Work Diary					24.28571429
6/28	Wed	8:00	14:00	6:00	0. Tx dept conference at 8:00 1. Dx: Gravis. Tx: Total Thyroidectomy. Dr. Kobori    1. Layers: skin, sc fat, platysma, infrahyoid.       (platysma: white thin layer)    2. Ligate superior/inferior thyroid a. L/R    3. thyoridectomy.    4. close. 2. Liver met from CRC.	met Dr. Kobori.
6/29	Thu	8:00	14:30	6:30	0. Tx dept conference at 8:00 1. lig tretz tumor + cecum tumor (2 primary tumors)    resect one by one. 4 hours. Jejunum tumor rare!
6/30	Fri	8:00	15:00	7:00	0. Tx dept conference at 8:00 1. breast cancer. Right side. RLQ. Lobectomy. 2. Thyroid adenoma. Lobectomy. L side. 3. Carcinoid Tumor: pancrase->liver met. Tx section 7 tomy.
7/1	Sat	12:00	22:00	10:00	1st dept of surgery 1. Esophagus perforation. Acute and such a bloody     surgery to give 3.5 packs of transfusion. 2. A stick of mop in the anal canal.    So deep and rectum perforation.    The only question is how it happens…	1. assisted by me. stamp: 79 means 4 years older licensed than 75.
7/2	Sun
7/3	Mon	8:00	15:00	7:00	0. Tx dept conference at 8:00 1. retroperitoneum liposarcoma. Huge. Blooddy. 4 packs of Tx. 2. Dermatoid cyst: at the buttocks. 30mins.	3. assisted by me
7/4	Tue	8:00	15:00	7:00	0. Tx dept conference at 8:00 1. Orthopedics: ICP. Botox Injection. 8 muscles.   1. rectus femoris, 2. add longus, 3. brevis, 4. biceps.f,   5. semitendinosus, 6. semimembrananosus, 7. glacilis.   (Dr. Telebessy) 2. Dr. Kobori consultation: remove the stitch, etc. 3. colecystectomy. 4. abd hernia: mesh placement
7/5	Wed	8:00	15:00	7:00	0. Tx dept conferece at 8:00 1. polycystic liver disease. Palliative bile leak treatment.    Many small cysts seen.    CT: huge liver. Polycystic Kidney disease. 38 yr ♀.    Liver Tx waiting. (Dr. Mathez) 2. cholecystectomy + Dixon: Lscope. (out in the middle)	1. assisted by me.
7/6	Thu	8:00	19:00	11:00	0. Tx dept conference at 8:00 1. outpt: post-op control.   A. uterus myofibroblast sarcoma: Dr. Farkas   B. Crohns -> anal fistula. Dr. Farkas.   C. cholecystectomy: Lscope->subcostal incision   D. appendicitis: laparasocopy   E. Mcburny's incision?(horizontal) post-op absess 2. OP:   1. Lscope->open cholecystectomy.   2. pancreas exploration: tumor susepected:      swollen LN->pathology
7/7	Fri	8:00	17:00	9:00	0. Tx dept conference at 8:00 1. liver tumor. Young male pt.  Almost whole Right lobe. demarcated."cap on the liver." 2. liposarcoma. Axillary region. 8cm x 8cm. 3. cholecystitis. Lscope. Normal. 4. tumor: right flexture. Colon CC. hemicolectomy.    Hard ca.(Dr. Bihari) 5. tumor: right flexutre. Colon cc. hemicolectomy. Lscope.    Dr. Bihari
7/8	Sat	12:00	18:00	6:00	1st dept: Waiting… but no acute cases.
7/9	Sun
7/10	Mon	8:00	17:00	9:00	0. Tx dept conference at 8:00 0. outpatient: post-op wound infect suspected. Dr. Sabo. 1. cholelith: cholecystectomy. 50s♀  Dr. Bihari.    Tumor-like mass on the isthmus of gall bladder. 2. inguinal hernia: sac ressection and suture. Dr. Sabo.    ♂ 60s. 3. colon Ca: Lscope ressection. Dr. Bihari.
7/11	Tue	8:00	17:00	9:00	0. Tx dept conference at 8:00 1. interventional radiology: Dx: CRC Liver met. Rx: microwave ablation.    3 vessel diseases: heart problem: CONTRA for surgery.    1 needle. + cooler fluid. 2. interventional radiology: Dx. RCC. Rx: RadioFreq ablation.    ♂90yrs. +cysts perforation. 5cm tumor.    2 needles with umbrella.    power: micro>RF. micro uses a needle, which is not good for closeness to diaphragm. 3. interventional radiology: Dx. HCC. Rx: polyvenyl embolism.    ♂60s. soft tumor palpable. R lobe, 8cm x 8cm.    last time Doxorubicin injjection shrank tumor.	went to Goki to find a contact there in order to join infant surgery.
7/12	Wed	8:00	3:00	19:00	0. Tx dept conference at 8:00 1. colonoscope: 60s♀. Dr. Peter.    Ugly looking sigmoid CA found.    Biopsy taken. ->histology 2wks. Chest/abd CT July 31.    OP in 1 month. 2. AV fistula for dialysis on cubital region. Dr. Szabo.    Cephalic v/brachial a anastomoses. renal failure.    left leg edema(unilateral): strange for renal failure. DVT? 3. gall bladder ca. small. cholecytectomy. Dr. kobori.    50% unresectable due to late finding by Sx.    soft mass + stones. 4. HCC. 96% ethanol injection. dr. kobori.    fibrotic liver. 50s♀. peripheral tumor. (contra: ablation).    resection had planned but changed to ethanol. 5. Kidney Tx  x2 from 22:00 -27:00    A. preparation.         a. remove fat tissue,         b. adjust renal a/v, ureter    B. Tx:        a. incision: right iliac fossa.        b. renal a -> v -> ureter anastomoses.	went to goki again. This time went good. Tomorrow I will see op there!
