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Primary Aldosteronism — NEJM

Primary aldosteronism resulting from an adrenocortical adenoma (aldosteronoma), as described by Conn,1 is one of a few potentially curable forms of hypertension. Aldosteronoma is the most common cause of primary aldosteronism. ..... After surgery, hypertension diminishes markedly or resolves in the majority of these patients.2,4 The blood-pressure response to spironolactone treatment before surgery can be a predictor of surgical outcome in patients with aldosteronoma, ...

UQ researchers identify thousands with curable high blood pressure ...

UQ researchers identify thousands with curable high blood pressure. Adrenal venous sampling being performed on a patient with primary aldosteronism to distinguish unilateral (surgically correctable) from bilateral forms. ... Excess hormonal activity by the adrenal glands causes this type of hypertension. When only one of the two adrenal glands is overactive, it can be safely removed, curing the condition. Professor Stowasser said people with hypertension should ask their ...

renal capsular pecoma-a rare cause of surgically correctable renal ...

we report a 40-year-old lady who presented with severe headaches, persistent microscopic haematuria and hypertension requiring anti-hypertensive medication. investigations for secondary hypertension were all normal except for a ct scan. ...

Surgical Hypertension

60 SURGICAL HYPERTENSION
Thomas A. Whitehill M.D.

1. What are the surgically correctable causes of hypertension?

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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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Portal Hypertension & Esophageal Varices. Controversy

CONTROVERSY

32. How should a patient with known esophageal varices be treated to prevent an initial variceal bleed?

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The combination of beta blocker and nitrate is used for primary prophylaxis, but endoscopic band ligation is at least equivalent to pharmacotherapy without the side effects (one third of patients cannot tolerate beta-blockers because of fatigue or bronchospasm, and 20% cannot tolerate nitrates secondary to pounding headaches). These treatments reduce the incidence of an initial bleed from 30% to < 10% and the mortality from 30% to 20%. Endoscopic band ligation was previously suggested for prophylaxis only in class C disease, but mounting evidence suggests that EBL is more effective than pharmacotherapy in all patients. The effect of combined EBL and beta blockade in primary prophylaxis remains to be established but makes great intuitive sense.
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Portal Hypertension & Esophageal Varices

42 PORTAL HYPERTENSION AND ESOPHAGEAL VARICES
Ramin Jamshidi B.S., B.S., Gregory V. Stiegmann M.D.

1. Describe the blood supply to the liver.

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Total hepatic blood flow is roughly 1500 mL/min, or 25% of cardiac output. The hepatic artery normally supplies about 30% of blood flow, and the portal vein contributes 70%. The hepatic artery and portal vein each supply 50% of the liver’s oxygen, however. With portal hypertension, portal flow decreases and the relative contribution of the hepatic artery necessarily increases.
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Surgical Infectious Disease. Management Of Surgical Infections

MANAGEMENT OF SURGICAL INFECTIONS

21. What is the drug of choice for the treatment of an abscess?

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A knife. Surgically drain the abscess. Abscesses have no circulation of blood within them to deliver an antibiotic. The antibiotic, even if injected directly into the abscess, would be worthless because the abscess contains a soup of dead microorganisms and white blood cells (WBCs). Even if the organisms were barely alive, they would not be reproducing and incorporating the antibiotic. The drug most likely would not work at all at the pH and pKa conditions of the abscess environment.
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Risks Of Bloodborne Disease

101 RISKS OF BLOODBORNE DISEASE
Caesar M. Ursic M.D., Doru I. E. Georgescu M.D.

1. What infectious diseases are transmissible via blood transfusion?

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Congenital Cysts & Sinuses Of The Neck

88 CONGENITAL CYSTS AND SINUSES OF THE NECK
Frederick M. Karrer M.D., Denis D. Bensard M.D.

1. What are branchial cleft anomalies?

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Cysts, sinuses, and fistulas that result from incomplete obliteration of the first, second, or third branchial clefts, and are present in early fetal development.

