Surgery videos & books

2022-04-20 07:01:13 AppendiceAl cArcinoid • Appearance: Firm, yellow, bulbar mass in the appendixQ • Majority of carcinoids are located in the tipQ of the appendix. • Mean tumor size for carcinoids is 2.5 cmQ. • Carcinoid tumors usually present with localized disease (64%)Q. Clinical Features • Carcinoid syndrome is rarely associatedQ with appendiceal carcinoid unless widespread metastases are present. • Symptoms attributable directly to the carcinoid are rareQ, although the tumor can occasionally obstruct the appendiceal lumen much like a fecalith and result in acute appendicitis • Malignant potential is related to size, with tumors < 1 cm rarely resulting in extension outside of the appendixQ or adjacent to the mass. Open / Comment

2022-04-19 06:59:27 Open / Comment

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2022-04-12 09:54:01 Esophageal achalasia is characterized by the findings of aperistalsis/atony and a failure of the LES to relax normally, resulting in esophageal dilatation proximally with a functional obstruction at the LES. Long-standing achalasia results in the characteristic barium swallow finding of a “bird’s beak.” Iatrogenic or tumor-related elevation of LES pressure can result in a “pseudoachalasia,” but should have normal peristaltic patterns on manometry. Patients with Barrett’s esophagus may have a “cobblestone” appearance on barium swallow, with normal peristalsis, and do not characteristically demonstrate esophageal dilatation; LES pressures may be normal or low. Finally, patients with Plummer-Vinson syndrome develop cervical dysphagia due to irondeficiency anemia; patients often present with cervical esophageal webs and can be at higher risk for developing esophageal squamous cell carcinoma. Open / Comment

2022-04-11 09:52:59 51) A 50-year-old male presents with difficulty swallowing. Esophageal manometry demonstrates absence of peristaltic waves and a nonrelaxing lower esophageal sphincter (LES). Which of the following is the most likely diagnosis? Open / Comment

2022-04-11 09:51:56 51) A 50-year-old male presents with difficulty swallowing. Esophageal manometry demonstrates absence of peristaltic waves and a nonrelaxing lower esophageal sphincter (LES). Which of the following is the most likely diagnosis? Open / Comment

2022-04-07 12:12:01 Testicular cancer is the most common malignancy in men between the ages of 15 and 35. It typically presents as unilateral scrotal swelling. On examination, it is important to distinguish intraparenchymal masses (usually malignant) from extraparenchymal masses (usually benign). This is easily done with scrotal ultrasound. Upon the diagnosis of an intraparenchymal testicular mass, a staging CT scan of the chest, abdomen, and pelvis should be obtained. It is reasonable to evaluate the serum levels of beta-HCG and AFP as they may be elevated in 80–85% of patients with nonseminomatous germ cell tumors. LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance. Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor. Additionally, the mass should be excised in order to establish a histologic diagnosis. A radical orchiectomy should be performed from an inguinal approach. Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes. The majority of testicular tumors occurring in young adults are malignant tumors. The tumors may originate from germinal or nongerminal cells. Approximately 95% of testicular tumors are germinal tumors. These include seminomas (the most common), embryonal cell carcinomas, choriocarcinomas, and teratocarcinomas. On the other hand, Leydig cell tumors and androblastomas originate from nongerminal cells and may produce excess testosterone. Benign tumors such as fibroma can occur but are rare. Open / Comment

2022-04-06 12:11:35 50) A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal… Open / Comment

2022-04-06 12:10:37 50) A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. Further management of his condition would include which of the following?
(A) close observation and repeat ultrasound in 3 months
(B) serum beta-human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH)
(C) fine needle aspiration to determine if the mass is malignant
(D) transscrotal orchiectomy
(E) a 2-week course of antibiotics with follow-up clinical examination after completion Open / Comment

2022-04-02 13:50:09 From the description, the diagnosis in this patient is acute regional enteritis. The incidental finding of regional enteritis in patients operated on for the presumed diagnosis of acute appendicitis is treated medically unless there is proximal obstruction. The risk of operating on patients with regional enteritis is the formation of a fistula and/or abscess, especially if the area to be resected is involved with the disease process. However, if the cecum and the appendix are not involved, it is advisable to perform an appendectomy. In this instance, it would be safe and eliminate acute appendicitis from the differential if his symptoms recurred. Open / Comment