Official Publication of the FAR EASTERN UNIVERSITY Dr Nicanor Reyes Jr School of Medicine Alumni Foundation ECTOPIC MURMURS Volume 21 Number 5 December 2010 Opinions and articles published herein are those of the authors and do not necessarily reflect that of the FEUDNSM Alumni Foundation th 36 Annual Balik -FEU DR DANIEL FABITO is Dean To attend the 36 th annual Balik-FEU scientific program, Lauro Panganiban memorial lecturer simply arrive first thing in the DANIEL FABITO MD as leader, general surgical surgeon, morning on the first day, Thursday, January 13, 2010, at the 33 rd annual Dean Lauro golfer, father, and husband. 64 the FEU-NRMF Dr Ricardo Panganiban memorial lecturer He belongs to Class . He Alfonso Conference room, and will speak on surgical had a rotating internship and register for the meeting, where management of abdominal residency at the Evangelical you can also reserve and pay the aortic aneurysm: the silent Deaconess Hospital of fee to attend for the Saturday, killer on Milwaukee WI, and later at the January 15, 2010 grand reunion Thursday University of Missouri and dinner dance to be held at morning, Missouri Baptist Medical Crowne Plaza Galleria at January 13, Center in St Louis MO. Ortigas and EDSA. Class 57 , Class 58 , Class 59 , 2010 at the He had a busy practice in 60 61 85 FEU- general, vascular and bariatric Class Class , and Class are free. NRMF Dr surgery in the St Louis area for Fees for the rest are, as DANIEL Ricardo at least 35 years. He was also follows: life members P500, and FABITO MD Alfonso affiliated with St Louis spouses/ guests P1200. Conferen University School of Medicine To be certain of your Room. Dr Fabito is the epitome as a clinical associate professor registration and reservation, you of a student leader, medical continue to page 13 can also email so for this purpose the alumna in charge of the MESSAGE from the event, LINDA TAMESIS MD, BOARD CHAIRMAN [email protected] continue to page 11 Philippines. Although I do not get home as often as I would MESSAGE from the President like, I can well remember the The contracts for the beginnings of the 2011 events were signed. The Christmas Winter Board meeting will be Season. held in Long Beach CA. The The first signs are date is March 26, 2011. the Christmas Renaissance Hotel will be the songs ringing out site of our board assembly. PEPITO C RIVERA MD from the radio. Twenty (20) rooms have been I wrote this column in early This is quickly reserved for Friday, March October. It brings to mind that OSCAR C 25 th and Saturday, March 26th followed by TUAZON MD Christmas preparations are displays of lovely rooms. The rate is $99/night. already in the process in the decorations The hotel is a sister company continue to page 13 of the Marriott Hotels. continue to page 12 Abstract proportional to aneurysmal flank, or abdominal pain and ABDOMINAL AORTIC diameter and intraluminal or varying degree of shock. Distal systolic blood pressure and embolization, thrombosis and ANEURYSM inversely related to wall thickness. duodenal or ureteral compression The Silent Killer* The incidence of AAA has can produce symptoms. DANIEL C FABITO MD 64 increased significantly and is Fifty percent of AAA are The attributed to increased detection identifiable on physical management of with the use of ultrasound and examination as a pulsatile mass at abdominal computer tomographic (CT) scan or above the umbilicus. aortic and aging population. Small Radiological evaluation includes aneurysm (<5 cm) account for abdominal cross-table lateral films, aneurysm 50% of all recognized AAA which ultrasonography, CT scan and (AAA) is important since much of the magnetic resonance imaging. requires uncertainty surrounding Operative approach is either the DANIEL understanding management concerns aneurysm traditional midline abdominal FABITO MD of the natural <5.5-cm AAA are diseases of the incision or left retroperitoneal, history, elderly diagnosed in the 6 th and 7 th especially obese patients, those diagnosis and treatment decades of life. with COPD, or with previous modalities. The development of Rick factors include intraabdominal surgeries. Unstable endovascular procedures has hypertension, chronic obstructive patients with presumed diagnosis added management option in pulmonary disease, smoking, of ruptured AAA are gently treating AAA. A carefully atherosclerosis, male gender, resuscitated and transferred to the family history of AAA, and operating room for surgery. planned elective treatment peripheral arterial disease. The Endovascular aneurysmal repair before elective surgical expansion rate of AAA is 2-3-mm (EVAR) was introduced by resection before complication of per year and increases as the Parodin in the early 1990s and is