A Colostomy is a surgical procedure that bypasses the intestinal tract therefore producing an alternate track for Bowell movements. This is required when there is disease or damage to the gastrointestinal tract. This procedure involves the connection of a section of the colon to an opening in the skin of the abdomen. A Stoma is the opening which allows the waste to drain. The waste then drains into a pouch called a colostomy pouch. A Colostomy can be temporary or permanent depending on the intent. If the intent is temporary, the colostomy can be reversed when the intestine is healed. In these cases the Stoma would closed. In a colostomy, the surgeon will cut away the diseases or damaged part of the colon. The more colon that can be used will lead to the more solidity of the stool.

Patients with Chrohn’s disease or Ulcerative Colitis experience discomfort and sudden urges to pass stool. A colostomy

A colostomy can be permanent or temporary. In intestinal surgeries where healing is needed, the drainage of waster can be re-routed away from the surgical site to allow recovery. Once the intestines are functioning properly again, the colostomy is reversed and the stoma closed.

A colostomy may be needed in severe cases of bowel disease, such as Chrohn’s disease or Ulcerative Colitis. Because the colon functions so poorly, patients experience extreme discomfort and unpredictable urges to pass stool. If conservative treatments do not improve the situation, a colostomy can provide significant relief of symptoms.

CHEYNE-STOKES RESPIRATION is a pattern of breathing with a gradual increase in the depth of respiration to a maximum, followed by a progressive decrease in the depth of respiration resulting in apnea; characteristically seen in coma associated with severe neurological insult.

Cheyne was the son of a Scottish surgeon who grew up in Leith in the outskirts of Edinburgh. He showed an early liking for medicine and it is said that he helped his father when he was only still thirteen years old to dress and bleed patients, as was the practice at the time. He entered Edinburgh University at the early age of 15, from where he graduated three years later to serve in Ireland as a surgeon with the British Army during the rising of the United Irishmen in 1798. He was with the English forces at the battle of Vinegar Hill when General Lake slaughtered 20,000 Irish peasant rebels armed only with pikes and farm implements.

After the insurrection was put down Cheyne returned to the Medical Faculty of Edinburgh University where he studied pathology and dissection with his classmate Charles Bell (Bells Palsy). He also began work on his first book “Essays on the diseases of Children” which he published in 1801. A few years later he published an important laryngology treatise called “Pathology of the membrane of the larynx and bronchia” Cheyne is widely considered to be the first doctor in the English speaking world to describe the condition of hydrocephalus in children. In 1809 he returned to Ireland and was appointed Professor of Medicine at the Royal College of Surgeons in Dublin. In the latter aspect of 1812 just as the victorious armies of Napoleon were entering the burning city of Moscow, he was elected Physician-General for Ireland. The father of William Stokes (Cheyne-Stokes breathing) (Stokes -Adams attacks) succeeded him as Professor of Medicine at the Royal College of Surgeons.

It was later in that year that Napoleon mentioned, “Even when I am gone, I shall remain in people’s minds the star of their rights, my name will be the war cry of their efforts, the motto of their hopes”. Let us also try and remember this less famous soldier from the period who perhaps was the real founder of Irish Medicine.

DUPUYTREN’S CONTRACTURE

Thickening and contracture of the palmar fascia of the hand resulting in the eventual flexure of the 4th and 5th fingers. There is an association with alcoholic cirrhosis and manual work, but in most instances the etiology is uncertain. “The poor village boy who became a Baron and possessor of a King’s ransom.”

G. Dupuytren was born in Pierre-Buffiere, France in 1777, the same year that Joseph Preistley told the world how he could produce oxygen by heating mercuric oxide. This was also the year that France went to war with Great Britain and aided the American colonists in their struggle to form an independent nation, the United States. When he was still only twelve years old, his family sent him to school in Paris on the advice of a local army officer. The year was 1789, and the revolutionary war in the Americas had left France in severe financial crisis. This is turn led to huge crowds gathering in the streets of Paris chanting for social reform. One of these groups stormed the royal fortress, the Bastille and begun the French Revolution. A series of elected legislatures then took control of the French Government and executed King Louis XV1 and his wife, Marie Antoinette.

Dupuytren’s family were keen that for him not to join the French army and under great physical duress his father decided that he should become a surgeon. His family were impoverished and the young man had to get a job in the autopsy department at his medical school to help pay his tuition . When he was only 24, he was elevated to the position as Chef de Travaux Anatomiques and later he wrote an illustrated anatomy book based on his years of working in the autopsy room. He also became an eminent lecturer in pathology and Lannaec and Bayle were among his students. It is said that Lannaec could not stand Dupuytren and considered him to be financially ambitious and opportunistic. By now it was now 1801, and Napoleon was in control of France, having won a great victory against the Austrians and succeeded in signing a peace treaty with the war-weary British.

Dupuytren was appointed to the Hotel Dieu in 1802, and was elected to the Chair of Operative Surgery in 1812, the same year that Napoleon’s troops were facing the first horrors of a Russian winter. He became Surgeon in Chief at the Hotel Dieu two years later and although considered to be a fine surgeon, remained unpopular with his other colleagues. He is said to have seen over forty patients a day outside of his hospital work and accumulated enough wealth to make him a millionaire. In that year also, the allies pursued Napoleon to Fontainebleau in Paris, where they forced to abdicate the Imperial throne to Louis XV111. This returned exile later made Dupuytren a Baron for services rendered to his family. The Bourbon family continued their reign with the succession of Charles X to the throne in 1824. Dupuytren was then appointed first surgeon to the family. Charles X was the younger brother of Louis XV111, and had originally escaped the Revolution by fleeing to Britain in 1789. He was forced to return there in 1830 after a failed attempt to restore the power of the French monarchy.

It is known that despite his famed meanness, Dupuytren offered Charles X one million francs after his dethronement. This money was respectfully declined. He continued to work at the Hotel Dieu and is still recognised as the first surgeon to successfully remove a lower jaw. he is also remembered as the first surgeon to recognise Dupuytren’s contracture and devise the operation to correct it. He invented surgical instruments which were found useful and modified by other surgeons such as Abraham Colles, Mikulicz and Sir Astley Cooper. In the fall of 1833, Dupuytren developed a stroke during one of his lectures but decided to continue despite his residual paralysis. From that period onward he remained invalided, and died little more than a year later. The year was 1835, and across the other end of the world, a Tasmanian sheep farmer, John Batman was more concerned about purchasing some land near the Yarra river from the local aborigines. The village that grew up around the settlement became the city of Melbourne.