Showing posts with label Surgery. Show all posts
Showing posts with label Surgery. Show all posts
Quotes for Surgeons


Here are a few assorted quotes related to the branch of Surgery. You might have read and heard a few of these before. Some of them are really amusing. Cheers to the passion of learning surgery!



It is better to open and see than to wait and see. 
-Sidney Cuthbert Wallace (1907)
Quotes for Surgeons


The flat abdomen is a good abdomen. 
-G A Decker

Abdominal wall closure: if it looks all right, it’s too tight – if it looks too loose, it’s alright. 
-Matt Oliver
Quotes for Surgeons



Better to have a piece of peritoneum on the bowel than a piece of bowel on the peritoneum.
Quotes for Surgeons


Two things surgeons fear the most are God and peritonitis. 
-Henri Mondor (1885 - 1962)
Quotes for Surgeons


Never let the skin stand between you and the diagnosis
Quotes for Surgeons


Who learns anatomy from books should operate on books only
Quotes for Surgeons


The advent of anaesthesia has made it so that any idiot can become a surgeon. 
-William Stewart Halsted (1852 – 1922)
Quotes for Surgeons



There is an inverse relationship between the surgeon’s ability and the frequency he asks for more muscle relaxants.
Quotes for Surgeons


A surgeon is someone who likes to operate, an anaesthetist is someone who doesn’t like to give anaesthetics. 
-David M. Dent
Quotes for Surgeon

He is not even fit for a haircut under local anaesthesia


Quotes for Surgeon



Blood brain barrier: the screen between the surgeon and the anaesthetist.
Quotes for Surgeons

The patient who can’t be intubated should be intubated.




Surgery is not an art, it is a personality disorder.

Have plenty of assistance but not many assistants. 
-Augustus C. Bernays (1854 - 1907)


A good assistant does not always become a good chief, but a bad assistant never does. 

A good chief has always been a good assistant. 
-Charles F. M. Saint (1886 - 1973)


A surgeon operates as good as his assistant permits.


The surgical resident is like a mushroom: kept in the dark, fed shit and expected to grow.

Poor surgeons can improve but poor assistants never become good surgeons. 
-Moshe Schein

All bleeding eventually ceases - when the patient is dead. 
-Guy de Chauliac (1300 - 1368)

The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is haemorrhage. 
-William Stewart Halsted

There are four degrees of intra-operative haemorrhage: 1. Why did I get involved in this operation? 2. Why did I become a surgeon 3. Why did I become a doctor? 4. Why was I born?. 
-Alexander Artemiev


Blood bank is the surgeon’s gas station.


The most common cause of post-operative coagulopathy: poor haemostasis. Operative atlases never bleed.

The most important clotting factor is the surgeon. 
-Moshe Schein

In men nine out of ten abdominal tumours are malignant, in women nine out of ten abdominal tumours are the pregnant uterus. 
-Rutherford Morris (1853 - 1939)

A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.
— Anonymous

At a given instant everything the surgeon knows suddenly becomes important to the solution of the problem. You can't do it an hour later, or tomorrow. Nor can you go to the library and look it up.
— John W. Kirklin

On Saturday, I was a surgeon in South Africa, very little known ... [and] ... On Monday, I was world renowned.
— Christiaan Barnard

Sepsis is an insult to a surgeon.
— Anonymous

There is no better surgeon than a man with many scars.
— Spanish Proverb

I don’t dawdle. I'm a surgeon. I make an incision, do what needs to be done and sew up the wound. There is a beginning, a middle, and an end.
— Richard Selzer

As a surgeon you have to have a controlled arrogance. If it's uncontrolled, you kill people, but you have to be pretty arrogant to saw through a person's chest, take out their heart and believe you can fix it. Then, when you succeed and the patient survives, you pray, because it's only by the grace of God that you get there
            — Mehmet Oz

A good surgeon doesn't just concentrate on technical ability, but also on the appropriateness of what you're doing. 
— Benjamin Carson 

 

To be great, a surgeon must have a fierce determination to be the leader in his field. He must have a driving ego, a hunger beyond money. He must have a passion for perfectionism. He is like the actor who wants his name in lights. 
— Donald B. Effler

Best Quotes for Surgeons Video


Here are some great surgery quotes from an episode of “THE SURGEON’S CUT “ featuring Dr Devi Shetty which is available on Netflix.


