International surgical boards

2021-12-17 11:11:31 Open / Comment

2021-12-17 07:49:20 Re-expansion pulmonary edema

Sometimes when a lung is collapsed for long time, and is then suddently re-expanded, edema may develop in this lung, this condition is called re-expansion pulmonary edema.

The etiopathogenesis of this condition is unclear, it may result from the mechanical stress of re-expansion which will then affect capillary permeability rendering them leaky with development of edema.

Generally, the risk is increased when fluid or air has been collapsing lung for longer than 72 hours, additionally sudden and rapid decompression is very risky, DO NOT REMOVE MORE THAN 1.5 L AS MAXIMUM AT A TIME.

Re-expansion pulmonary edema tend to develop rapidly, and it is a lethal condition with a mortality rate of 20%.

Above fig show right pneumothorax, which was drained, with development of right sided re-expansion pulmonary edema, these Xrays are from the same patient. Open / Comment

2021-12-17 07:38:47 Open / Comment

2021-12-17 07:35:27 Open / Comment

2021-12-17 07:16:23 Question

48 year old male smoker presented with severe left chest pain and dysnpea, respiratory rate was 28 breath per min, heart rate is 160/min, SBP is 85 mmHg, a chest X ray was done and revealed massive left pleural effusion, therapeutic drainage was performed and yielded about 2 L of blood stained fluid.
The patient improved for a while but then suddently deteriorated rapidly with cyanosis, breathlessness, chest crackles and finally collapsed to death.

Q1: What is the most probable cause of death in this patient?.

Q2: What was wrong in this patient management that had led to his death?. Open / Comment

2021-12-16 16:23:27 Note

Almost all autoimmune diseases associated with MHC class II (HLA DR) are more common in females, whereas almost all autoimmune diseases associated with MHC class I are more common in males. Open / Comment

2021-12-16 13:24:11 Open / Comment

2021-12-16 10:26:49 Open / Comment

2021-12-16 06:54:57 Question

65 years old male patient presented with severe recurrent abdominal pain that was like a cramp or a gripping like pain, the pain occured after eating.
Examination revealed weight loss, soft lax but tender abdomen, there was loss of hair from the lower limbs, and diminished lower limb pulses bilaterally.
ECG pattern shows ST segment depression in leads V5 and V6.

Q: What is the most likely cause of the patient's abdominal pain?. Open / Comment

2021-12-16 06:21:53 Veno-occlusive disease (VOD)

This disease is caused by widespread occlusion of the small terminal central hepatic venules with sparing of the large hepatic veins differentiating it from Budd-Chiari syndrome.

The cause of this occlusion can be due to (1) Irradiation injury to the liver, (2) Cytotoxic drugs, (3) Some plants used in making tea, such as Senecio and Heliotrope plants that contain toxic Pyrrolizidine alkaloids.

In hematopoeitic stem cell transplant this disease can occur in up to 20% of all cases with mortality rate of 90% in severe cases

The presentation is identical to Budd-chiari syndrome, but there is radiological evidence that the large hepatic veins are patent, Biopsy confirm diagnosis (above fig shows occluded hepatic venule).

Treatment is supportive, Defibrotide is a promising drug that bind to endothelial cells and promote fibrinolysis. Open / Comment