HHooppkkiinnss GGeenneerraall SSuurrggeerryy RReevviieeww MMaannuuaall Hopkins General Surgery Manual 1 Introduction This “manual” is a compilation of study notes I have made over the past 5 years based on a number of sources, including those listed here: Text books (see reference list) Review books (see reference list) Didactic lectures and conferences at both Johns Hopkins and the NCI Surgery Branch Presentations I gave during weekly conferences at NCI Primary and review articles Points made by attendings and other residents on rounds or in the OR Intern Sunday morning lecture with Dr. Cameron (2001 – 2002) Halsted quizzes SESAP questions UpToDate® Disclaimer: Individual illustrations and material may belong to a third party. Unless otherwise stated all figures and tables by Peter Attia When I began putting my notes together on random pieces of paper and my Palm Pilot, I did not intend to do much else with them. However, in time, they became so numerous that I needed to organize them in a better way. A resident from the Brigham whom I worked with in the lab at NIH encouraged me to put them together in what he jokingly referred to as an “Attia Bible” of surgical wisdom, something he had done with his own notes. The intent of these notes was not as much to be a review for a specific test per se, as it was an “all‐purpose” compilation of salient points to consider as I go through residency. Of course, these notes come with the standard disclaimer that they are not meant to replace reading from primary sources, rather to supplement it. In addition, while I have tried to be as accurate as possible, during my readings I encountered several “facts” that were either contradictory to “facts” I had been taught as a resident or read in other sources. For this reason I can make no guarantees about the validity of each statement made here. I have tried my best to amalgamate each set of facts into a somewhat concise, yet accurate document. Hopefully, these notes will provide you with some benefit as well. I welcome all criticism and correction and look forward to supplementing and augmenting this first edition many times over. Peter Attia, MD Surgical Resident The Johns Hopkins Hospital Copyright, Peter Attia, 2005. All rights reserved. Hopkins General Surgery Manual 2 Reference List 1. Vascular Surgery 3rd Ed. House Officer Series. Faust GR, Cohen JR., 1998. 2. ABSITE Killer. Lipkin AP, 2000 3. Rush University Review of Surgery 3rd Ed. Deziel, Witt, Bines, et al., 2000. 4. Current Surgical Therapy 6th Ed. Cameron JL, 1998. 5. Current Therapy of Trauma 4th Ed. Trunkey DD and Lewis FR, 1999. 6. Surgery: Scientific Principles and Practice 3rd Ed. Greenfield LJ, et al., 2001. 7. Shackelford’s Surgery of the Alimentary Tract 5th Ed. Yeo CJ and Zuidema GD. Volumes I – V, 2001. 8. Atlas of Human Anatomy 8th Ed. Netter FH, 1995. 9. Atlas of Surgical Operations 7th Ed. Zollinger & Zollinger, 1993. 10. General Surgery Board Review 3rd Ed. Gold MS, Scher LA, and Weinberg G, 1999. 11. General Surgery Review. Makary MA, 2004. 12. Advances in Surgery® Vol 33. Ed. Cameron JL, et al., 1999. 13. Pitfalls of Data Analysis. Clay Helberg, 1995. 14. Principles of Biostatistics. 2nd Ed. Pagano M and Gauvreau K. 2000. Editors The following individuals have been generous with their time and thoughts, and have made several changes and additions to my original “manual”. H. Richard Alexander Surgery Branch, National Cancer Institute William A. Baumgartner The Johns Hopkins Hospital John L. Cameron The Johns Hopkins Hospital Michael A. Choti The Johns Hopkins Hospital Peter L. Choyke Department of Radiology, National Institutes of Health Paul M. Colombani The Johns Hopkins Hospital Matthew Cooper The University of Maryland Edward E. Cornwell, III The Johns Hopkins Hospital Todd Dorman The Johns Hopkins Hospital Frederic E. Eckhauser The Johns Hopkins Hospital David T. Efron The Johns Hopkins Hospital Anne C. Fischer The Johns Hopkins Hospital Julie A. Freischlag The Johns Hopkins Hospital Susan L. Gearhart The Johns Hopkins Hospital Vincent L. Gott The Johns Hopkins Hospital McDonald Horne Department of Hematology, National Institutes of Health Udai S. Kammula Surgery Branch, National Cancer Institute Herbert Kotz Department of Gynecology, National Cancer Institute Steven K. Libutti Surgery Branch, National Cancer Institute Pamela A. Lipsett The Johns Hopkins Hospital Martin A. Makary The Johns Hopkins Hospital Bruce J. Perler The Johns Hopkins Hospital Peter A. Pinto Urology Branch, National Cancer Institute Jorge D. Salazar University of Texas, San Antonio, TX Anthony P. Tufaro The Johns Hopkins Hospital Peter S. Walinsky Presbyterian Heart Group, Albuquerque, NM Stephen S. Yang The Johns Hopkins Hospital Charles J. Yeo Thomas Jefferson University Martha A. Zeiger The Johns Hopkins Hospital Hopkins General Surgery Manual 3 Table of Contents Breast Disease ................................................................................................................................................................................... 5 Head & Neck Disease...................................................................................................................................................................... 9 Thyroid Gland and Disease ......................................................................................................................................................... 12 Parathyroid Gland and Disease................................................................................................................................................... 15 Multiple Endocrine Neoplasia (MEN) ....................................................................................................................................... 18 Gastrinoma...................................................................................................................................................................................... 21 Glucagonoma.................................................................................................................................................................................. 22 Insulinoma ...................................................................................................................................................................................... 23 Adrenal Gland ................................................................................................................................................................................ 24 Pheochromocytoma........................................................................................................................................................................ 27 Pituitary Gland ............................................................................................................................................................................... 28 Thoracic Surgery ............................................................................................................................................................................ 29 Mediastinal Disease ...................................................................................................................................................................... 32 Cardiac Surgery: Congenital Defects ......................................................................................................................................... 34 Cardiac Surgery: Acquired Defects............................................................................................................................................. 36 Vascular Surgery ............................................................................................................................................................................ 42 Urology............................................................................................................................................................................................. 54 Orthopedic Surgery ....................................................................................................................................................................... 55 Gynecologic Pathology ................................................................................................................................................................. 56 Neurosurgery .................................................................................................................................................................................. 57 Cancer Epidemiology .................................................................................................................................................................... 58 Esophageal Disease........................................................................................................................................................................ 59 Stomach & Gut Physiology and Disease ................................................................................................................................... 63 Small Bowel Physiology and Disease ........................................................................................................................................ 67 Colorectal Disease.........................................................................................................................................................................