DOCSLIB.ORG

Community Surgery Learning Objectives

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Community Surgery Learning Objectives COMMUNITY SURGERY LEARNING OBJECTIVES Preamble The Community General Surgery rotation offers the General Surgery resident the opportunity to experience general surgical practice in a community setting. This rotation has both urban and rural sites available. The resident should contact the Surgical Education Office sufficiently in advance in order to secure his/her desired site. General Objectives Upon completion of the Community General Surgery rotation, the General Surgery resident is expected to: Demonstrate knowledge, clinical and technical skills, decision-making capabilities and attitudes essential to the roles of specialist in General Surgery practiced in the community Appreciate the features of General Surgery practiced in the community that make it distinct from tertiary General Surgery Specific Objectives At the completion of the Community General Surgery rotation, the General Surgery resident will have acquired the following competencies and will function effectively as: Medical Expert General Surgeons possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date and (whenever possible) evidence-based, ethical and cost-effective clinical practice and effective communication in partnership with patients, other health care providers and the community. The role of the medical expert is central to the function of the general surgeon and draws on the competencies included in the role of communicator, manager, health advocate, collaborator, scholar and professional. At the completion of training, the General Surgery resident will be able to: Function effectively as a consultant, integrating all of the CanMEDS roles to provide optimal, ethical and patient- centered general surgical care . Effectively perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional . Identify and appropriately respond to relevant ethical issues arising in patient care . Effectively and appropriately prioritize professional duties when faced with multiple patients and problems . Demonstrate compassionate and patient-centered care . Recognize and respond to the ethical dimensions in medical decision-making . Demonstrate medical expertise in situations other than patient care (e.g. presentations, medico-legal cases, etc.) Establish and maintain clinical knowledge, skills and attitudes appropriate to the practice of General Surgery . Apply knowledge of the clinical, socio-behavioral and fundamental biomedical sciences relevant to General Surgery . Apply lifelong learning skills to implement a personal program to keep up-to-date and enhance areas of professional competence . Contribute to the enhancement of quality care and patient safety, integrating the available best evidence and best practices The resident in General Surgery is required to attain sufficient knowledge as follows: Basic/General Areas Surgical Anatomy and Embryology Surgical Physiology Surgical Pathology Clinical Pharmacology Analgesics; sedatives; anesthetic agents Respiratory and cardiovascular Gastrointestinal Antibiotics Antineoplastic agents Antiemetic agents Medical Problems in the Surgical Patient Preoperative assessment Preparation for specific operative interventions Antimicrobial prophylaxis Anticoagulation and thromboembolic prophylaxis Corticosteroid management Diabetes management Conduct of a Surgical Procedure General principles Specific operative interventions Postoperative Care Prevention and treatment of postoperative infections Management of cardiac/hypertensive complications Management of postoperative thromboembolic complications Management of postoperative pulmonary complications Management of endocrine/metabolic problems (e.g. diabetes) Management of fluid and electrolyte/renal problems Wound Management and Healing Sepsis and Surgical Infections Hemostasis and Use of Blood Products Epidemiology and Biostatistics Trauma and Thermal Injuries Metabolic response to critical illness/trauma Multi-organ dysfunction Trauma assessment and resuscitation (ATLS principles) Triage and transport Airway management in trauma Shock in trauma Injuries to the central nervous system Injuries to the face and jaw Injuries to the neck Injuries to