Thoracoscopic neurofibroma
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A 12-year-old girl presented with swelling in her right index finger and left side of her neck pushing her sternoclavicular joint forward and deforming it. Examination revealed multiple skin nodules and neurofibroma was diagnosed. A CT scan showed a mass in her left thorax and a separate neck mass causing scoliosis. Thoracoscopic surgery was planned to remove the intrathoracic mass, which was situated between the arch bifurcation and subclavian vessels. The mass was successfully removed using three ports and she recovered well, being discharged after three days.
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Dear Readers,
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have a nice day,
hanan
OPSX32SandallOscarMCCG240 Case Scenario OPSX32 Sandall, Os.docx
OPSX32SandallOscar
MCCG240 Case Scenario OPSX32 Sandall, Oscar.html[10/21/2021 10:55:48 AM]
Outpatient Surgery
Patient Case Number: OPSX32-Sandall, Oscar
Patient Name: Oscar Sandall DOB: 02-19-72 Sex: M
Date of Service: 05-05-XX Surgeon: Sandra Cullman, MD
Pre-Operative Diagnosis
Right knee complex medial
meniscus tear
Post-Operative Diagnosis
Right knee complex medial meniscus tear and medial plica
Procedure Performed: Knee arthroscopy w/ partial medial meniscectomy, chondroplasty of medial
femoral condyle, excision of medial plica
Anesthesia: General Complications: None
Indication for Procedure:
The patient is a 46y/o male who was referred to me with complaints of right knee pain. He has had pain
for several months and failed nonoperative treatment. I recommended a right knee arthroscopy with
partial medial meniscectomy. The risks, benefits and possible complications from the surgery were
discussed in detail and the patient wishes to proceed. The potential risks include: Infection, bleeding,
neurovascular damage, residual pain and dysfunction, recurrence as well as the surgery possibly not
improving the patient’s symptoms. If a meniscectomy is performed the patient understands that there is
an increased chance of developing or accelerating any existing arthritis in that knee. The patient also
understands the risks of anesthesia which include stroke, heart attack, aspiration, blood clot, pulmonary
embolus and death.
Description of Procedure:
After consent was obtained the patient was taken to the operating room and was administered a general
anesthetic and intubated. A well-padded tourniquet was applied to the right upper thigh. The extremity
was then prepped and draped in the usual fashion. An Esmarch was used to exsanguinate the right lower
extremity and the tourniquet inflated to 325 mmHg. a superomedial portal was made for the introduction
of the inflow. An anterolateral portal was made for the introduction of the arthroscope. An anteromedial
portal was made for the introduction of arthroscopic instruments. The findings are as follows:
1. Suprapatellar pouch: Normal
2. Medial plica: Frayed
3. Medial gutter: Normal
4. Lateral gutter: Normal
OPSX32SandallOscar
MCCG240 Case Scenario OPSX32 Sandall, Oscar.html[10/21/2021 10:55:48 AM]
5. Patella: Normal
6. Trochlea: Grade I Chondromalacia - Softening Articular Cartilage
7. Medial Femoral Condyle: Grade IIA Chondromalacia - Fissures/Fragmentation Articular Cartilage
<50% and Grade 118 Chondromalacia -Fissures/Fragmentation Articular Cartilage >50%
8. Medial meniscus: Tear, Complex- Root, Posterior Horn, Body
9. Medial Tibial Plateau: Normal
10. ACL: Normal
11. PCL: Normal
12. Lateral Femoral Condyle: Normal
13. Lateral Meniscus: Normal
14. Lateral Tibial Plateau: Normal
15. Popliteus: Normal
16. Popliteal Hiatus: Normal
A partial medial meniscectomy was performed. Using a combination of an upbiting basket, straight
basket and a 4.2 mm Cuda shaver I removed 50 % of the ro.
