What’s new in Surgery for April features: Appendectomy, Neck Mass, Management of Chronic Wounds, Acute Mesenteric Ischemia, Upper Gastrointestinal Bleeding.

Surgery_WhatsNew_april

Appendectomy

MARTIN D. ZIELINSKI, MD, FACS

Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN

 

Acute appendicitis remains a therapeutic challenge during active pregnancy. Both laparascopic and open approaches can be considered; the techniques remain largely the same, with a few caveats. Fetal monitoring may be performed using a transvaginal or left lateral abdominal wall approach. For open appendectomy, ultrasonography and magnetic resonance imaging may provide direction for the incision. Laparascopic appendectomies should be approached with a open trocar placement in the midline, with direct visualization. Late-term pregnancies may require alternative approaches in the subcostal region, and the patient may be rolled with their left side down to facilitate exposure of the appendix and relieve pressure on the inferior vena cava.

 


 

 

Neck Mass

GERARD M. DOHERTY, MD

Department of Surgery, Boston University, Boston Medical Center, Boston, MA

 

The primary operative procedure for medullary thyroid cancer is total or near-total thyroidectomy. Total thyroidectomy allows the use of 131I scanning to monitor for recurrence and increases the sensitivity of thyroglobulin and calcitonin assays in posttreatment surveillance. Patients with medullary thyroid cancer should additionally undergo bilateral central neck dissection, screening for ret proto-oncogene mutations, and screening for  pheochromocytoma.

 


 

 

Management of Chronic Wounds

DANA HENKEL, MD

University of Wisconsin Hospitals and Clinics, Madison, WI

ANGELA GIBSON, MD, PhD

Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI

 

Stem cells serve as the source for replenishing lost cells necessary for repair and tissue regeneration. During the inflammatory phase of wound healing, bone marrow-derived hematopoietic stem cells migrate to the wound site to supply leukocytes and differentiate into dendritic cells via the Notch signalling pathway. Ideally, a consistent, sustained, localized delivery method of these diffusible factors is necessary to augment the healing process of chronic woulds. The role for stem cell therapy in the treatment of chronic wounds is promising; however, the method of delivery to wound, such as intradermal injection, topical delivery, or chemotactic stimulation, is under investigation.

 


 

 

Acute Mesenteric Ischemia

MOHAMMAD H. ESLAMI, MD, MPH

Department s of Surgery and  Radiology, Boston University School of Medicine, Boston, MA

 

Among the various imaging modalities, computed tomography angiography (CTA) is a useful tool for fast and accurate diagnosis of acute mesenteric ischemia (AMI), and has become the most important radiologic study used to make a diagnosis of AMI and other abdominal catastrophes. Compared with conventional contrast angiography, CTA is better able to detect stenosis of the celiac artery, and has been reported to have 100% sensitivity for the detection of superior mesenteric artery stenosis.

 


 

 

Upper Gastrointestinal Bleeding

MATTHEW B. SINGER, MD

Department of Surgery, Division of Trauma, Critical Care, Burns, and Emergency Surgery, The University of Arizona Medical Center, Tucson, AZ

ANDREW L. TANG, MD

Department of Surgery, Division of Trauma, Critical Care, Burns, and Emergency Surgery, The University of Arizona Medical Center, Tucson, AZ

 

Bedside video capsule endoscopy is a real-time diagnostic tool for rapid identification of patients likely to have stigmata of high-risk bleeding at the time of endoscopy. Several studies have reported that rapid VCE predicts those patients most likely to have high-risk stigmata of bleeding with high degrees of sensitivity and specificity. There are several advantages to  bedside VCE: it can easily and rapidly be performed in the emergency setting, it does not require sedation,  it poses limited risks to patients, and it does not interfere with subsequent upper endoscopy.

 

 


As seen in Scientific AmericanTM Surgery.