Publication in professional journals is where advancements in surgery are reported and verified. Thus academic surgery holds common ground with journalism, where the principles of service, communication, and integrity are the basis of their public trust and standing in society. Writing for the Denver Post the author learned lessons that are relevant to academic surgery. Facts have to be solid. There are important issues to be discussed. Articles have to be interesting and not tiresome to read. And if it's something new—the essence of news—get it out there first. The American Surgeon embodies the same principles. The journal is a place where members of the Southeastern Surgical Congress discuss important matters, like surgical education, and share stories of interest, like a Japanese surgeon trying to treat victims of nuclear war. It is accessible yet disciplined, dedicated to advancing our field and fostering fellowship and communication among its members.

The History of Premedication

“- An anaesthetic is a frightening adventure into the unknown over which a patient can exert no control, and few can meet this type of ordeal with equanimity”1. British Medical Journal, 1964. Prior to the discovery of anaesthesia, medication before surgery was the only way of diminishing the patient's suffering. In 1682, George Wedel, Professor of Medicine at Jena, suggested that opium could be given to a patient prior to an amputation so that he “… bears the burning and cutting of the limb with a readier spirit”2. Alcohol was often recommended for the same reason3. In 1805, Seishu Hanaoka, a Japanese surgeon, administered a potent oral mixture of alkaloids, largely from the Datura stramonium plant, to a woman for a mastectomy4. He called this mixture Tsusensan, successfully using it on many patients: it produced hours of complete unconsciousness – long before Morton demonstrated the effect of ether.