questions and the auxiliary materials which are needed for an acquirement of the curriculum can be found on the website of the department (http://soki.aok.pte.hu). Taking part in practices is obligatory and the missed practice(s) must be substituted.The absentee should provide the office of the department with a certificate.The practices are built on each other that is reason the students must immediately substitute the missed one e.g. by taking part in the same practice in an another group -after recieving a permission to do so-. When there is an extraordinary indication, we will organize a replacement practice in the last week of the semester which date will be announced on the homepage of the departement.
1.2.Our main research territories
I. Innovative surgical models
•NOTES (Natural Orifice Transluminal Endoscopic Surgery)
•Hernia surgery (silicone covered mesh, physiology and biomechanical investigations
of abdominal wall etc.)
•Wound closure techniques (suture materials and other possibilities)
•Vascular surgery (stent grafts, laser welding, vascular staplers, osteointegration for
femoral amputees)
•Small bowel autotransplantation
•Acute haemarthrosis (the role of the oxidative stress)
II. Pathomechanism of Oxygen Free Radicals (OFR)- mediated cellular injury
•To reduce the ischemia reperfusion injury of the myocardium (pharmacological possibilities, signal transduction pathways)
•Experimental and clinical examinations of the endogenous adaptation response mechanisms of the myocadium
•Examination of the oxidative stress, leukocytes and platelets activation in patients admitted to the ICU and in other clinical pictures
•Experimental and clinical examinations for reducing the degree of ischemia reperfusion injury of myocardium and lung injuries in patients undergoing cardiac surgery
Student Research Work related to the above-mentioned issues can also be found on the homepage of the department. For these students - besides the scientific researcheswe also ensure possibilities to take part in operations, as well as to perform them (following getting appropriate experiences). We count on them in the education as well.
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2. HISTORY OF SURGERY
”The history of surgery is the history of the last 100 years, which started in 1846 with the discovery of nacrosis and the possibility of no-pain operation. Everything, which was before, is just a night of ignorance, pain and barren groping in the dark.”
(Bertrand Gosset, 1956)
The history of surgery is devided into three periods: I. Period
It lasted from the primaeval times until the middle of the 19th century, when only the removal of the injured parts had occured.
II. Period
It lasted from the discovery of nacrosis (1846) until the sixties (1960s). This period included not only the removal of the injured parts, but also their reconstruction. Mildstone was the initation and application of the principle of sepsis and antisepsis, discovery of blood-groups and the development of intensive therapy.
III. Period
It lasted from the sixties until nowadays. The development of the instruments, natural science researches (e.g. physiology, biochemistry, pharmacology, immunology, bacteriology, genetic, molecular biology), as well as the technical developments (e.g. diagnostic, computerization, technical arrangement of the wound, endoscopy, laparoscopy, invasive radiology) have betokened an enormous advance in the development and application of the new surgical approaches and interventions.
I. Period
Hippocrates (5th century B.C.) is the founder of the rational-empiric therapy. He treated the patients, teached the students and described his experiences in the island of Kos. In ”Corpus Hippocraticum” we can read about the technique of bandaging, the treatment of fractures; dislocations; and emphyema thoracis, and even trepanation in details. The elements of asepsis (i.e. to keep clean and to change the bandage) appear in the management of the wounds.
In the middle ages, the ecclesiastical dogmas prevented the development of the medicine in Europe. At that time, the principle of healing was based on the will of God. Surgical interventions were performed by monks in monasteries. They performed the venesection, treated the cataract, and operated the haemorrhoids. Some army doctors -without having any special training -could also treat the patients at that period. It was often a big sacrifice from the side of the sufferer.
In 1543, they published the ”De humani corporis fabrica” in Basel. It was written by Andreas Vesalius (1514-1564) who teached at the University of Padua. In his work, the Flamand - anatomist and surgeon who was born in Bruxellesdisproved more than 200 medical theories, which were accepted till that time. He approved the similarities and differences which exist in the set-up of the living organisms by means of experiments on animal models. The autopsies were big shows in every town and many times the local notabilities were present. These autopsies were usually performed by surgeons, who used their own instruments which were
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used in the living persons later on. In this manner, they could also cause lethal infections plenty of times.
During the siege of Damvilliers in 1552, for the first time since the roman ages Ambroise Pare (1510–1590) used a vascular clamp. He also was the first who applied the ligatures to manage the bleedings.
