European Stars and Stripes (Newspaper) - February 13, 1990, Darmstadt, Hesse                                To your health Many surgeons Sheath the knife what is the difference Between a surgeon and an internist the surgeon armed to the Teeth seeks to overwhelm and control the body the medical Man strives with pills and potions to cooperate with that body even to the Point of making concessions to disease. One is the stance of the Warrior the other that of the statesman. Richard Selzer letters to a Young doctor by Sandra Boodman and Larry Thompson Washington Post these Days Many surgeons Are becoming less like Warrior Sand More like statesmen although like physician Autho Selzer Many surgeons May still consider themselves the glory of Medicine they no longer rely solely on the scalpels and sutures they once wielded with such authority with modern techniques from lasers to new imaging tools surgeons now can select and treat Many diseases that once required difficult and sometimes disfiguring surgery innovative diagnostic devices capable of peering into the most  Region of the body have rendered the Lime honoured practice of exploratory surgery virtually obsolete magnetic resonance imaging introduced in most hospitals in the mid 1980s, uses magnetic holds to provide detailed images of the brain spinal Cord heart Maior blood vessels and 0ints such As the knee cat scans computerized Axial tomography can locale Lumores and provide clearer and More detailed pictures than earlier Lorms of x rays in the last live years some disabling and Pam Lul operations have been completely replaced by much simpler techniques the removal of kidney stones Lor example which once required surgery and weeks of recovery now can be performed with a machine the device called a Lilholt Raptor. Pulverizes and dissolves the stones using sound Waves patients Are also less Likely to Sutler disfigurement these Days a diagnosis of cancer does not automatically mean a woman will lose her breast or a Man wi1 suffer the loss of his prostate with the usual consequence of impotence a decade ago both were common occurrences because of technology we re definitely operating  said David Selzman. Lormer past president of the medical society of the District of Columbia when you operate less patients have fewer complications and Are living longer meanwhile ambulatory surgery centers and outpatient surgery departments have grown tremendously since the mid-1980s, according to the american College of surgeons operations that were once performed Only in hospitals and required several Days stay such As hernia repairs and dilatation and Curettage a common gynaecological procedure that involves scraping the lining of the uterus Are now routinely performed on an outpatient basis in the Field of urology surgeons find they Are doing less the treatment of Hydron Ephrice is a serious condition in which the kidney becomes distended with urine due to a blockage once required corrective surgery that would allow insertion cd a tube to dram the urine now the corrective procedure is performed without cutting with the insertion of a Needle into the patient s Side that can extract and Drain the urine we have flexible instruments that can go up anywhere and Down anything to every part of the  said Seitzman. Similar advances have been made with the treatment of gallstones which now can be pulverized with sound Waves the same Way Lithot raptors destroy kidney stones the elimination of surgery for these conditions has minimized the most typical Post operative complications including infection and the need for a two week hospitalization and a six week recovery period the result is thai in urology today you re Lell with congenital defects or malignancies which May require surgery and that s about  Selzman said most cancers Are increasingly diagnosed and in some cases treated without surgery cutting a patient open to determine the extent and precise location of a tumor has Boon eclipsed by techniques such As Fri and increasingly refined cat scans most imaging x Ray procedures have now replaced exploratory surgery which is a horrible alternative when you consider the consequences Cost risk modern medical techniques such As lasers and imaging tools have made the time honoured practice of exploratory surgery virtually obsolete. And pain said Martin g Begley. Senior staff radiologist at the clinical Center of the National institutes of health the ability to see inside the body without cutting open the patient also helps doctors tailor therapy a Type of Fri scanning called spectroscopy now being used experimentally can Tell whether the tumor is alive or  said Vincent t Devotta or. Chief physician at memorial Sloan Kettering cancer Center in new York with this information physicians will be Able to administer continued on Page 17 looking inside the body 4 techniques Fri in magnetic resonance imaging a Palione is Lii cd inside a Strong Magneto Field Energy in the form of Rad o Waves is then introduced causing the atoms to resonate the atoms in each Type of tissue respond . A computer creates a composite picture it Schui compute ended tomography uses narrow focused a rays. The source of the a rays rotates rapidly around the body and a Detector measures How much radiation passes through the patient the computer sudds an image of a thin slice of the body. Pet scan in positron emission tomography. Radioactive chemicals Are injected into tissue they Emil positively charged electrons when a positron collides with an Electron pairs of photons Ity n opposite directions hitting detectors a chemical map is produced. Ultrasound High frequency sound Waves pro Duce echoes when they bombard tissue. The boundaries Between tissues produce different kinds of echoes depending on the relative resistance of the tissues a computer converts the echoes to an image d q a us is them Page 16 the stars and stripes tuesday  13, 1990