Atlas of Surgery

Appendix testis (Hydatid of Morgagni)

2010-08-05T11:57:00.000-07:00

The development of testis starts in very early fetal life with the first 'kidney'- the pronephros, which does not function. The second kidney appears in the fourth week, as the pronephros is degenerating, and is the mesonephros with its mesonephros duct. This mesonephros also degenerates, but the mesonephric duct persists (the Wolffian duct), which in male persists and develops into the epididymis, vas deferens, ejaculatory ducts and seminal vesicles. In females this Wolffian duct degenerates, but the paramesonephric ducts (Mullerian ducts) grow and develop into the female genital tract. The Mullerian ducts do not persist in the male( due to the secretion of Mullerian inhibiting substance), apart from the most cranial end which persists as the appendix testis (hydatid of Morgagni) on the upper pole of testis.

Hyperparathyroidism

2010-03-10T09:34:00.000-08:00

Intraoperative views of enlarged right inferior parathyroid gland.

X-ray showing marked subperiosteal bone resorption due to increased parathyroid hormone.

CT scan showing right ileal bony cyst/ lytic lesion/ brown tumor due to increased PTH.

Von Recklinghausen's disease/ Neurofibromatosis

2010-01-18T10:55:00.000-08:00

Cafe au lait spots.

Under GA for a lump excision.

White bile/ Leukobilin

2010-01-18T10:10:00.000-08:00

Aspirating white bile from the gall bladder.
White bile develops when both cystic and common bile duct are blocked.
It can be found in both malignant and benign forms of Jaundice, but malignancy (GB, Pancreas) is a more common cause.
Rare causes are Phosphorus poisoning and congenital deficiency of liver cells

Advanced Osteosarcoma of left thigh

2010-01-18T10:03:00.000-08:00

Getting ready for left hip joint disarticulation.

Radio-cephalic fistula

2009-12-22T08:49:00.001-08:00

Pectus excavatum

2009-12-22T08:47:00.001-08:00

Carcinoma cheek

2009-12-22T08:46:00.001-08:00

Carcinoma tongue

2009-12-22T08:44:00.000-08:00

Gynaecomastia

2009-12-21T11:31:00.000-08:00

Gynecomastia, is the development of abnormally large mammary glands in males resulting in breast enlargement. The term comes from the Greek (γυνή) gyne (stem gynaik-) meaning "woman" and (μαστός) mastos meaning "breast".

This condition can occur physiologically in neonates due to female hormone from mother and the discharge is known as 'Witches milk'.
Breast prominence due solely to excessive adipose is often termed as pseudogynaecomastia or sometimes lipomastia.
The condition should be differentiated from work hypertrophy of the pectoralis muscles caused by exercise.
Types are:

Puffy nipples: very common, glandular tissue is concentrated under and typically confined to areola.
Pure glandular: In bodybuilders this may be a result of the use of anabolic steroids
Adolescent: Congenital/Hereditary- boys of 9-14 years.
Adult: most common.
Pseudogynaecomastia: This is generally the only type which can be improved by liposuction.
Asymmetrical/Unilateral.
Severe: is characterized by excess and/or saggy skin and severely enlarged breasts.

Treatment:

Correcting underlying cause.
Selective estrogen receptor modulator eg. tamoxifen, clomiphen or androgens or aromatase inhibitor such as letrozole.
Surgery: Reduction mammoplasty, liposuction, gland excision
Radiation therapy is sometimes used to prevent gynaecomastia in patients with prostrate cancer prior to estrogen therapy.

Trichobezoar

2009-12-14T10:19:00.000-08:00

Hair balls.

Salient features:

Unusual
Virtually exclusively found in young female phychiatric patients
Caused by pathological ingestion of hair.
Presentation is often suggestive of Ulceration, GI bleeding, perforation or Obstruction.
Endoscopy is diagnostic, Plain x-rays may help.
Treatment is removal: endoscopically or sometimes open surgery.

Other similar condition is Phytobezoars which are made of vegetable material and found principally in patients with gastric stasis.

Local Gigantism

2009-12-13T02:21:00.000-08:00

Local gigantism is a condition in which a certain part of the body acquires larger than normal size due to excessive growth of the anatomical structures or abnormal accumulation of substances. It is more common in fingers and toes, where it is termed macroodactyly.

This is broadly classified into two:
CONGENITAL:

Klippel Trenaunay Weber syndrome
Maffucci syndrome
Macrodystrophia lipomatosa
Nerurofibromatosis
Lipoatrophic diabetes
Proteus syndrome, which affected the elephant man:

ACQUIRED:

Inflammation
Tumors - osteoid osteoma, melorheostosis, lipofibromatous hamartoma

3. Arteriovenous malformations (before the closure of epiphysis in long bones)
4. Elephantiasis (S-E Asia, filariasis)
5. Still's disease
6. Amyloidosis
7. Acromegaly
Treatment ranges from antibiotics to correction of the underlying anatomic anomaly.

Squamous Cell Carcinoma

2009-12-07T11:33:00.001-08:00

Cutaneous SCC