        1.For me Surgery is an art and all surgeons are artists.Whatever we do ..in the end it should look beautiful .If it looks beautiful it always works.


       2.As Surgeons we should be supremely confident of our skills .


     3.The worst thing is to see one of your patients you operated on die.The patient dies  once ,but we die a hundred times. And that particular day,believe me I’m in no mood to do anything .I cancel rest of the operations ..I just want  to  be left alone .


    4.My mother was deeply spiritual so when  something goes wrong,it is my spirituality that keeps me going .


5.I feel I am an instrument in the hands of God and I do exactly what he wants me to do .Nothing more nothing less.


6.Believing that someone else is in command and that I am an instrument in the hands of god  ,I do exactly what he wants me to do .This helps me get rid of my anxiety and nervousness .


7.The skill of surgery is given by God and it should be available to everyone .


8.I don’t find myself extraordinary other than the passion to cut and stitch .


9.To the 4000 children I operated in Kolkata :All I ask of you is -can you spend a few minutes of your precious time with someone who need it without expecting anything back in return .”



Read more: https://www.wisesayings.com/surgeon-quotes/#ixzz6eqI4Zrle 




Read more: https://www.wiseoldsayings.com/surgeon-quotes/#ixzz6eLH8bOdX

More Quotes in Surgery (For Surgical Residents) 

More Quotes in Surgery (For Surgical Residents)




Keywords: Surgical Quotes, Great Sayings in Surgery, Inspiring Surgery Quotes, Funny Surgical Quotes, Offbeat, Surgery, Surgery Quotes, Inspiration, Best Surgery Quotes, Inspirational Surgery Quotes




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THE JOURNEY FROM A RANK OF 54000 IN NEET PG TO A RANK OF 62 BY DR HIMANSHU GUPTA

BEST NEET PG INSPIRING STORIES AND NEET PG MOTIVATIONAL YOUTUBE VIDEOS

NEET PG SUCCESS STORIES: DR ASHUTOSH KARN

NEET PG SUCCESS STORIES: DR ABHINAYA JEYARAMAN






  Eligibility requirements for FRCS General Surgery


Following are eligibility requirements for appearing for FRCS General Surgery:

Now it is not compulsory to crack MRCS for JSCFE FRCS (International). You can appear in FRCS General Surgery even if you don't have cleared MRCS. 

There are two versions of FRCS, one for domestic and other for International candidates.

  • JCIE  FRCS (Joint Committee on Intercollegiate Examinations) (domestic - UK & Ireland) 
  • JSCFE FRCS (Joint Surgical Colleges’ Fellowship Examinations) (international)

Being an Indian medical graduate currently working as a General Surgeon, you will have to appear for JSCFE FRCS General Surgery. 

To appear for this exam you need to have a minimum of 6 years of experience to be just eligible to write the exam. 3 Year of your General Surgery residency experience + 3 years of Post residency experience. 

For this you need to provide evidence in form of following:

What you'll need at the time of application for FRCS General Surgery?

  • Medical Qualification – year/country obtained (Candidate should have completed a locally recognized General Surgery residency program)
  • MRCS – month/year obtained [if applicable, not mandatory]
  • Your three signed Structured References (pdf format)
  • Curriculum Vitae (pdf format)
  • Summary of Operative Experience -Logbook in prescribed format (pdf format)
  • Photocopy of your passport (identification page)

Structured References required for eligibility of your training for FRCS General Surgery

  • The principal referee must be the applicant’s current of Head of Department or Head of the Recognised Training Committee/Programme in which the applicant has participated 

  • The  second  referee must  be a  senior  clinician who  has worked  with  the applicant and  has knowledge of the applicant’s work in his/her specialty within the last two years 

  • The  third  referee  must  be  a  senior  clinician  who  has  worked  with  the  applicant  and  has knowledge of the applicant’s work in his/her specialty within the last two years

What is the Exam Format for FRCS General Surgery?

Section 1 examinations from 1 January 2021 the format will be as follows: 
  • Paper 1 120 Single Best Answer [SBA] (2 hours 15 mins) 
  • Paper 2 120 Single Best Answer [SBA] (2 hours 15 mins) 
Once you pass the Section 1 exam, you will receive a ‘Eligibility to Proceed’ certificate by email, after which you will be allowed to appear for the Section 2 exam.

Section 2 examinations: Clinical component consisting of a series of carefully designed and structured interviews on clinical topics, some being scenario based (structured orals) and some being patient based.


