Lecture Notes- General Surgery
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What Does a Diagnosis of Myeloma Mean in 2015
What does a diagnosis of Myeloma mean in 2015 Dr Aristeidis Chaidos Consultant Haematologist Hammersmith Hospital Learning objectives • define myeloma and related disorders • diagnosis & disease monitoring • “many myelomas”: staging & prognostic systems • the evolving landscape in myeloma treatment • principles of management with emphasis to care in the community • future challenges and novel therapies Myeloma – overview • malignancy of the plasma cells (PC): the terminally differentiated, antibody producing B cells • myeloma cells infiltrate the bone marrow • IgG or IgA paraprotein (PP) and/or free light chains in blood and urine • bone destruction • kidney damage • anaemia • despite great advances in the last 15 years myeloma remains an incurable disease Myeloma in figures • 1% of all cancers – 13% of blood cancers • median age at diagnosis: 67 years • only 1% of patients <40 years • 4 – 5 new cases per 100,000 population annually, but different among ethnic groups • 4,800 new myeloma patients in the UK each year • the prevalence of myeloma in the community increases with outcome improvements and aging population Myeloma related conditions smoldering symptomatic remitting plasma cell MGUS refractory myeloma myeloma relapsing leukaemia <10% PC ≥10% PC +/- ≥10% PC or plasmacytoma circulating PC PP <30g/L PP ≥30g/L Any PP in serum and/or urine extramedullary no organ no organ disease damage or damage or organ damage & symptoms symptoms symptoms Death MGUS monoclonal gammopathy of unknown significance • The most common pre-malignant condition: -
Guidelines on the Assessment of Bleeding Risk Prior to Surgery Or Invasive Procedures
guideline Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures British Committee for Standards in Haematology Y. L. Chee, 1 J. C. Crawford, 2 H. G. Watson1 and M. Greaves3 1Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, 2Department of Anaesthetics, Southern General Hospital, Glasgow, and 3Department of Medicine and Therapeutics, School of Medicine, University of Aberdeen, Aberdeen, UK surgery or invasive procedures to predict bleeding risk. The Summary aim is to evaluate the use of indiscriminate testing. Appro- Unselected coagulation testing is widely practiced in the priate testing of patients with relevant clinical features on process of assessing bleeding risk prior to surgery. This may history or examination is not the topic of this guideline. The delay surgery inappropriately and cause unnecessary concern target population includes clinicians responsible for assess- in patients who are found to have ‘abnormal’ tests. In addition ment of patients prior to surgery and other invasive it is associated with a significant cost. This systematic review procedures. was performed to determine whether patient bleeding history and unselected coagulation testing predict abnormal periop- Methods erative bleeding. A literature search of Medline between 1966 and 2005 was performed to identify appropriate studies. The writing group was made up of UK haematologists with Studies that contained enough data to allow the calculation of a special interest in bleeding disorders and an anaesthetist. the predictive value and likelihood ratios of tests for periop- First, the commonly employed coagulation screening tests erative bleeding were included. Nine observational studies were identified and their general and specific limitations (three prospective) were identified. -
Surgery Guidelines Infection Prevention
SURGERY GUIDELINES SURGICAL SITE INFECTION: REDUCING YOUR RISK A surgical site infection is a Stanford Hospital & Clinics is committed to implementing strategies to improve risk with any type of surgery. surgical care and to reduce the risk of You can take steps to reduce surgical site infections. your risk of surgical site We want your surgical experience at Stanford Hospital & Clinics to be positive. infection and complications. That experience includes educational • Talk with your healthcare provider materials that describe the process of your about your risk of infection and review surgery and the measures we take to ensure your safety. It is especially important to steps