Indications of mastectomy in early breast cancer rather than wide local excision followed by radiotherapy are:

1) Large tumour in relation to the size of the breast.
2) Central tumour below or involving the nipple.
3) Multifocality/ Multicentricity.
4) Patient's preference.
5) Local recurrence.

#Surgery

Serum thyroglobulin can be used as a serum marker for thyroid malignancy, and also to help diagnose factitious thyrotoxicosis whereby patient is taking exogenous thyroid hormones, in such case the serum thyroglobulin will be greatly depressed, another note to make, that antithyroglobulin antibodies may interfer with the interpretation of serum thyroglobulin in those with thyroid malignancy.

#Surgery

Differential diagnosis of right iliac fossa mass

◼️We can remember them as 4 iliocecal, 4 appendiceal, and 4 surrounding masses, these include the commonest causes and not all of them.

1) Four iliocaecal :
- Crohn's disease.
- Iliocaecal tuberculosis.
- Iliocaecal actinomycosis.
- Tumours of caecum and distal ileum.

2) Four appendiceal :
- Appendicular inflammatory mass.
- Appendicular abscess.
- Mucocele of vermiform appendix "see above figure".
- Appendicular tumours "most common is carcinoid tumour".

3) Four surrounding masses :
- Psoas abscess.
- Desmoid tumour.
- Hernia.
- Aneurysm of iliac artery.

#Surgery

Summary of Fractures Treatment.

#Surgery

MEN syndromes.

#Surgery

To differentiate between testicular torsion and acute epididymo-orchitis:

-If pain is relieved by scrotal elevation, it acute epididymo-orchitis.

-If pain is increased by scrotal elevation, then it's torsion. "Perhin's sign".

#Surgery

Any tumor in testis is malignant until proven otherwise.

Because 99٪ of testicular tumors are malignant!

#Surgery

-The normal appendix may not be visualized on US.
-The diameter of the appendix is usually less than 6 mm. When visible, the normal appendix compresses when pressure is applied with the transducer.

-The inflamed appendix is noncompressible (using a technique called graded compression).

#Surgery

Pericardial tamponade
-Becks triad
•Hypotension
•Engorged neck veins (elevated JVP)
•Muffled heart sounds.

-Acue tamponade 👉🏼100 cc of blood
-Chronic tamponade 👉🏼700-1000 cc of blood.
(Chronic tamponade occurs in pericarditis due to TB, renal failure, liver failure, heart failure, tumor).

#Surgery

Esophageal echo is the best investigation to reveal cardiac injury.

#Surgery

-Penetrating trauma has inlet only. -Perforating trauma has inlet and outlet.

#Surgery

In TensionPneumothorax:

Needle puncture or needle decompression (wide bore needle): in the 2nd intercostal space at the level of mid-clavicular line, converting it into open pneumothorax allowing air to escape into atmosphere thus temporarily relief the tension pneumothorax.

#Surgery

You must be able to identify the visceral pleural line(Fig.10-1) to make the definitive diagnosis of a pneumothorax!

-Visualization of the visceral pleural line—a must for the diagnosis.

#Surgery

Recognizing  acute cholecystitis  on  US:

-The presence of gallstones, possibly impacted in the neck of the  gallbladder or cystic duct)  (Fig.  21-5)
-Thickening  of the gallbladder  wall  (>3  mm) (see  Fig.  21-5,  A)
-Pericholecystic fluid (fluid around the  gallbladder) (see  Fig.  21-5,  B)
- A positive sonographic Murphy sign  (A positive Murphy sign in this case is pain  that is  elicited  by compression of  the gallbladder with the US probe).

•In  the  presence  of  gallstones  and  gallbladder wall  thickening, US  has  a  positive  predictive  value  for  acute cholecystitis  as high  as 94%.

#Surgery

Normal urine output

Adults = 0.5 mL/Kg/Hr.
Children = 1.0 mL/Kg/Hr.
Infants = 2.0 mL/Kg/Hr.

#Surgery

-In perforation of intra-abdominal viscus, liver dullness may become resonant due to air in peritoneal cavity.

#Surgery

-Edema due to fluid overload can usually be differentiated from that caused by hypoproteinemia based on clinical examination, in fluid overload the jugular venous pressure will be raised, whereas in hypoproteinemia it will not appear raised.

#Medicine

Phlegmasia cerulea dolens

-This literally means "painful blue swelling", it is a manifestation of extensive deep venous thrombosis affecting the ileofemoral vein.

#Surgery