Allowed Number of Examination Attempts for FRCS General Surgery

Candidates are given up to a maximum of 7 years to complete the examination process as follows: 
  • Section 1(MCQ):  Candidates will have a maximum of 4 attempts with no re‐entry  
  • Section 2 (OSCE):  Candidates will have a maximum of 4 attempts with no re‐entry 


References:


Read other related Posts regarding FRCS Preparation



Questions from readers regarding MRCS Part A/B and FRCS General surgery

Hi Sir , Saw your post in LGS about FRCS .
Just wanted to ask 1 doubt.
Myself , i completed MS General surgery and i am working here in india as Asst Prof since past 5 years.
I wish to relocate to UK.
My ultimate aim is to become a consultant there .
However , i could find that there are 2 boards of FRCS and international FRCS is not of much importance when it comes to working in UK . 
Is it true sir?
Anyways i decided to appear for MRCS PART A now due to this . 
But if i am wrong , i will prepare for FRCS from here itself 
Can u please guide me regarding this 🙏

Response: If relocation to the UK is your priority, clear MRCS A and B first, then IELTS, get GMC registration, get a training job (matching your experience level) , and then give FRCS General Surgery there...

Surgical NEET SS Exam Preparation and Books

Pattern of Surgical NEET SS Exam 

  1. You can choose a maximum of two super speciality courses for which your broad specialty qualification is eligible.
  2. 40% of the questions shall be from General Surgery and the remaining 60% shall be from the super specialty course selected.

Facebook Group for Surgery NEET SS Aspirants

Following is the link for facebook group for Surgery NEET SS Aspirants. In this group we can discuss and share knowledge and facts related to Surgery NEET SS preparation. Best books to study, important topics and discussion of MCQs and much more.

Books for preparation for General Surgery NEET SS (40% Questions)

Surgery Essence 7th Edition 2019 By Pritesh Singh





Continuing with my previous post (BEST SPECIALTIES AFTER MS/ DNB GENERAL SURGERY ? (PROS AND CONS) - PART 1), here is the part 2 review of various pathways for specializing after completing MS General Surgery. In this post I will be reviewing following:


Contents

NEET SS Best Specialties after General Surgery

MCh/ DNB Plastic Surgery

  • Includes wide number of both Cosmetic and Reconstructive Procedures
  • Plastic surgery is not just liposuction and nose jobs, it is much much more than that. Plastic surgery as a branch has a wide spectrum of procedures which includes: Skin, Hand Surgery, cranio-maxillo-facial reconstructions, Tendon Reconstruction, peripheral nerve surgery, burns management, genitourinary reconstructions, oculoplastic surgery, bed sore management, diabetic foot management and the list goes on
  • Decent demand in large private setups, high demand in large government and semi government setups
  • Usually good load of cases only in big cities
  • Procedure time is usually long 
  • Patients may have unrealistic expectations from plastic surgeons as popularized on television and in movies
  • Easy to get the seat

MCh/ DNB CTVS 

  • Usually not preferred by most these days but it does not mean that there is less scope.
  • It is still a required specialty in tertiary care hospitals with many procedure both cardiac and thoracic in the armamentarium of Cardiothoracic and vascular surgery. Some examples are Coronary artery bypass grafting (CABG), Heart valve repair or replacement, Ventricular assist devices, carotid endarterectomy, Heart transplant, Surgery in great vessels (aortic coarctation repair, Blalock-Taussig shunt creation, closure of patent ductus arteriosus), congenital heart disease surgeries, Lung volume reduction surgery, Lung cancer surgery, pleurectomy, lung transplant surgery etc. 
  • Very demanding in terms of challenges of access during the surgery and the need of long term intensive care support required
  • One needs to be very passionate for being a heart surgeon
  • Usually the work hours are more as the teams are small and number of hours one needs to put are more
  • Very easy to get the seat


MCh/ FNB Minimal Invasive Surgery 

  • It is more like extension of your general surgical training
  • For those who already have a good hands on in laparoscopic procedures, it might not be very useful
  • Limited seats
  • Good exposure to Bariatric surgery which we usually do not get in general surgery training
  • Good only if taken in high volume laparoscopic surgery centers (only a few centers like GEM, Coimbatore |  Sir Ganga Ram, Delhi| Meenakshi Mission, Madurai | Galaxy, Pune)
  • All across India minimal access surgery is being practised largely by general surgeons only
  • FNB and Mch MAS at AIIMS are only two courses in India which are recognised by medical council for Minimal Access surgery
  • Adoption of Robotic Minimal Access surgery is still in its nascent stages in India, you will require additional training separately
So to conclude, I would say that all specialties have some good things and some bad things. There are some which are in high demand in the job market for freshers, but in the long term, more or less, all specialties offer good scope for talented and deserving surgeons. 