you can take to reduce your reduce the risk of infection. risk prior to the procedure. These are general guidelines. You will • Know the signs and symptoms be provided with more specific instructions of surgical site infection. related to your surgery before your discharge from the hospital. • Know how to reduce your risk while you are in the hospital. INFECTION PREVENTION stanfordhospital.org stanfordhospital.org PRIOR TO DAY OF AFTER SURGERY SURGERY SURGERY KEY POINTS HEALTHCARE TEAMS’ ROLE IN PREVENTION After your surgery and hospital stay, it is Tell your healthcare provider about other • Your surgeon may use electric clippers to important to watch for any changes in your medical problems you may have. Factors remove some of your hair before surgery. symptoms. Call your physician immediately or such as diabetes, obesity, smoking and some • Your surgical team will apply a skin antiseptic go to the nearest emergency room if you are medications could affect your surgery and immediately before the surgery experiencing any of the following symptoms: your treatment. -
CV-Summer 2017.Pdf
CURRICULUM VITAE NAME: MARY THERESE KILLACKEY, MD OFFICE ADDRESS: 1430 Tulane Avenue New Orleans, LA 70112 t 504.988.2317 f 504.988.1874 [email protected] PLACE OF BIRTH: Yonkers, NY EDUCATION: 1990-1994 Columbia College, Columbia University New York, NY, B.A. (Biology) 1994-1998 College of Physicians & Surgeons, Columbia University New York, NY M.D. POST-GRADUATE TRAINING: 6/1998-6/1999 Intern, General Surgery Strong Memorial Hospital University of Rochester Rochester, NY 6/1999-6/2003 Resident, General Surgery Strong Memorial Hospital University of Rochester Rochester, NY 7/2003-6/2005 Fellow, Abdominal Organ Transplant Surgery Recanati/Miller Transplant Institute The Mount Sinai Hospital New York, NY 11/2010 Leadership Development Program American Society of Transplant Surgeons Northwestern University Kellogg School of Management Chicago, IL 6/2015 Surgeons as Leaders Course American College of Surgeons Chicago, IL 9/2015-8/2016 Clinical Leadership Development Program Tulane School of Medicine, Office of the Dean New Orleans, LA 12/2015 Mid-Career Women Faculty Professional Development Seminar Association of American Medical Colleges Austin, TX 6/2016 Being a Resilient Leader Association of American Medical Colleges Washington, DC 6/2017 - 4/2018 Fellow, Executive Leadership in Academic Medicine Drexel University College of Medicine Philadelphia, PA ACADEMIC APPOINTMENTS: 7/2003-6/2005 Instructor in Surgery Mount Sinai School of Medicine New York, NY 10/2006-present Assistant Professor of Surgery and Pediatrics Tulane University -
Medications to Avoid Before Surgery
ENTRUST MEDICAL GROUP Pre‐operative Information Medications to Avoid Before Surgery It is important to avoid certain medications prior to surgery. The following medications can have effects on bleeding, swelling, increase the risk of blood clots, and cause other problems if taken around the time of surgery. Please notify your surgeon’s office if you are taking any vitamins, herbal medications/supplements as these can also cause problems during your surgery and should not be taken for the two week period before surgery and one week after surgery. It is extremely important that if you come down with a cold, fever, rash, or “any new” medical problem close to your surgery date, you should notify your surgeon’s office immediately. Section One: The following drugs contain aspirin and/or aspirin like effects that may affect your surgery (abnormal bleeding and bruising). These drugs should be avoided for at least two weeks prior to surgery. A.P.C. Doloprin Nuprin A.S.A. Easprin Orudis A.S.A. Enseals Ecotrin Pabalate‐SF Advil Emprin with Codeine Pamelor Aleve Endep Parnate Alka‐Seltzer Plus Equagesic Tablets Percodan Alka‐Seltzer Etrafon Pepto‐Bismol (all types) Anacin Excedrin Persantine Anaprox Feldene Phenteramine Ansaid Fiorinal Phenylbutzone Argesic Flagly Ponstel Arthritis pain formula Four Way Cold Tablets Propoxyphene Compound Arthritis strength Bufferin Gemnisyn Robaxisal Arthropan Liquid Gleprin Rufen AS.A. Goody’s S‐A‐C Ascriptin Ibuprofen (all types) Saleto Asperbuf Indocin Salocol Aspergum Indomethacin Sine‐Aid/Sine‐Off/Sinutab Aspirin (all brands) Lanorinal SK‐65 Compound Atromid Lioresal St. Joseph’s Cold Tab B.C. -
