Plymouth 2008

The conference started with an update by Noritza Torossian from Toulouse. on the teaching of medical English to French medical students. English has been compulsory in French Medical Schools since 1992 but many students are not happy with lessons despite there being more than180 hours of tuition per yearwhich includes reading and writing papers in English. There are formal English examinations in consultation skills with both patients and colleagues. Developments continue with a meeting of interested parties which was held in Paris on 11th October 2008 in Paris (AFMB and AFMS were participants).

Christopher Turnbull discussed the use of a type of Positron Emission Tomography (PET) scanning in the diagnosis of different types of Parkinson’s disease/syndromes entitled “Une évaluation de DaTSCAN dans le diagnostic de la maladie de Parkinson”. There is clinical overlap between different types of Parkinson’s disease; there is a 67% diagnostic error rate in primary care and even specialists make about 20% errors. Main clinical criteria are the encapsulated in the “UKPDS Brain Bank”. In order to address the diagnostic issues in difficult cases one can use a DaTSCAN which uses a cocaine analogue which adheres to the pre-synaptic dopamine transporters in the caudate and putamen nuclei; if uptake is absent or reduced, Idiopathic Parkinson’s is the diagnosis. An audit in Merseyside showed that this scanning modality altered management in 71% of patients in whom the diagnosis was difficult.

The next four presentations were fascinating insights into the lives of famous doctors from the past, both French and English. John Murray discussed John Snow “the first epidemiologist”. However, it turns out that he was famous for the wrong thing, i.e. for establishing that Cholera was a water-borne disease. He was in fact one of the first anaesthetists who, remarkably, did not kill one person with chloroform. Despite this he was credited for describing the 1852 cholera epidemic around Golden Square when there were 5000 deaths surrounding the water pump in Broad Street; most of the work was done by one of his colleagues.

Paul Benfredj gave us an insight into the life of Jean Arnous, “Founder of Proctology” who established the first specialised gastroenterology service in France. He revolutionized the surgery of haemorrhoids, as well as anal fissures and fistulas.

Jean Louis Large spoke on « Le Baron Larrey, chirurgien des armées ». A great humanitarian and fast amputator of limbs, famous for being an egalitarian many years before Political Correctness and anti-racist legislation; he conceived the flying ambulance and front line surgery. Napoleon’s great doctor, he was recognised by both Napoleon and the enemies of France as a great man.

We have all heard of Nissen’s fundoplication and Walford Gillison talked about Rudolf Nissen, a pioneer in oesophageal surgery. His mother was Jewish which meant he had to leave Nazi Germany and, via Turkey and the USA, he eventually settled in Switzerland. The operation was initially used for penetrating injury of the stomach and when he met an old patient whom he had treated for this who, by chance, had his reflux cured; he started to use “fundoplication” to treat oesophageal reflux.

Friday kicked off with Nicola Strickland illustrating her presentation with many excellent pictures. “The contribution of MRI to Oncology”, much discussion followed.

There are clearly many facial surgery experts in France and we were treated to a Tour de Force by Lauront Guyot from Marseille. He discussed newer ways to address abnormalities of facial structure that require surgical correction as well as those changes associated with ageing; addressing not only the skin, but also the skeletal structure and the teeth. Functional assessment of the whole facial structure is key to this approach in order to ensure a good cosmetic result.

Being a Diabetologist myself I was like a rabbit in headlights listening to Prof. Terry Wilkin from the Peninsula Medical School treating us to probably the most fascinating series of figures and statistics that this author has heard for some time. He spoke about a type 2 pre-diabetic study in children looking at physical activity (measured electronically), gas exchange and blood flow as well as bone density. There were many non-intuitive findings that politicians (and the profession) will have to inwardly digest: e.g. children taken to school by car expend have the same energy, when other activities are measured, as those who walk. Another observation is that poorer children compensate for less physical activity at school by increasing it outside. Importantly, excessive weight gain occurs between birth and 5 years of age and then tends to flatten out. So, the anti-obesity boat has been missed by the time children start school! Moreover, the median Body Mass Index (BMI) has not changed since 1990, whereas the top quartile has, suggesting that there is not an epidemic of obesity and insulin resistance, but rather a problem with a sub-group of the population. This seems to be a relationship between the obesity of mothers and obesity within their daughters; AND between fathers and sons……

Six students competed for the James Tudor Prize of £800, this was a closely-run race, won by Thomas Kelly from Manchester.

After a fantastic Gala Dinner in the Officers’ Mess at the home of the Royal Marines hosted by “Colours” (a Royal Marine Colour Sergeant) with many delegates retiring “tired and emotional” the last session was, rather amazingly perhaps, attended by a large majority of delegates…..

Paul Ward (Plymouth) updated us on childhood cancers with many excellent photographs and images. He also outlined the issues faced due to nearest Specialist Centre being in Bristol, 2 hours drive away.

This was, appropriately, followed by another keynote address by Prof. Bertrand Macé facing up to the problems faced by childhood cancer survivors who often have problems with fertility due to the success of the selective poisons used to cure them of their previous cancers. Ongoing developments include trying to generate spermatozoa from pre-pubertal testicular tissue which can then be used for Intra-Cytoplasmic Spermatozoa Injection (ICSI). Research continues in mice and now is starting in humans.

The last session was an HIV/AIDS session led by Annie Van De Wielle and Rex Melville. After a detailed tour of the virology of HIV from Annie Van De Wielle, Rex Melville spoke about his clinical experiences in Burundi, Africa. Some anti-retroviral drugs are now free whereas almost all non-HIV related illnesses still demand payment from (poor) African patients (at least in Burundi). Point of care testing is now becoming available and this will allow cheaper and so, more, testing for HIV. Essentially there are now local guidelines which are being implemented by local Health Care Staff, this permits “buy in”; and after diagnosis even second-line therapy is available. Nevertheless, this is precarious and slow progress.

Overall the 25th conference was a great success and many thanks are due to the local organisers, Paul Ward and Sean Bennett.