InsideSurgery Medical Information Blog » Tip of the Day

Where Does the Appendix Rupture?

Editor — Wed, 21 Jul 2010 08:00:21 +0000

In rupture or perforated appendicitis, the most common location is the antimesenteric border of the middle third because this area has the most anatomically deficient blood supply.

Glasgow Coma Score (GCS) Predictive Ability

Editor — Tue, 20 Jul 2010 08:00:55 +0000

The most important and most predictive scale (motor, verbal, eye opening) in the Glasgow Coma Score is the motor scale or response.

Coagulopathy in Renal Failure

Editor — Mon, 19 Jul 2010 08:00:11 +0000

Coagulopathy and increased bleeding risk that occurs secondary to renal failure is often treated with DDAVP rather than blood component therapy (i.e., administering platelets or fresh frozen plasma (FFP)).

Fluid Resuscitation in Burn Injuries

Editor — Sun, 18 Jul 2010 08:00:46 +0000

One of the most important components of adequate treatment in burn injuries in sufficient fluid resuscitation. Burn injuries have massive fluid loss due to evaporation and third spacing and outcomes are directly related to prompt and vigorous fluid administration, usually guided by the Parkland formula or analagous algorithm.

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Blandin Hernia

Editor — Sat, 17 Jul 2010 08:00:32 +0000

This rarely occurring internal hernia occurs when intraperitoneal tissue (most commonly bowel or omentum) passes through the foramen of Winslow.

Causes of Hepatic Masses

Editor — Fri, 16 Jul 2010 08:00:40 +0000

Unfortunately for patients, masses found in the liver have a depressingly high incidence of malignancy. Solid liver masses are just as likely to be metastatic in nature as is the incidence of focal nodular hyperplasian and hepatic adenomas, so these masses should almost always be worked up.

Cancer of the Cecum

Editor — Thu, 15 Jul 2010 08:00:47 +0000

The astute clinician will always have a high index of suspcion for the presence of cecal cancer in any elderly patient who presents with anemia and signs and symptoms of appendicitis.

Treatment of Hyperaldosteronism (Conn’s Disease)

Editor — Wed, 14 Jul 2010 08:00:00 +0000

When primary hyperaldosteronism is discovered, usually on laboratory studies and clinical presentation, the treatment algoritm depends on the cause.

If the hyperaldosteronism is caused by an adenoma the treatment is adrenalectomy or surgical removal of the affected adrenal, usually by a laparosocpic approach.

If the cause of the hyperaldosteronism is bilateral hyperplasia, the treatment is spironolactone.

Usually a computed tomography (CT) test will be able to detect an adenoma if present.

Treatment of Small Bowel Diverticula

Editor — Tue, 13 Jul 2010 13:09:49 +0000

Most small bowel diverticula are asymptomatic and are not treated if they are found incidentally. If they become symptomatic, they are surgically resected (removed).

Tea Tree Oil Does Not Kill MRSA

Editor — Mon, 14 Jun 2010 00:26:37 +0000

Publically used gym equipment is notorious as a breeding ground for MRSA (methicillin resistant Staph aureus) and is considered a risk factor for contracting a MRSA infection. These infections are difficult to treat and can be life-threatening.

The Staph aureus organism found on gym mats and equipment handles is fairly easy to kill if the correct aseptic material is used. Wiping down the equipment for 15 seconds with bleach or 30 seconds with chlorhexidine will reduce the bacterial burden and decrease the chances of being colonized with the bacteria.

One “cleaner” that most emphatically will not kill MRSA is tea tree oil. The editors know of at least one fitness instructor in Kentucky who stated emphatically when queried about the cleaning done to reduce MRSA responded that she thoroughly cleans at the end of the day with tea tree oil.

This is woefully inadequate. While there are some reports in the scientific literature investigating tea tree oil as an antimicrobial that may have some efficacy against MRSA, there are no data that support its use as a single bactericidal agent for cleaning contaminated surfaces.

In fact, there are studies that suggest that using tea tree oil in a sublethal concentration makes MRSA more antibiotic resistant and difficult to kill. Almost universally, hospitals do not consider the use of this substance to meet the requirement as an adequate MRSA disinfectant.