Goals/Objectives Choice of local therapy Types of mastectomy Lymph node dissection Sentinel node and mastectomy Breast Cancer: Surgical Therapy Theodore N. Tsangaris From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Overview As breast cancer care moves into the second decade of the twenty-first century, much has changed regarding diagnosis, staging, and treatment. However, in the multidisciplinary approach to breast cancer care, the surgeon…

Goals/Objectives Anatomy Indications Techniques Duct Excision Anthony Visioni Julian A. Kim From Delaney CP: Netter's Surgical Anatomy and Approaches, 1st edition (Saunders 2013) Introduction Nipple discharge is a common complaint for women, with the possibility of intraductal cancer the greatest concern. However, benign disease is more often the cause of nipple discharge. It is therefore important to identify patients who might be at risk for malignancy and would…

Goals/Objectives Differential Types of Cysts Indications Complications Cysts of the Breast From Mansel RE, Webster DJT, Sweetland HM: Hughes, Mansel and Webster's Benign Disorders and Diseases of the Breast, 3rd edition (Saunders 2009) Key Points and New Developments 1. Macrocysts constitute the commonest discrete benign breast mass, estimated to occur in 7–10% of all women. 2. Microcysts develop from apocrine metaplasia of a single lobule throughout…

Goals/Objectives Basic Principles Anatomy Technical Considerations Management of Complications Indications and Techniques for Biopsy Marshall M. Urist Kirby I. Bland From Bland K, Copeland EM: Breast: Comprehensive Management of Benign and Malignant Diseases, 4th edition (Saunders 2009) Invasive Techniques Localization of occult breast masses has markedly improved with the use of radiopaque needles and wires that can be radiographically guided into the breast. Once inserted, the relative position…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Management of the Axilla in Breast Cancer Elizabeth Min Hui Kim Barbara L. Smith From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Overview The pathologic status of the axillary lymph nodes remains one of the most important prognostic factors in patients with breast cancer. The presence of axillary node metastases indicates a poorer prognosis and often…

Goals/Objectives Indications Anatomic considerations Technical considerations Lymphatic Mapping and Sentinel Lymphadenectomy for Breast Cancer Baiba J. Grube Armando E. Giuliano From Bland K, Copeland EM: Breast: Comprehensive Management of Benign and Malignant Diseases, 4th edition (Saunders 2009) Technical Considerations General Technical Considerations The opportunity to save a patient from axillary lymph node dissection (ALND) or to improve staging through sentinel lymph node dissection (SLND) depends on accurate identification.…

Goals/Objectives Instrumentation: rigid, flexible Complications Indications Lower GI Endoscopy From Keighley MRB, Williams NS: Surgery of the Anus, Rectum and Colon, 3rd edition (Saunders 2007) Proctosigmoidoscopy A rigid sigmoidoscopy will usually be performed at the completion of the digital examination in the unprepared patient provided there is no painful anal lesion. Disposable instruments are standard in many practices due to the risk of transmissible disease. The…

Goals/Objectives Anatomy Application Techniques You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Goals/Objectives Anatomy Indications Contraindications Complications Diagnostic Upper Endoscopy Jean Marc Canard Jean-Christophe Létard Anne Marie Lennon From Canard JM, et al: Gastrointestinal Endoscopy in Practice, 1st edition (Churchill Livingstone 2011) Key Points Upper endoscopy is a commonly performed procedure. Always intubate under direct vision and never push. Be aware of “blind” areas, which can be easily missed. Cancers should be classified using the Paris classification system. Introduction Esophagogastroduodenoscopy (EGD) is…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Diagnostic Colonoscopy Jean Marc Canard Jean-Christophe Létard Ian Penman From Canard JM, et al: Gastrointestinal Endoscopy in Practice, 1st edition (Churchill Livingstone 2011) Key Points High quality colonic preparation is essential. Good technique is the key to allowing a rapid, complete examination of the colon. The colonoscope should be advanced under visual control. The colonoscope should be shortened frequently to ensure a…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Fiberoptic Bronchoscopy Massimo Antonelli Giuseppe Bello From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders, 2011) Before Procedure Indications Diagnostic uses: To assess the patency and anatomy of the upper airway To evaluate problems associated with endotracheal tubes and airway stents (e.g., tracheal damage, device malposition, airway obstruction) To investigate lung…

Goals/Objectives Indications Anatomic considerations Technical considerations Bronchoalveolar Lavage and Protected Specimen Bronchial Brushing Lillian L. Emlet From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) Before Procedure Indications Diagnosis of pneumonia: Viral, bacterial, fungal, mycobacterial, Pneumocystis carinii pneumonias Quantitative cultures for ventilator-associated pneumonias Infiltrates in an immunocompromised host Evaluation of diffuse lung infiltrates Suspected pulmonary hemorrhage Suspected…

Goals/Objectives Topical therapy Immunotherapy Surgery Condyloma Acuminata Vivek Chaudhry Russell K. Pearl From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Goals/Objectives Anatomy Indications Techniques Diseases of the Anorectum Peter W. Marcello From Feldman M, et al: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th edition (Saunders 2010) Internal Hemorrhoids Symptoms and Signs It is speculated that internal hemorrhoids become symptomatic when their supporting structures become disrupted and prolapse of the vascular cushions occurs. Hemorrhoids occur more commonly in people with constipation who have hard, infrequent stools. They also…

Goals/Objectives Anatomy Degree/Types of Hemorrhoids Complications Hemorrhoidal Disease From Keighley MRB, Williams NS: Surgery of the Anus, Rectum and Colon, 3rd edition (Saunders 2007) Assessment of the Patient History The definitive diagnosis of hemorrhoidal disease can be made almost always if a careful history is taken, paying particular attention to the colour and character of the bleeding, the relation of discomfort to defecation and the unequivocal…

Goals/Objectives Basic Principles Anatomy Technical Considerations Management of Complications Anorectal Abscess and Fistula Scott R. Steele Eric K. Johnson David N. Armstrong From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Introduction Anorectal abscess is a debilitating condition originating from a cryptoglandular infection in the anal canal in about 90% of patients, and it remains one of the more common anorectal conditions encountered in general surgical…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Anal Fissure Cybil Corning Eric G. Weiss From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Definition An anal fissure is a painful linear tear in the skin or anoderm overlying the internal anal sphincter distal to the dentate line. Fissures may be classified as acute or chronic depending on their time course and associated findings. Although…

Goals/Objectives Etiology Anatomic considerations Technical considerations Anorectal Abscess and Fistula From Keighley MRB, Williams NS: Surgery of the Anus, Rectum and Colon, 3rd ed (Saunders, 2007) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Goals/Objectives Basic types Physiologic considerations Technical considerations Colon and Rectum Robert D. Fry Najjia N. Mahmoud David J. Maron Joshua I.S. Bleier From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Large Bowel Obstruction and Pseudo-Obstruction Large bowel obstruction can be classified as dynamic (mechanical) or adynamic (pseudo-obstruction). Mechanical obstruction is characterized by blockage of the large bowel (luminal, mural, or extramural), resulting in increased intestinal contractility as…

Goals/Objectives Physiology Indications Techniques Colon and Rectum Robert D. Fry Najjia N. Mahmoud David J. Maron Joshua I.S. Bleier From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Intestinal Stomas Occasionally, the intestinal tract needs to be interrupted and fused to the skin to divert bodily wastes, temporarily or permanently, for a variety of reasons. A stoma, or ostomy, is an artificial opening of the intestinal or urinary…