the chest/diaphragm/great vessels Abdominal trauma (including major vascular injuries) Injuries to the urogenital tract Musculoskeletal injuries Injuries to the extremities (vascular; bone; soft tissues) Burns and other thermal injuries Fluid Management and Acid-Base Problems Metabolic and Nutritional Care Hemodynamics/Oxygen Transport/Shock Transplantatation and Implantation Immunology and transplantation biology Specifics of transplantation techniques Cancer Principles of neoplasia Diagnosis and staging Therapeutic options: surgery; chemotherapy; radiation; other Principles of chemotherapy Principles of radiation oncology Legal and Ethical Issues in General Surgery Radiology for the General Surgeon Plain x-rays Mammography/stereotactic breast biopsy Contrast studies and interventional radiology Computerized tomography Ultrasound Magnetic resonance imaging Nuclear medicine studies Positron emission tomography (PET) Laboratory Medicine for the General Surgeon Hematology Biochemistry Microbiology GI laboratory studies: esophageal manometry and pH; anorectal manometry Vascular laboratory studies Specific Disease Entities Skin and Soft Tissue Pressure sores Hidradenitis suppurativa Pilonidal sinus disease Cysts Neoplasms, including melanoma and Kaposi’s sarcoma Breast Fibrocystic condition/simple cyst/complex cyst Fibroadenoma and other benign neoplasms/phylloides tumour Abscess/mastitis Nipple discharge Gynecomastia Mastodynia Evaluation of dominant mass/thickening Atypical epithelial hyperplasia LCIS/DCIS Inherited breast cancer Paget’s disease Invasive breast cancer Male breast cancer Breast reconstruction Head and Neck Lip lesions Oral cavity lesions Salivary gland lesions: inflammatory; infectious; neoplastic Thyroid disorders: goiter; neoplastic; inflammatory Parathyroid disorders: metabolic; neoplastic Veins and Lymphatics Thromboembolic disorders Venous insufficiency Varicose veins Lymphatic disorders Esophagus and Diaphragm Motility disorders Gastroesophageal reflux disease Barrett’s esophagus Perforation/Mallory-Weiss tear Diverticulum Esophageal cancer Caustic injury Varices Diaphragmatic hernia Diaphragmatic injury/rupture Stomach and Duodenum Gastritis/gastropathy Peptic ulcer/H. pylori Volvulus Diverticula Menetrier’s Disease Bezoars Postgastrectomy syndromes Neoplasms: benign; malignant Arteriovenous malformations; GAVE; watermelon stomach Dieulafoy’s lesion Varices Gastroparesis Duodenal diverticulum Crohn’s disease SMA syndrome Small Intestine Crohn’s disease Celiac disease Enteritis/enteropathy Neoplasms: benign; polyps; malignant Small intestinal fistulas Diverticulum; Meckel’s Blind loop syndrome Pneumatosis Short bowel syndrome/intestinal failure Intestinal obstruction Motility disorders/ileus Mesenteric ischemia Colon and Rectum Mechanical obstruction Paralytic ileus/pseudo-obstruction Inflammatory bowel disease: Crohn’s; ulcerative colitis Ischemic colitis Infectious colitis Pseudomembranous colitis Radiation enterocolitis Diverticular disease Megacolon Volvulus: sigmoid; cecal Polyps and polyposis syndromes Neoplasms: benign; malignant; HNPCC Solitary rectal ulcer Rectal prolapse Constipation/motility disorders/functional disorders Pneumatosis Angiodysplasia/vascular malformations Colorectal bleeding Foreign bodies of the rectum Rectal trauma Anus Neoplasms: benign; malignant Anal infections/sexually-transmitted disease Condyloma/AIN Hemorrhoids Fistula Fissure Pruritis ani Incontinence Levator ani syndrome Appendix Appendicitis Neoplasms: benign; malignant Crohn’s disease Liver and Portal System Abscess Cyst Neoplasms: benign; malignant Portal hypertension and its manifestations Biliary Tract/Gallbladder Gallstone disease and its manifestations Choledochal cyst Sclerosing cholangitis Cholangiohepatitis Neoplasms: benign; malignant Hemobilia Pancreas Pancreatitis: acute; chronic Cyst Periampullary neoplasms: benign; malignant Endocrine disorders of the pancreas Spleen Operative indications for splenectomy Hypersplenism Neoplasms: benign; malignant Metabolic disorders Erythrocyte disorders Autoimmune disorders Vascular disorders Cyst Infections/abscess Splenosis Hematologic effects of splenectomy Postsplenectomy sepsis Peritoneum and Retroperitoneum Peritonitis Abscess Ascites Adhesions Retroperitoneal fibrosis Retroperitoneal hematoma Neoplasms/pseudomyxoma Internal hernia Omentum and Mesentery Omental torsion Omental cyst Mesenteric vascular disease Neoplasms: benign; malignant Abdominal Wall/Hernia Rectus sheath hematoma Neoplasms: benign; malignant Inguinal hernia Femoral hernia Umbilical hernia Ventral hernia Spigelian hernia Lumbar hernia Obturator hernia Richter’s hernia Parastomal hernia Adrenal Cushing’s syndrome Adrenogenital syndrome Primary aldosteronism Addison’s disease Estrogen-secreting neoplasms Pheochromocytoma Neuroblastoma Ganglioneuroma