II. Period: from the discovery of narcosis (1846) until the 1960s.
In 1772, a British scientists called as Joseph Priestley (1733-1804) discovered the laughinggas (N2O, nitrous oxide). In 1800, Humphry Davy (1778-1829), a British chemist, following his experiences determined that the nitrous oxide is suitable for surgical anaesthesia. Horace Wells (1815-1848), an American dentist, used nitrous oxide during a dental extraction in 1844.
On the 16th of October 1846 (”Ether day”), William Morton (1819-1868), an American dentist narcotized a patient in a Massachusetts General Hospital of Boston. The patient was under analgesia during a major surgical intervention. This was the first public demonstration of a surgical intervention in which the patient was narcotized by ether. Morton in cooperation with C. Jackson, who was a chemist, discovered the ether and first performed a selfexperiment in Boston. He used a bulb which had two openings. In the inner one he put pieces of sponge which were impregnated in ether. The patient inhaled the gas and after an initial anxiety he falled asleep shortly after it. A neoplasm of the left jaw was removed by professor John Collins Warren in 5 minutes. After the patient became consciuos he declared that he did not feel any pain during the operation. This success opened a new era in treatment of surgical patients. In 1847, Oliver Holmes introduced the conception of ”anaesthesia”.
In 1847, Ignác Semmelweis (1818–1865), a Hungarian obstetrician, introduced the compulsory hand-washing with chlorinated lime to prevent the puerperal fever. It was obligatory for all doctors, medical students, as well as the nurse staff. Thereafter, the mortality rate of women, who were in labour, decreased from 30% to 1%. It unambiguously proved that decomposing organic matter on the specialists’ hands, who made the examinations and treatments, propagated the mortal disease. In 1847, Kolletschka, who was a professor of forensic medicine, died in sepsis following an injury during an autopsy. Based on the report of autopsy of Kolletschka, Semmelweis determined that his septic clinical picture was similar to those seen in autopsies of women who died in puerperal fever. He recognized the common cause: The corpusles from the dead body could enter into the blood stream. Semmelweis had to face many rejections when he introduced the effectiveness of hand disinfectioning.
The Hungarian surgeon, János Balassa (1814-1868) was the first one in Hungary who applied ether narcosis. He was 28 years old when they nominated him as the head of the department of the Surgical Diseases. He was a professor of surgery, obstetrics and ophthalmology. He established and made internationally known the independent Hungarian Surgery by his multifaceted surgical works and publications. He took part in the preparation of the universities educational reform and in the organization of modern surgical education. He worked out numerous operative procedures. He established the urological surgery. He performed a large number of urinary bladder incisions and the disintigration of the stones. He applied new methods in the field of the plastic (reconstructive) surgeries. His written works are of great importance in abdominal hernias and plastic surgeries. He set up the Medical Weekly Journal in 1857, which is the fifth one among the oldest medical journals all over the world and also a
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part of the Hungarian Cultural Heritage. He was contemporary with the Pál Bugát (17931865), who created many (medical) words and so the main parts of those words which are used nowdays in the medical literature are orginating from him.
1860. Louis Pasteur (1822–1895) worked out the “germ theory”. He also assumed that microscopic particles, which are originated from the surrounding tissues, cause wound infection and pus formation.
1861. Sándor Lumnitzer (1821-1892), a Hungarian surgeon, effectively dealed with the plastic surgery. He was an excellent traumathologist and introduced many technical innovations.
1867. Sir Joseph Lister (1827-1912), who was a professor of surgery in Glasgow, based on the “germ theory” of Louis Pasteur introduced the disinfectioning processes in surgery. He believed that even in the case of a complicated fracture there is only a need to inject a material into the wound which can kill the septic germs. Lister found the carbolic acid (phenol) as an effective material for this purpose. In the operating theatre Lister sprayed carbolic acid onto the operative area, onto the instruments and bandages, and even onto the air. His ”antiseptic theory” revolutionized the surgery, since the surgeons were incapable of managing the wound infection until that time. Hümér Hültl (1868-1940) played an important role in the spread of the antiseptic surgery in Hungary.
1878. Emil Theodor Kocher (1841-1917), a Swiss surgeon, edited his book about the surgical removal of goitres. He paid more attention to the courses of the vessels than his ancestors. He avoided the injury to the recurrent laryngeal nerve.He also saved the neck muscles resulting to good cosmetic results. In 1909 he was awarded the Nobel Prize for his work on the thyroid gland.