Organ Transplant Discrimination Against People with Disabilities Part of the Bioethics and Disability Series
Organ Transplant Discrimination Against People with Disabilities Part of the Bioethics and Disability Series National Council on Disability September 25, 2019 National Council on Disability (NCD) 1331 F Street NW, Suite 850 Washington, DC 20004 Organ Transplant Discrimination Against People with Disabilities: Part of the Bioethics and Disability Series National Council on Disability, September 25, 2019 This report is also available in alternative formats. Please visit the National Council on Disability (NCD) website (www.ncd.gov) or contact NCD to request an alternative format using the following information: [email protected] Email 202-272-2004 Voice 202-272-2022 Fax The views contained in this report do not necessarily represent those of the Administration, as this and all NCD documents are not subject to the A-19 Executive Branch review process. National Council on Disability An independent federal agency making recommendations to the President and Congress to enhance the quality of life for all Americans with disabilities and their families. Letter of Transmittal September 25, 2019 The President The White House Washington, DC 20500 Dear Mr. President, On behalf of the National Council on Disability (NCD), I am pleased to submit Organ Transplants and Discrimination Against People with Disabilities, part of a five-report series on the intersection of disability and bioethics. This report, and the others in the series, focuses on how the historical and continued devaluation of the lives of people with disabilities by the medical community, legislators, researchers, and even health economists, perpetuates unequal access to medical care, including life- saving care. Organ transplants save lives. But for far too long, people with disabilities have been denied organ transplants as a result of unfounded assumptions about their quality of life and misconceptions about their ability to comply with post-operative care. -
General Surgery
- 1 - KALEIDA HEALTH Name: ___________________________________ Date: ____________________________ DELINEATION OF PRIVILEGES - GENERAL SURGERY PLEASE NOTE: Please check the box for each privilege requested. Do not use an arrow or line to make selections. We will return applications that ignore this directive. GENERAL STATEMENTS - Privileges in Adult Surgery are separated into the following divisions: General Surgery and Plastic Surgery. Applicants desiring procedure privileges in more than one division must complete separate forms for each. Procedures designated with an asterisk (*) indicate that Moderate or Deep Sedation may be required. If you do not have Moderate or Deep Sedation privileges, you must invite a Kaleida Health anesthesiologist to participate in the procedure. Procedures are also separated into levels of complexity (Level I-A, Level I-B, Level I, Level II, and Level III), which require increasing levels of education and experience. In general, procedures learned during residency are grouped in Level I-A or Level I and are granted upon evidence of successful completion of residency training. Level II procedures may or may not require evidence of additional training beyond residency. Documentation of additional training and/or experience is required for all Level III procedures. LEVEL I-A PRIVILEGES Procedures which involve primarily wound care, can be done under local anesthetic and occasionally involve application of temporary skin coverage or application of agents to expedite wound healing. Can be performed by any competent -
General Surgery Career Resource
