SERVICIO DE CIRUGIA GENERAL: 2008

FLUIDOTERAPIA Y ALTERACIONES ELECTROLÍTICAS

CONCEPTO DE SUEROTERAPIA - FLUIDOTERAPIA

La fluidoterapia es la parte de la terapéutica que tiene por objeto mantener el equilibrio interno o restaurarlo mediante la administración de líquidos y o de diversos componentes electrolíticos, bien sea por vía oral o parenteral. El balance hídrico habitualmente se considera en términos del balance externo de agua y electrólitos entre el organismo y el entorno, por lo que conviene repasar los aspectos básicos del equilibrio normal de los mismos.
Sueroterapia: Tratamiento consistente en la administración de sueros con la finalidad de restablecer el equilibrio hidroelectrolítico.
Fluidoterapia: Método terapéutico destinado a mantener o a restaurar por vía endovenosa el volumen y la composición normal de los fluidos corporales.
Suero: Nombre genérico de determinadas soluciones de electrolitos empleadas en terapéutica para restablecer el equilibrio hidroelectrolítico.
Objetivo de la Sueroterapia-Fluidoterapia:
Recuperación y mantenimiento del equilibrio hidroelectrolítico alterado.
Indicaciones principales de la Sueroterapia-Fluidoterapia:
- Hipovolemia
- Depleción de fluído extracelular
- Depleción acuosa
- Depleción salina
- Hipernatremia

ACCEDER A LOS ARCHIVOS.... http://www.4shared.com/dir/11066692/7bc11710/FLUIDOTERAPIA.html

TRAUMA

Hernia diafragmatica traumatica y su tratamiento laparoscopico.
A proposito de un caso y revision de la literatura.
LINK HACIA LOS ARCHIVOS Y EL CASO.

POLIPOSIS INTESTINAL

POLIPOSIS INTESTINO DELGADO Y COLON

Psoas abscess

Psoas abscess rarely requires surgical intervention

Yacoub, W.N.; Sohn, H.J.; Chan, S.; Petrosyan, M.; Vermaire, H.M.; Kelso, R.L.; Towfigh, S.; Mason, R.J.

American Journal of Surgery
Vol: 196 Nro: 2 Págs: 223 - 227 Fecha: 01/08/2008

BACKGROUND: Surgeons are increasingly, encountering psoas abscesses. METHODS: We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. RESULTS: Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography-guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P <.001). The mortality rate was 3%. CONCLUSIONS: Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences. (c) 2008 Elsevier Inc. All rights reserved

COLON, RECTO Y ANO

Anastomotic Leak Testing After Colorectal Resection

Objective: To determine the value of anastomotic leak
testing of left-sided colorectal anastomoses.
Design: Cohort analysis.
Setting: Subspecialty practice at a tertiary care facility.
Patients: Consecutive subjects were selected from a
prospective colorectal database of 2627 patients
treated between January l, 2001, and December 31,
2007.
Intervention: Creation of left-sided colorectal anastomoses
and air leak testing per surgeon preference.
Main Outcomes Measures: Anastomosis type, method
(handsewn vs stapled), performance of air leak testing,
repair method of anastomoses after air leak tests yielding
positive results, and development of postoperative
clinical leak.
Results: A total of 998 left-sided colorectal anastomoses
were performed without proximal diversion; 90.1% were
stapled and 9.9% were handsewn. Intraoperative air leaks
were noted in 65 of 825 tested anastomoses (7.9%), that is,
7.8% of stapled anastomoses and 9.5% of handsewn anastomoses.
Aclinicalleakdevelopedin48patients(4.8%).Clinical
leaks were noted in 7.7% of anastomoses with positive
air leak test resultscomparedwith3.8%ofanastomoseswith
negative air leak test results and 8.1% of all untested anastomoses
(P.03). If air leak testing yielded positive results,
suture repair alone was associated with the highest rate of
postoperative clinical leak compared with diversion or reanastomosis,
12.2% vs 0% vs 0%, respectively (P=.19).
Conclusions: Our data indicate a high rate of air leaks
at air leak testing of left-sided colorectal anastomoses. In
addition, the high rate of clinical leaks in untested anastomoses
leads us to recommend air leak testing of all leftsided
anastomoses, whether stapled or handsewn.
Arch Surg. 2009;144(5):407-411

LIBROS DE COLOPROCTOLOGIA

http://books.google.com.ar/books?id=imEv3PqkJSEC&pg=PA248&dq=hemorrhoidectomy&client=firefox-a&sig=OCQbxmGK9pecCxdjsY4dnAEvg6I#PPP1,M1

http://books.google.com.ar/books?id=VufdwFnykCMC&pg=PA81&dq=hemorrhoidectomy&client=firefox-a&sig=I7Bm7ADwIHd4e4SKNBb6gIUELk4#PPP1,M1

