Surgical resection

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Ms. Barker had a bowel resection 4 days ago. After a culture and sensitivity test of her draining surgical wound, the primary health care provider orders penicillin G aqueous IV as a continuous drip. Determine what questions you would ask Ms. Barker before the penicillin is added to the IV solution. 

Parenteral Fluids. During the past ten years interest has been renewed in the total alimentation of the infant by vein (2). The motivation for this is the fact that neonates may suffer from some congenital malformation of the intestinal tract which would require surgical resection. If this is done, then one needs some outside way for alimentation, bypassing the intestine, until the intestine is able to heal and recover its normal function. This may take many weeks. A second source of motivation is the small premature infant weighing less than a kilogram, whose immature central nervous system and gastrointestinal tract make it difficult to establish nutrition by oral intake soon after birth. These also require total intravenous nutrition for a substantial period of time. 

Treatment of distal intestinal obstruction syndrome (DIOS) consists of oral or nasogastric administration of polyethylene glycol electrolyte (PEG) solutions. Enemas may also be used to facilitate stool clearance. IV fluids are often required to correct dehydration due to vomiting or decreased oral intake. Re-evaluation of enzyme compliance and dosing is essential to prevent further episodes. Patients with recurrent symptoms may require daily PEG administration (Miralax ).5 Severe presentations of DIOS or initial meconium ileus may require surgical resection. 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

Antibiotics have been studied based on the rationale that they may interrupt the inflammatory response directed against endogenous bacterial flora. Metronidazole and ciprofloxacin have been the two most widely-studied agents.32 Metronidazole may benefit some patients with pouchitis (inflammation of surgically-created intestinal pouches) and patients with CD who have had ileal resection or have perianal fistulas. Ciprofloxacin has shown some efficacy in refractory active CD. Both drugs may cause diarrhea, and long-term use of metronidazole is associated with the development of peripheral neuropathy. 

Surgical resection is considered the treatment of choice for Cushing s syndrome from endogenous causes if the tumor can be localized and if there are no contraindications. 

If endogenous Cushing s syndrome, determine if patient is an appropriate candidate for surgical resection of the tumor. Does the patient have any conditions that contraindicate surgical resection, such as advanced disease (metastatic adrenal carcinoma) ... 

If surgical resection does not achieve satisfactory disease control or is not indicated, evaluate the patient for pituitary radiation or bilateral adrenalectomy with concomitant pituitary radiation. 

O Surgical resection of the pituitary tumor through transsphenoidal pituitary microsurgery is the treatment of choice for most patients with growth hormone-producing pituitary adenomas. 

Flanigan RC, Reda DJ, Wasson JHM, et al. 5 year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia a Department of Veterans Affairs cooperative study. J Urol 1998 160 12-17. 

O Most intraabdominal infections are secondary infections that are caused by a defect in the gastrointestinal tract that must be treated by surgical drainage, resection, and/or repair. 

Locally advanced breast cancer often is treated with neoadjuvant therapy to make the tumor surgically respectable. During neoadjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy, and a physical examination and ultrasound exams to detect size of tumor are performed after the cycles of neoadjuvant therapy are completed. After a complete surgical resection, monitoring proceeds as described earlier for early breast cancer. 

Surgical resection of the tumor is the mainstay of treatment in early-stage non-small cell lung cancer and produces the longest survival rates. 

The term adjuvant therapy refers to the use of chemotherapy or radiotherapy following surgical resection of a tumor mass. The rationale behind adjuvant chemotherapy is to eradicate micrometastases or other tumor cells that may have been missed during removal of the primary tumor. The recent results of five relatively large prospective trials (n = 344—1867) suggest that there is benefit from adjuvant chemotherapy. The largest study, the International Adjuvant Lung Trial (IALT),24 has led to the... 

Individuals with stage I to III colorectal cancer should undergo a complete surgical resection of the tumor mass with removal of regional lymph nodes as a curative approach for... 

Adjuvant chemotherapy is administered after tumor resection to decrease relapse rates and improve survival in patients with colon cancer by eliminating micrometastatic disease that is undetected on imaging studies. Patients diagnosed with stage I colon or rectal cancer usually are cured by surgical resection, and adjuvant chemotherapy is not indicated in these patients.16 The role of adjuvant... 

Another unique aspect of rectal cancer is the use of neoadjuvant therapy. Preoperative radiation with or without chemotherapy is given to downstage the tumor prior to surgical resection to improve sphincter preservation by making the surgical procedure easier to perform. The issue of preoperative versus postoperative radiation is a subject of debate and investigation in the United States and will require further data to determine the superiority of one method over the other. 

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