Capgras Syndrome : Forgetting VIPs in your Life.

Have you ever had the feeling that the friend you have known for ages may not be the one who's standing in front of you?

Weird, right? you are pretty sure the person is not your friend, and yet everyone is telling you that he or she is.

Before you start debating with everyone else and insists on your thoughts, let me tell you about a certain theory that had caught my attention these past few days -- CAPGRAS DELUSION THEORY or the Capgras Syndrom

The syndrome is a disorder in which a certain person believes that a friend or a relative has been replaced by an identical-looking impostor. This is classified under the delusional misidentification syndrome, a certain kind of delusional beliefs that involves misidentification of people, places or objects. It may be acute, transient or chronic. 

This is commonly seen in patients diagnosed with schizophrenia, although it can also occur with brain injury and dementia. 


One of the earliest study regarding the cause of Capgras Delusion suggested that prospagnosia may be have caused it as shown by the study of brain-injury patients. In this condition, the patient cannot recognize faces consciously but are able to recognize other types of visual objects. 


Recent studies shows that although these patients can consciously recognize the faces, they do not show the usual autonomic emotional arousal response (Ellis, 1997). Further, patients can still feel emotions and recognize familiar faces but can't feel emotions when recognizing those faces which are familiar to him. The study states a hypothesis that the origin of Capgras syndrome is the disconnection between the temporal lobe (part of the brain in charge in the recognition of faces) and the limbic system (emotions).


Since the patient could not put memories and feelings, he believed objects in a photograph are new everytime he sees it, though they normally should have triggered feelings (Ramachandran).
 

Appendectomy Marathon

appendix attached to a straight clamp and a bobcock forcep with the first knife 

used to cut the specimen

Appendectomy is one of the most frequent operations we have in our operating room. It is a cross between a minor and a major operation.The best surgeons can perform this kind of procedure at an average time of fifteen minutes, some appendectomy can last up to an hour or two, excluding the induction of anesthesia. 


This is one of my most favorite operations (depending on the surgeon, actually) because it is very basic. Things needed beside the major basic set is a baby richardson retractor and some basic sutures. One simple basic thing to remember about appendectomy: THIS IS A PROCEDURE WHERE YOU USE THE FIRST KNIFE AFTER THE SKIN. You usually keep the first knife away from your field since it is considered as dirty. But in AP cases, we use the first knife to cut the appendix. Most of the surgeons preferred staples to close the operating site. Usually it's a small site at the right lower quadrant often referred to as McBurney's Point. 


What is Appendectomy?
Appendectomy or sometimes referred to as appendisectomy or appendicectomy is the surgical removal of the veniform appendix. This kind of surgery is normally done as an emergency procedure when the patient is suffering from acute appendicitis. 


Appendicitis
Appendicitis is the inflammation of the appendix, how do you know? Here are the list of the signs and symptoms to know if you're suffering from one:

• You can feel pain that often begins around your navel and transfers to your lower right adbomen
• The pain becomes more intense after several hours
• You can feel tenderness when you apply pressure to your lower right abdomen
• A sharp pain is felt in your right lower abdomen when the area is being pressed and the pressure is quickly released. This is referred to as rebound tenderness.
• Nausea and vomiting
• Low-grade fever

Just  remember not to drink any pain-relieving medications if you are experiencing these things because it will mask the symptoms and can delay treatment.

the arrangement of the major basic set in the mayo table. 

There are 3 Types of Incision that Surgeons often do in the hospital where I worked for:

1.    Rocky-Davis incision. This is a small incision that extend horizontally on the abdominal wall in the right lower quadrant

2.    McBurney incision. This is a small incision that runs diagonally on the abdominal wall in the right lower quadrant

3.    Midline incision- this is sometimes done if the appendix has already ruptured, they could not find the appendix, they needed a resection or for children

the back table, while the nurse is preparing for the operation. This is where we put the gown, gloves, operating sponge, drapes and the lap tray.

 

 

the mayo table (top view): army navy, thumb forceps, tissue forceps, clamps: hemostats, straight clamps, round nose, allis forceps, kochers straight, mixters,scalpel, metz, suture scissor, mayo scissors

But I hate an AP marathon. There was this one time when I was the only night duty scrub nurse and we needed to finish 4 appendectomy. I came from an 8 hour PM shift and when straight for another 8 hours. After we had the specimen out from one patient, another patient is being prepared to be wheeled in inside the operating room. I barely had time to breathe! It was a bitter sweet experience. Thank God I am with the best surgical team in the hospital :D

VP SHUNTING: ALL ALONE!

