Surgery Clinical Features Archive

A perioperative approach
 for pediatric asthma

A perioperative approach
 for pediatric asthma


Pediatrics patients with asthma who have to undergo surgery are at risk for complications.

When type 1 diabetes complicates surgery

When type 1 diabetes complicates surgery

The patient, aged 69 years, had a 43-year history of type 1 diabetes and was scheduled to undergo a chest wall resection.

Transplant, steroids, and diabetes: Inpatient and outpatient management

Transplant, steroids, and diabetes: Inpatient and outpatient management

A patient, aged 60 years, was admitted to the hospital to undergo renal transplant therapy. He had a history of type 2 diabetes for 15 years.

Ethyl chloride before anesthesia

Ethyl chloride before anesthesia

Consider using topical ethyl chloride before the use of anesthesia when working with infected skin.

Transitioning a patient with a complex insulin regimen from hospital to home

Transitioning a patient with a complex insulin regimen from hospital to home

When creating outpatient diabetes management plan, the patient's inpatient medication regimen should be considered but not necessarily replicated.

Type 2 diabetes management in a post-bariatric surgery patient

Type 2 diabetes management in a post-bariatric surgery patient

A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years.

Antibiotics may suffice in appendicitis

Antibiotics may suffice in appendicitis

More than 80,000 children undergo appendectomies each year.

No benefit with arthroscopic surgery for knee OA

No benefit with arthroscopic surgery for knee OA

Arthroscopic partial meniscectomy does not improve degenerative medial meniscus tear symptoms in patients without knee osteoarthritis.

Steroid dose increase after CRS unnecessary to prevent hypotension

Steroid dose increase after CRS unnecessary to prevent hypotension

No difference in hypotension between low-, high-dose steroids for IBD patients undergoing major colorectal surgery.

Brain injury caused by ear surgery

Brain injury caused by ear surgery

Intracranial bleeding and pressure after removal of an acoustic neuroma leads to permanent damage.

Involve parents when 
suturing a child

Involve parents when 
suturing a child


Enlisting a parent's help can provide comfort without a scary needle or painful injection.

Do surgical metals affect security or MRI scans?

Do surgical metals affect security or MRI scans?

Learn what factors distort the waves used in scanning procedures when metal is present.

Stopping medications before knee or hip surgery

Stopping medications before knee or hip surgery

Which drugs need to be stopped before surgery and how far in advance?

A pitchfork to the head

A pitchfork to the head

A young patient sustains a serious injury while playing with his brother.

A centarian survives a complicated surgery

A centarian survives a complicated surgery

A geriatric patient undergoes a complex procedure for gastric outlet obstruction and causes a medical team to question their stance on geriatric surgery.

A lawn-mowing accident requires neurosurgery

A lawn-mowing accident requires neurosurgery

A reluctant, asymptomatic patient visits an ophthalmology clinic for a 'minor' injury at his wife's prompting.

Emergency surgery after a tonsillectomy

Emergency surgery after a tonsillectomy

A nurse anesthetist acts quickly when a child begins coughing up copious amounts of blood after a routine procedure.

A 'pillowectomy' in the ED

A 'pillowectomy' in the ED

A patient with a gunshot wound to the head presents complaining of a fierce headache with a pillow hanging from his head.

Self harm on the surgical ward

Self harm on the surgical ward

A nurse misses a doctor's written order not to remove a patient's hand restraints.

Physical therapy adequate first Tx for osteoarthritis with meniscal tear

Physical therapy adequate first Tx for osteoarthritis with meniscal tear

Physical therapy associated with functional improvements similar to surgery for patients with meniscal tear and knee osteoarthritis.

Extended apixaban, dabigatran cuts recurrent VTE

Extended apixaban, dabigatran cuts recurrent VTE

Extended anticoagulation with apixaban or dabigatran reduces recurrent VTE and mortality without increasing major bleeding.

Accidental hand ­amputation requires ­extensive surgery

Accidental hand ­amputation requires ­extensive surgery

A woman is rushed to the ­emergency department after severing her hand in a woodworking accident at home.

