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Zosyn Injection (Piperacillin and Tazobactam Pharmacy Bulk Vial ...
In a prospective, randomized, comparative, open-label clinical trial of pediatric patients with severe intra-abdominal infections (including appendicitis and/or peritonitis), 273 patients were treated with Zosyn (112.5 mg/kg every 8 hours) ..... The half-life of piperacillin and of tazobactam increases by approximately 25% and 18%, respectively, in patients with hepatic cirrhosis compared to healthy subjects. However, this difference does not warrant dosage adjustment of ...
Critical Care | Full text | Intraoperative fluid optimization ...
The trial was approved by local research ethics committee and all patients gave their informed consent. High-risk patients scheduled for major abdominal surgery with anticipated operation time longer than 120 minutes or presumed blood loss ...... Lee A, Bindi L, Bisa M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F: Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. ...
Prevention and Treatment of Major Blood Loss — NEJM
YF Shao, JM Yang, GY Chau, Safety and hemostatic effect of recombinant activated factor VII in cirrhotic patients undergoing partial hepatectomy: a multicenter, randomized, double-blind, placebo-controlled trial.. Am J Surg 2006;191:245-249 .... (2010) Role of Factor VII in Correcting Dilutional Coagulopathy and Reducing Re-operations for Bleeding Following Non-traumatic Major Gastrointestinal and Abdominal Surgery. Journal of Gastrointestinal Surgery 14:8, 1311-1318 ...
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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Penetrating Abdominal Trauma
24 PENETRATING ABDOMINAL TRAUMA
Clay Cothren M.D., Ernest E. Moore M.D.
1. Why is there a different approach to stab and gunshot wounds?
Show answer
Whereas one third of stab wounds to the anterior abdomen do not penetrate the peritoneum, 80% of gunshot wounds violate the peritoneum. Furthermore, penetration of the peritoneum by a bullet is associated with visceral or vascular injuries in > 95% of cases, whereas only one third of stab wounds violating the peritoneal cavity produce significant injury. (See Figure 24-1.)
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Properties In Evaluation Of The Acute Abdomen. Lab Stadies
LABORATORY STUDIES
15. How is a complete blood count helpful?
Show answer
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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, acute abdomen lab, acute adbomen, lab activity on evaluation of the abdomen, labs air in stomach, recovery free air in abdomen, symptoms of mesh rejection, three way of the abdomen,Abdominal Aortic Aneurysm
71 ABDOMINAL AORTIC ANEURYSM
Mark Nehler M.D., William C. Krupski M.D.
1. What is an abdominal aortic aneurysm (AAA)?
Show answer
A ≥ 50% increase in normal aortic diameter. Normal infrarenal aortic diameter is 2.0 cm for men. A definition of AAA as an aorta ≥ 3.0 cm in diameter is appropriate.
2. What is the incidence of AAA?
Abdominal Tumors. Controversy
CONTROVERSY
6. Should patients with hepatoblastoma receive preoperative chemotherapy to shrink the tumors?
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CONTROVERSY
14. What is the role of laparoscopy and thoracoscopy after penetrating abdominal trauma?
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Although an intriguing diagnostic modality with additional therapeutic capabilities, laparoscopy thus far appears to have limited application after trauma. With the exception of suspected diaphragmatic injury, an isolated solid organ injury, or evaluation for peritoneal penetration, laparoscopy has yet to demonstrate advantages over the algorithm delineated above. The potential for missed injuries, poor evaluation of the retroperitoneum, and expense are major drawbacks. In patients with wounds to the lower chest with pneumothorax (and, thus, an indication for chest tube placement), thoracoscopy is reasonable to exclude diaphragmatic injury.
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PHYSICAL EXAMINATION
7. Are vital signs important?
Show answer
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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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.
Intestinal Ischemia. Controversies
CONTROVERSIES
30. What is celiac compression syndrome (Dunbar’s syndrome)?
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Celiac compression is a rare and controversial disorder most commonly described in women (female-to-male ratio = 4:1) between the ages of 20 and 50 years. Patients appear to suffer from chronic mesenteric ischemia without angiographic evidence of atherosclerotic disease. The mechanical compression is believed to be caused by the left crus of the diaphragm (i.e., marginal arcuate ligament), and diagnosis occasionally is confirmed by demonstrating transient celiac compression during expiration. The associated pain is the result of a complicated and still heavily debated redirection of flow (foregut steal) away from the SMA. Effective treatment has required not only release of the compression but also bypass to improve the likelihood of pain resolution.
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Blunt Abdominal Trauma
23 BLUNT ABDOMINAL TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What elements of the history are important in evaluating a patient with suspected blunt abdominal trauma (BAT)?
