CME : Your SA Journal of CPD - Volume 25, Issue 7, July 2007

The common themes that emerge in minimally invasive endocrine surgery are that:

1. proper patient selection is crucial to good results
2. it is best to localise the tumours preoperatively whenever possible for a focused operation
3. invasive cancers and very large tumours are usually contraindications to minimally invasive approaches
4. multiple techniques are usually available, although some may be more versatile than others
5. surgeon and institutional experience is of paramount importance in the choice of specific surgical technique and in obtaining good results
6. good prospective studies are sorely needed to evaluate these techniques.

1. Aortic stentgrafts have expanded the treatment options for repair of abdominal aortic aneurysms.
2. Surgery and EVAR are complementary, not competitive, treatment strategies.
3. 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.
4. Current limitations to EVAR include hostile proximal aortic neck anatomy, difficult iliac access, and small calibre vessels in females.
5. EVAR in appropriate patients has excellent early and improving intermediate results. In experienced hands it is safe and effective.
6. The magnitude of surgery may be reduced by the adjunctive use of aortic stentgrafts ('hybrid' procedures for complex aortic aneurysm repairs).
7. EVAR, despite being minimally invasive, is not a lesser procedure. The magnitude of procedure-related complications rivals that associated with open surgery.
8. In the long term, EVAR is more expensive than surgery.
9. The long-term durability of aortic stentgrafts has yet to be defined.
10. 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.

• 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.

1. Malignant colonic obstruction carries a high mortality rate.
2. The priorities of treatment are fluid resuscitation and decompression of the upstream bowel.
3. Right-sided obstructing lesions are usually treated by a right hemicolectomy and primary anastomosis.
4. Colonic stenting offers a safe, minimally invasive approach to decompressing the obstructed colon.
5. Colonic stenting may be done as definitive palliation, or as a 'bridge to surgery'.
6. 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.
7. 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.

1. Cholestatic jaundice caused by intrahepatic hepatocellular disease may be clinically and biochemically indistinguishable from cholestasis due to extrahepatic bile duct obstruction.
2. The most common intrahepatic causes of jaundice are viral hepatitis, alcohol-induced hepatitis, cirrhosis and drug-induced jaundice.
3. 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.
4. 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.
5. Dilated ducts are indirect evidence of biliary obstruction.
6. 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.

Routine use of anthelmintics can improve anaemia

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Combination therapy for uncomplicated falciparum malaria in Ugandan children

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Fortifying maize flour with iron in Kenya

Brief intervention on alcohol use leads to safer sex

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Depression linked to progresion of HIV in Tanzanian women