ALL SURGEONS ARE PHYSICIANS, BUT NOT ALL PHYSICIANS ARE SURGEONS.

All doctors receive a similar education, whether they attend medical school and become an M.D., or an osteopathic college and become a D.O.. However, most will pursue specialized training in a specific field of medicine. Many of these areas of practice involve surgery, and their practitioners are referred to as surgeons. Those who perform little or no surgery are simply referred to as physicians. All surgeons are physicians, but not all physicians are surgeons.

Training
Medical education and training varies considerably across the world. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, India, China, Africa), or graduate-entry programs (mainly Australia, Canada, United States). In the US and much of North America, all doctors begin their careers in a three- to four-year undergraduate pre-medical program, earning a bachelor of science degree that satisfies the prerequisites for medical or osteopathic college. Those schools represent the next step, a four-year doctorate combining hands-on clinical experience with classroom instruction in physiology, pharmacology, organic chemistry, medical ethics and related topics. In some other parts of the world, initial training is taken at medical school which is traditionally divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and surgery.  At graduation, the newly minted doctor must choose an accredited residency program in one or another area of practice. This is where career paths for physicians and surgeons diverge. Physicians spend their residencies practicing medicine under the supervision of experienced practitioners, while surgeons spend theirs learning a range of surgical techniques appropriate to their specialty.

What Physicians Do
Physicians may be specialists or practice primary care. Primary care physicians are generalists, such as family doctors, gynecologists and pediatricians. They build long-term relationships with their patients, counseling them on wellness and lifestyle choices, as well as treating their illnesses. Specialists focus on specific diseases, such as cancers or breathing disorders, or specific parts of the body, such as the digestive system or heart. They typically see patients for specific conditions, rather than providing general care. Both types of physicians treat illnesses, injuries and other conditions with medicines, physical therapy and other non-surgical techniques.

What Surgeons Do
Surgeons perform many of the same duties as other physicians, recording patients' medical histories and diagnosing illnesses, injuries and other conditions. However, while physicians' therapies typically encourage the body to heal itself, surgeons act directly to correct illnesses, injuries and deformities. Working through open incisions in the traditional way with scalpels or with tiny instruments inserted into the body through fine tubes, surgeons cut, fuse and reshape the body's tissues to restore proper function. Some physicians who are classed as non-surgeons -- including interventional cardiologists, neurologists and radiologists -- use the same minimally invasive techniques to perform repairs on their patients.

Comparative Income(US data)
In its 2011 salary survey, medical staffing firm Merritt Hawkins reported a salary range of $130,000 to $290,000 per year for family medicine, with an average salary of $178,000. For emergency medicine physicians, the average was $255,000, with the high and low ranging from $160,000 to $380,000 per year. Anesthesiologists fared better, with a range of $290,000 to $475,000 and an average salary of $355,000 a year. General surgeons reported an average salary of $330,000, with a low of $205,000 and a high of $450,000. Orthopedic surgeons had especially high salaries, ranging from a low of $380,000 per year to a high of $650,000. Their average salary was $532,000 per year.

 Most of the info, with some alterations, from http://forum.facmedicine.com/

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ATYPICAL CLINICAL FEATURES OF APPENDICITIS

5^th International conference “Surgery 4 All”. Moscow. Published in the “SURGERY made simple” Magazine

ATYPICAL CLINICAL FEATURES OF APPENDICITIS

Presented by: I.M. Kapuwa; M.A. Chinikov , MD, PhD

Extract...

Appendicitis is an inflammation of the appendix that causes the organ to fill with fluid. In classic descriptions of appendicitis, patients will experience a progressively worsening amount of periumbilical (near the navel) pain in the abdominal region followed by nausea, right lower quadrant pain, and later, vomiting with fever. However, some people, especially pregnant women, the elderly, children and people with situs inversus totalis (mirrored positions of internal organs), may suffer from atypical symptoms, making a proper diagnosis more difficult.
Acute appendicitis is one of the most common surgical emergencies encountered by general surgeons. When appendicitis manifests in its classic form, it is easily diagnosed and treated. Unfortunately, these classic symptoms occur in just over half of patients with acute appendicitis therefore, an accurate and timely diagnosis of atypical appendicitis remains clinically challenging and is one of the most commonly missed problems in the emergency department. Furthermore, the consequence of missing appendicitis, leading to perforation, significantly increases morbidity and prolongs hospitalization.