Load more

Recommended publications
  • Laparoscopic Longitudinal Pancreaticojejunostomy for Chronic Pancreatitis
    JOP. J Pancreas (Online) 2015 Sep 08; 16(5):438-443. REVIEW ARTICLE Laparoscopic Longitudinal Pancreaticojejunostomy for Chronic Pancreatitis Tamotsu Kuroki, Susumu Eguchi Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan ABSTRACT function. Pancreatic ductal drainage is one of the most important factors for the management of chronic pancreatitis. A longitudinal pancreaticojejunostomyChronic pancreatitis is ischaracterized a simple and byradical severe surgical abdominal treatment pain for and pancreatic progressive ductal insufficiency drainage. However, of pancreatic in recent endocrine/exocrine years laparoscopic pancreatic procedures have developed rapidly, and reports concerning laparoscopic pancreatic resection including laparoscopic longitudinal for chronic pancreatitis compared with conventional open surgery are unclear. In this review, we note that laparoscopic longitudinal pancreaticojejunostomy ishave a technically increased feasible, in number. safe and Nevertheless, effective surgical the benefits procedure of inlaparoscopic selected patients longitudinal with chronic pancreaticojejunostomy pancreatitis. INTRODUCTION Laramée et al. [22] found that surgical drainage treatment was highly cost-effective compared to endoscopic In patients with chronic pancreatitis, severe recurrent drainage treatment for patients with obstructive chronic pancreatitis. debilitatingabdominal [1–7].pain Theand elevated functional pressure endocrine/exocrine in the pancreatic Laparoscopic surgery was
    [Show full text]
  • Total Pancreatectomy-Autologous Islet Cell Transplantation (TP-AIT) for Chronic Pancreatitis – What Defines Success?
    CellR4 2015; 3 (2): e1536 Total Pancreatectomy-Autologous Islet Cell Transplantation (TP-AIT) For Chronic Pancreatitis – What Defines Success? C. S. Desai, K. M. Khan, W. X. Cui Medstar Georgetown Transplant Institute, Washington, DC, USA Corresponding Author : Wanxing Cui, MD, Ph.D; e-mail: [email protected] ABSTRACT 30 per 100,000 in United States according to the Na - Chronic pancreatitis is an inflammatory disease tional Institutes of Diabetes, Digestive and Kidney which is characterized by irreversible morpho - diseases (http://www.niddk.nih.gov). Patients with logic changes that typically causes pain and per - chronic pancreatitis suffer from debilitating pain, manent loss of the functions. The lack of good which progresses to significant narcotic medication treatment options for patients with chronic pan - requirement and deterioration in quality of life. Pa - creatitis is in part is related to any therapy need - tients can undergo multiple endoscopic and surgical ing to address the “3Ps” that are necessary for intervention procedures without significant success. this disorder.1) Pain relief, 2) Prevention of brit - In one report, pain recurs in over 50 percent of pa - tle diabetes mellitus and 3) Prevention of pan - tients after having endoscopic surgical procedures 1. creatic cancer. Total pancreatectomy and Total pancreatectomy may ameliorate the pain of autologous islet cell transplant (TP-AIT) does chronic pancreatitis however the resultant severe offer a definitive therapy while addressing these brittle diabetes makes this a less than desirable op - three; however there has not been a universal tion. Autologous islet cell transplant after total pan - uptake of this treatment to consider it the stan - createctomy (TP-AIT) gives patients with chronic dard of care due to it being considered highly in - pancreatitis the hope of pain relief and reduces the vasive and success being measured mainly by the potential for brittle diabetes.