The American Journal of Surgery (2013) 206, 719-723 Association of Women Surgeons: Career Development Resources General surgery career resource Ana M. Parsee, M.D.a, Sharona B. Ross, M.D.b, Nancy L. Gantt, M.D.c, Kandace Kichler, M.D.d, Celeste Hollands, M.D.e,* aJohns Hopkins Hospital, Baltimore, MD, USA; bFlorida Hospital, Tampa, FL, USA; cNortheast Ohio Medical University, St. Elizabeth Health Center, Rootstown, OH, USA; dUniversity of Miami, Palm Beach Regional Campus, Palm Beach, FL, USA; eSt John’s Children’s Hospital, Springfield, IL, USA KEYWORDS: Abstract General surgery residency training can lead to a rewarding career in general surgery and General surgery; serve as the foundation for careers in several surgical subspecialties. It offers broad-based training with General surgery exposure to the cognitive and technical aspects of several surgical specialties and prepares graduating residency; residents for a wide range of career paths. This career development resource discusses the training as- Surgical fellowship; pects of general surgery. Surgical subspecialties; Ó 2013 Elsevier Inc. All rights reserved. Transition to practice; Surgery interest groups General surgery training provides the foundation for who enter medical school with an interest in surgery and many different surgical career paths. The training begins those who become interested early can become involved with a general surgery residency, which is usually followed in their schools’ surgery interest group (SIGs) as early as by either entry into practice or additional training. General the first day of medical school at most institutions. Each surgery residency programs provide broad-based training local SIG has different offerings to help students explore with exposure to the cognitive and technical aspects of and develop their interest in surgery as a career. -
Posterior Cervical Discectomy: an Optimally Invasive Approach to Laterally Prolapsed Cervical Disc
Original Research Article DOI: 10.18231/2455-8451.2016.0005 Posterior cervical discectomy: An optimally invasive approach to laterally prolapsed cervical disc Shashank Sah1,*, Suresh Kumar Kaushik2, Neeraj Prajapati3 1Associate Professor, Dept. of General Surgery, 2Associate Professor, Dept. of Orthopaedics, 3Associate Professor, Dept. of Radiology, SRMSIMS, Bareilly, Uttar Pradesh *Corresponding Author: Email: [email protected] Abstract Aim: Posterior cervical discectomy is one of the surgical techniques for management of laterally prolapsed cervical disc causing cervical radiculopathy. This method has remained under-utilized in comparison to the classic technique of Anterior Cervical Discectomy and Fusion (ACDF). The study was conducted to evaluate it’s feasibility in terms of ease, challenges and short term outcome. Material and Methods: This is a prospective study conducted over a period of 65 months. Patients visiting to neurosurgery/ orthopedics OPD’s with cervical disc diseases and requiring surgery, were further evaluated on the basis of selection criteria for the feasibility of posterior cervical discectomy. Patients meeting the selection criteria were then operated upon by this approach and the outcome was evaluated. Results: Posterior cervical discectomy is essentially a disc conserving, optimally invasive microscopic technique - best suited for selected subset of patients with laterally prolapsed disc causing radiculopathy. 21 out of 23 patients appreciated the surgical benefit by as early as 48 hours of operation. There were no complications. Conclusion: Posterior cervical discectomy is an excellent direct approach to the diseased segment provided case selection criteria are properly followed. Keywords: Cervical disc, Posterior cervical discectomy, Lamino-foraminotomy, Motion preserving cervical disc surgery Introduction approach has largely remained underutilized and Cervical disc disease is a prevalent and disabling therefore in the present study we evaluated this disorder. -
Chiari Malformation by Ryan W Y Lee MD (Dr
Chiari malformation By Ryan W Y Lee MD (Dr. Lee of Shriners Hospitals for Children in Honolulu and the John A Burns School of Medicine at the University of Hawaii has no relevant financial relationships to disclose.) Originally released August 8, 1994; last updated March 9, 2017; expires March 9, 2020 Introduction This article includes discussion of Chiari malformation, Arnold-Chiari deformity, and Arnold-Chiari malformation. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations. Overview Chiari malformation describes a group of structural defects of the cerebellum, characterized by brain tissue protruding into the spinal canal. Chiari malformations are often associated with myelomeningocele, hydrocephalus, syringomyelia, and tethered cord syndrome. Although studies of etiology are few, an increasing number of specific genetic syndromes are found to be associated with Chiari malformations. Management primarily targets supportive care and neurosurgical intervention when necessary. Renewed effort to address current deficits in Chiari research involves work groups targeted at pathophysiology, symptoms and diagnosis, engineering and imaging analysis, treatment, pediatric issues, and related conditions. In this article, the author discusses the many aspects of diagnosis and management of Chiari malformation. Key points • Chiari malformation describes a group of structural defects of the cerebellum, characterized by brain tissue protruding into the spinal canal. • Chiari malformations are often associated -
Chiari Type II Malformation: Past, Present, and Future
Neurosurg Focus 16 (2):Article 5, 2004, Click here to return to Table of Contents Chiari Type II malformation: past, present, and future KEVIN L. STEVENSON, M.D. Children’s Healthcare of Atlanta, Atlanta, Georgia Object. The Chiari Type II malformation (CM II) is a unique hindbrain herniation found only in patients with myelomeningocele and is the leading cause of death in these individuals younger than 2 years of age. Several theories exist as to its embryological evolution and recently new theories are emerging as to its treatment and possible preven- tion. A thorough understanding of the embryology, anatomy, symptomatology, and surgical treatment is necessary to care optimally for children with myelomeningocele and prevent significant morbidity and mortality. Methods. A review of the literature was used to summarize the clinically pertinent features of the CM II, with par- ticular attention to pitfalls in diagnosis and surgical treatment. Conclusions. Any child with CM II can present as a neurosurgical emergency. Expeditious and knowledgeable eval- uation and prompt surgical decompression of the hindbrain can prevent serious morbidity and mortality in the patient with myelomeningocele, especially those younger than 2 years old. Symptomatic CM II in the older child often pre- sents with more subtle findings but rarely in acute crisis. Understanding of CM II continues to change as innovative techniques are applied to this challenging patient population. KEY WORDS • Chiari Type II malformation • myelomeningocele • pediatric The CM II is uniquely associated with myelomeningo- four distinct forms of the malformation, including the cele and is found only in this population. Originally de- Type II malformation that he found exclusively in patients scribed by Hans Chiari in 1891, symptomatic CM II ac- with myelomeningocele. -
2005 Iowa Orthopedic Journal
Designed for Wear Reduction • Improved Function • Optimal Kinematics4 VOLUME 25 2005 THERE IS A DIFFERENCE The Iowa Orthopaedic Journal DEPUY ROTATING PLATFORM KNEE 1 REDUCED WEAR BY 94% Polyethylene wear has been associated with osteolysis in the knee.2,3 * The rotating platform knee, used with GVF JOURNAL ORTHOPAEDIC THE IOWA polyethylene, reduced wear by 94% when compared to a fixed bearing knee. Results based on knee simulation testing. Available only from DePuy Orthopaedics. Trusted Innovation. 1 ASTM Symposium on Cross-linked Thermally Treated Ultra High Molecular Weight Polyethylene for Joint Replacements (data on file). Miami Beach, Florida Nov. 5 and 6, 2002. 2 Lewis, Peter; Cecil H. Rorabeck, Robert B. Bourne and Peter Devane. “Posteromedial Tibial Polyethylene Failure in Total Knee Replacements.” CORR Feb. 1994: 11-17. 3 Cadambi, Ajai, Gerard A. Engh, Kimberly A. Dwyer and Tuyethoa N. Vinh. “Osteolysis of the Distal Femur After Total Knee Arthroplasty.” The Journal of Arthroplasty Dec. 1994: 579-594. * GVF - Gamma Vacuum Foil IMPORTANT • The presence of osteomyelitis, pyrogenic infection or other overt infection of the These include: This Essential Product Information sheet does not include all of the information nec- knee joint; essary for selection and use of a device. Please see full labeling for all necessary infor- • Patients with loss of musculature or neuromuscular compromise leading to loss of •Vascular deficiency at the bone site; mation. function in the involved limb or in whom the requirements for its use would affect •Inadequate bone stock to assure both a firm press fit and close apposition of the cut recommended rehabilitation procedures.