65-year-old Male With Testicular Hernia

You have been asked to perform a preoperative consultation on a 65-year-old male who will be undergoing a testicular hernia repair. Of the following findings, which is of most concern in predicting a cardiac complication in this patient undergoing noncardiac surgery?

a) Age over 60
b) History of myocardial infarction 3.5 years ago
c) Harsh systolic crescendo-decrescendo murmur radiating to the carotids
d) ECG and subsequent telemetry showing up to five PVCs per minute
e) Serum creatinine 2.0 mg/dL

Answer:

34 year-old Man With Intermittent Melena

A 34-year-old man presents to the emergency department(ED) with intermittent melena of 3 days’ duration. He is mildly fatigued but hemodynamically stable and denies any hematemesis or coffee ground emesis. His serum hemoglobin level is 8.2 g/dL. Intravenous (IV) fluids are started. Physical examination is essentially unremarkable. What is the next best step in this patient’s evaluation?

A. Check serum Helicobacter pylori antibody levels
B. Perform a colonoscopy
C. Perform an esophagogastroduodenoscopy(EGD)
D. Start a histamine2 receptor antagonist (H2 blocker)
E. Transfuse 2 U of packed red blood cells

Answer: 

Did You Know ? Surgical Fact #1

Peptic ulcer disease was once being recognized as a complicated disease which can turn out to be life threatening. For more than a century, it was often being treated surgically, with resulting high morbidity and mortality rate.  The perception of the pathophysiology of peptic ulcer disease has totally changed during the 1980s, when Barry J. Marshall and J. Robin Warren discovered the relationship between helicobacter pylori with gastritis and gastric ulcer. Since then, the management of peptic ulcer disease has been shifted towards conservative treatment with various pharmacological therapy being  introduced to inhibit the gastric acid secretions and to eradicate the H.pylori J. Marshall and J. Robin Warren were being awared the 2005 Nobel prize for their contribution.

The Case of the Sickly Scribbler With an Agonizing Belly Ache

The patient was a 59-year-old white male author who complained of severe abdominal pain.

Personal History

The patient was the eldest of 10 children. Two siblings died of typhoid -- one from peritonitis secondary to a perforated intestinal ulcer that had been caused by the disease. His mother died of abdominal cancer at age 44 and his father died at age 82. As an adult, the patient smoked and drank copious amounts of white wine -- often becoming inebriated. He led an irregular life, frequently moving, sometimes eating poorly, and, although he had multiple medical problems, he often failed to comply with medical advice. He had 2 children, a son and a daughter who required frequent hospitalization for attacks of schizophrenia.

Medical History

Throughout adulthood, the patient experienced a number of severe medical conditions. At age 27, he was hospitalized with what was thought to be rheumatic fever, which was followed by attacks of polyarthritis over the course of his life. The patient also suffered from attacks of iritis and glaucoma, which were treated with medications and applications of leeches. He also underwent multiple eye operations. Despite these efforts, his vision gradually deteriorated. In later life, he became blind in his right eye, with limited vision in his left eye. Eventually he could only write using crayons to form large letters, depending on friends to type his manuscripts. Additional health problems included severe dental caries, sciatica, and tonsillitis. Beginning in his twenties, the patient had several attacks of upper abdominal pain, sometimes lasting for a week or more. It was after a final attack that the patient died. Until this last event, his physicians never obtained abdominal x-rays, nor had they succeeded in establishing a definitive diagnosis for the abdominal condition.

Final Illness

His final illness began with "stomach cramps" after an evening meal washed down with copious amounts of white wine. The abdominal pain became so severe that at 4:00 AM the patient called a local physician who administered morphine. Later that day, a surgeon visited the patient and advised hospitalization. The next morning, abdominal x-rays were obtained, and approximately 30 hours after the initial onset of pain, the patient underwent an abdominal operation. For the first several postoperative hours, the patient seemed to be doing well, but he soon weakened. The dLay following surgery, he developed gastrointestinal bleeding and received 2 transfusions. Unfortunately, he soon lapsed into a coma and died on the second postoperative day.^[2] An autopsy was performed.

What is your diagnosis?

1. Intestinal obstruction
2. Ruptured peptic ulcer
3. Ruptured aortic aneurysm
4. Mallory-Weiss syndrome 

1st Surgical Meeting: A Step Onto The Surgical Ladder

I want to be a surgeon. Yes, I really do. I want to start my plans and be prepared for the path ahead of me. But, then again , I don't have a clue of the surgical training in Malaysia. MRCS ? Masters in Surgery ?  If I succeeded in being a surgeon , what would life be after that? 

Have you ever pondered upon the pathway to become a surgeon , how you should go about it , what are the requirements and how life as a surgeon is? 

Well , I do. I bet some of you do too! 

You are in luck ! 

IMU Surgical Society will be having our 1st Surgical Meeting on the 16th of June 2012, Saturday ! The main objectives of this Surgical Meeting is to clear your doubts and answer the inquiries that you have about Surgical Training in Malaysia and life as a surgeon. 

We have invited speakers to enlighten us on the path before us. There will also be clinical anatomy workshops. This will definitely be a treat! Also , for those who have excellent suture techniques , here's your chance to shine as a Suture Competition will be held ! 

It will be held in IMU Clinical School Seremban 9.00am - 5.00pm. 

Early bird registration fee : RM 20 ( before 31st May ) 

So what are you waiting for ?! Download the form and register quick !

You can download the Surgical Meeting details, program sheet and registration form from here :

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Cheers !