empyema necessitans
Sengstaken-Blakemore tube
A Sengstaken-Blakemore tube is an oro- or nasogastric tube used occasionally in the management of upper gastrointestinal hemorrhage due to bleeding from esophageal varices (distended veins in the esophageal wall, usually as a result of ...
What Is Cancer. Controversy
CONTROVERSY
24. Is axillary lymph node treatment for breast cancer of therapeutic value, or does it merely help select patients who should receive chemotherapy?
What Is Cancer
63 WHAT IS CANCER?
John A. Ridge M.D., Ph.D.
1. What is a neoplasm?
Show answer
A neoplasm is a new growth of tissue (tumor) in which cells grow progressively under conditions that do not prompt the growth of normal cells. A malignant neoplasm (cancer) is composed of cells that invade other tissues and spread.
2. What kinds of cancers are there?
Show answer
Malignant tumors of epithelial (surface tissue) cells are carcinomas. Malignant tumors of mesenchymal (connective tissue) cells are sarcomas. Carcinomas and sarcomas are solid tumors. Hematologic malignancies, such as leukemia, are liquid tumors of mesenchymal origin.
3. What about skin cancers?
Primary Therapy For Breast Cancer
62 PRIMARY THERAPY FOR BREAST CANCER
Benjamin O. Anderson M.D.
1. How is breast cancer diagnosed?
Show answer
A diagnosis requires tissue confirmation by needle sampling or surgical biopsy. Excisional biopsy is the gold standard: the preferred initial diagnostic method has become core-needle biopsy or fine-needle aspiration (FNA). Needle sampling (1) allows complete operative planning, including decisions about lumpectomy margins or the use of sentinel node mapping and (2) does not distort the breast shape or architecture for future clinical breast examination (CBE) and breast imaging.
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Breast Masses
61 BREAST MASSES
Christina A. Finlayson M.D.
1. What are the three parts of breast screening that assist in the early diagnosis of breast cancer?
Show answer
Breast self-examination (BSE) should begin at age 20 years and should be performed monthly. The breast is usually easiest to examine on the days immediately after the menstrual cycle. BSE can be frustrating to patients, particularly when they have fibrocystic changes, because they are not certain what they are feeling or supposed to feel. The BSE technique should be taught early and reinforced regularly. Women who regularly perform BSE present with tumors 1 cm or smaller more frequently than women who do not perform BSE. BSE has yet to translate into a survival benefit, however. Some women are spooked by repetitive false-positive findings. These women need to rely on their physicians to perform a breast examination once a year.
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Surgical Hypertension
60 SURGICAL HYPERTENSION
Thomas A. Whitehill M.D.
1. What are the surgically correctable causes of hypertension?
Show answer
Renovascular hypertension, pheochromocytoma, Cushing’s syndrome, primary hyperaldosteronism (Conn’s syndrome), coarctation of the aorta, and unilateral renal parenchymal disease. Surgical hypertension accounts for 5% of all hypertensive patients.
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Thyroid Nodules & Cancer
59 THYROID NODULES AND CANCER
Robert C. McIntyre Jr., M.D.
1. What is the prevalence of thyroid nodules and cancer?
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Thyroid nodules increase throughout life. Nodules are four times more common in females than in males, and 50% of 50-year-old women have a palpable nodule. After exposure to radiation, nodules develop at approximately 2% annually, reaching a peak at 25 years. Nodules are 10 times more frequent in glands examined by ultrasound, at surgery, or at autopsy. Fewer than 50% of thyroid nodules that appear solitary on physical examination are truly solitary.
Each year in the United States, there are approximately 15,000 new cases and 1000 deaths due to thyroid cancer. Up to 35% of thyroid glands examined at autopsy contain occult papillary cancer (< 1.0 cm).
Hyperthyroidism
58 HYPERTHYROIDISM
Robert C. McIntyre Jr., M.D.
1. What are the symptoms and signs of hyperthyroidism? Show answer
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General:
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Heat intolerance, perspiration, flushing, tremor, sleep disturbance
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Psychological:
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Nervousness, emotional lability, anxiety, aggressiveness, delusions
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Cardiovascular:
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alpitations, tachycardia, supraventricular dysrhythmias
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Respiratory:
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Breathlessness, hoarseness
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Gastrointestinal:
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Increased appetite, weight loss, increased frequency of bowel movements
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Reproductive:
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Gynecomastia, irregular menses
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Bone:
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Osteoporosis
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Other:
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Ophthalmopathy, dermopathy
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2. What causes hyperthyroidism?
Hyperparathyroidism
57 HYPERPARATHYROIDISM
Robert C. McIntyre Jr., M.D.
1. What is the prevalence of hyperparathyroidism (HPT)?
Show answer
There are approximately 100,000 new cases of HPT annually in the United States. Primary HPT occurs in 1 in 500 women and in 1 in 2000 men older than 40 years. Approximately 10% of patients with primary HPT are referred for surgery.
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Inguinal Hernia. Controversies
CONTROVERSIES
36. What are some of the anatomic issues related to inguinal hernias?
Show answer
At issue is the iliopubic tract, which is central to the Anson/McVay anatomic description of the inguinal area and featured in the McVay Cooper’s ligament repair. Although the McVay repair is used in England, the iliopubic tract is not referred to or described in English anatomic texts.
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Inguinal Hernia
56 INGUINAL HERNIA
Gregory P. Victorino M.D., Jyoti Arya M.D., James Bascom M.D.
1. “Groin” hernia refers to which three hernias?
Show answer
Direct and indirect inguinal hernias and femoral hernias.
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Anorectal Disease. Pilonidal Sinus Disease
PILONIDAL SINUS DISEASE
29. What is the most common clinical presentation of a pilonidal sinus?
Show answer
Pain and swelling in the sacrococcygeal region, which typically are associated with a (sometimes several) chronic draining sinus tract.
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Anorectal Disease. Hemorrhoids
HEMORRHOIDS
21. What are hemorrhoidal tissues, and what are their normal functions?
Show answer
Hemorrhoids are cushions of vascular tissue that contribute to anal continence and protect the sphincter mechanism during defecation. Hemorrhoids are not veins, but sinusoids. Bleeding originates from presinusoidal arterioles, thus explaining the bright red arterial color.
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Anorectal Disease. Anal Fissure
ANAL FISSURE
14. What is the most common location for idiopathic anal fissure?
Show answer
90% are posterior, and 10% are anterior.
15. What are the most common symptoms of anal fissure?
Show answer
Tearing anal pain and bleeding with bowel movements.
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Anorectal Disease. Anorectal Abscess & Fistula In Ano
ANORECTAL ABSCESS AND FISTULA IN ANO
5. What is the most common cause of anorectal abscess?
Show answer
Ninety percent result from cryptoglandular infection.
6. What are the four potential anorectal spaces used to classify anorectal abscesses?
Show answer
1. Perianal (area of the anal verge)
2. Ischiorectal (area lateral to the external sphincter muscles, extending from the levator ani muscles to the perineum)
3. Intersphincteric (area between the internal and external sphincter muscles, continuous inferiorly with the perianal space and superiorly with the rectal wall)
4. Supralevator (area superior to the levator ani muscles, inferior to the peritoneum, and lateral to the rectal wall)
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Anorectal Disease
55 ANORECTAL DISEASE
Eric L. Sarin M.D., John B. Moore M.D.
1. What aspect of the initial patient encounter is most important in the diagnosis of anorectal disease?
Show answer
Clinical history, including duration of complaints, exacerbating or alleviating issues, precipitating events, dietary and bowel habits, and current or previous treatments. This may not sound glamorous, but you will never encounter a more grateful patient than one whose rectal problem you have solved.
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
