Absite Topic Review General Surgery

Nir Hus, MD, PhD. Mount Sinai Medical Center Miami Beach

Topics

  1) BRCA-1,2.   2) Rx Postop Parotitis.   3) Rx Non-healing burn wound.

Nir Hus

Predict Increased risk BRCA-1,2 mutation

 BRCA I  Ovarian CA – 40% lifetime risk  Male Breast CA – 1% lifetime risk

 BRCA II  Ovarian CA – 10% lifetime risk  Male Breast CA – 10% lifetime risk

Nir Hus

BRCA cont.

 BRCA gene + family Hx = 60% lifetime risk of breast CA (autosomal dominant)

 Bi prophylactic mastectomy w/ BRCA gene results in decreased risk of breast CA by 90%  Add TAH & BSO decrease risk 95%

 CA in a person w/ BRCA I,II carries a 50% risk of developing CA in contralateral breast.

Nir Hus

Parotitis   Can occur in the surgical patient and identified during the

postoperative period.   Particularly in elderly   Dehydrated individuals.

  Therapy should be directed toward   Rehydration   Enhancing salivation   Ensuring that no mechanical obstruction of the duct of Stensen

is present   Obtaining stains and cultures   Administering antibiotics directed against S. aureus, which is the

most common offending organism.   In ICU patients who are often colonized with gram-negative

bacteria, the possibility of gram-negative bacterial parotitis should be considered and appropriate empiric therapy used.

  I&D Nir Hus

Rx Non-healing burn wound.

 Q: 30 y.o veteran suffered a burn wound to arm 2nd or 3rd degree over one year ago and the wound is ulcerated. What to do next.  A: Marjolin’s tumor – need Bx

Nir Hus

Ulcers associated with burns

 Curling’s ulcer – gastric ulcer that is associated with burns.

 Marjolin’s ulcer – highly malignant squamous cell CA.

Nir Hus