VP Shunting all by myself and I survived!

I thought all the while that my fellow nurses are just teasing me --- but no. It was written on our whiteboard. An emergency VP shunting or Ventriculoperitoneal shunting. There is only one neuro-surgeon that graces our operating room and he goes by the name Dr. ♥. Although there was an eerie space on the surgeon's name, you'd be a dimwit to ask if he'd be the one to do it.

My friends had already choose cases to scrub and according to them - seniors are the one who are in charge of scrubbing cases such as these (in short, when it comes to hard cases, seniors first. if easy cases, juniors first). I already felt an impending migraine. Ok! I have assisted several cranio (but if i have any other choice, I'd rather not). I always felt like a newbie every time I stand up on that white platform I fondly call 'stage'. I really don't know why I feel so nervous and uncomfortable (but never to the point of hyperventilation) -- maybe because it is Dr. ♥'s aura? I am almost in a trance.

Why I am making a big deal out of it? :D Primarily because, there would normally be two people scrubbing for VP shunting or any craniotomy procedure. I find it so funny because we would prepare for like two hours and the procedure will just last less than an hour. Back to the two scrub nurses,

the first scrubber is assigned in the two mayo tables where the skin instruments and the bone instruments are placed and the second scrubber is at the back table where the sponges, bowls, cottonoids, bone wax, gelfoam and the rest of the set are being placed. Since I am the only one who is scrubbing this awful procedure, I have readied all my instruments and stuffs double time. 

VP Shunting is normally done to children who are suffering from hydrocephalus. But this time - the operation is done to an adult. Did the patient have a hydrocephalus as well? What is VP Shunting?

Ventriculoperitoneal shunting is a surgery done to relieve the increasing pressure inside the skull due to excessive cerebrospinal fluid (CSF) on the brain.

Done under general anesthesia, the procedure may take about 1 to 1 ½ hour depending on the surgeon. The hair is shaved off and a surgical cut shaped after a horseshoe (U-shape) is done behind the ear. Another cut is done in the abdominal area (that is why the VP Shunting drape has a hole than the adult lap).

A small hole is drilled in the skull using the cranial burrs (we only have three ‘useable’ burrs in our hospital). A small thin tube called catheter is passed into a ventricle in the brain and another is placed under the skin behind the ear and moved down the neck, past the chest and usually into the peritoneal cavity in the abdomen. The doctors sometimes make a small cut in the neck to help position the catheter.

A fluid pump or valve is placed under the skin behind the ear. This is attached to both catheters. When extra pressure builds up around the brain, the valve would open and excess fluid drains out of it into the abdomen. This action helps in decreasing intracranial pressure.

Valves in recent shunts can be program to drain exact fluid from the brain.

Causes of Hydrocephalus in Adults:

• meningitis, 
• tumors, 
• traumatic head injury, 
• subarachnoid hemorrhage, 

The NEURO SET

 NEURO SKIN INSTRUMENTS: Three bowls, towel clips, mosquitoes, straight clamps, kelly curves, allis forcep, dandy forcep, blade holders, suture scissors, needle holders, metz, tissue forceps, thumb forcep, adson forcep

 This is the only new one in the neuro set SKIN INSTRUMENTS, this is the dandy forcep

  NEURO BONE INSTRUMENTS: Cranial burrs, periosteal elevator, gigli saw, Rongeurs, bone curette, malleables,

Periosteal Elevators are used to strip portions of the membrane (periosteum) covering the exterior surface of a bone. Periosteal Elevators are used for trauma, spinal and other bone and soft tissue procedures. 

Rongeurs are surgical instruments which are designed to chip, crack, or cut away bone and tough tissue such as cartilage.

Bone Curette is a surgical instrument shaped like a scoop or spoon, used to remove tissue or growths from a body cavity.

Dura Separator
 

 a cranial burr: perforator, Dr. ♥ used this instrument to make a whole in the skull.This is the first among the three available burrs that he used.

Just came straight from SUGBU!

Beautiful Butterfly found at Jumalon's Butterfly Sanctuary in Cebu City

Will post some of my travel memoirs s00n :)