Show answer
First, the mechanism of injury (e.g., motor vehicle collision, automobile-pedestrian accident, fall) is important. In motor vehicle accidents, note the position of the victim in the car, velocity of impact (high, moderate, low), type of accident (front, lateral, or rear impact; side swipe; rollover), and type of restraint used (shoulder restraint, air-bag, lap belt). Information about damage to the vehicle, such as a broken windshield or bent steering wheel, may raise suspicion of cervical and chest injuries. In a fall, it is important to note the distance fallen and the site of anatomic impact. Vertical landing on the feet or in a sitting position causes a different pattern of injury than lateral landing on the side. Serial vital signs and mental status are always important.
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Abdominal Tumors
87 ABDOMINAL TUMORS
Frederick M. Karrer M.D., Denis D. Bensard M.D.
1. What are the most common malignant solid abdominal tumors in children?
Show answer
Neuroblastomas, Wilms’ tumors, and hepatoblastomas, in that order. Neuroblastomas are derived from neural crest tissue; in the abdomen, they originate from the adrenal glands and paraspinal sympathetic ganglia. Wilms’ tumor (nephroblastoma) derives from the kidney, and hepatoblastomas originate in the liver.
2. Is it tough to differentiate Wilms’ tumor from neuroblastomas clinically?
Show answer
Yes. Both tumors present as an asymptomatic abdominal mass. The differences are summarized in Table 87-1. In addition, because neuroblastomas produce hormones, affected children may exhibit flushing, hypertension (catecholamine release), watery diarrhea, periorbital ecchymosis, and abnormal ocular movements.
Table 87-1. DIFFERENTATION BETWEEN WILMS’ TUMOR AND NEUROLASTOMA
|
Wilms’ Tumor
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Neuroblastoma
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|
|
Age at presentation
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3-4 yr
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1-2 yr
|
|
Extend across midline
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Rare
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Common
|
|
Surface on palpation
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Smooth
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Knobby
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|
X-ray calcifications
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No
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Yes
|
3. How are Wilms’ tumors and neuroblastomas treated?
Table 87-2. TREATMENT OF WILMS’ TUMOR AND NEUROBLASTOMA
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Wilms’ Tumor
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Neuroblastoma
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|
|
Primary surgical excision
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Important (likely)
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Important (less likely)
|
|
Chemotherapy
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Enormous impact
|
Less responsive
|
4. What are the major prognostic factors in neuroblastomas and Wilms’ tumor?
In neuroblastomas, age at presentation is the major prognostic factor. Children younger than 1 year have an overall survival rate > 70%, whereas the survival rate for children older than 1 year is < 35%. Shimada proposed a prognostic classification based on evaluation of histologic parameters (tumor differentiation, mitosis-karyorrhexis index [MKI]) as well as age. Aneuploid tumors, tumors with low MKI, and tumors with < 10 copies of the n-myc gene also have better outcomes.
Age is also important in children with Wilms’ tumors, but the prognosis is better because the tumors are more readily excised and much more sensitive to chemotherapy.
5. What are the differences between hepatoblastomas and hepatocellular carcinomas? How are the tumors treated?
Hepatoblastomas usually occur in infants and young children, whereas hepatocellular carcinoma usually occurs in children older than 10 years. Hepatocellular carcinoma usually is associated with cirrhosis and hepatitis B and is histologically identical to the adult form. Surgical resection is the primary therapy for both tumors. Hepatoblastomas often have a good response to adjunctive chemotherapy, whereas hepatocellular carcinoma rarely responds to chemotherapy.
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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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Urinary Calculus Disease
94 URINARY CALCULUS DISEASE
Bretat B. Abernathy M.D.
1. What are the most common types of urinary stones found in North America?
Show answer
* Calcium stones (calcium oxalate, calcium phosphate, or mixed calcium stones): 70%.
* Struvite or magnesium ammonium phosphate stones, often associated with infection: 20%.
* Uric acid stones (radiolucent): 5%
* Cystine stones, often with a genetic association: 5% Read more
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22 PENETRATING THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with penetrating chest wounds need an operation?
Show answer
Surprisingly rarely. Most civilian penetrating injuries are from knives and low-energy handguns. Consequently, although injuries to the chest wall and lung are common, the majority of patients can be treated with tube thoracostomy alone. Formal thoracotomy or median sternotomy is required in < 15% of isolated penetrating chest injuries.
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56 INGUINAL HERNIA
Gregory P. Victorino M.D., Jyoti Arya M.D., James Bascom M.D.
1. “Groin” hernia refers to which three hernias?
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Direct and indirect inguinal hernias and femoral hernias.
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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