WHAT YOU NEED TO KNOW: Anatomy - 

Normal Appendix anatomy

• Blind pouch off of cecum

• Contains lymphoid tissue which peaks in adolescence, atrophies with age

• Function still unclear

• Appendix can be anywhere within peritoneal cavity

• One study showed 65 % retrocecal, 31 % pelvic

APPENDICITIS INCIDENCE & COMPLICATIONS

o 6 % lifetime incidence, Slightly more common in men

o 69 % are ages 10 to 30

o 1 in 6 of the population will have an appendectomy.

o More common in European societies (Diet); less common in vegetarians

o Only 55% have classical features.

o Atypical 45%

o Up to 30 % misdiagnosed initially

o Mortality : 0.1 to 0.2 % unruptured, 3 to 5 % ruptured Significant morbidity

Various positions of the Appendix

PRESENTATION: Atypical presentation of appendicitis may occur because of the position of the appendix, the age of the patient, or coexisting conditions such as pregnancy. In such cases the diagnosis may be particularly challenging. The position of the appendix as related to the caecum may also influence the clinical presentation and the differential diagnosis. When the inflamed appendix is in retroacecal and retroileal position it is shielded from the anterior abdominal wall by the overlying caecum and ileum. The pain, therefore, seems less severe with a mild to moderate manifestation that doesn't worsen or shift.

The classic shift of pain from the epigastrium to the right lower quadrant may not occur. Tenderness or sensitivity to touch will be slight and not worsen. In some cases, there is no tenderness at all. Another atypical symptom of appendicitis is a change in bowel movements, including a reduction in frequency or a change in the consistency, with harder and drier stools. Without the presence of pain and tenderness, appendicitis is likely to be misdiagnosed as constipation.

Urinary frequency may result from direct irritation of the ureter. Muscular rigidity is absent and abdominal tenderness is minimal in these cases. With inflamed appendix in pelvic position, pain is often localized to the lower abdomen. The absence of abdominal signs can be deceiving, but tenderness is usually elicited on rectal examination.

DIAGNOSIS:  Diagnosis is clinical; for there is no specific test to confirm the diagnosis of acute appendicitis. The Alvarado score can be used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total of 10 points.

THE ALVARADO CLINICAL  ‘MANTRELS’ SCORE.                                                               Established in 1986

Characteristic	Point
Migration of pain to right lower quadrant (RLQ)	1
Anorexia	1
Nausea / vomiting	1
Tenderness in RLQ	2
Rebound pain	1
Elevated temperature	1
Leukocytosis	2
Shift of white blood cell count to left	1
Total	10

Diagnosis of appendicitis in the elderly is often delayed. Even with advanced inflammation, pain may be minimal and fever is absent. Appendicitis in pregnancy is also difficult to diagnose. Patients usually seek obstetric advice for their symptoms.  Area of maximal abdominal tenderness may be adjacent to the umbilicus or in the right subcostal area because of upward displacement of caecum. 

Imaging diagnostics:

 Ultrasonography

 Computed tomography/ magnetic resonance imaging

 X-ray 

 Laparoscopy 

 Vaginal/rectal examination 

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Will the rapture really take place today?

 I woke up this morning expecting the coming of my Lord Jesus, as alleged by Harold Camping and his Family Radio team. It's past 6pm here now and still waiting to receive the Lord...we're waiting! 

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AMBASSADOR YAMBASU SHOWCASES SIERRA LEONE…AS 50TH INDEPENDENCE ANNIVERSARY CELEBRATED IN GRAND-STYLE

   The Ambassador Extraordinary and Plenipotentiary of the Republic of Sierra Leone to the Russian Federation and CIS States H.E Mr. John Sahr Yambasu has just proven the trust and honour bestowed upon him by H.E Dr. Ernest Bai Koroma in making Sierra Leoneans proud and be seen on the streets of Russia.

