General

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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "To limit postoperative morbidity, it is desirable and usually possible to employ a muscle-sparing approach, affording adequate exposure yet limiting or avoiding division of the serratus anterior and latissimus dorsi. The scapula is elevated off the chest wall by retractor to gain exposure, and palpation is used to count the ribs to the correct interspace. In most situations in infants, the highest palpable rib is the second. Generally, the fourth interspace is used for a lobectomy, although the fifth also can be used effectively."

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The breast tissue present in gynecomastia is most often tender, firm, and subareolar. One third of boys will present with unilateral gynecomastia. A mass in the breast that is not subareolar and is asymmetric should raise concern for other conditions. A testicular exam is a key component of the physical exam to rule out hypogonadism, suggestive of Klinefelter’s syndrome, a varicocele, or possible estrogen-secreting tumors of the testes, such as germ cell tumors, Sertoli cell tumors, or Leydig cell tumors."

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reason for burning over second rib for 5cm laterally during thoracic sympathectomy, to burn The Nerve of Kuntz, to decrease recurrence post sympathectomy. recommendation is to burn over all ribs from 2 to 4, 5cm lateral to sympathetic trunk after its resection.

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The diagnosis of eventration is usually made on a chest x-ray. Frontal and lateral chest x-rays will show an elevated diaphragm with a smooth, unbroken outline. Fluoroscopy is a useful investigation for differentiating a complete eventration from a hernia. Paradoxical movement of the diaphragm is seen if complete eventration is present. Ultrasonography is the most useful study in the diagnosis of eventration of the diaphragm and for identification of abdominal organs underneath the eventration. Other investigational modalities include pneumoperitonography, contrast peritonograph…

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