Anorectal malformations
- Anorectal malformations (ARMs) range from minor defects to complex anomalies associated with other issues. They occur in approximately 1 in 5,000 births.
- Evaluation of newborns with ARMs involves examining the anus, genitals, and spine. Imaging studies like ultrasound, MRI and contrast enemas are used to characterize the anatomy and identify any associated anomalies in other organ systems.
- Treatment depends on the specific type of ARM, but may involve procedures like colostomy to allow the distal anatomy to develop before definitive repair. The long-term goals are to establish bowel and urinary continence.
General surgery specimens
this ppt slides are for quick revision of general surgery specimens in final practical exams for undergraduates as well as postgraduates.
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Cervical traction Gardner Wells-type was performed previously; using weight of 120 kg for 3 min, the fracture was reduced successfully.
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Bibliography
1 - Withington ET. Hippocrates. On Wounds in the Head. In the
Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical
Library 149. Cambridge, MA: Harvard University Press. 1928
- National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: Universityof Alabama (Accessed June 2, 2005). •
2.- Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991;75:15– 26. •
3.- Blight AR. Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line sampling. Neuroscience 1983;10:521–43. •
4.- Bracken MB, Shepard MJ, Collins WF, et al. A rand_x0002_omized controlled trial of methylprednisolone or nalox_x0002_one in the treatment of acute spinal cord injury. N Engl J Med 1990;322:1405–117
5.-AOSpine Continuous Training Program. trauma. Classification of vertebral traumatic injuries. Author: Dr. Alexandre Sadao Iutaka.Editor.Dr. Nestor Fiore
1 - Withington ET. Hippocrates. On Wounds in the Head. In the
Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical
Library 149. Cambridge, MA: Harvard University Press. 1928
- National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: Universityof Alabama (Accessed June 2, 2005). •
2.- Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991;75:15– 26. •
3.- Blight AR. Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line sampling. Neuroscience 1983;10:521–43. •
4.- Bracken MB, Shepard MJ, Collins WF, et al. A rand_x0002_omized controlled trial of methylprednisolone or nalox_x0002_one in the treatment of acute spinal cord injury. N Engl J Med 1990;322:1405–117
5.-AOSpine Continuous Training Program. trauma. Classification of vertebral traumatic injuries. Author: Dr. Alexandre Sadao Iutaka.Editor.Dr. Nestor Fiore
1 - Withington ET. Hippocrates. On Wounds in the Head. In the
Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical
Library 149. Cambridge, MA: Harvard University Press. 1928
- National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: University of Alabama Different types of laparoscopic hernia repair
The document discusses laparoscopic hernia repair, including definitions of hernias, types of hernias, and laparoscopic repair options. It focuses on the transabdominal preperitoneal (TAPP) technique for laparoscopic inguinal hernia repair. The TAPP procedure involves entering the abdominal cavity laparoscopically, incising the peritoneum to access the preperitoneal space, dissecting and removing hernia sacs, placing mesh to reinforce the defect, and closing the peritoneum. Key anatomical structures are identified including the triangles of doom and pain. The steps of TAPP repair and important technical considerations are described in detail.
HSG DCS and Sailography
Hysterography and sialography are radiological procedures used to examine the uterus and salivary glands respectively. Hysterography involves injecting contrast medium into the cervix to visualize the uterus and fallopian tubes. It is typically performed 4-10 days after the start of menstruation to evaluate infertility, recurrent miscarriages, or uterine abnormalities. Sialography involves injecting contrast medium into the ducts of the salivary glands to examine for obstructions or other abnormalities causing salivary gland issues. Both procedures require injecting contrast medium under fluoroscopic guidance and obtaining x-ray images to evaluate the anatomy and check for any blockages or abnormalities. Precautions must be taken to minimize radiation
M132 Module 06 Coding Assignment 1. Case Study #1PREOPERAT.docx
M132 Module 06 Coding Assignment
1. Case Study #1
PREOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
POSTOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
PROCEDURE PERFORMED: Right modified radical mastectomy, left prophylactic mastectomy
PREOPERATIVE HISTORY: The patient is an unfortunate 37-year-old woman who had a pregnancy associated breast cancer of the right breast with extensive involvement of the breast, clinically a stage III breast cancer. She underwent neoadjuvant chemotherapy with a complete clinical response to therapy with no residual palpable tumor in the breast and no palpable adenopathy. She has elected to undergo a bilateral mastectomy. She will have reconstructive surgery at a later time.