No increased delirium with hydromorphone after hip surgery

No increased delirium with hydromorphone after hip surgery

Hydromorphone for postoperative pain does not appear to increase delirium in elderly patients having hip fracture surgery.

Easing pain during suturing

Easing pain during suturing

Steps to follow after wound irrigation to ensure patient comfort.

Foul-smelling urine caused by supplements

Foul-smelling urine caused by supplements

Could vitamin D and calcium supplements be causing foul smelling urine?

Fire in the operating room

Fire in the operating room

A lack of communication
 between a surgeon 
and an anesthetist has disastrous consequences.

Painful skin ulcer ­develops in older woman on dialysis

Painful skin ulcer ­develops in older woman on dialysis

Metastatic calcification of the left 
breast in a patient with renal failure 
raises suspicion.

Aspirin and clopidogrel after coronary bypass surgery

What are the current evidence-based recommendations for aspirin and clopidogrel (Plavix) use following coronary artery bypass graft (CABG) surgery (both on- and off-pump procedures)?

How to treat lymphedema

What are the most effective therapies available to treat lymphedema?

Intracranial arterial stenting plus aggressive medical management increases stroke risk

Intracranial arterial stenting plus aggressive medical management increases stroke risk

Current recommendations from the American Heart Association and the American Stroke Association classify percutaneous transluminal angioplasty with stenting (PTAS) as an investigational intervention with unknown utility for patients with transient ischemic attack or stroke.

Size up, not down, when choosing a catheter for a man

Larger catheters are stiffer, thus better able to pass through the prostatic urethra.

Timely reminder to keep stretching

Getting patients to perform stretching exercises for minor rehabilitation can be problematic, but a physician assistant shares his secret for improving compliance.

Preventing diarrhea after esophageal reconstruction

Advising patients to take OTC antidiarrheal medications at specific times in relation to when they eat their meals can help reduce the number of bowel movements.

When a patient falls, the pain 
indicates dislocation

When a patient falls, the pain 
indicates dislocation

Tenderness over the hypothenar eminence, swelling and limited flexion also suggest fracture.

Updated information 
on MRSA infections

Updated information 
on MRSA infections

The number of hospital-acquired MRSA infections is down; however, 
community-acquired MRSA infections continue to rise.

Stopping warfarin before cataract surgery

Does an individual undergoing cataract surgery with standby or local anesthesia need a full workup if he or she has been stable on current medications, regardless of medical history?

Acute onset of pain and a noncompressible area in the anterior forearm

Acute onset of pain and a noncompressible area in the anterior forearm

After a high-impact fall, a middle-aged 
firefighter presents with ecchymosis and fixed flexion in the right arm and hand.

Treating chronic esophageal reflux

What treatment options are available for chronic esophageal reflux? Is surgery ever preferable to long-term treatment with a proton-pump inhibitor?

Recurrent bouts of biliary colic

A gastroenterologist and surgeon have recommended cholecystectomy for a patient with recurrent biliary colic and a 3% biliary ejection fraction on CCK-HIDA scan. Is this advisable?

Painful BP cuff leads to arm injury

Painful BP cuff leads to arm injury

Can a clinician be sued for battery if a patient objects to a medical treatment, even after giving consent?

A running accident leads to the discovery of a humeral lesion

A running accident leads to the discovery of a humeral lesion

A woman fractured her upper arm in a fall while exercising. A large osteolytic growth was discovered on x-ray.

Surgical clearance guidelines

Many dentists, optometrists and other specialty providers are sending adult patients to our primary-care clinic for surgical or procedural clearance. Are there standards of practice for such patients?

Kidney mass detected on ultrasound doubles in size over nine months

Kidney mass detected on ultrasound doubles in size over nine months

Imaging was ordered when the patient's clinician could not palpate her ovaries.

Are certain antidiabetes drugs better than others after gastric bypass?

Following gastric bypass surgery, many patients will still need metformin or glipizide (Glucotrol). Is there any evidence that one class of hypoglycemic agents is better absorbed than another?

Post-splenectomy vaccination recommendations

What vaccines and vaccination schedule are recommended for splenectomy patients?

How serious is latex allergy?

Do I really need to worry about vials with latex tops or BP cuffs with latex bladders? Can't rash be treated symptomatically, or is escalation to anaphylaxis a major concern?