The key to success is always dependent on the amount of interest you take and the amount of hard work you put into nurturing your surgical skills. It also depends on the right choice of institute to work in and an optimal match between the demand of the specialty that you choose and number of doctors already offering those services in your city.  

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ADVANTAGES AND DISADVANTAGES OF DOING MRCS
Here is one of my recent presentation on Microsurgical anatomy of Medial Temporal Lobe, hope you find it informative.

Synopsis

Introduction


  • Temporal Lobe is unique as neocortex, paleocortex and archicortex coexist  
  • This makes it preferred site for certain tumors and epilepsy
  • Most common target for resections to treat convulsive disorders 

Histology

Three-layered archicortex (allocortex)
  • hippocampus 
  • semilunar gyrus of the uncus
  • prepiriform area
Six-layered paleocortex (mesocortex)
  • parahippocampal gyrus

Six-layered neocortex (isocortex)
  • Superior temporal gyrus
  • Middle temporal gyrus
  • Inferior temporal gyrus
  • Transverse temporal  gyri 
  • Fusiform gyrus.

Boundaries of Temporal Lobe

  • Located below sylvian fissure
  • Anterior and inferior limits are natural bone structures
  • posteriorly separated from the occipital lobe by the lateral parietotemporal line  
  • separated from the parietal lobe by the occipitotemporal line

Surfaces of Temporal Lobe
4 Surfaces
  • Lateral 
  • Superior  (aka Temporal Operculum)
  • Inferior
  • Medial

Relationship of the temporal lobe with bony structures

  • Sylvian fissure - Squamosal suture 
  • Temporal pole - Greater wing of the sphenoid bone. 
  • Lateral surface - Squamous part of the temporal bone
  • Basal surface - sits on the floor of the middle fossa

Lateral Surface of Temporal Lobe

Three gyri: 
  • Superior
  • Middle
  • Inferior

Separated by two parallel sulci: 
  • Superior sulcus
  • Inferior Sulcus

Superior Surface  of Temporal Lobe

It presents three morphologically distinct parts 
  • Planum polare 
  • Heschl’s gyrus- contains the primary auditory cortex (Brodmann area 41)
  • Planum temporale

Basal Surface of Temporal Lobe

The basal surface is composed laterally to medially

  • part of the inferior temporal gyrus
  • occipitotemporal sulcus
  • fusiform gyrus
  • collateral sulcus
  • parahippocampal gyrus 

Medial Surface of Temporal Lobe

  • Hippocampus 
  • Uncus
  • Parahippocampal gyrus
  • Fimbria
  • Dentate gyrus
  • Amygdala 

Hippocampus


  • Club-shaped structure divided into three parts: head, body, and tail.
  • Curved shape which resembles a shape of a seahorse 
  • Appears ‘ S’ shaped on coronal section
  • Consists of two interlocking C shaped gray matter structures
                  – Hippocampus proper
                  – Dentate gyrus
  • CA stands for cornu ammonis, from its ram's horn shape 
  • Gray matter of the hippocampus is an extension of the subiculum
Parahippocampal Gyrus

  • Occupies transitional area between the basal and the mesial surfaces of the temporal lobe
  • grey matter cortical region surrounding the hippocampus 
  • part of the limbic system 
  • role in memory encoding and retrieval.
  • Components of the Parahippocampal gyrus
               -Subiculum: medial round edge of the parahippocampal gyrus. 
               -Presubiculum
               -Parasubiculum
               -Entorhinal area 

Uncus: Clinical Significance
  • Seizures preceded by hallucinations of disagreeable odours originate here
  • ICP-  uncal herniation -> III nerve compression -> ipsilateral fixed, dilated pupil and an eye with a characteristic "down and out" gaze
Amygdala

Temporal or principal amygdala: located in the temporal lobe
Extratemporal or extended amygdala: located in the primordial floor of the lateral ventricle

Relations

Temporal amygdala -located within anterior segment of uncus 
Superiorly- blends into the globus pallidus without any clear demarcation 
Inferiorly- bulges inferiorly from the most anterior portion of the roof of the temporal horn

