Search

Interactions among human beings are very complex. Using only an ethical code as reference to deal with moral conflicts is hardly ever enough. Responsibility ethics demand such a profound reflection as well as a discussion about human essence and its role in society. The responsibility of a surgeon is inherent in a profession based since its origin, not only on altruism and humanity, but also on compassion, courage and tolerance. The studies and the comprehension of these qualities as well as the transmission of these values to the students and to the surgery residents are essential for human education of these individuals. This essay offers to show that these essential virtues are strongly connected to the work the surgeon develops whereas his/her responsibility starts before the surgery - when one intends to act.

The Merkel cell carcinoma is a rare, serious, neuroendocrine, malignant skin cancer with lymph node involvement in half of patients and disseminated metastases in 20% of cases at the time of pathological diagnosis. Its treatment is not fully established, though the sentinel lymph node has been considered essential and may bring benefits to the therapeutic armamentarium of patients.

Objective: To assess the value of abdominal ultrasonography in the diagnosis of acute appendicitis and the influence of gender, physical constitution, experience of the radiologist and the time evolution of the disease on the results of diagnostic indices., Methods: We prospectively evaluated 156 patients with clinical diagnosis of acute appendicitis who underwent laparoscopic appendectomy and abdominal ultrasonography, together with pathology of the excised appendices. Patients were allocated in relation to BMI in both groups (below or above 25 kg/m²) and radiologists, in three groups according to their professional experience (less than five years, between five and 10 years and more than 10 years). The survey also assessed the influence of gender and time of disease progression using the median of 36 hours., Results: The sensitivity and specificity of abdominal ultrasonography for diagnosing appendicitis were 64.9 and 72% respectively. Gender, body mass index, length of experience of the radiologists in the three groups and time of onset of symptoms showed no significant differences in the establishment of sonographic diagnosis of acute appendicitis., Conclusion: The abdominal ultrasonography showed low sensitivity and specificity and little contribution to the diagnosis of acute appendicitis. Gender, physical constitution, the experience of the radiologist and time of onset of symptoms did not affect the outcome of the sonography.

The fragments and compartments of medical knowledge are not the only causes of difficulty found to form surgeons. The abandon of medical education associated with human science (social science) has formed professionals that understand biological science but don't understand life science. The distance from individual and cultural everyday reality enables one to not understand uniqueness and differences of each human being. Surgeons frequently have been described as someone endowed with bad qualities which actually just represent a tough and daring aspect. In other words, you don't need to be gifted to operate. All you need is effort, hard work and determination. Education built with problems produces a critical knowledge that makes an individual intervene in reality that physicians lives in a transformer, conscious and objective way. The critical and humanistic construction of knowledge will only be possible if teaching includes historical and socio-cultural characteristics and not only bio-centric and hospital-centric ones.

A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.