Laparoscopic Hysterectomy

Laparoscopic hysterectomy is a surgical removal of the uterus,Laparoscopic hysterectomy is alternative to abdominal hysterectomy.Hysterectomy is the second most common major operation performed in the United States today, second only to cesarian section.The first laparoscopic hysterectomy (LH) was performed in January 1988 by Harry Reich in Pennsylvania.The indications for laparoscopic hysterectomy are similar to the generally accepted indications for hysterectomy.
The contraindications for laparoscopic hysterectomy include postpartum hysterectomy and adnexal masses which cannot be removed with an endobag. The size of the uterus and access to it also limit the scope of the procedure depending on the experience of the surgeon.Hysterectomy is usually performed for problems with the uterus itself or problems with the entire female reproductive complex. Some of the conditions treated by hysterectomy include uterine fibroids (myomas), endometriosis (growth of menstrual tissue outside of the uterine cavity), adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall), several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and at least three forms of cancer (uterine, advanced cervical, ovarian). Hysterectomy is also a surgical last resort in uncontrollable postpartum obstetrical haemorrhage.

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Case of Wegener’s granulomatosis

A 43y old man presents with fever and arthritis. During the past 2 mo, he has been treated four times for a maxillary sinus infection. He also complains of the recent onset of hematuria. Which of the following is the most likely diagnosis?

• a.Churg-Strauss syndrome
• b.Wegener’s granulomatosis
• c.Lofgren syndrome
• d.Sjogren syndrome
• e.Sarcoidosis

** The answer is (b).

Wegener’s granulomatosis involves the upper airways (nasopharynx and sinuses) and the lungs, kidneys, and joints. The diagnosis is made by the clinical picture, a positive antineutrophil cytoplasmic antibody with a cytoplasmic staining pattern (C-ANCA), and biopsy showing necrotizing granulomas. The disease causes a systemic necrotizing arteritis and is fatal without treatment.
The typical history for Churg-Strauss syndrome(allergic angiitis and granulomatosis) is asthma followed by systemic vasculitis with eosinophilia (mnemonic is RAVE: Rhinitis, Asthma, Vasculitis, and Eosinophilia). Lofgren syndrome is a benign form of sarcoidosis that
causes bilateral hilar adenopathy, periarthritis of the ankles, and erythema nodosum of the anterior tibial regions of the lower extremities. Sjogren syndrome is a slowly progressive autoimmune disease that primarily affects middle-aged women; it affects the lacrimal and salivary glands,resulting in xerostomia and dry eyes. It may occur alone (primary) or in
association with other autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus.

Drugs in Allergic Rhinitis

Drugs in Allergic Rhinitis :
#H1 antihistamines are effective for treating nasopharyngeal itching, sneezing, watery rhinorrhea, and ocular itching, tearing, erythema.

*Side effects associated with older H1 antihistamines include sedation, visual disturbance, urinary retention, and arrhythmias

#Newer H1 antihistamines:( terfenadine (Seldane) astemizole (Hismanal))

*These agents exhibit less sedation associated with .......

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Clinical Surgery

Guidelines in Clinical Surgery is a handbook for all trainees in surgery, providing an invaluable and expert guide to all aspects of clinical surgery that the trainee will encounter during their day to day work. General chapters on clinical examination, pre-operative, peri-operative and post-operative care are accompanied by expert guidance on how to deal with specific surgical problems, such as respiratory failure, wound healing, MRSA infection, tropical surgery and acute ischaemia. Further chapters provide invaluable information on topics including nutrition, anaesthsia, sutures and surgical incisions. The special problems associated with the surgical management of elderly patients are discussed, and the reader is introduced to the principles of surgical oncology and laparoscopic surgery. With its concise and easy-to read layout, Guidelines in Clinical Surgery is written by a team of expert surgeons, some of whom are also examiners for the Royal College of Surgeons. It is an invaluable on-the-job guide for Foundation level doctors on surgical rotation, as well as for those studying for the MRCS, FRCS and equivalent examinations. Guidelines in Clinical Surgery is a handbook for all trainees in surgery, providing an invaluable and expert guide to all aspects of clinical surgery that the trainee will encounter during their day to day work. Generalchapters on clinical examination , pre-operative, peri-operative and post-operative care are accompanied by expert guidance on how to deal with specific surgical problems, such as respiratory failure, wound healing, MRSA infections, tropical surgery and acute ischaemia. Furtherchapters provide invaluable information on topics including nutrition, anesthesia, sutures and surgical incisions. The special problems associatted with the surgical management of elderly patients are discussed, and the reader is introduced to the principles of surgical oncology and laparoscopic surgery.
With its concise and easy-to read layout, Guidelines in Clinical Surgery is written by a team of expert surgeons, some of whom are also examiners for the Royal College of Surgeons. It is an invaluable on-the-job guidefor Foundation level doctors on surgical rotation, as well as for those studying for the MRCS, FRCS and equivalent examinations .

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Oral Manifestations of Sjogren's Syndrome

Sjögren's (SHOW-grins) syndrome is an autoimmune disease that attacks the exocrine glands (i.e., moisture-producing glands) of the body, specifically the lacrimal and salivary glands. ..................

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Chronic (total) renal infarction X-ray

Renal infarction due to acute renal artery occlusion. (A) An initial nephrotomogram demonstrates a thin cortical rim surrounding the right kidney (arrows), reflecting viable renal cortex perfused by perforating collateral vessels from the renal capsule. (B) Four months later, a repeat nephrotomogram shows a marked decrease in the size of the atrophic right kidney (arrowheads).

Imaging Findings :
Global shrinkage of the kidney with absent opacification. There may be a peripheral rim of opacified cortex during the nephrogram phase (probably reflects viable renal cortex perfused by perforating collateral vessels from the renal capsule).

NOTE : Renal occlusion is most commonly secondary to an embolism from the heart. A decrease in renal size is detectable within 2 weeks and reaches its maximum extent by 5 weeks. Compensatory enlargement of the contralateral kidney (in individuals young enough to provide this reserve).

Appendectomy:Most important things to know

Laparoscopic Appendectomy Surgery


conventional Appendectomy


NOTE:Laparoscopic appendectomy is an acceptable procedure for complicated appendicitis, with the same rate of infectious complications as the conventional approach.
Appendicitis: Most important things to know