Arteries encountered in Medial Temporal Lobe surgical interventions

  • Middle Cerebral Artery 
  • Posterior Cerebral Artery 
  • Anterior Choroidal Artery 
  • Internal Carotid Artery 

Middle Cerebral Artery and Medial Temporal Lobe


Posterior Cerebral Artery and Medial Temporal Lobe

  • Main role of supplying the Medial Temporal Region and the inferior surface of the temporal lobe. 
  • 4 segments: P1, P2, P3, and P4 

Anterior Choroidal Artery 
  • Arises from the posterior wall of the ICA 
  • Supplies the anterior MTR 
Internal Carotid Artery 

Branches of the ICA supplying the MTR
  • present in 45% of hemispheres. 
  • If present, these arteries always arose from choroidal segment of the ICA 
Venous Drainage of Medial Temporal Region
  • Superficial group 
  • Deep group 
Superficial group: Venous Drainage of Medial Temporal Region




Deep Group: Venous Drainage of Medial Temporal Region

Drainage of anterior MTR (2 variants)
  • posterior peduncular segment via the anterior basal anastomotic vein 
  • cavernous sinus or into the sphenoparietal sinus via a large preuncal vein 

Drainage of middle MTR 
  • amygdalar vein drains to basal vein
  • anterior longitudinal hippocampal vein drains to basal vein

Drainage of posterior MTR
  • posterior longitudinal hippocampal vein
  • medial temporal vein
  • lateral and medial atrial veins. 
  • all drain to mesencephalic segment of the basal vein 

Surgical techniques for temporal lobe epilepsy (TLE)

Non Selective

  • Anterior temporal lobectomy (ATL)


Selective

  • Transcortical selective amygdalohippocampectomy (TCAH):
  • Transsylvian selective amygdalohippocampectomy (TSAH): 


Anterior Temporal Lobectomy


  • Two-step resection of
                 -anterior temporal neocortex
                 -anterior hippocampus and lateral amygdala
  • 4 cm of anterior neocortex removed

Transcortical selective amygdalohippocampectomy (TCAH)


  • access is obtained through middle temporal gyrus
  • selective amygdalohippocampectomy
  • lateral temporal neocortex is not resected


Transsylvian selective amygdalohippocampectomy (TSAH)

  • Less distance to reach to the temporal horn
  • Need for the retraction of the sylvian lips 
  • Presence of vascular structures 
  • Damage to the lenticulostriate artery or MCA branches - > Ischemic injury - > causes surgical morbidity
  • Finding the temporal horn is difficult, because a blind dissection in the white matter

Landmarks to achieve a safe resection in Medial Temporal Lobe Surgery

Collateral eminence (at floor of temporal horn): Neural tissue lateral to the collateral eminence can be removed safely without any risk of damaging midbrain structures 

Tentorial edge: Resection is aimed lateral to the free edge of the tentorium, the damage to the inferior limiting sulcus, the sylvian fissure, and midbrain structures will be avoided 

Choroidal fissure: Never extend the resection superior to the choroidal fissure

Avoiding Optic Radiation in Temporal Lobe Surgery

Optic radiations lies
  • roof of the temporal horn 
  • cover its lateral wall except its anterior part 
  • At the level of the atrium -> cover only lateral wall
  • medial wall of the atrium -> free from the optic radiation
  • Exceed the anterior wall by a few millimeters -> Meyer Loop
  • 5mm +/- 3.9mm
  • Optic radiation courses in the superior aspect of the temporal horn
  • Transcortical transtemporal approach-> lateral wall is opened 
  • Transcortical approach is less likely to threaten the optic radiation
Memory Deficit in Temporal Lobe Surgery

Neocortical removal can also lead to negative neurocognitive sequelae 
Two structures having memory function  have important role 
  • Uncinate fasciculus (UF)
  • Inferior Longitudinal fasciculus  (IOFF )
Download this presentation: "Microsurgical Anatomy of Medial Temporal Lobe








Steps for Below Knee Amputation Surgery (Without Bone Bridge)

Following are the gross steps for doing a below knee amputation surgery, for detailed steps please check out these links ( Link1 and Link2 ) .