OPERATIVE NOTE: The patient was taken to the operating room. General anesthesia was induced. A Foley catheter was inserted. Her arms were placed on pads. Her legs were placed on pads. Bear hugger was applied and her entire upper torso was sterilely prepped and draped in usual fashion. Symmetric skin sparing mastectomies were planned incorporating the nipple-areolar complex on both sides. We began on the left side. An elliptical incision was made incorporating the nipple-areolar complex, carried down through the skin into the subcutaneous tissue. Flaps were raised circumferentially from the superior aspect to the clavicle, medially to the midline, inferiorly to the inframammary, fold and laterally out to the latissimus dorsi. The breast was then removed from the pectoralis major muscle incorporating the fascia, reflected laterally and truncated. It was marked for orientation, weighed and sent to pathology. Hemostasis was achieved where necessary using electrocautery. There was no evidence of bleeding at the end of the case. Moist laps were placed under the flaps and we moved to the right breast. Again, an elliptical incision was created incorporating the nipple-areolar complex and a little more skin laterally in that breast because the breast was a larger breast on that side. Flaps again were raised from superior infraclavicular and a portion of the breast circumferentially to the midline and subsequently to the inframammary fold and subsequently out to the latissimus dorsi muscle. The breast was removed from the pectoralis major muscle incorporating the fascia, reflected laterally. The clavipectoral fascia was opened and a level I and level II axillary lymph node dissection was performed on both sides, sparing the long thoracic and the thoracodorsal neurovascular bundle, as well as at least 1 intercostal brachial cutaneous nerves. The axillary lymph nodes will be examined for metastasis. There was no palpable adenopathy in level III. The breast and axilla were marked for orientation, weighed and sent to pathology. Irrigation was performed. Hemostasis was achieved where necessary using some Surgiclips and electrocautery. There was no evidence of blee ...
Surgical approaches to skull base
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M132 Module 08 Coding Assignment Build the correct ICD 10 PCS .docx
M132 Module 08 Coding Assignment
Build the correct ICD 10 PCS code based on the documentation in the Operative Report documentation given under each Case Study.
1. Case #1
PREOPERATIVE DIAGNOSES:
1. A 37 weeks intrauterine pregnancy.
2. Previous cesarean section with rupture of membranes.
POSTOPERATIVE DIAGNOSES:
1. A 37 plus weeks gestation.
2. Previous cesarean section with spontaneous rupture of membranes.
3. Pelvic adhesions.
ANESTHESIA: Spinal.
PROCEDURE PERFORMED: Repeat low-transverse cesarean section.
FINDINGS: Male infant, 6 pounds, 5 ounces. Apgars 9 and 9.
ESTIMATED BLOOD LOSS: 800 mL.
The patient's condition after surgery, the patient tolerated the procedure well.
PERTINENT HISTORY AND PHYSICAL: The patient is a 20-year-old black female, gravida 2, para 1-0-0-1, last normal menstrual period 08/02/2006, EDC 05/08/2007, 37-5/7th weeks gestation, she presented to L D with spontaneous rupture of membranes, history of previous cesarean section in 2009 for CPD.
PAST MEDICAL HISTORY: She denies allergies.
MEDICATIONS: She is on prenatal vitamins.
MEDICAL SURGICAL: She denies any significant history except for C-section in 2006.
SOCIAL HISTORY: She denies ethanol, tobacco, or drugs.
