Absite Topic Review General Surgery

Nir Hus, MD, PhD. Mount Sinai Medical Center Miami Beach

Topics
1)

BRCA-1,2. 2) Rx Postop Parotitis. 3) Rx Non-healing burn wound.

Nir Hus

Predict Increased risk BRCA-1,2 mutation

BRCA

Ovarian

CA 40% lifetime risk Male Breast CA 1% lifetime risk

BRCA

II

Ovarian

CA 10% lifetime risk Male Breast CA 10% lifetime risk

Nir Hus

BRCA cont.
BRCA

gene + family Hx = 60% lifetime risk of breast CA (autosomal dominant) Bi prophylactic mastectomy w/ BRCA gene results in decreased risk of breast CA by 90%
Add

TAH & BSO decrease risk 95%

CA

in a person w/ BRCA I,II carries a 50% risk of developing CA in contralateral breast.

Nir Hus

Parotitis

Can occur in the surgical patient and identified during the postoperative period.

Particularly in elderly Dehydrated individuals.

Therapy should be directed toward

Rehydration Enhancing salivation Ensuring that no mechanical obstruction of the duct of Stensen is present Obtaining stains and cultures Administering antibiotics directed against S. aureus, which is the most common offending organism. In ICU patients who are often colonized with gram-negative bacteria, the possibility of gram-negative bacterial parotitis should be considered and appropriate empiric therapy used. I&D

Nir Hus

Rx Non-healing burn wound.

Q:

30 y.o veteran suffered a burn wound to arm 2nd or 3rd degree over one year ago and the wound is ulcerated. What to do next.
A:

Marjolins tumor need Bx

Nir Hus

Ulcers associated with burns

Curling

s ulcer gastric ulcer that is associated with burns. Marjolin s ulcer highly malignant squamous cell CA.

Nir Hus