Marking the incision for flap using following parameters

  • Anterior incision 10cm distal to tibial tubercle
  • Anterior incision 2/3 total circumference
  • Posterior incision 1/3 total circumference
  • Posterior flap should be distal to the musculotendinous junction of the gastrocnemius
  • Round out the distal ends of the posterior skin flap to reduce redundancy of skin upon closure


Putting the Incision and Anterior Soft Tissue Dissection

  • Incision is deepened in layers
  • Saphenous vein is clamped and ligated;
  • Anterior incision is then carried through all tissues to bone
  • Now one can identify anterior tibial artery and veins, and deep peroneal nerve anterior to interosseous membrane; anterior neurovascular bundle can always be identified by spreading between the tibialis anterior and the EHL muscles
  • Incision is carried out thru lateral compartment, superficial peroneal nerve is identified, ligated proximally and cauterized


Transection of Fibula

  • Fibula is transected 1-2 cm proximal to the level of the tibial transection. Periosteum of the fibula is elevated proximally before transection


Tibial transection

  • Periosteal layer of the tibia is cut sharply 1 cm distal to the level of the skin and elevated proximally about 1-1.5 cm, leaving a layer for suture of the posterior musculature
  • Tibia is sectioned with power saw 1 cm distal to skin edge and anterior cortex is beveled obliquely


Posterior Flap Dissection

  • Posterior muscle mass is sharply and carefully freed from its attachments to the tibia and fibula distally to the level of the posterior skin incision
  • Posterior tibial artery & veins and the peroneal artery and veins are individually clamped and tied
  • Tibial nerve is pulled, cut proximally and allowed to retract
  • Deep muscles: tibialis posterior, FDL, FHL are transected just distal to the level of the tibia and allowed to retract;
  • Soleus muscle is isolated and excised, leaving the gastrocnemius as sole muscle of the myocutaneous flap
  • Sural nerve is pulled, cut proximally and allowed to retract


Myodesis

  • Drill holes just anterior to the bone bevel for myodesis
  • Use a locking style Krackow suture through the gastrocnemius aponeurosis and secure it to the tibia
  • Place a submuscular drain
  • Secure the borders of the gastrocnemius to the proximal anterior fascia


Final Steps

  • Wound is closed in layers
  • Soft dressing is applied
  • Cast is applied to immobilize the knee  to avoid a postoperative flexion contracture



Milestones in the history of intestinal anastomosis

Intestinal anastomosis has been successfully performed for more than 150 years using a variety of techniques and suture materials. Major milestones in the development of this technique are:

Lembert : Seromuscular suture technique for bowel anastomosis in 1826

Kocher : Utilised a two-layer anastomosis. First a continuous all-layer suture using catgut, then an
inverting continuous (or interrupted) seromuscular layer suture using silk

Halsted : Favoured a one layer extramucosal closure, it was felt to cause the least tissue necrosis or
luminal narrowing. This technique has now become widely accepted.

Currently accepted technique for intestinal anastomosis

Of these, the method that has proven successful in most situations and in the hands of most surgeons has been the two-layer anastomosis using interrupted silk sutures for an outer inverted seromuscular layer and a running absorbable suture for a transmural inner layer.

The only appreciable shortcoming of the two-layer technique is that it is somewhat tedious and time-consuming to perform. Recently, several reports have appeared advocating a single-layer continuous anastomosis using monofilament plastic suture.

Single layer continuous extramucosal closure has now become widely accepted.

A single-layer continuous anastomosis can be constructed in significantly less time and with a similar rate of complications compared with the two-layer technique. It also costs less than any other method and can be incorporated into a surgical training program without a significant increase in complications.

Single Layer , Extramucosal, Interrupted- End to End bowel anastomosis (simulation)





Side to side bowel anastomosis (simulated)



Difference between Extramucosal Technique and Seromuscular Suture Technique

The extramucosal suture must include the submucosa as this has a high collagen content and is the most stable suture layer in all sections of the gastrointestinal tract.

Suture Materials used in Intestinal Anastomosis

Catgut and silk have been replaced by synthetic, usually absorbable, polymers.

The suture materials should be of 2/0–3/0 size and made of an absorbable polymer, which can be braided (e.g. polyglactin), or monofilament (e.g. polydioxanone), mounted on an atraumatic round-bodied needle. 

Suture bites should be approximately 3–5 mm deep and 3–5 mm apart depending on the thickness of
the bowel wall.

Stay sutures are put to avoid the need for tissue forceps. They are important for displaying the bowel
ends and in accurate alignment of the bowel and the placement of the sutures.