PSYCHIATRIC HISTORY: Noncontributory.
FAMILY HISTORY: Noncontributory.
PHYSICAL EXAMINATION: Vital Signs: Temperature, the patient is afebrile, pulse 94, respiratory rate 20, BP 97/50, fetal heart tone was 140 to 145. HEENT was within normal limits. Neck is supple. Chest: Cardiovascular, Sl and S2 regular without gallop or murmur. Lungs: Clear both fields. Breasts: No masses or tenderness. Abdomen: Gravid. Pelvic: Cervix was 50% effaced, 1 to 2 cm dilated, presenting part was vertex at -2 station, there was gross fluid, clear and Nitrazine was positive. The patient was therefore taken to the operating room for a repeat low-transverse cesarean section.
OPERATIONAL TECHNIQUE: The patient was brought to the operating room and under spinal anesthesia, was prepped and draped in the usual manner for a gynecologic abdominal operation. Through the old suprapubic Pfannenstiel skin incision, the abdominal cavity was entered into after much difficulty because of the pelvic abdominal adhesion. Following entry into the abdominal cavity, the bladder peritoneum was identified, reflected down. Following that, a midline low-transverse incision was made at the lower uterine segment with a knife and carried down into the uterine cavity without any difficulty. The incision was then extended to the level of the round ligament on both sides. Following which a male infant in vertex position was delivered with vacuum and handed over to the nursery staff in attendance. Birth weight was 6 pounds 5 ounces. Apgar was 9 and 9. Placenta was manually delivered. After remnants of the placental membranes have been removed from the uterine cavity, the uterine cavity was then closed with #1 chromic continuous interlocking suture. Hemostasis was verified and found to be adequa ...
CSF fand ANS
A 9 year old boy presented with balance issues and headaches and was found to have hydrocephalus on imaging. Specifically, a CT scan showed dilated ventricles and MRI revealed a stenotic cerebral aqueduct. He underwent a ventriculostomy which resolved his symptoms.
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Case Presentation On Reconstruction With Pectoralis Major Myocutanious Flap
Case Presentation On Reconstruction With Pectoralis Major Myocutanious Flap
Case Review #8: 62 year old female with cervical spinal stenosis
Case Review #8: 62 year old female with cervical spinal stenosis
OPSX32SandallOscarMCCG240 Case Scenario OPSX32 Sandall, Os.docx
OPSX32SandallOscarMCCG240 Case Scenario OPSX32 Sandall, Os.docx
Clowards Anterior approach with Interbody fusion in a patient with AO Spine C...
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M132 Module 06 Coding Assignment 1. Case Study #1PREOPERAT.docx
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M132 Module 08 Coding Assignment Build the correct ICD 10 PCS .docx
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Thoracoscopic neurofibroma
- 1. Thoracoscopic Neurofibroma excision Prakash Agawral R.K.Bagdi Apollo Children’s Hospital
- 2. History • A 12 year old girl • Swelling in the -Right index finger -left side neck region pushing the sternoclavicular joint anteriorly and deforming it.
- 3. Examination • Multiple skin nodules all over the body with melanotic freckles over the skin. • Diagnosis of Neurofibroma advised CT Scan thorax, to see for any thoracic extension
- 4. Radiology • Lesion in the apical area of left hemithorax and a separate mass in the neck. • The mass had no spinal extension and was causing scoliotic deformity of the spine. • It was situated between the bifurcation of the arch and subclavian vessels.
- 5. Surgery • We planned a thoracoscopic removal of the intrathoracic mass in the apex of left hemithorax. • The patient was placed in a semi prone position and -ports were introduced in the 5th intercostal space at the tip of scapula, -posterior axillary line and -medial border of scapula.
- 6. Surgery
- 7. Post op • Recovered well • Full feeds after 8 hours • ICD out on 2nd post op day • Discharged after 3 days • Histopathology - Neurofibroma