7/13	Thu	12:00	0:00	12:00	1st Dept of surgery.  Dr. Akosi 1. acute abdomen: perforation. She suffers a serious pain.    70yr♀. Comodity: lung CA->brain met.    Emergency Dept. morphine. CT. result: free air.    Back to surgery dept. at 24:00 2. stroke pt @ Emergency dept. (SBO in Hungarian.).    Eye movment: nrml. -> angio at 23:00	1st time to Emergensy Dept.
7/14	Fri	8:00	3:00	19:00	0. Tx dept conference at 8:00 @ Goki. Dr. Prozan. 1. Hypoplastic left ventricular sy(HLVS). 2 days old.♂    Rx: Norwood I Procedure. 10:00-15:00.    Sano(JP) tube.     2nd step in 1yr : Glenn: SVC(upper body) -> pul a.     3rd step in 2,3yr: Fontane. Inf V.C(lower body).->pul a.       TCPC(total caval-pul connection.(shunt)     not so successful. Dr. Gergely.M mentioned. 1st dept of surgery. Dr. Friedman, Dr. Fulop. 4 op! 2. large mass breast ca: grows outward.    Rx: left mastectomy. part of pectris maj too.     2cm->15cm in 6months. not responsive to chemo.    interductal cc. 3. post-op(diverticulosis) abscess. exploration and lavage.    AB: ciproflaxicin changed to imipenam(broad-spectrum). 4. strangulation of Small bowell. 44yr　♀.    Rx. open surgery: lots of adhesion from prev gynacological sugery.(leiomyoma).    lots of fluid in abdominal cavity.  clear the volvulus and remove adhesion.   to close the suture, move the bowel contents back to stomach and sack it through nasogastiric tube. 5. acute pancreatits. 60s ♀. very bad general condtion. ICU. non-conscious.    lots of fluid in abdomen. redish and blakish. hemorrhagic pancreatitis.    suction+ removal of necrotic pancreatic tissue by hands.    duodenocystostomy: cysts in the head of pancreas. 6. umbilical hernia. 70s　♀  30mins.    1. open the hernia.    2. check the hernia content: 1 loop of intestine+omentum.    3. cut the hernia sack.    4. put back the content.    5. suture. without mesh.	1, 3, 4, 5, 6 assisted by me. 1st time to see infant pt. 1st time to touch a pumping heart. Extracorporal pump. Stop-the-heart procedure->body temp 20 degree. Big ugly tumor. Disgusting yellow pus! Looks really painful.
7/15	Sat	16:00	22:00	6:00	1st dept. 1. remove drain tube. Lscope cholecystectomy.
7/16	Sun	14:00	19:00	5:00	2nd dept. 1. cholecystitis. 28yr ♂. Generally good condition.    OP tomorrow(elective). PE examination. Marphy's sign.	1st time to 2nd dept. Marphy's!
7/17	Mon	8:00			0. Tx dept conference at 8:00 @1st dept: 1. splenectomy: splenomegaly. ♂60s.    Pancreas tumor@tail-ectomy.  Colectomy<-invasion.    Tail ca is very hard. LN swollen. X 3.(removed.)    Dr. Kupcsulik said it had looked like lymphoma in spleen on CT,    but it is actually pancreas ca. Spleen is big and whitish pathological mass inferiorly. 2. colon ca: Miles precedure planned. ♀60s.    found invaded vagina, sacrum. irresectable.    sigmoidstomia. palliative. sigmoid is pulled out of abdominal wall but no incision on the colon. why? 3. pancras tumor suspected. open exploration.    peridural anasthesia failed after two anesthesiologists' trial.    it is a virtual space, much harder than spinal anasthesia(sub arachnoid, CSF space).
7/18	Tue
7/19	Wed				0. Tx dept ward-walk-around 0. Tx dept conferen
7/20	Thu				0. Tx dept ward-walk-around 0. Tx dept conferen 1st dept 15:00. acute ambulancia. 1. Diabetic foot. Rx: amputation. 2nd toe. 20mins.    Xray@radiology dept. 2. acute appendicitis. Rx. Appendectomy. 30 mins.    Perforation suspected by US, radiologist, but no. 3. acute pancreatitis. doctors left her. looks really painful.    curling up, mumbling it hurts, it hurts.    US@radiology dept. 4. needle swallow pt @ dentistiry. from slovenia. speaks English.     perforation->surgery, 3weeks ago.     she came back again for the serious pain. Abscess?     US negative -> AB therapy.     Is it true? maybe PICA?	with Tarek
7/21	Fri				0. Tx dept ward-walk-around 0. Tx dept conference 1. out patient: colestoma prolapse. Dr. szabo.    First time to see. 1st dept of surgery: acute case 2. peri-proctal abscess. Rx: oncotomy.    Lots of pus. Nausea evoking Disgusting… 3. acute appendicitis: physical examiniation.    RLQ: pain. warmer.    acute case but ate. needed to wait for 6 hours.
7/22	Sat
7/23	Sun
7/24	Mon				0. Tx dept conference. Goki. 1. patent tranucus arteriosus. 2yr♀.    2nd op: change the pul trunk with valves.    1st op at 1month. Close the v septum + separate the trunk.
7/25	Tue				0. Tx dept conference. Kidney Tx shceduled. But Dr. Telekesi refused me staying the hospital at 21:00
7/26	Wed
7/27	Thu
7/28	Fri					Kenya!
7/29	Sat
7/30	Sun
total				155:30