Hopkins General Surgery Review Manual by Peter Attia

By Peter Attia

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Thoracic duct 5. Esophagus Tumors ‡ Thymoma Germ cell tumor Lymphoma Thyroid adenoma Parathyroid adenoma Lipoma Carcinoma Hemangioma Bronchogenic cysts Pericardial cysts Lymphoma Neurogenic tumors Lymphoma Enteric cysts ‡ Most common in bold Hopkins General Surgery Manual 32 Role of thymoma and Myasthenia Gravis: ƒ ƒ ƒ ƒ Resecting thymus in MG, even in absence of thymoma, improves symptoms in 90%, as thymus has been implicated in producing post‐synaptic anti‐Ach‐antibodies Complete remission most likely if: age < 60 and operation performed < 8 months from diagnosis Radiate thymoma after excision only if margins positive and consider platinum‐based chemotherapy.

RIND (Reversible Ischemic Neurologic Deficit): 24 – 48 hour resolution 4. Fixed deficit: stroke Risks of Stroke: 700,000 per year 160,000 deaths/year 1 year post stroke Æ 2/3 of survivors have disability TIA: 15% stroke in first year, then about 6% per year thereafter (40% chance of stroke in 5 years without ASA) Cortical TIA Vertebral TIA Unilateral Dizzy Arm weakness Bilateral “woozy” Decreased vision “Drop attack” (transient loss of motor tone) Asymptomatic: Carotid Stenosis Stenosis > 50%: about 4% per year Stenosis > 80%: 35% risk over 2 years 2% per year risk of stroke for patients > 60 ƒ ƒ Low resistance arterial systems (such as ICA): total blood flow does not decrease until stenosis > 50%.

Clinical Classification 1. Asymptomatic: bruits (+ bruit Æ 30 – 50% have significant stenosis; + significant stenosis Æ 20 – 50% bruit; Bruit are actually a significant predictor of cardiac disease) 2. TIA: < 24 hour resolution (90% resolve within 2 hours) 3. RIND (Reversible Ischemic Neurologic Deficit): 24 – 48 hour resolution 4. Fixed deficit: stroke Risks of Stroke: 700,000 per year 160,000 deaths/year 1 year post stroke Æ 2/3 of survivors have disability TIA: 15% stroke in first year, then about 6% per year thereafter (40% chance of stroke in 5 years without ASA) Cortical TIA Vertebral TIA Unilateral Dizzy Arm weakness Bilateral “woozy” Decreased vision “Drop attack” (transient loss of motor tone) Asymptomatic: Carotid Stenosis Stenosis > 50%: about 4% per year Stenosis > 80%: 35% risk over 2 years 2% per year risk of stroke for patients > 60 ƒ ƒ Low resistance arterial systems (such as ICA): total blood flow does not decrease until stenosis > 50%.

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