1879. Jules Émile Péan (1830-1898), a French surgeon, resected the stomach partially due to a pyloric cancer and then sewed the remaining part to the duodenum.
1881. Theodor Billroth (1829-1894), an Austrain surgeon, performed the first successful gastrectomy.The patient survived the intervention.He carried out the first oesophageal resection and the first total laryngectomy. In his experiments, he developed the optimal methods for surgical treatment of the cancers of the bladder and intestines.He applied the statistical analysis in medicine.
1886. Gustav Adolf Neuber (1850-1932), a surgeon from Kiel, applied the aseptic treatment of wounds aimfully to prevent the infections.
1886. Ernst von Bergmann (1836-1907), a surgeon who introduced the gas sterilization of the instruments in his clinic in Berlin. This was a determinate step towards the aseptic system of work.
1889. Charles McBurney (1845-1913) was an American surgeon. His classic report on early operative interference in cases of appendicitis was presented before the New York Surgical Society in its scientific session. He described that in 99% of cases the symptoms of inflammation are originated from the right lower part of the abdomen (i.e. from the appendix). He determined the area of greatest abdominal pain which is the exact place of the typical muscle guarding (nowdyas, known as McBurney’s point). Later, he set forth in another paper
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the incision that he used in cases of appendicitis, now called McBurney’s incision.
1895. Wilhelm Conrad Röntgen (1845-1923), who was a German physicist, discovered the X- ray which revolutionized the patient treatment. In 1901, he was awarded the Nobel Prize in Physics.
1896. William S. Halsted (1852-1922) was a surgeon at the Johns Hopkins Medical School, who developed the surgical rubber gloves.In 1890 he asked the Goodyear Rubber Company to manufacture thin surgical gloves for his chief scrub nurse (and his later wife) Caroline Hampton) who was suffering of dermatitis due to use of disinfectants. Joseph C. Bloodgood (1867-1935), who was Halsted’s student, initiated the rutine use of surgical gloves in 1896. This method reduced the incidence of the dermatitis, as well as the number of the postoperative wound infections.
1900. Hunter initiated the use of surgical mask. During sterile intervention, all participants use paper or textile cap - which covers their whole hairas well as surgical mask.
1901. Karl Landsteiner (1868-1943), an Austrian pathologist, who discovered the blood groups and described the ABO and Rh systems. He was awarded the Nobel Prize in 1930.
1902. Imre Ullmann (1861-1937) was born in Pécs. He studied and worked in Vienna from 1880. Then he visited Pasteur in Paris and made experiments there. At the Vienna Surgical Society he reported the first case of renal autotransplantation in which the kidney was placed in the the neck of a dog. He did not use any vascular suture. He sewed the ureter onto the skin. The kidney was functioning for five days. Later, he stopped his researches in this field but his results stimulated Carrel.
1902. Alexis Carrel (1873-1944), a French surgeon, developed and published a technique for the end-to-end anastomosis of blood vessels. Thus, he created the surgical basis of the cardiovascular surgery and organ transplantation. He took sewing lessons in Lyon to develop his technique. In 1904, he joined the American physician Charles Guthrie in Chicago. They transplanted vessels, thyroid gland, parathyroid gland, ovarium, tescicle and heart. Carrel was awarded the Nobel Prize for Physiology and Medicine in 1912.
1902. Georg Kelling (1866-1945) the word ”laparoscopy” was used by him which is a Greek word: αραπαλ, meaning soft tissue, and κσcοωεπ meaning inspection.
1904. Ferdinand Sauerbruch (1875-1951) was a surgeon in Berlin. His main professional field was the thoracicand lung surgery, especially the surgeries of alterartions due to tuberculosis. In the Congress of German Surgical Society he demonstrated the pressure equalizing process invented by him.
1907. Gyula Dollinger (1849-1937) was a surgeon, who founded the Hungarian Surgical Society.
1907. Hümér Hütl (1868-1940). According to the Hungarian surgical belief, Victor Fischer (an ingenious designer of surgical instruments) was the inventor of the first surgical stapler that was used by Hümér Hütl. In 1924 Aladár Petz (1889-1953) designed this device further. The Petz-stapler spreaded world-wide as a rutine instrument and became the prototype for future GI staplers.
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