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Intestinal Obstruction Of Neonates & Infants

83 INTESTINAL OBSTRUCTION OF NEONATES AND INFANTS
Richard J. Hendrickson M.D., Denis D. Bensard M.D.

1. What signs or symptoms suggest intestinal obstruction in the neonate?

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Signs and symptoms vary according to the level of obstruction. Proximal intestinal obstruction leads to the early onset of bilious emesis, generally with minimal abdominal distention. In contrast, neonates with distal intestinal obstruction present after the first day of life with bilious vomiting and pronounced abdominal distention. Bilious emesis should always be interrogated further in infants and children.
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j pediatr surg 37:909-911,

Diverticular Disease Of The Colon

48 DIVERTICULAR DISEASE OF THE COLON
Gregory P. Victorino M.D., Jyoti Arya M.D., Lawrence W. Norton M.D.

1. What is a colonic diverticulum?

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A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused by low dietary fiber and constipation.
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Diagnosis & Therapy of Chronic Pancreatitis

41 DIAGNOSIS AND THERAPY OF CHRONIC PANCREATITIS
Clay Cothren M.D., Jon M. Burch M.D.

1. What is chronic pancreatitis?

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The classic syndrome consists of smoldering abdominal pain and evidence of pancreatic insufficiency. Histologically, chronic inflammation results in destruction of the functioning endocrine and exocrine pancreatic cells.
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answers to chronic pancreatitis secondary to alcoholism, http://www ascsurgery com/abstracts/acs/acs0304/htm,

Basic Care Of Hand Injuries

34 BASIC CARE OF HAND INJURIES
Michael J.V. Gordon M.D., Lawrence L. Ketch M.D.

1. What are the goals of hand repair?

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Functional considerations override cosmesis in the treatment of hand trauma. There are no minor hand injuries. Initial diagnosis and management determine the final result; expert secondary repair cannot overcome primary errors in diagnosis or decision making.
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Hepatic & Biliary Trauma. Operative Management Of Liver Injury

OPERATIVE MANAGEMENT OF LIVER INJURY

11. How are acute liver injuries classified?

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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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Hepatic & Biliary Trauma. Surgical Anatomy Of The Liver

SURGICAL ANATOMY OF THE LIVER

7. How many anatomic lobes are present in the liver? What is their topographic boundary?

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The liver is divided into two anatomic lobes, the right and the left. Their boundary lies in an oblique plane extending from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. The three hepatic veins define the division between the lobar segments and the planes of surgical resection. Lobar segments are numbered I-VIII, according to Couinaud’s nomenclature. (See Figure 25-1.)
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Properties In Evaluation Of The Acute Abdomen. Surgical Treatment

SURGICAL TREATMENT

22. If the patient is sick (and not getting better), what should be done?

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After fluid resuscitation, the patient’s abdomen should be explored. An exploratory laparotomy has been touted as the logical conclusion of a complete physical examination.

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Properties In Evaluation Of The Acute Abdomen. Lab Stadies

LABORATORY STUDIES

15. How is a complete blood count helpful?

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1. Hematocrit. If the hematocrit is high (> 45%), the patient is most likely dry or may have chronic obstructive pulmonary disease. If it is low (< 30%), the patient probably has a more chronic disease (associated with blood loss-always do a rectal and test the stool for blood).
2. White blood cell count. It takes hours for inflammation to release cytokines and elevate the white blood cell count. A normal white blood cell count is entirely consistent with significant abdominal trouble. Read more

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Properties In Evaluation Of The Acute Abdomen. Physical Exam

July 7, 2009 · Posted in GENERAL TOPICS · Comment 

PHYSICAL EXAMINATION

7. Are vital signs important?

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Yes. They are vital. If heart rate and blood pressure are on the wrong side of 100 (heart rate > 100 beats/min, systolic blood pressure < 100 mmHg), watch out! Tachypnea (respiratory rate >16) reflects either pain or systemic acidosis. Fever may develop late, particularly in the immunosuppressed patient who may be afebrile in the face of florid peritonitis.
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