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World Journal of Emergency Surgery | Full text | Angiography and ...

Hence methods of grading the injury cannot be accurately used to distinguish patients at risk of delayed complications [32] and the use of splenic injury grade as the sole criterion for determining management strategy remains controversial [31] .... Figure 5 shows a grade III liver laceration that was initially treated conservatively but the patient required delayed operative management due to clinical deterioration. Complications such as false aneurysm or a posttraumatic ...

Treatment of Traumatic Brain Injury with Moderate Hypothermia — NEJM

Original Article from The New England Journal of Medicine — Treatment of Traumatic Brain Injury with Moderate Hypothermia.

Case 27-2008 — NEJM

... decreased liver echotexture that was suggestive of edema, with no intrahepatic biliary ductal dilatation, a normal gallbladder, a common bile duct that was 5 mm in diameter, a diffusely hypoechoic pancreas, and a normal spleen. ...

Splenic Trauma

July 7, 2009 · Posted in TRAUMA · Comment 

26 SPLENIC TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.

1. What is the physiologic role of the spleen?

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In fetal development, the spleen serves as a major site for hematopoiesis. In early childhood the spleen produces immunoglobulin M (IgM) and tuftsin. The spleen also functions as a filter, allowing resident macrophages to remove abnormal red blood cells (RBCs), cellular debris, and encapsulated and poorly opsonized bacteria.

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Facial Lacerations. Controversies

July 8, 2009 · Posted in TRAUMA · Comment 

CONTROVERSIES

14. What controversies exist regarding the care and repair of facial lacerations?

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Facial Lacerations

July 8, 2009 · Posted in TRAUMA · Comment 

33 FACIAL LACERATIONS
Lawrence L. Ketch M.D.

1. What distinguishes facial from other lacerations?

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Appearance is clearly of primary importance. Quality of the final result depends on strict adherence to basic principles of wound management and painstaking technique. Copious irrigation, judicious debridement, gentle tissue handling, meticulous hemostasis, and minimization of sutures combined with early stitch removal are critical to an optimal result. Fine suture and sharp instruments should be used; eversion of the wound margin with layered closure, obliteration of dead space, and lack of tension are mandatory.
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Can Health Care Be Reformed?

July 14, 2009 · Posted in HEALTH CARE · 1 Comment 

100 CAN HEALTH CARE BE REFORMED?
Alden H. Harken M.D.

1. Is health care reform an oxymoron?

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Yes.

2. What is fee for service?

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The doctor establishes the price, and the patient agrees to pay it. This traditional system of exchange has great merit if both parties understand the value of the service provided. If either party (usually the patient) cannot estimate the service value, it is possible (even likely) that the doctor will honestly escalate the service value in a fashion unchecked by the patient’s perceptions. Thus, in a fee-for-service system, medical prices tend to increase.
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Tracheoesophageal Malformations

July 11, 2009 · Posted in PEDIATRIC SURGERY · Comment 

85 TRACHEOESOPHAGEAL MALFORMATIONS
Denis D. Bensard M.D., David A. Partrick M.D.

1. What are tracheoesophageal fistula (TEF) and esophageal atresia (EA)?

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The trachea and esophagus appear as a ventral diverticulum arising from the primitive foregut during the third week of gestation. The trachea and esophagus undergo separation by the ingrowth of ectodermal ridges during the fourth week of gestation. Failure of separation results in anomalous connection of the trachea to the esophagus (i.e., TEF) with or without incomplete formation of the esophagus (i.e., EA).
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Imperforate Anus

July 11, 2009 · Posted in PEDIATRIC SURGERY · Comment 

84 IMPERFORATE ANUS
Frederick M. Karrer M.D., Denis D. Bensard M.D.

1. What is imperforate anus?

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It is a congenital defect in which the opening of the anus is absent or misplaced, usually fistulizing anteriorly to the perineum or genitourinary (GU) tract. Anorectal malformations range from slight anterior malpositioning of the anus to complex cloacal deformities. Children with anorectal malformations commonly have other congenital anomalies, such as the VACTERL association.
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Thoracic Surgery For Non-Neoplastic Disease. Empyema

July 10, 2009 · Posted in CARDIOTHORACIC SURGERY · Comment 

EMPYEMA

10. What is an empyema, and what causes it?

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An empyema is a purulent (infected) effusion. Fluid or blood in the pleural space can be directly innoculated (with bugs) during surgery or trauma (33%) or by contamination from contiguous sites (50%) such as bronchopulmonary infection (most common). Most empyemas are parapneumonic, and the most commonly involved organisms are Staphylococcus aureus, enteric gram-negative bacilli, and anaerobes. Many times, infections are polymicrobial. Often there is no growth of an empyema culture because of effective antibiotic therapy or inadequate culture techniques, particularly with anaerobes.
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Thoracic Surgery For Non-Neoplastic Disease. Pleural Effusion

July 10, 2009 · Posted in CARDIOTHORACIC SURGERY · Comment 

PLEURAL EFFUSION

6. What is a pleural effusion?

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Pleural fluid is generated in normal adults at a rate of 5-10 L per 24 hours in the combined hemithoraces, but normal adults have only 20 mL of pleural fluid present at any time. Pleural effusions develop when there is either increased production or decreased resorption. Pathologic conditions leading to effusions include increased capillary permeability (inflammation, tumor), increased hydrostatic pressure (e.g., in congestive heart failure [CHF]), decreased lymphatic drainage (tumor, radiation fibrosis), decreased oncotic pressure (hypoalbuminemia), or combinations of these.
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Thoracic Surgery For Non-Neoplastic Disease. Tuberculosis

July 10, 2009 · Posted in CARDIOTHORACIC SURGERY · Comment 

TUBERCULOSIS

1. What are the clinical manifestations of pulmonary tuberculosis?

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They can be almost anything or nothing (it has been stated that if you know tuberculosis, you know all of medicine), but the most common symptoms and signs are chronic fever; weight loss; night sweats; and cough, sometimes with hemoptysis. Chest radiograph typically shows upper lobe infiltrates, with or without cavitation, and can be misdiagnosed as a neoplastic process. HIV-positive or immunocompromised patients usually have mediastinal adenopathy, pleural effusions, and a miliary pattern.
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Primary Therapy For Breast Cancer

July 9, 2009 · Posted in BREAST SURGERY · Comment 


62 PRIMARY THERAPY FOR BREAST CANCER
Benjamin O. Anderson M.D.

1. How is breast cancer diagnosed?

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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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Primary Therapy For Breast Cancer

July 9, 2009 · Posted in BREAST SURGERY · Comment 

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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1 Are You Ready For Your Surgery Rotation?

July 6, 2009 · Posted in GENERAL TOPICS · Comment 

Unlike medical rounds, where in order to “keep up” you need to “one up” by quoting a current (preferably yesterday’s) journal article, in surgery, you can flourish by knowing the following references-but you need to know them cold.
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ARE YOU READY FOR YOUR SURGERY ROTATION?

July 1, 2009 · Posted in GENERAL TOPICS · Comment 

Surgery is a participatory, team, and contact sport. Present yourself to patients, residents, and attendings with enthusiasm (which covers a multitude of sins), punctuality (type A people do not like to wait), and cleanliness (you must look, act, and smell like a doctor). Read more

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Queries 2

August 5, 2009 · Posted in Uncategorized · Comments Off 

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Queries 3

August 14, 2009 · Posted in Uncategorized · Comments Off 

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