Gleason Grade of Carcinoma Prostate

(1–5)is asfollows:
1.Small uniform glands
2.More stroma between glands
3.Distinctly infiltrative margins
4.Irregular masses of neoplastic glands
5.Only occasional gland formation (undifferentiated).

#Surgery

Treatment of Hypospadius:
Staged Procedure

I. At the age of one and half years, surgical correction of the chordee is done.

II. At the age of 5–7 years, reconstruction of urethra is done using prepucial skin (ideal) or scrotal skin if the patient has been circumcised. Best is prepucial skin.

-Perineal urethrostomy is done for diversion.
-Perineal urethrostomy should be there until reconstruction of urethra takes up well (Denis-Browne procedure).
-MAGPI repair: Meatal advancement glandular repair—for glan-dular hypospadias.


#Surgery

Remember:

-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.

#Surgery

Among the sources of bleeding, fractures are not to be taken lightly,

-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.

#Surgery

Bed sore score:

Grade 1: redness erythema not disappear with pressure.
Grade 2: superficial ulcer
Grade 3: superficial and subcutaneous tissue but not through fascia.
Grade 4: deep to muscles and joints.

#Surgery

Exceptions of Courvoisier's law (in 20% of cases):

a-Calcular obstruction of CBD with palpable G.B. :
1.Metabolic stone with a healthy distensible G.B.
2.Stone in CBD & another stone in cystic duct .
3.A stone of Hartmann's pouch obstructing both cystic duct and CBD (Mirrizi syndrome).

b-Malignant obstruction of CBD without G.B. enlargement:
1.Associated chronic cholecystitis.
2.Malignancy at the porta hepatis.

#Surgery

- Most Common organ injured in blunt abdominal trauma is the spleen ( the second is the liver).

-Most Common organ injured in penetrating abdominal trauma is the small intestine.

-Blunt truma patient with hemodynamic instability should be evaluated by USG ( FAST).

-FAST =( Focused  assessment  with  Sonography for Trauma)
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-Rapid diagnostic examination to assess patients with potential thoracoabdominal injuries , performed  within 2 - 4 minutes

#Surgery

•Redness more dangerous than cynosis in ischaemic limb, Why?

-Because redness means extravasation of blood form dead. tissues.

#Surgery

-Crystalloids include saline, Ringer’s lactate, and glucose.

-Colloids include blood products such as red blood cells (RBCs) and albumin.

#Surgery

ERCP Complications:

2B 2P
2B
1-Bleeding
2-Bacterial cholangitis.

2P
1-Perforation 
2-Pancreatitis.

#Surgery

Features of compartment syndrome:
The 6 Ps

-Pain
-Pallor
-Paresthesias
-Pulse deficit
-Poikilothermia
-Paralysis.

#Surgery

Rule in RTA:

-Any unconscious patient should be considered as having spinal cord injury untill proved otherwise.

#Surgery

Meckel’s diverticulum (Rule of 2’s):

•2% of population
•2 times commoner in males
•2 feet proximal to ileocaecal valve
•2 inches in length
•2 types of common ectopic tissue
(gastric and pancreatic).

#Surgery

Rule in malignant surgery:

-Don not do surgical operation for cancer if metastasis is present.

-Note: may be done if the operation is for palliative procedure in critical sites as trachea .

#Surgery

Remember 6F

•Follicular carcinoma of Thyroid:
-Follicular
-Female
-Forty
-Far away "mets. by blood"
-FNAC" not conclusive "
-Familial.

•Gall stones:
-Forty
-Female
-Fatty
-Fair
-Flatulent
-Fertile.

•Generalized abdominal distention:
-Fluid
-Fetus
-Full bladder
-Faces
-Fat
-Fibroma
-Flatus.

#Surgery

GALLSTONE ILEUS

-It is a type of acute intestinal obstruction, often seen in elderly and is due to blockage by a bolus or mass of gallstones which commonly enter the intestine through cholecystoduodenal fistula (75%) or rarely through cholecystointestinal or gastric fistulas.


#Surgery

Aortoiliac disease (Leriche syndrome)

-Triad of bilateral buttock, hip, or thigh claudication, erectile dysfunction, and absent/diminished femoral pulses.

#Surgery

•Thyroid swelling and toxic features appear simultaneously in primary thyrotoxicosis.

#Surgery

-Dyspnea in thyroid:
• Tracheomalacia in long standing MNG
• Retrosternal extension
• Cardiac failure due to secondary thyrotoxicosis
•Infiltration by anaplastic carcinoma.

-Hoarseness of voice:
•Infiltration of recurrent laryngeal nerve by malignancy
• Edema of vocal cord.

#Surgery