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Pulmonary Roundtable: Solitary pulmonary nodule
Solitary pulmonary nodule. I recently saw a 62-year-old woman with a past medical history of fibromyalgia who received a CT scan for chest pain, which picked up an incidental pulmonary nodule. She is asymptomatic; no shortness of breath or ... Presuming there are no mediastinal nodes, I think either of two approaches is reasonable: The boards answer here would be to refer to CT surgery for a wedge resection and, if the frozen or final path are + proceed with a lobectomy. ...
Transthoracic esophagectomy and lobectomy performed in a patient ...
One of the two pulmonary nodules was histologically diagnosed as metastasis. When esophageal perforation occurred during palliative therapy, esophagectomy became necessary together with the right lower lobectomy for the removal of the ...
Intrapulmonary glomus tumor in a young woman -- De Cocker et al ...
A 21-year-old female patient presented with pneumonia and on chest roentgenogram a solitary pulmonary nodule was incidentally found. After an observation period she underwent left upper lobectomy because of documented tumor growth. ...
Solitary Pulmonary Nodule
80 SOLITARY PULMONARY NODULE
Jamie M. Brown M.D., Marvin Pomerantz M.D.
1. What is a solitary pulmonary nodule?
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A solitary pulmonary nodule or “coin lesion” is < 3 cm and is discrete on chest radiograph. It is usually surrounded by lung parenchyma.
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should an infectious solitary pulmonary nodule be removed,Thyroid Nodules & Cancer
59 THYROID NODULES AND CANCER
Robert C. McIntyre Jr., M.D.
1. What is the prevalence of thyroid nodules and cancer?
Show answer
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).
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aortic arch medullary cancer thyroid, abernathys surgical secrets thyroid nodules, can a follicular benign thyroid nodule change to cancerous in few months, debulking berry picking surgical non toxic goiter, hurthle cell thyroid nodule, multiple thyroid nodules, thyroid nodule at aortic arch, thyroid nodules vagus nerve, us thyroid multiple nodules, what is inferior thyroid nodule, \hurthle vegus\,What Is Pulmonary Insufficiency?
5 WHAT IS PULMONARY INSUFFICIENCY?
Alden H. Harken M.D.
1. What is pulmonary insufficiency?
how answer
The alveolar-capillary surface of the lung is the size of a singles tennis court. The purpose of the lung is to match alveolar ventilation (Va) to blood flow (Q). Mismatching leads to pulmonary insufficiency.
2. How is Va/Q mismatching characterized?
Show answer
Shunt: decreased ventilation relative to regional blood flow; pulmonary arterial (unoxygenated) blood “shunts” by hypoventilated alveoli
Dead space: decreased pulmonary regional blood flow relative to ventilation
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Central Venous & Pulmonary Artery Pressure Monitoring
12 CENTRAL VENOUS AND PULMONARY ARTERY PRESSURE MONITORING
Dipin Gupta M.D., Glenn J.R. Whitman M.D., Alden H. Harken M.D.
1. What does a catheter in the central venous circulation measure?
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All intrathoracic veins have nearly the same pressure. A catheter in the central venous circulation (anywhere) measures this central venous pressure (CVP) (or right atrial pressure). CVP, plus a little right atrial “kick,” pushes blood into the right ventricle. This right ventricular “filling pressure” is also termed preload.
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pulmonary artery catheter central venous pressure and saturation, wedging svo2,Cardiopulmonary Resuscitation
2 CARDIOPULMONARY RESUSCITATION
Norman A. Paradis M.D., Alden H. Harken M.D.
1. Define sudden cardiac death.
Sudden ventricular fibrillation (VF) or pulseless electrical activity (PEA). Acute coronary ischemia and preexisting cardiac disease are the most common causes. VF is becoming less common.
2. What is the predominant determinant of successful cardiopulmonary resuscitation (CPR)?
Show answer
Time to restoration of spontaneous circulation, which itself is a function of the time to effective chest compression and time to defibrillation of VF. The chance of a good outcome decreases by 10% per minute. Successful outcomes are more likely if CPR is initiated promptly and if preexisting hypothermia is present.
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KIDNEY AND PANCREAS TRANSPLANTATION
CONTROVERSIES
13. Is HLA (human leukocyte) matching still important?
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It is somewhat important. Historically, HLA matching was an important consideration when matching cadaver kidneys to recipients. With today’s improved immunosuppressive agents, many transplant surgeons believe that HLA matching is no longer critical. Six antigen match kidneys are still shared nationally and do enjoy some improvement in long-term graft survival. Donor organ quality remains the primary determinant in how well the transplanted organ functions. For example, a poorly matched living-donor kidney will still usually outlast a well-matched cadaveric kidney.
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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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Queries 4
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Mitral Stenosis
75 MITRAL STENOSIS
David A. Fullerton M.D., Glenn J.R. Whitman M.D.
1. What causes mitral stenosis?
Show answer
Rheumatic fever.
2. Which gender most commonly gets mitral stenosis?
Show answer
Women by a ratio of 3:2.
3. What are the physical findings of mitral stenosis?
Show answer
On ascultation, an opening snap and a diastolic murmer are heard best at the apex.
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Renal Cell Carcinoma
95 RENAL CELL CARCINOMA
Brett B. Abernathy M.D.
1. How common is renal cell carcinoma?
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In the United States, 30,000 new cases of renal cell carcinoma are predicted for 2004 and 2005, about 3% of all adult malignancies.
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Hyperparathyroidism
57 HYPERPARATHYROIDISM
Robert C. McIntyre Jr., M.D.
1. What is the prevalence of hyperparathyroidism (HPT)?
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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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Lung Cancer
79 LUNG CANCER
Jamie M. Brown M.D.
1. How common is lung cancer?
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The incidence of lung cancer is approximately 180,000 new cases annually or 54.2 per 100,000 patients. More than 162,000 patients die annually, so the overall survival rate is 10%. This number has not improved over the past 35 years despite some treatment advances because of:
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cancer antiangiogensis,Parotid Tumors
65 PAROTID TUMORS
Joyesh K. Raj M.D., William R. Nelson M.D.
1. What is the differential diagnosis of a mass located in front of the ear in a patient of any age?
Show answer
If the mass is painless, discrete, nontender, and located just anterior or just beneath the ear lobe, a parotid tumor is the first choice. The differential diagnosis for other isolated masses include parotitis, primary salivary neoplasm, upper jugular chain node enlargement, tumor of the tail of the submandibular gland, enlarged preauricular or parotid lymph node, branchial cleft cyst, epithelial inclusion cyst, or any mesenchymal neoplasm. Diffuse unilateral enlargement of the parotid gland indicates parotid duct obstruction that can either be persistent or intermittent because of calculi in the main duct. Bilateral diffuse enlargement may be caused by systemic conditions such as mumps, starch-eaters disease, and fatty infiltration.
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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
