CME : Your SA Journal of CPD - Volume 25, Issue 7, 2007
Volume 25, Issue 7, 2007
Author Eugenio PanieriSource: CME : Your SA Journal of CPD 25, pp 312 –313 (2007)More Less
The common themes that emerge in minimally invasive endocrine surgery are that:
- proper patient selection is crucial to good results
- it is best to localise the tumours preoperatively whenever possible for a focused operation
- invasive cancers and very large tumours are usually contraindications to minimally invasive approaches
- multiple techniques are usually available, although some may be more versatile than others
- surgeon and institutional experience is of paramount importance in the choice of specific surgical technique and in obtaining good results
- good prospective studies are sorely needed to evaluate these techniques.
Source: CME : Your SA Journal of CPD 25, pp 314 –318 (2007)More Less
- Aortic stentgrafts have expanded the treatment options for repair of abdominal aortic aneurysms.
- Surgery and EVAR are complementary, not competitive, treatment strategies.
- Current stentgraft configuration for EVAR involves a modular, bifurcated, design. Thoracic stentgrafts employ a tube configuration, with current limitations involving obtaining an adequate seal in the aortic arch and bulky, rigid, delivery devices.
- Current limitations to EVAR include hostile proximal aortic neck anatomy, difficult iliac access, and small calibre vessels in females.
- EVAR in appropriate patients has excellent early and improving intermediate results. In experienced hands it is safe and effective.
- The magnitude of surgery may be reduced by the adjunctive use of aortic stentgrafts ('hybrid' procedures for complex aortic aneurysm repairs).
- EVAR, despite being minimally invasive, is not a lesser procedure. The magnitude of procedure-related complications rivals that associated with open surgery.
- In the long term, EVAR is more expensive than surgery.
- The long-term durability of aortic stentgrafts has yet to be defined.
- EVAR is less invasive, but patients require serial long-term follow-up and imaging surveillance, with increased probability of secondary reinterventions (approximately 40% are free of reinterventions at 5 years). This needs to be discussed with patients.
Source: CME : Your SA Journal of CPD 25, pp 320 –323 (2007)More Less
- The injured patient must be taken to the most appropriate hospital and not the closest.
- A more liberal use of the CT head is required in children after head trauma.
- An open mouth view is not accurate in the intubated patient.
- A CT scan may be used to determine the need for angiography and contrast studies in the stable patient with the transmediastinal gunshot wound.
- Damage control surgery is an attempt to control bleeding and prevent contamination as rapidly as possible.
Author Douglas StupartSource: CME : Your SA Journal of CPD 25, pp 324 –327 (2007)More Less
- Malignant colonic obstruction carries a high mortality rate.
- The priorities of treatment are fluid resuscitation and decompression of the upstream bowel.
- Right-sided obstructing lesions are usually treated by a right hemicolectomy and primary anastomosis.
- Colonic stenting offers a safe, minimally invasive approach to decompressing the obstructed colon.
- Colonic stenting may be done as definitive palliation, or as a 'bridge to surgery'.
- Several operative strategies exist for left-sided colonic obstruction, and the choice of procedure depends on the general condition of the patient, and the surgeon's experience.
- In an unstable patient, or when the surgeon is inexperienced in major colonic surgery, a defunctioning colostomy is a safe option for emergency decompression of the bowel.
Source: CME : Your SA Journal of CPD 25, pp 328 –331 (2007)More Less
- Cholestatic jaundice caused by intrahepatic hepatocellular disease may be clinically and biochemically indistinguishable from cholestasis due to extrahepatic bile duct obstruction.
- The most common intrahepatic causes of jaundice are viral hepatitis, alcohol-induced hepatitis, cirrhosis and drug-induced jaundice.
- Extrahepatic jaundice is most often due to a stone in the common bile duct or a pancreaticobiliary malignancy. Pancreatic pseudocysts, chronic pancreatitis, sclerosing cholangitis, benign bile duct strictures or parasites in the bile duct are less common causes.
- Ultrasound is a useful initial investigation because it is non-invasive and assesses pancreaticobiliary structures in real-time without exposing the patient to ionising radiation.
- Dilated ducts are indirect evidence of biliary obstruction.
- If bile ducts are not dilated, hepatocellular disease is the likely diagnosis; however, parenchymal liver disease or sclerosing cholangitis may prevent biliary dilatation despite obstruction being present.