    [Show full text]
  • Puestow Modified Procedure in the Era of Advanced
    CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 15 (2015) 85–88 Contents lists available at ScienceDirect International Journal of Surgery Case Reports journa l homepage: www.casereports.com “Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report” a,∗,1 a,1 a,1 a,1 Georgios P. Fragulidis , Antonios Vezakis , Dionissios Dellaportas , Ira Sotirova , b,2 a,1 a,1 Vassilis Koutoulidis , Elliseos Kontis , Andreas Polydorou a 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece b 1st Department of Radiology, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece a r t i c l e i n f o a b s t r a c t Article history: INTRODUCTION: Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of Received 23 May 2015 intractable pain which is their main symptom. Decompression options of for the main pancreatic duct Received in revised form 14 August 2015 are both surgical and advanced endoscopic procedures. Accepted 14 August 2015 PRESENTATION OF CASES: A 64-year-old male with known CP due to alcohol consumption and a 36-year- Available online 20 August 2015 old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal Keywords: pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent Modified Puestow procedure results. Partington-Rochelle procedure DISCUSSION: Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct Chronic lithiasic pancreatitis Surgical treatment strictures and calculi of the main pancreatic duct in CP patients.
    [Show full text]
  • Robotic Surgery for the Treatment of Chronic Pancreatitis. Pain Control, Narcotic Use Reduction and Re-Intervention Rate. Ten Years Follow-Up Retrospective Study
    isorders c D & ti a T e h r e c r a n p a y P ISSN: 2165-7092 Pancreatic Disorders & Therapy Research Article Robotic Surgery for the Treatment of Chronic Pancreatitis. Pain Control, Narcotic Use Reduction and Re-Intervention Rate. Ten Years Follow-Up Retrospective Study Eduardo Fernandes*, Valentina Valle, Gabriela Aguiluz Cornejo, Roberto Bustos, Roberto Mangano, Pier Cristoforo Giulianotti University of Illinois at Chicago College of Medicine Chicago, IL United States ABSTRACT Introduction: Surgical treatment of chronic pancreatitis is reserved to patients with intractable pain, pancreatic duct obstruction or suspicion of malignancy. Robotic surgery in this context has proven to be a safe and feasible. The aim of this study was to evaluate the effect of robotic assisted surgery in the context of chronic pancreatitis with regards to pain control, narcotic usage and need for re-intervention. Methods: A retrospective analysis of a prospectively collected divisional database at the University of Illinois Hospital & Health Sciences System was carried out. The primary endpoint was: 1) Evaluation of pre and post-operative pain and narcotic usage. The secondary endpoints were: 1) 10-year overall survival; and 2) ‘Event Free Survival’ (EFS). Results: 37 patients entered the study. The procedures performed were: pancreatic head resection (7), total pancreatectomy (1), hepatico-jejunostomy (6), longitudinal Roux-en-Y pancreato-jejunostomy (4), pancreato- gastrostomy (14) and thoracoscopic splanchnicectomy (7). The mean pre and post-operative pain scores were 6.5 and 4.5 respectively (p<0.05, paired Student t-test). Rates of narcotics use pre and post-surgery were 74% and 50% of patients respectively.