Important Considerations while doing Bowel Anastomosis

In cases of major size discrepancy of size of bowel end to be anastamosed, a side-to-side or end-to-side anastomosis is done.

In cases of minor size discrepancy, Cheatle split (making a cut into the antimesenteric border) may
help to enlarge the lumen of distal, collapsed bowel and allow an end-to-end anastomosis to be fashioned.



1. Most common neuroendocrine tumor seen in MEN-1
Nonfunctioning or that secrete pancreatic polypeptide (PPoma)


2. Xanthogranulomatous cholecystitis is caused by 
Inflammatory response to extravasated bile, possibly from ruptured Rokitansky-Aschoff sinuses


3. Most common organism responsible for Xanthgranulomatous pyelonephritis
Proteus

4. Most common organism responsible for Emphysematous pyelonephritis
E. coli


5. Most common organism responsible for Emphysematous cholecystitis
Clostridium welchii

6. Trauma and injury severity score (ISS) includes
Injury Severity Score + Revised trauma score + Age + Mechanism


7. University of Wisconsin solution used for preserving Liver, Pancreas and Kidney before transplant: Relative Cationic composition (potassium and sodium) ?
mimics intracellular levels : High Potassium and Low Sodium


8. Duodenal switch operation includes
Sleeve gastrectomy, Duodenoileostomy, Jejunoileal bypass, Cholecystectomy, Appendectomy


9. MC endocrine abnormality in MEN-1 is
multiglandular parathyroid tumors


10. First biochemical abnormality in MEN 1 (It precedes the clinical onset of a pancreatic NET or pituitary neoplasm by several years)
Hypercalcemia


These triads and pentads somehow tend to be favourite questions of examiners during clinical exams and vivas. Other use of these is to depress your friends by asking questions related to them. Enjoy the read!



Name
Triad
Disease
What is Bergman’s triad?
1. Mental status changes
2. Petechiae (often in the axilla/thorax)
3. Dyspnea 
Fat emboli syndrome
What is Beck's triad ?
Muffled heart sound, Distended neck veins, Hypotension
Right Upper Quadrant Pain, Fever, Jaundice
What is Cushing's triad of Increased Intracranial Pressure ?
Bradycardia, Bradypnea, Hypertension
Head Injuries
What is Dieulafoy's triad ?
Hyperesthesia of the skin, exquisite tenderness and guarding over McBurney's point
Acute appendicitis
 What is Triad of Sandblom ?
Malena, Obstructive jaundice, Biliary colic
Hemobilia
What is Triad of Meigs' Syndrome ?
Ascites, Pleural effusion, Benign ovarian tumor
What is Hutchinson's triad ?
Hutchison's teeth, Interstitial keratitis, Nerve deafness
What is Kartagener Syndrome Triad ?
Triad of bronchiectasis, Recurrent sinusitis, and, Situs inversus,





What is Leriche's syndrome Triad ?


·         Triad of bilateral hip, thigh, and buttock claudication,
·         Impotence
·         Symmetric atrophy of the bilateral lower extremities due to chronic ischemia

What is Meckler's triad ?
Vomiting, Pain and Subcutaneous emphysema
What is Saint's Triad ?
Gall stones, Diverticulosis, Hiatus hernia
What is Samter's triad (also known as Acetylsalicylic acid triad or Widal's triad or Francis' triad or Aspirin triad) ?
Aspirin sensitivity, Nasal polyps, Asthma
What is Tetany Triad ?
Stridor, Carpopedal spasm, Convulsions
What is Triad of Hypernephroma ?
Pain, Hematuria, Renal mass
What is Triad of Plummer-Vinson syndrome ?
Iron defiency anemia, Dysphagia, Esophageal webs
What is Trotter's Triad ?
Conductive deafness, Immobility of homolateral soft palate, Trigeminal neuralgia
What is O’ Donoghue Triad (Unhappy Triad) ?
ACL, MCL, Medial Meniscus injury (Twisting force on knee)
Knee Injury
What is Virchow's triad ?
Stasis, Hypercoagulability, Vessel injury



What is Whipple's Triad ?
·         Hypoglycaemia during attacks
·         Resolution of symptoms upon correction of blood glucose
·         Symptoms brought about by low glucose states.
Insulinoma              

Pentads


What is Reynolds Pentad ?
Abdominal pain, Fever, Jaundice, Shock and Depression of central nervous system function
Acute Suppurative Cholangitis






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