Saturday, July 15, 2017

Endocrine Surgery1


  • THE ENDOCRINE SYSTEM
    1. INTRODUCTION
    1.1 General Endocrinology can be defined as the study of
    communication between cells by a chemical messenger (Hormone)
    synthesized by endocrine cells in vivo and directed at specific
    target cells.
    1.2 Most endocrine cells that synthesise the hormones have a
    limited capacity to store the hormone. Thus these glands need to
    turnover several times just to keep pace with daily requirements
    for the hormones. The normal thyroid gland contains two weeks
    stored supply in the form of thyroglobulin. Nerve endings may have
    several days supply of norepinophrine.
    1.3 The rate of different hormone release is periodic in the form
    of a set rhythm, the cycles varies from minutes to hours or daily
    (Circadian) loss of this rythm in clinical cases may be an early
    evidence of a disordered state.
    2. A HORMONE
    A hormone, being the chemical substance synthesized by a
    group of endocrine cells (in ductless glands) and secreted
    directly into the blood stream (since there are no ducts) for
    quick transport to target organs so as to influence their internal
    metabolism.
    2.1 The important body functions responsive to hormone actions
    are:
    2.1.1 The Milieu Interior (fluid, Electrolytes). The internal
    environment
    2.1.2 Emergency stress response i.e.metabolic response to injury
    2.1.3 Reproduction i.e. ova and sperm production, fertilisation
    and implantation
    2.1.4 Growth and development of both
    i) Normal tissue and
    ii) Neoplastic tissue
    2.2 The hormones we know are either
    * Peptides (made of sequence of amino acids)
    * Steroids (The hormones has a six sided steroid ring and the
    precursor is cholesterol) or
    * amines (are also derived from amino acids)
    Hormone action starts with the step of binding with a cell
    membrane or intracellular specific receptor for the hormone.
    2.3 There is evidence available that the Endocrine System is
    integrated in its activity to achieve biologic goals. The ed by
  • the activity of the pituitary gland (Fig 30.1a & b). The pituitary
    gland receives instruction through neural signals (Fig 30.2


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Sunday, July 9, 2017

Renal Transplantation 5 Longterm follow up

LONG-TERM FOLLOW-UP
Patients   with  satisfactory  renal  function  can  usually   be
discharged from hospital 2 to 3 weeks after the operation.
Regular monitoring on a daily or alternate day basis is essential
during the first month after position.

A  live donor transplant offers a much greater chance of  success
than a cadaver graft

Excellent   results  can  be  expected  in  the  rare  cases   of
transplantation between identical twins.

However, with a kidney from and HLA identical sibling the  I-year
graft survival in most centres is over 90%

In  sibling  transplants  without complete HLA  identify  and  in
parent  to  child operations; the levels of  graft  survival  are
lower, but still around 75% at I year.

An  increasing  awareness of the potentially  lethal  effects  of
immunosuppression has led to a gradual reduction in the mortality
and morbidity of transplantation.

Today  2 year survival in 40-60 years recipients is 61%, 4  years
survival in the same age group is 71%. Survival in 15 to 45 years
stands at 90% at 86% at 2 and 4 years. This has been achieved  by

some supportive dialysis after transplantation when required.

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Monday, July 3, 2017

Renal Transplantation 4 post operative

POST-OPERATIVE MANAGEMENT
Patients  are usually nursed in isolation for the first 48  hours
after  operation  and careful isolation and  barrier  nursing  is
essential.
*  Kidneys  with a  short warm ischaemic  time  usually  function
   immediately after transplantation
*  In this situation, biochemical estimations are the mainstay of
   the diagnosis of rejection
*  The  serum creatinine , creatinine clearance  and  blood  urea
   should be estimated daily
*  Of these, the  serum creatnine is the most reliable  index  of
   rejection
*  Confirmatory clinical signs are often present
These include graft swelling and tenderness:
-  A reduction in urine volume
-  Pyrexia
-  Unexplained weight gain or
-  A rise in blood pressure
*  Isotope  techniques such as gamma  camera  sintiscanning,  the
   uptake of 125I fibrinogen and the injection of Indium labelled
   autologous  platelets have all been used to give arly  warning
   of rejection
*  The  urine  may  also be tested  for  the  presence  of  cells
   fibrin/fibrinogen  degradation products and  specific  urinary

   enzymes such as N-acetyl glucosaminidase.

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