    [Show full text]
  • Open Modified Puestow Procedure in an Advanced Endoscopic Era For
    International Journal of Surgery Science 2020; 4(3): 71-76 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science Open modified puestow procedure in an advanced www.surgeryscience.com 2020; 4(3): 71-76 endoscopic era for chronic pancreatitis with dilated Received: 06-05-2020 Accepted: 08-06-2020 pancreatic duct and stones Dr. Ajay A Gujar Department of General Surgery, Dr. Ajay A Gujar, Dr. Amrita A Gujar and Dr. Aashay Dharia Amruta Surgical and Maternity Hospital, Mumbai, Maharashtra, DOI: https://doi.org/ 10.33545/surgery.2020.v4.i3b.471 India Dr. Amrita A Gujar Abstract K J Somaiya Hospital and Background: Chronic pancreatitis has been defined as a continuing inflammatory disease of the pancreas Research centre, Sion, Mumbai, characterized by irreversible morphological changes. These changes typically cause pain and loss of Maharashtra, India exocrine and endocrine pancreatic function. The most common symptom of chronic pancreatitis is pain, which can be severe and intractable in some Dr. Aashay Dharia patients. Although it is itself benign, chronic pancreatitis can significantly affect quality of life and can Dharia K J Somaiya Hospital and cause significant distress with its complications [1]. Research centre, Sion, Mumbai, The initial treatment for pain in most cases is to start of enzyme replacement, control of diabetes with Maharashtra, India insulin, and administration of oral analgesics. Surgical intervention is required in patients with intractable pain that is resistant to conventional nonsurgical therapy, in patients with associated or suspected malignancy, and in patients who have developed complications such as biliary or duodenal obstruction, pancreatic fistulae, pancreatic [2] ascites/pleural effusion, pseudocyst, or rare hemosuccus pancreaticus .
    [Show full text]
  • Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future
    Hindawi Gastroenterology Research and Practice Volume 2017, Article ID 8418372, 6 pages https://doi.org/10.1155/2017/8418372 Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future Stephanie Plagemann, Maria Welte, Jakob R. Izbicki, and Kai Bachmann Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany Correspondence should be addressed to Stephanie Plagemann; [email protected] Received 14 March 2017; Revised 2 July 2017; Accepted 5 July 2017; Published 27 July 2017 Academic Editor: Riccardo Casadei Copyright © 2017 Stephanie Plagemann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient’s general condition preoperatively and finding the appropriate timing for surgical treatment.
    [Show full text]
  • Laparoscopic Lateral Pancreaticojejunostomy for Chronic Pancreatitis; a Single Operator Tertiary Center Experience from Western India
    Research Article Clinics in Surgery Published: 28 Jan, 2019 Laparoscopic Lateral Pancreaticojejunostomy for Chronic Pancreatitis; a Single Operator Tertiary Center Experience from Western India Rege SA*, Kulkarni GV, Surpam Shrinivas, Amiteshwar Singh and Chiranjeev R Department of General Surgery, King Edward Memorial Hospital, India Abstract Introduction: Lateral Pancreaticojejunostomy (LPJ), has its recognized applications in the decompressive management of Chronic Pancreatitis (CP), and is recommended in patients with concomitant pain, obstructed, dilated pancreatic duct. Performing this procedure laparoscopically is technically challenging. We describe our technique and report our series of 33 patients who underwent this procedure. Methods: Between March 2013 and June 2018, 33 patients (19 males, 14 females) hailing from 5 different states in India, with an established diagnosis of CP underwent laparoscopic LPJ by a single surgeon in a tertiary care center in Western India. The median age and pancreatic duct diameter on CT were 41.8 (22 to 54) years and 8.73 (7 to 10) mm, respectively. Results: Thirty two patients were included in the final analysis in which the procedure was completed laparoscopically while one surgery necessitated conversion to open, owing to hemorrhage from the gastroduodenal artery. Median operating time was 131.2 (104 to 163) minutes and intraoperative blood loss of approximately 100 mL. There were no peri-operative deaths and no mortality at the six month follow up. No peri-operative blood transfusion was required, and the median postoperative hospital stay was 5.25 (5 to 8) days. Two patients required readmission at 8 months for pain. Twenty four patients reported to be nearly pain free on follow up while remaining 8 patients were managed OPEN ACCESS with appropriate analgesia without further procedures.