rupture, thrombosis and aneurysm enlarges. Twenty now the operative approach for embolism continues to provide percent of AAA expand at a rate of half of AAA treatment in the the best results. Mortality for more than 4-mm per year. While United States. Approved by the elective repair at 2 to 5% and 80% grow at a slower pace. FDA in 1997, the first device for ruptured aneurysm repair with Population-based studies in the EVAR, and since then with 50–70% repair underscores the 1990s show that rupture risk does expanded use, it has a positive importance for early recognition not increased until the aneurysm impact in the mortality associated and proper treatment of AAA. diameter has reached 5 cm. with AAA repair. EVAR involves Rupture risk for small aneurysm, passage of self expandable, Aneurysm results with the e.g., <5 cm, is 1% per year; 5-10% covered stent into the aorta loss of structural integrity of the per year for medium-sized (5.5 to through the femoral artery using arterial wall, namely 7 cm) aneurysm, and 10 to 25% fluoroscopy and contrast degradation of the network of per year for large (>7-cm) arteriography. EVAR is associated structural proteins, such as aneurysms. reduction of perioperative elastin and collagen in the In the UK, small aneurysm and morbidity and mortality, shorted middle and outer layers. The the detection and management, duration of hospitalization and less weakening advances to according to the Adam Trial has blood transfusion. dilatation and aneurysmal shown no benefit to early open Currently, 5.5-cm AAA is the formation, which is at least 1.5 repair of aneurysm between 4 to appropriate threshold for repair. times the normal diameter of 5.4-cm. Safe observations of these There is no justification that aneurysms include ultrasound EVAR should change accepted the aorta. The risk of rupture is every 3–6 months. All good-risk size threshold for repair between described by the law of Laplace patients presenting with aneurysm open repair and EVAR. which places arterial wall stress 5.5-cm or larger undergo a contrast Patients’ preference is also of in relation to vessel diameter enhanced aortic CT scan and are great importance; and patients and arterial pressure. Rupture offered endovascular repair. should be well informed to make occurs when the intraluminal About 75% of AAA are such choices. pressure exceeds the tensile asymptomatic and are found rd strength of the wall of the aorta. incidentally. Aneurysm expansion *33 Annual Dean Lauro The risk of rupture is therefore or rupture may cause severe back, Panganiban Memorial Lecture IF YOU DREAM profession. To me, it was a that each class of alumni be dream coming true. I call it the asked to donate $2,000 as early IT, DO IT #3 best days of my life. Those days as possible. I exchanged letters THE STORY OF had given me an evergreen with Dr de la Rosa and assured 42 MICROSCOPES impact in my mind, a him that we were working hard CESAR D CANDARI MD 61 dreamer who was ready to to grant his request. In 1998, during the embrace life with passion. Thereafter, on July 12,1999, chairmanship of Dr Daniel I believe that we gain a lot I wrote a letter to each class more than just an education president, from Class 57 to Fabito of the 89 FEUDNRSM from our medical school Class and the jubilarians. This Alumni and it is imperative that we try letter was also printed in the Foundation, I to give back as much as we can. ECTOPIC MURMURS. was the vice- We must realize that we are Dear… president of the giving back for the future and Our medical school in the board trustees. continued development of our new facility in Fairview, institution. Our donations go a Quezon City, will soon be CESAR I was assigned CANDARI MD to chair an ad- long way to sustain our Alma inaugurated. hoc committee to respond to the Mater in its regular programs In the recent Board of letter of Dr Liberato C de la and initiatives to support Trustees meeting in Atlantic Rosa, chairman of the deserving students. It will help City on July 9, 1999, I department of Microbiology improve the education and presented a request from our and Parasitology, FEU-NRMF, curriculum being offered by our medical school for 60 brand- Institute of Medicine. I was alma mater. I have volunteered new microscopes that are extremely happy to chair this my time as service to give back, intended for the medical committee (for no reason, there realizing that I am helping students in the Department of was no members). It has given someone gain the valuable asset Microbiology and Parasitology. me the inspiration and of a quality education in my The Board of Trustees has enthusiasm to be of service to medical school. approved this request in our organization. To me, it was Dr de la Rosa to Dr.