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening........http://www.4shared.com/dir/6115382/9abe40e3/COLON_RECTO_Y_ANO.html

INCIDENTALOMA

Se considera incidentaloma suprarrenal la lesión adrenal no sospechada, clínicamente silente, descubierta casualmente por estudios de imagen realizados a priori, por problemas no relacionados con las glándulas suprarrenales. Nuestro objetivo es presentar series de incidentalomas, revisando el proceso diagnóstico y las técnicas de tratamiento.
La alta resolución de la ecografía, la TC y la RM, así como el mayor número de exploraciones radiológicas realizadas, ha incrementado el número de incidentalomas suprarrenales, como ocurre en la mayoria de las series suponen mas de 50% de la patología suprarrenal.... PARA BAJAR ARTICULOS ORIGINALES: http://www.4shared.com/dir/6368351/bb9bcad2/INCIDENTALOMA.html

OTROS LINKS RELACIONADOS:

http://www.surgical-tutor.org.uk/default-home.htm?system/hnep/incidental.htm~right

http://www.websurg.com/lectures/viewer.php?doi=lt01envanheerden002&redim=1

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Diagnostic value of serum chromogranin-A combined with MIBG scintigraphy inpatients with adrenal incidentalomas.

Q J Nucl Med Mol Imaging 2008 Jun ;52(1):84-8

A Male Case of Nonclassical 21-Hydroxylase Deficiency First Manifested in HisSixties with Adrenocortical Incidentaloma.

Endocr J 2008 Mar ;

1,161 patients with adrenal incidentalomas: indications for surgery.
Langenbecks Arch Surg 2008 Mar ;393(2):121-6

Differential diagnosis of incidentally detected adrenal masses revealed onroutine abdominal CT.
Eur J Radiol 2008 Jan

Malignant and unclear histological findings in incidentalomas. Eur Surg Res 1900 ;40(2):235-8

Computed tomography, magnetic resonance imaging and (11)C-metomidate positronemission tomography for evaluation of adrenal incidentalomas. Eur J Radiol 2007 Dec ;0():-

Adrenal ganglioneuroma. A neoplasia to exclude in patients with adrenalincidentaloma. Acta Chir Belg 1900 ;107(6):670-4

The incidental indeterminate adrenal mass on CT (> 10 H) in patients withoutcancer: is further imaging necessary? Follow-up of 321 consecutive indeterminate adrenal masses. AJR Am J Roentgenol 2007 Nov ;189(5):1119-23

Marked chromogranin A elevation in a patient with bilateral adrenalincidentalomas, and its rapid normalization after discontinuation of proton pump inhibitor therapy. Clin Endocrinol (Oxf) 2007 Nov ;67(5):805-6

The incidental indeterminate adrenal mass on CT (> 10 H) in patients withoutcancer: is further imaging necessary? Follow-up of 321 consecutive indeterminate adrenal masses. Int Braz J Urol 1900 ;33(6):860-1

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HERNIA INGUINAL EN NIÑOS

Hernia Inguinal en Niños.

DEFINICIÓN
La hernia es un defecto del canal inguinal, que permite la salida del contenido de la cavidad abdominal fuera del abdomen, a través de una bolsa o saco herniario.
Podemos encontrar 3 tipos de hernias inguinal a la infancia:

Hernia Inguinal Indirecta	99 %	Saco herniario que protruye por el orificio inguinal profundo.
Hernia Inguinal Directa	0.5 %	Protruye a través de la pared posterior del canal inguinal, por dentro de los vasos epigástricos, destruyendo o alcanzando la fascia transversal, puede penetrar por el canal inguinal y de aquí al escroto, por fuera de la vaginal y del cremáster.
Hernia Crural o Femoral	0.5 %	Protruye por el orificio crural, por debajo del ligamento inguinal, y por dentro de la vena femoral.

Nos referiremos a la más frecuente de todas ellas: La hernia inguinal indirecta. Para comprender mejor el proceso veremos primero un resumen del desenvolvimiento del canal inguinal.....

http://www.4shared.com/dir/6303007/7588575a/HERNIA_INGUINAL_EN_NIOS.html

LIBROS

CIRUGIA DE MICHANS

NETTER

ATLS

MANUALES CTO

TEP, TVP Y TTO. ANTITROMBOTICO

El TEP se define como la oclusión total o parcial de la circulación pulmonar por un coágulo sanguíneo proveniente de la circulación venosa sistémica, incluidas las cavidades cardiacas derechas. Se excluyen los embolismos de otro tipo, como aéreo, tumoral, de líquido amniótico, séptico, etc...