Abdominal mass in a pregnant woman forces induction

Abdominal mass in a pregnant woman forces induction

After developing pancreatitis, the patient was admitted to the hospital and the tumor removed.

Physician assistant collaboration the future of surgery

Are you a physician assistant contemplating specializing in surgery? Clinical Advisor recently spoke with Michael Doll, MPAS, PA-C, about his career in cardiothoracic surgery.

Combination CRT and ICD therapy may reduce HF hospitalizations, deaths

Previous trials investigating cardiac resynchronization therapy (CRT) (biventricular pacing) combined with an implantable cardioverter defibrillator (ICD) in patients with heart failure have shown nonsignificant improvements in mortality compared with ICD monotherapy. But a newer study has promising results.

Pursuing surgical subspecialties as a physician assistant

General surgery and surgical subspecialties attract a significant number of new physician assistant graduates each year due to the flexibility, variety and dynamic setting the field offers.

Hyponatremia on the rise

I seem to be seeing a lot more hyponatremia. Some of these patients are taking diuretics, while others have psychogenic polydipsia or syndrome of inappropriate antidiuretic hormone secretion (SIADH). Others have no known cause. Is there an explanation for this increase?

Partial limb amputation causes suit

Partial limb amputation causes suit

Undetected vascular disease reaches its apex while a man is vacationing. Is the on-call clinician to blame?

Erectile dysfunction after prostate cancer

Erectile dysfunction after prostate cancer

As a side effect of radical prostatectomy, the favored treatment for many, erectile dysfunction can affect a man's mental and physical quality of life.

MRSA infections not limited to hospitals

MRSA infections not limited to hospitals

The Infectious Diseases Society of America's first treatment guidelines on this topic focus on the management of community-acquired infections.

Nonhealing hand ulcer turns erythematous

Nonhealing hand ulcer turns erythematous

A woman aged 34 years was referred for treatment of a recurrent, painful, nonhealing ulcer of six months' duration on her left hand.

Oral lesions caused by human papillomavirus

Oral lesions caused by human papillomavirus

Commonly found in the oral cavity, HPV lesions may persist or relapse spontaneously and occasionally require surgical excision.

Unexplained low-back pain in an adolescent with scoliosis

Unexplained low-back pain in an adolescent with scoliosis

Nothing offered more than temporary relief for the aching, constant pain, which was unaccompanied by other symptoms.

Facilitating self-care in patients wearing rigid collars

Practical advice to make life easier for patients who wear rigid collars.

Teen patient complains of vaginal discomfort

Physical exam reveals congenital condition.

Patient with ovarian cancer seeks reassurance

Woman refuses to be discharged after a simple stent procedure.

Trouble finding patient's appendix signifies rare congenital condition

Nurse noted weak heart sounds and large surgical opening after patient underwent appendectomy.

Sentinal lymph node resecton or axillary lymph node dissection in women with breast cancer?

New reports from the National Surgical Adjuvant Breast and Bowel Project B-32 trial show that SLN resection is as effective for survival as ALND and may reduce postsurgical morbidity and symptoms in node-negative women.

Checklists during team training may reduce surgical mortality

A surgical safety checklist developed by the WHO to facilitate communication and safety checks was associated with reduced surgical mortality in a before-and-after study at eight hospitals.

Target perioperative hematocrit levels may reduce blood transfusions during CABG

The decision as to when to give blood transfusions is complex, requiring a careful assessment of risks and benefits.

ED doctor struggles to discover cause of patient's collapse and paralysis

Pulsatile abdominal mass reveals clot in abdominal aorta.

Patient deteriorates quickly after cardiothoracic surgery

Fast-acting physician assistant saves a life and changes a man's outlook on the world.

Wound left untreated for 24 years

A nurse makes a surprise discovery when an obese woman visits the office for a tetanus shot.

ER patient complains of a headache after an accident

Nurses act quickly to reattach a man's scalp.

Outdated warning against using epinephrine in digital blocks

Do the benefits now outweigh the risks of using lidocaine with epinephrine in digital blocks?

Gallbladder mystery

Should a patient with a negative abdominal ultrasound be referred for cholecystectomy?

PICU patient, staff become family

A boy born with dextrocardia and right pulmonary sequestration gets a new bronchus.

Abdominal pain in a posthysterectomy patient

Ms. L, 34 years old and para 1 gravida 2, presented to the emergency room one evening following a four-day battle with "the flu." She became concerned after experiencing increasing pain in her left flank and pelvic area. On questioning, she recounted being constipated and very nauseated.

Patient's rare gastrointestinal condition resolves after unexpected visit

A 22-year-old female has a loop of bowel around her pancreas and elevated pancreatic enzymes.

Immigrant refuses appendicitis care

Language barriers and financial concerns could have had fatal results, but an insistent nurse prevailed.

Man chokes while undergoing anesthesia

Man chokes while undergoing anesthesia

A nurse anesthetist's quick reaction saves a patient's life during a routine endoscopic procedure.

An unexpected foreign object

An unexpected foreign object

After taking all her pills at once, the patient developed dysphagia. But the meds weren't to blame.

Diabetic foot ulcers in underinsured patients

Diabetic foot ulcers in underinsured patients

Successful treatment can cost tens of thousands of dollars. With limited access to care, these patients often present with advanced disease.

Preventing abrasions caused by rigid cervical collars

Padding collars with fleece or felt is an inexpensive way to protect pressure areas.

Fallout from a ruptured inclusion cyst

What causes an inclusion cyst to come to a head and rupture, and what effect does this have?

Who takes the blame for medical errors?

Who takes the blame for medical errors?

Mistakes are not always the fault of an individual—sometimes, the system is the problem. An expert takes a hard look at what should be done.

Endoscopic surgery for fistula creation

Endoscopic surgery for fistula creation

A new, minimally invasive approach will decrease morbidity amonghemodialysis patients and help improve their quality of life.

Anticoagulants after valve replacement

What is the most appropriate choice following replacement with a bioprosthetic valve?

Disposable lead wires in postoperative heart patients

What are the recommendations for using disposable lead wires for postoperative heart patients in the cardiac critical care unit?

Postsurgical infection could have been avoided

Postsurgical infection could have been avoided

When a patient refuses to follow advice, should the clinician be held liable for any adverse outcomes?

Blocked artery goes undetected

The patient's ECG was first interpreted as normal, but he later suffered an MI following surgery.

Assessing knee pain in the primary-care clinic

Assessing knee pain in the primary-care clinic

Not all knee complaints require orthopedic referral. This review of basic testing and exam techniques will help you arrive at an accurate diagnosis.

Arthroscopic surgery may not be beneficial for moderate-to-severe knee osteoarthritis

Arthroscopic surgery may not be beneficial for moderate-to-severe knee osteoarthritis

For moderate-to-severe secondary or idiopathic knee osteoarthritis, the addition of arthroscopic surgery appears no more effective than optimized physical and medical therapy alone.

HIGH-DOSE METOPROLOL INCREASES MORTALITY IN HIGH-RISK SURGERY PATIENTS

Perioperative beta blockers have been promoted to reduce the risk for perioperative MI. However, while high-dose perioperative extended-release metoprolol succinate (Toprol XL) for noncardiac surgery decreased MI in high-risk patients, it increased mortality, based on...

Surgery required to remove painless lump in a 7-year-old's arm

Surgery required to remove painless lump in a 7-year-old's arm

With the help of an expert orthopedist and pathologist, a definitive diagnosis was reached in this unusual case.

Clinician ducks trial crossfire

Dr. P, 45, was a family physician with a suburban practice in the Northeast. He saw a variety of patients but referred many cases that he felt...

Typical angina with an atypical diagnosis

The patient continued her aerobic workouts despite persistent chest pressure with an unknown etiology.

Preoperative evaluation: Take it step by step

Preoperative evaluation: Take it step by step

Identifying patients at higher risk for mortality and morbidity during the perioperative period can lead to strategies to minimize those risks.

Choosing right the therapy for herniated disks

Choosing right the therapy for herniated disks

Studies have determined which patients would benefit from spine surgery and which ones would not.

Sign Up for Free e-newsletters