measures for post-transplant infection(Vaccinations for pneumococci and hepatitis B are typically given prior to transplant to ensure an adequate immune response)
Post-transplant measures
Monitoring for the following infections:
・CMV viral loads in blood monthly for a minimum of 12 months
・EBV viral loads in blood for a minimum of 12 months
Universal prophylaxis
・PCP prophylaxis with ★trimethoprim-sulfamethoxazole for a minimum of 6–12 months
・CMV prophylaxis with ganciclovir or valganciclovir for 12–14 weeks transplantationsurgeryUWorld step2CK Dec 4, 2020, 4:31 AM HirotoShishido
Indication for operative management of Intussusception発症後時間が経過して壊死が疑われるまたは腹膜炎を伴う場合や，高圧浣腸で整復されない場合は，Hutchinson手技（開腹して内筒を押し出す整復法）を用いる． pediatricssurgery卒試 Oct 18, 2020, 5:00 AM HirotoShishido
treatment of chylothorax乳び胸の治療は胸腔ドレナージと栄養管理が基本である．胸腔ドレナージにより貯留した乳びを排出し，肺の圧迫を解除する．栄養管理では☆絶食＋中心静脈栄養とし，乳びの産生を抑制する．このとき，胸管を介さずに門脈系に取りこまれる中鎖脂肪酸（MCT）の割合を増やすことで，乳びを減らす方法も試みられる．また，近年,オクトレオチド（ソマトスタチンアナログ）が有効であるとの報告もある．
treatment of pneumothorax■ stable, small (<2 cm between lung and chest wall on x-ray), minimal symptoms: observation + O2
■ symptomatic or large (>2 cm): aspiration
■ unstable/tension pneumothorax: needle decompression then chest tube, and VATS if unsuccessful
(25-50%) respiratorysurgery卒試 Oct 16, 2020, 4:27 AM HirotoShishido
penile fracture陰茎折症
① 性交中など陰茎の勃起時に強力な外力が加わって，☆陰茎海綿体白膜が断裂したもの．陰茎海綿体に損傷が及ぶこともある．
② 受傷時には断裂音を伴い，激痛が生じる．血腫のため対側に屈曲する．
③ 治療は，血腫除去と白膜断裂部の縫合を速やかに行う． urologysurgery国試過去3回 Oct 12, 2020, 3:00 AM HirotoShishido
definition of massive hemoptysis, and management for thatbleeding more than 600 mL/24hr or 100 mL/hr
secure airway first,and treat cause; persistent bleeding treated via ★bronchoscopic interventions, embolization, or resection
★Urgent thoracotomy and surgical intervention are reserved for patients with unilateral bleeding who continue to bleed despite initial bronchoscopy and/or pulmonary artery embolization. respiratorysurgeryUWorld step2CK Sep 23, 2020, 8:24 AM HirotoShishido
treatment for large bowel obstruction (LBO)•supportive management: IV fluids, gastrointestinal decompression; 75% require surgical intervention
•surgical correction of obstruction
•volvulus: ☆initial decompression with flexible sigmoidoscopy, operative reduction or sigmoid resection dependent on severity
•mechanical obstruction: ostomy alone(fecal diversion), colectomy with primary anastomosis or Hartmann procedure. May pursue stenting as bridging (follow with another intervention) or palliation gastrointestinalsurgery国試過去3回 Sep 23, 2020, 3:05 AM HirotoShishido
laparotomy is mandatory in the patient with penetrating abdominal trauma if★Hemodynamic instability
Peritonitis
Evisceration
Impalement
Peritoneal penetration & significant organ injury
Free air in abdomen
Blood in NG tube, Foley catheter, or on
DRE(digital rectal exam) gastrointestinalsurgeryUWorld step2CK Sep 22, 2020, 5:03 AM HirotoShishido