    [Show full text]
  • SOMC Surgical Lecture Series 1St Edition
    SOMC Surgical Lecture Series 1st Edition Thomas L. Khoury, MD FACS, RPVI, RVT, Professor of Surgery and Master Faculty OUHCOM Lecture Chapters Chapter 1: Care of the Surgical Patient Chapter 2: Care of the Angiography Patient Chapter 2: Nursing Symposium Care of the Surgical Patient Chapter 3: Fluids and Electrolytes Chapter 5: Surgical Critical Care Chapter 6: Wound Care Center Chapter 7: Cancer Screening Symposium Chapter 7: Cutaneous Neoplasms Chapter 8: Breast Diseases Chapter 9: Endocrine Surgery Chapter 9: The Pancreas Chapter 10: The Esophagus Chapter 11: The Stomach Chapter 12: Small Bowel Chapter 13: Liver and Biliary Tree Chapter 14: The Colon Chapter 15: Lung Cancer Surgery Chapter 16: Abdominal Compartment Syndrome Chapter 16: Carotid Stenting Chapter 16: Dialysis Access Evaluation Chapter 16: Minimally Invasive Vascular Interventions Chapter 16: Vascular Surgery Chapter 18: Arterial Aneurysm Disease: Natural History, Chapter 18: Critical Limb Ischemia Chapter 20: DVT Treatment Chapter 20: Heparin Induced Thrombocytopenia Chapter 20: Iliofemoral DVT Chapter 20: Thrombolytic Therapy in the Management of Deep Venous Thrombosis Chapter 20: Venous Disease Grand Rounds Chapter 20: Venous Disease Ground Rounds Chapter 21: Thrombolytic Therapy for Significant Pulmonary Embolic Chapter 1: Care of the Surgical Patient > Over 70 > Overall Physical status Assessment of Operative Risk > Elective v/s Emergency > Physiologic Extent of Age Procedure > Number of Associated Illnesses > Psychological frank but optimistic Preparation of Patient
    [Show full text]
  • Chronic Pancreatitis: Introduction
    Chronic Pancreatitis: Introduction Authors: Anthony N. Kalloo, MD; Lynn Norwitz, BS; Charles J. Yeo, MD Chronic pancreatitis is a relatively rare disorder occurring in about 20 per 100,000 population. The disease is progressive with persistent inflammation leading to damage and/or destruction of the pancreas . Endocrine and exocrine functional impairment results from the irreversible pancreatic injury. The pancreas is located deep in the retroperitoneal space of the upper part of the abdomen (Figure 1). It is almost completely covered by the stomach and duodenum . This elongated gland (12–20 cm in the adult) has a lobe-like structure. Variation in shape and exact body location is common. In most people, the larger part of the gland's head is located to the right of the spine or directly over the spinal column and extends to the spleen . The pancreas has both exocrine and endocrine functions. In its exocrine capacity, the acinar cells produce digestive juices, which are secreted into the intestine and are essential in the breakdown and metabolism of proteins, fats and carbohydrates. In its endocrine function capacity, the pancreas also produces insulin and glucagon , which are secreted into the blood to regulate glucose levels. Figure 1. Location of the pancreas in the body. What is Chronic Pancreatitis? Chronic pancreatitis is characterized by inflammatory changes of the pancreas involving some or all of the following: fibrosis, calcification, pancreatic ductal inflammation, and pancreatic stone formation (Figure 2). Although autopsies indicate that there is a 0.5–5% incidence of pancreatitis, the true prevalence is unknown. In recent years, there have been several attempts to classify chronic pancreatitis, but these have met with difficulty for several reasons.
