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
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
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．
signs of complicated SBO(small bowel obstruction)changes in the character of the pain, fever, hemodynamic instability (hypotension, tachycardia), guarding, leukocytosis, and significant metabolic acidosis (low bicarbonate in this patient)
Delay in surgery (★urgent surgical exploration)may lead to perforation and significant risk of mortality.
thracentesis
locationThoracentesis is typically performed between
①the 6th and 8th ribs along the midclavicular line,
②☆the 8th and 10th ribs along the midaxillary line (above image),
③and the 10th and 12th ribs along the paravertebral line.
This allows pleural fluid to be drained without risking lung injury (which can occur at higher insertion sites). However, insertion of a needle ☆below the 9th rib still risks penetrating abdominal structures. surgeryUWorld Mar 22, 2020, 10:28 AM HirotoShishido
disinfectant and antiseptic that is used for skin disinfection before surgery and to sterilize surgical instrumentschlorhexidine (chlorhexidine gluconate,CHG) surgerypharmacology Oct 27, 2019, 8:08 AM HirotoShishido
小外傷の初期対応動脈損傷 → 腱・神経損傷 → 異物・皮膚欠損範囲 の順に確認する
ただし，異物や皮膚欠損に感染が重なると長期的に機能予後にも影響しうる
また災害時においても，優先順位は①生命，②機能，③整容であり，同様の順番で確認する 必修surgery Jul 24, 2020, 12:53 AM HirotoShishido
top 3 causes of small bowel obstructionABC (in order)
Adhesions
Bulge (hernias)
Cancer (neoplasms) gastrointestinalsurgery Sep 20, 2020, 11:43 AM HirotoShishido
Leriche syndromeThigh claudication is suggestive of occlusive disease of the ipsilateral external iliac artery or its more distal branches (ie, common femoral, superficial femoral, profunda femoris arteries).
Accompanying ☆★impotence and/or ☆gluteal claudication suggests ☆more proximal aortoiliac occlusion (so-called Leriche syndrome), which, in addition to affecting the external iliac artery, also diminishes blood flow to the internal pudendal and gluteal branches of the internal iliac artery. cardiologysurgeryUWorld step2CK Jun 27, 2020, 8:57 AM HirotoShishido
