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In memory of Prof. Ahmed Shafik

PROFESSOR AHMED SHAFIK (1933 - 2007)

On October 31st, 2007, Professor Ahmed Shafik untimely passed away from cardiac insufficiency.

Ahmed Shafik was born in Shebin-elKom, Menoufia Governorate, Egypt, in May 1933. He graduated from the governmental high school in 1951 and completed his undergraduate studies at the Cairo University Faculty of Medicine in 1957. He worked his way from house officer through professor of general surgery (in 1975), and was elected Chairman of the Department of Surgery and Experimental Research at the same Faculty in 1990.

Ahmed was a member of our Journal’s Editorial Board and the Honorary President of the Mediterranean Society of Coloproctology, whose biennial congress was held in Cairo under his supervision, two years ago. We still remember his generous support and his live surgery session held at the Shafik’s Hospital in the Center of the town.

To follow there is a compendium of Ahmed Shafik enormous contribution to science and to Coloproctology, partly taken from the website of the Ahmed Shafik Foundation for Science and kindly supplied by his son Ali.

A surgeon by profession, Shafik was also a tireless and obsessed researcher who, without the support of any funding of whatever size at whatever time (at least this is what his website reports), has made more than 1000 contributions to medical science, many of which being fundamental research and landmark entries, if not turning points, in medical knowledge. It was the merit of his digging down to the roots of unknown or controversial issues, and of his questioning what is commonly accepted or taken for granted in anatomy, physiology and pathology, that a great number of entities have been added to basic science and others been amended.
In 1963, he was forced to abandon his work for 3 months when he was developing his new technique for urinary diversion which was later published in the Journal of Urology and is known internationally as 'Shafik I'. Likewise in 1964, when he was working on fashioning a bladder substitute, an operation he published in the British Journal of Urology which the literature refers to as 'Shafik II', the Establishment interfered to detain him from work for a full 12 months.
At another time, in 1967, he surprised the world with the first ever known successful bladder transplantation which, however, put him up in disciplinary measures with the administration. Yet with the results of his operations speaking up for themselves, he felt encouraged rather than demoralized. It was urological research that stimulated his investigations into a side branch, andrology, to reveal new anatomical, physiological and pathological evidence. Amazingly enough, it was also urology that was behind Shafik's sudden breakthrough into proctology in 1974: while seeking new anatomical support for new surgical methods for urinary continence, he was more than surprised to find the anal sphincter mechanism differing basically from the descriptions in the scientific literature. This revolutionary discovery, published in Investigative Urology, was the first towards major changes in the anatomy of the anorectal region. The many findings he introduced in coloproctology, gastroenterology, urology, andrology, gynecology and endocrinology, made him discover important interdisciplinary relations in the intricate conception of the pelvic floor.

While revisiting the anatomy of the pelvic musculature, e.g. the novel concept of the triple loop of the external sphincter, he has likewise added information on missing links in the functional roles of both the gastrointestinal and genital tracts when he revealed reflexes that constitute the responsible coordinators in deglutition, and another group of reflexes which control genital functions and sexual performance including coitus in both sexes.
He liked to invent and perform novel operations or describe new physio-anatomical pattern, more than carry out metanalyses or prospective controlled trials, which is now considered less and less scientifically correct. Neverthless his findings often stimulated other more orthodox researchers to develop his pioneering intuitions.

His anatomical and physiological studies provided him with the clues leading to the description of 19 syndromes and dozens of other pathologies which had not yet been described. He created animal models in order to ease and support experimental work on diseases.

Naturally for Shafik, the newly acquired knowledge of pathologies and their etiologies was conducive to the development of clinical applications.
Shafik created also highly effective non-surgical alternatives like nerve stimulation and non- or mini-invasive therapies in an attempt to reduce or even avoid surgical intervention whenever possible. The most prominent of the injection techniques he devised is the very successful submucosal anal injection which uses the rectourogenital communicating veins as a new and direct route for drug administration in pelvic malignancies such as advanced cancer of the bladder, prostate, uterus, the cervix, and the rectum.

He invented and developed a drug, Raca 85, a promising immunomodulator with striking bactericidal and antiviral effects. In addition to its impressive results in oncology experiments, Raca surprised in rheumatoid arthritis, lupus erithematosis, conjunctivitis, asthma, and autoimmune disorders. Despite opposed by ethical criticisms ( a not infrequent problem in Shafik work), subsequent trials showed that the immunomodulating properties of the drug had a marked potential to reduce the devastating side effects of chemotherapy.

He also made several advances in medical and biological engineering. To simplify the procedures of clinical assessment, for example, Shafik took advantage of electric activity, which is generated by the rectum and sigmoid colon, the urinary bladder, kidney, ureters and vas deferens as well as the uterus, oophora and oviducts, esophagus, choledochus, gall bladder and last not least the liver, in order to develop the transcutaneous electrography for their evaluation. Likewise, he introduced the fecoflowmeter for the assessment of the rectal function, and the rectosigmoid pacemaker for the treatment of disordered defecation.
Amhed Shafik was awarded the Egyptian state prize for science and arts, first class, in 1977, and was honored for the best presentation in congress at various scientific events. In 1981, he was nominated for the Nobel prize in medicine.