    [Show full text]
  • AHPBA 2019 Annual Meeting | Eposter Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019
    AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 P 73. TRAVEL DISTANCE IS ASSOCIATED WITH IMPROVED SURVIVAL IN HEPATOCELLULAR CARCINOMA C Hester, N Rich, M Augustine, J Mansour, M Porembka, S Wang, H Zeh III, A Singal, A Yopp Presenter: Caitlin Hester MD | University of Texas Southwestern Medical Center Background: An association between travel distance and survival measures has been been demonstrated across gastrointestinal malignancies but thus far has not been examined in patients newly diagnosed with hepatocellular carcinoma (HCC). We aimed to determine the association of travel distance with time to treatment (TTT) and overall survival (OS) in patients newly diagnosed with HCC. Methods: Newly diagnosed HCC patients who received treatment were identified in the Texas Cancer Registry from 2004 to 2015. We compared system- and patient-level factors among patients who traveled short (<12.5 miles), intermediate (12.5-49.9 miles), and long (≥50 miles) travel distances for initial treatment. Anova and Chi-square analyses were used to compare clinicopathologic variables, and Kaplan-Meier with log rank and cox regression models were used to compare survival. Results: 4,329 patients were identified: 2,136 (49.3%) short, 1,380 (31.9%) intermediate, and 813 (18.9%) long distance patients. Patients who traveled intermediate and long distances were more likely to be Non- Hispanic White (59% for intermediate and 60% for long vs 33% for short, p<0.001) and a higher proportion of privately insured patients (29% for intermediate and 24% for long vs 16% for short,p<0.001).
    [Show full text]
  • Northwestern Handbook of Surgical Procedures
    V a LANDES d LANDES BIOSCIENCE BIOSCIENCE V a d e m e c u m eme cum V a d e m e c u m Table of contents (excerpt) Northwestern 1. Gastrointestinal 2. Endocrine Handbook 3. Surgical Oncology Northwestern Handbook of Sur 4. Plastic Surgery 5. Cardiothoracic Surgery of Surgical 6. Transplantation 7. Vascular Surgery Procedures gical Procedures The Vademecum series includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Landes Bioscience Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house Kaufman staff and practicing physicians. We hope you will find them a valuable resource. Bell ISBN 1-57059-684-0 Richard H. Bell, Jr. All titles available at Dixon B. Kaufman www.landesbioscience.com 9 781570 596841 vademecum Northwestern Handbook of Surgical Procedures Richard H. Bell, Jr., M.D. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois, U.S.A. Dixon B. Kaufman, M.D., Ph.D. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois, U.S.A. Illustrations by Simon Kimm, M.D.
    [Show full text]
  • Classic Diseases Revisited Chronic Pancreatitis
    Postgrad Med J 1996; 72: 327 - 333 (© The Fellowship of Postgraduate Medicine, 1996 Classic diseases revisited Postgrad Med J: first published as 10.1136/pgmj.72.848.327 on 1 June 1996. Downloaded from Chronic pancreatitis: diagnosis and treatment Summary Three-dimensional magnetic reson- ance cholangiopancreatography is Sandeep Sidhu, Rakesh K Tandon currently the most exciting new ima- ging technique for chronic pancrea- titis. Endoscopy-assisted duodenal intubation during the secretin-cho- Chronic pancreatitis is prevalent in most parts of the world although its lecystokinin test reduces intubation aetiology and clinical course may vary in different regions. Community-based time in difficult cases. The NBT- field studies from our centre have revealed that tropical chronic pancreatitis in para-amino benzoic acid test has Southern India is a mild disease with onset of symptoms in early adulthood,' been refined to enhance its discri- and a prevalence of 1:793 in endemic areas. The predominant symptoms are minant power. The cholesteryl- abdominal pain (30.6%), diabetes mellitus (52.8%) and malabsorption [C13]octanoate breath test and the (16.7%).' On the other hand, patients presenting to office practice,2 or to local faecal elastase test are newer highly or tertiary care hospitals3 have severe chronic pancreatitis, with abdominal pain sensitive and specific tubeless tests. as the predominant symptom (approximately 80%); exocrine pancreatic Pain in chronic pancreatitis con- insufficiency and calcification are seen in 80 - 90% patients.2 In a recent tinues to be a vexing therapeutic study,3 surgical treatment for pain was required in 53.9% of chronic pancreatitis issue. Enzyme treatment continues patients referred to the All India Institute ofMedical Sciences, a leading tertiary despite criticism.
    [Show full text]