  

     As the 50^th Independence fever has been among Sierra Leoneans all over the globe, Russia was not an exception. Sierra Leoneans in Moscow, especially the students, have been preparing for this great event for the past two months with weekly rehearsals and meetings to make sure everything went on well. The Ambassador, on his own part guaranteed the students got all they wanted and went an extra mile to meet the needs of Sierra Leoneans in Russia. Sierra Leone @ 50 paraphernalia like T-Shirts, caps, cups & plates, wall clocks, gift bags and pin-ups were presented to all Sierra Leoneans and guests at the Independence celebrations.

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HOW SALONE'S GOLDEN JUBILEE WAS CELEBRATED IN RUSSIA

Sorry, for the late report but you'll be updated soon with live videos, photos and reports on the grand event

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SIERRA LEONE’S NEW AMBASSADOR ARRIVES IN MOSCOW IN AN AWE-INSPIRING WAY TO ASSUME OFFICE

 

MOSCOW, RUSSIA. - Sierra Leone’s new Ambassador to the Russian Federation, Mr. John Yambasu, landed at the Domodedovo International Airport in Moscow yesterday on the 20^th October 2010 at the start of his posting to Moscow.

H.E Mr. Yambasu and Entourage

  

    H.E Mr. Yambasu, together with a high-powered entourage from members of the United Kingdom Branch of the All People’s Congress (APC) Party were greeted with bouquets of flowers at the airport by the Head of Chancery, Mr. Ibrahim V. Kondoh, and staff of the Sierra Leone Embassy in Moscow, members of the Union of African Ambassadors and Executive members of the National Union of Sierra Leone students in Russia. In a short but exuberant reception in one of the VIP lounges at the airport, the Kenyan Ambassador to Russia, H.E Paul K. Kurgat ,who coincidentally happened to have graduated from the same University where Ambassador Yambasu did his preparatory Russia language course some 30 years ago was given the honour to chair the auspicious ceremony and he requested that there be a self introduction for fear  of mispronouncing someone’s name. He officially welcomed H.E Yambasu to Russia and to their Ambassadors’ Group.  “We hope to have a wonderful time with you and pray you enjoy your stay, but there are just two things I need to tell you about Russia: the extremely harsh weather and the Moscow ‘Probka’ (Traffic Jam)”

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Michelle Obama...a Sierra Leonean?

Mrs. Michelle Obama, nee Robinson, may be descended from a Sierra Leonean rice farmer who was probably captured in his farm in Southern Sierra Leone and sold in to North American slavery at the instigation of the Lords Proprietors of England, probably in the early to mid-18th Century. 

The Lords Proprietors were grand land speculators based in London who obtained grants from the King of England to develop the Carolinas in North America as a commercial enterprise in 1663 and 1665. Carolina was defined as land from the Atlantic to the Pacific Coast. By late that Century, the Lords Proprietors were virtually bankrupt and desperate for survival when they happened upon a sea captain who, noticing the geographical similarities between South Carolina and Sierra Leone (hot, humid, swampy lowlands on the Atlantic coast; rivers-originating highlands in the Northern interior) and knew from experience that rice flourished in Sierra Leone, suggested that the Lords Proprietors adopt rice as their cash crop. They did and so the existing slave trade took a catastrophic turn for Sierra Leone’s successful rice farmers. 
 

Michelle Obama traces her ancestry back 5-generations to her great-great grandfather, one Jim Robinson, who was born into slavery in the Friendfield Plantation, Georgetown, South Carolina, a rice plantation. Despite its name: 8 0Friendfield’, it was most certainly not a friendly place for the enslaved inhabitants who toiled in swamps from day break to beyond sunset six-and-a-half days a week from childhood until a few months or weeks before death. Whereupon, they were interred in the plantation’s swamps! 
Mrs. Obama’s connection to Sierra Leone first came to light only recently when her Gullah-speaking relatives from South Carolina showed up in Washington for her husband’s inauguration as the 44th President of the United States. The Gullah Language is a Creole-like language that originated with the West African-trans-Atlantic Slave Trade and still spoken in the South Carolina low country were rice farmers from Sierra Leone were forced to settle create the rice industry for whites. 

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