ARCHIVOS Y FOTO EN: http://www.4shared.com/dir/6190418/a948bfc2/TEP-TVP_Y_TTO_ANTITROMBOTICO.html

Tromboembolismo pulmonar masivo

http://tratado.uninet.edu/c0208i.html

EMBOLIA PULMONAR: FISIOPATOLOGIA Y DIAGNOSTICO.

http://escuela.med.puc.cl/publ/boletin/Tromboembolismo/EmboliaPulmonar.html

HEMORRAGIA DIGESTIVA

Mallory-Weiss Tear

Mallory-Weiss syndrome is characterized by upper gastrointestinal bleeding secondary to longitudinal mucosal lacerations at the gastroesophageal junction or gastric cardia. The original description by Mallory and Weiss in 1929 involved patients with persistent retching and vomiting following an alcoholic binge. However, Mallory-Weiss syndrome may occur after any event that provokes a sudden rise in intragastric pressure or gastric prolapse into the esophagus.

A Mallory-Weiss tear (MWT) likely occurs as a result of a large, rapidly occurring, and transient transmural pressure gradient across the region of the gastroesophageal junction. Acute distension of the nondistensible lower esophagus can also produce a linear tear in this region.

With a rapid rise in intragastric pressure due to precipitating factors, such as retching or vomiting, the transmural pressure gradient increases dramatically across the hiatal hernia, which abuts a low intrathoracic pressure zone. If the shearing forces are high enough, a longitudinal laceration eventually occurs. Within the hernia, the tear is more likely to involve the lesser curvature of the gastric cardia, which is relatively immobile compared to the remainder of the stomach.

Another potential mechanism for MWTs is the violent prolapse or intussusception of the upper stomach into the esophagus, as can be witnessed during forceful retching at endoscopy.

http://www.4shared.com/file/39549681/29fb7e90/Mallory_Weiss.html

ABDOMEN AGUDO

http://www.4shared.com/dir/4963883/d6b8f1c/ABDOMEN_AGUDO.html
Woman With an Acute Onset of Nausea and Vomiting
Background
A 46-year-old woman presents to the emergency department (ED) with a history of worsening, constant right upper quadrant pain that radiates to her back and side. She has had nausea and has vomited twice in the past several hours. She underwent a laparoscopic cholecystectomy 2 weeks ago, without complications, and returned to her normal diet. She has not had any bowel movements or flatulence since the pain began. She denies having any fever, chills, or rigors. Her medical history is significant only for high blood pressure, high cholesterol levels, and gallbladder disease. She takes lisinopril, aspirin, multivitamins, and ginseng. She denies smoking or drinking alcohol.

On physical examination, the patient is awake, alert, and oriented. Her vital signs are within the normal range, with a heart rate of 84 bpm and a blood pressure of 124/76 mm Hg. She appears to be in mild distress. The cardiorespiratory examination yields normal findings, with clear lungs and a regular heart rhythm. Her abdomen is soft, but her bowel sounds are decreased, and she has marked tenderness in the right upper quadrant. The rest of her abdomen is minimally tender, with no evidence of guarding or rebound and no palpable masses. The other physical findings are normal.

The laboratory investigation reveals an elevated WBC count of 14.0 × 10⁹/L (14.0 × 10³/µL), with a left shift of 87% neutrophils. Her liver function tests, lipase level, and basic chemistry panel are unremarkable.

Contrast-enhanced computed tomography (CT) scans of the abdomen and pelvis are ordered. Figure 1A shows an anteroposterior (AP) scout image, and Figure 1B shows a selected axial section.

ACTIVIDADES DE CIRUGIA ENDOSCOPICA

ACTIVIDADES EN LA DIVISION ENDOSCOPIA Y CIRUGIA PERCUTANEA

	LUNES	MARTES	MIERCOLES	JUEVES	VIERNES
08-09		ATENEO CIR.		ATENEO HOSP
09-10	PASE	PASE	PASE	PASE	PASE
10.00 - 12.00	CONSULTORIO CIRUGIA -Roldan 31 -Bernardi 32	CONSULTORIO CIRUGIA -Albizzati 31 -Buonomo 30	CONSULTORIO CIRUGIA -Taboada 31 -Bernardi 32	CONSULTORIO CIRUGIA -Flores 31 -Buonomo 30	CONSULTORIO CIRUGIA -Quinteros 31 -Gomez 32
10.00 - 20.00		ENDOSCOPIA		ENDOSCOPIA
14.00 - 20.00	CONSULTORIO GASTROENT. -Villamea 32 -Cuadrado 31	ECOGRAFIA	CONSULTORIO GASTROENT. -Villamea 32 -Cuadrado 31	ECOGRAFIA	CONSULTORIO GASTROENT. -Villamea 32 -Cuadrado 31

DETALLES: http://www.4shared.com/file/39215211/60036d75/A_CRONOGRAMA_COMPILADO_2.html

PREPARACIONES PARA PROCEDIMIENTOS ENDOSCOPICOS DIAGNOSTICOS Y TERAPEUTICOS: