bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial Management of Life-Threatening Trauma
Authors: Cantrell Emily , Doucet Jay
Published: January 2021

Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allows for rapid assessment and initiation of life-preserving therapies. This initial assessment must proceed systematically and be prioritized according to physiologic necessity for survival. Beginning in the prehospital setting, coordination, preparation, and appropriate triage of the injured are crucial to facilitating rapid resuscitation of the trauma patient. Next, active efforts to support airway, breathing, circulation, and disability are performed with simultaneous intervention to treat life-threatening injuries and restore hemodynamic stability in the primary survey. With ongoing evaluation and continued resuscitation, a secondary survey provides a head-to-toe assessment of the patient allowing for further diagnosis of injuries and triage to more definitive care.

This review contains 12 figures, 8 tables and 63 references
Key Words: advanced trauma life support, definitive airway, FAST/eFAST, field triage, Glasgow coma scale, primary survey, 1:1:1 resuscitation, secondary survey
Injuries to the Face and Jaw
Authors: Hopper Richard A. , Walmsley Graham G , Hu Michael S , Lorenz H Peter
Published: January 2021

The human face is vulnerable to injury most frequently as the target of interpersonal violence or when inadequately restrained within a motor vehicle collision. Injuries to both the soft tissues and skeleton of the face are common reasons of emergency department admissions and consultations. Isolated maxillofacial trauma is rarely life threatening or an immediate cause of death unless associated with airway compromise; however, approximately 20% of all patients with facial soft tissue, dentoalveolar, or facial fracture trauma have associated injury to additional body systems. In particular, motor vehicle crash victims, personal assault, occupational injuries, and motorcycle crash victims may have associated injuries to additional body systems. This review covers the assessment and management of maxillofacial fractures, initial evaluation, comprehensive survey, treatment of soft tissue injuries, and treatment of maxillofacial fractures. Figures show a patient with a combination of blunt and penetrating trauma to the central face; fractured mandible; fractured zygoma; infraorbital fracture; broken nose; soft tissue injuries involving the facial nerve distal to the vertical line, likely too small for primary repair; injuries to the parotid duct repaired by passing a catheter through the Stensen duct and through the area of laceration and then repairing the parotid duct over the catheter; mandibular fracture; Le Fort I, Le Fort II, and Le Fort III fractures; findings in patients with Le Fort III maxillary fractures immediately after injury, before obliterative edema develops; and preoperative and postoperative right-sided orbitozygomatic fracture.
This review contains 12 highly rendered figures, and 29 references
Key words: Jaw injuries; Face injuries; Maxillofacial injuries; Le Fort level; Facial fractures; Orbital fractures; Maxillary fractures;
Operative Exposure of Abdominal Injuries and Closure of the Abdomen
Authors: Nealeigh Matthew D , Bowyer Mark W
Published: January 2021

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text.
This review contains 7 figures, 2 tables, and 41 references. 
Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation
Management of the Patient with Thermal Injuries
Authors: Mosier Michael J. , Gibran Nicole S.
Published: January 2021

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients.
This review contains 3 highly rendered figures, 12 tables, and 134 references
Pulmonary Insufficiency and Respiratory Failure
Authors: Chung Bruce , Hoth J. Jason
Published: January 2021

Pulmonary insufficiency is the most common complication after surgical procedures. From minor atelectasis to acute respiratory distress syndrome (ARDS), postoperative pulmonary insufficiency occurs in up to 50% of surgeries. Here we discuss the anatomy, mechanics, and pathophysiology of pulmonary insufficiency; preoperative and postoperative assessment of lung function; and treatment for pulmonary insufficiency with regard to atelectasis, pulmonary edema, and ARDS. Pulmonary insufficiency secondary to cardiac disease, thromboembolism, and central nervous system depression are discussed elsewhere. Preoperative identification of risk factors for pulmonary insufficiency and understanding the physiologic changes in the perioperative period can potentially mitigate postoperative respiratory failure.
Stress Response and Endocrine Deregulation during Critical Illness
Authors: Marik Paul E.
Published: January 2021

The stress system receives and integrates a diversity of cognitive, emotional, neurosensory, and peripheral somatic signals that arrive through distinct pathways. Activation of the stress system leads to behavioral and physical changes that are remarkably consistent in their qualitative presentation. The stress response is mediated largely by the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal system, which includes the sympathetic nervous system and the adrenal medulla. The stress response is normally adaptive and time limited and improves the chances of the individual for survival. The time-limited nature of this process renders its accompanying antigrowth, antireproductive, catabolic, and immunosuppressive effects temporarily beneficial and/or of no adverse consequence to the individual. However, chronic activation of the stress system as occurs in critically ill patients may lead to a number of disorders, including stress hyperglycemia, dysfunction of the HPA and hypothalamic-pituitary-thyroid (HPT) axes, and hypothalamic-pituitary growth hormone (GH) dysfunction. These disorders are reviewed in this chapter. Diagnosis of adrenal insufficiency/critical illness–related corticosteroid insufficiency and who to treat with steroids are also covered in depth. The author emphasizes the controversial management of these deregulated hormonal axes with only limited data supporting an improvement in outcome with hormonal replacement therapy.
This review contains 3 Figures, 1 Table, 39 References, 5 Board-Styled MCQs, and a Teaching Slide Set for teaching and reference purposes.
Postoperative and Ventilator-Associated Pneumonia
Authors: Fitzgerald Caitlin A. , Coopersmith Craig M.
Published: January 2021

Postoperative pneumonia is currently the third most common complication seen in surgical patients and is associated with an increase in both patient morbidity and hospital costs. The incidence of postoperative pneumonia varies among the different surgical subspecialties. A number of evidence-based strategies exist regarding the prevention and management of pneumonia. However, the majority of studies on ventilator-associated pneumonia (VAP) do not specifically focus on surgical patients but rather are based on mixed medical-surgical ICU patients. The aim of this review is to define the incidence, pathogenesis, and risk factors of both postoperative and VAP; determine what pathogens are commonly encountered; discuss treatment methods; and introduce measures that can be implemented in both the surgical wards and the ICU aimed at preventing this complication.
This review contains 5 figures, 7 tables, and 64 references. 
Key Words: antimicrobial therapy, disease prevention, postoperative pneumonia, surgical critical care; ventilator associated pneumonia, culture, prevention, management, bundles, diagnosis
Injuries to the Spleen and Diaphragm
Authors: Long Andrea M. , Miller Preston R , Hoth J. Jason
Published: January 2021

The spleen is one of the most commonly injured abdominal organs in blunt trauma patients. The mechanisms of injury are similar to those seen with liver injuries: motor vehicle collisions, automobile-pedestrian collisions, falls, and any type of penetrating injury. Stab wounds to the abdomen are less likely to cause spleen injury compared with liver injury due to the spleen’s protected location. Stab wounds to the spleen typically result in direct linear tears, whereas gunshot wounds result in significant cavitary injuries. This review covers injuries to the spleen and injuries to the diaphragm. Figures show findings on imaging that may be associated with failure of nonoperative management for splenic injuries, intraparenchymal splenic blush noted on an initial computed tomographic scan, the first step in mobilizing the spleen by making an incision in the peritoneum and the endoabdominal fascia, beginning at the inferior pole and continuing posteriorly and superiorly, splenorrhaphy performed using interrupted mattress sutures through pledgets along the raw edge of the spleen, left diaphragm ruptures evident with the gastric bubble located in the left hemithorax, whereas right-sided ruptures present with the appearance of an elevated hemidiaphragm, and the use of Allis clamps to approximate the diaphragmatic edges, with the defect closed with a running No. 1 polypropylene suture. The table lists American Association for the Surgery of Trauma organ injury scales for diaphragm and spleen.
This review contains 6 figures, 1 table, and 55 references
Keywords: spleen, injury grading, angioembolization, splenorrhaphy, splenic salvage
Molecular and Cellular Mediators of the Inflammatory Response
Authors: Makley Amy T. , Goodman Michael D. , Pritts Timothy A.
Published: January 2021

Inflammation is a highly complex process involving vascular, neurogenic, humoral, and cellular responses. Although the descriptive features of acute inflammation have long been known (i.e., heat, redness, pain, swelling), a single satisfactory definition of this phenomenon is still lacking. Successful therapy for inflammation rests not only on investigating the type of injury, but also on the timing of the intervention. This review focuses on humoral and cellular responses to injury, defining essential and interrelated inflammatory pathways. Systemic inflammatory response system (SIRS), in relation to sepsis syndrome, is defined by the global proinflammatory physiologic response to a stimulus. In contrast, compensatory antiinflammatory response (CARS) results from a predominant antiinflammatory response to an insult, also causing immunosuppression and increased susceptibility to infection. Also discussed are the roles of cytokines, adhesion molecules, inflammatory cells such as neutrophils, mast cells, and lymphocytes, extracellular vesicles, sphingolipids, reactive oxygen metabolites, nitric oxide, the complement cascade, and eicosanoids. Therapeutic implications and trials are examined in relation to cytokines in SIRS and CARS, activated protein C, and inflammatory bowel disease.
This review contains 11 figures, 4 tables, and 79 references.
The Pediatric Surgical Patient
Authors: Nunez Lopez Omar , Bowen-Jallow Kanika A
Published: January 2021

The surgical care of pediatric patients requires familiarization with the physiologic principles that govern homeostasis in neonates, infants, children, and adolescents. These principles must be taken into consideration in the perioperative management and trauma care of pediatric patients. In addition to surgical problems common to all age groups, there are specific pathologic processes requiring surgery (or treatment by a surgeon) that are seen only in pediatric patients. Here we present an overview of the physiologic considerations important for the surgical care of children and a review of the most commonly encountered pediatric surgical conditions, with an emphasis on the acute management and stabilization of the patient. References to current guidelines are being provided when available.
 
This review contains 5 figures, 8 tables, and 63 references
Keywords: abdominal wall defects, diaphragmatic hernia, gastroschisis, nonaccidental trauma, nutrition, pediatric surgery, pediatric trauma, perioperative care
Urologic Considerations for the General Surgeon
Authors: Eaton Samuel H. , Nadler Robert B.
Published: January 2021

An understanding of the anatomic, physiologic, and pathologic features of the urogenital system is a necessary component of general surgical education. Anatomic considerations include thorough knowledge of the kidneys and ureters; bladder; prostate and seminal vesicles; penis and urethra; and the testes. Urologic injuries are common when multiple organ systems are damaged, occurring in about 10% of cases of major trauma. Iatrogenic injuries can also occur during any open or laparoscopic procedure in the abdomen or the pelvis and may result from transection, ligation, laceration, resection, crushing, or ischemia; they are most likely during gynecologic procedures. The bladder is the genitourinary organ that is most frequently injured during an operation. Statistics and general treatment regimens for urologic malignancies are discussed and include renal cell carcinoma; bladder cancer; prostate cancer; and testicular cancer. The chapter concludes with the incidence and symptoms of benign prostatic hyperplasia, which is becoming increasingly common in the older, male population. Figures show the anatomic relationship of the kidneys to abdominal organs and venous drainage of the kidneys.
This review contains 2 figures, 1 table, and 82 references.
Neuroendocrine Tumors of the Pancreas
Authors: Morgan Katherine A.
Published: January 2021

Pancreatic neuroendocrine tumors (PNETs) comprise a diverse, heterogeneous group of tumours that range in presentation and biologic behavior, including small, asymptomatic, incidentally discovered, nonfunctional neoplasms, functional tumors (both localizable and unlocalizable) with associated clinical syndromes, and diffuse metastatic disease. Based on its functional status, the malignancy of a PNET can vary, from the benign (insulinoma) to that which is commonly malignant more than 50% of the time (gastrinoma, somatostatinoma). According to a recent study, PNETs appear to be increasing in incidence or at least in clinical detection; currently the disorder accounts for 1 to 2% of pancreatic tumors and with a reported clinical incidence of one to five cases per million persons annually in the United States. Nonfunctional PNETs make up the majority of cases, and comprise 2% of all pancreatic malignancies. Treatment has been primarily done through surgical management, particularly via resection. However, medical management has played a more increased role for patients where the disease is advanced, encompassing biotherapy, chemotherapy, and targeted therapies such as peptide receptor radionuclide therapy (PRRT). For nonfunctional PNETs—insulinomas, gastrinomas, glucagonomas, somatostatinomas, and VIPomas—the epidemiology, biology of disease, clinical presentation and diagnosis, localization of tumor, operative management considerations, surgical management of primary tumor, and prognosis and outcomes of each are discussed.

This review contains 6 figures, 18 tables, and 58 references
Keywords: Pancreas, neuroendocrine tumor, gastrinoma, somatostatinoma, VIPoma, insulinoma, incidentaloma, glucagonoma, enucleation
Lower Gastrointestinal Endoscopy
Authors: Deepak Parakkal , Bruining David H.
Published: January 2021

Since the advent of the first flexible fiberoptic sigmoidoscope in 1967, lower gastrointestinal endoscopy equipment has technologically advanced and is used for a number of diagnostic and therapeutic procedures. This review covers the definition of and indications for lower endoscopy; diagnostic and screening colonoscopy, bowel preparation for colonoscopy, special considerations for patients on anticoagulants and antiplatelet agents; endocarditis prophylaxis; general technique; diagnostic and therapeutic techniques during colonoscopy, sigmoidoscopy, anoscopy, endoscopic ultrasonography, balloon-assisted colonoscopy, and lower endoscopy training; and innovations on the horizon. Figures show room setup and patient positioning for colonoscopy; technique for insertion of a colonoscope and endoluminal view of rectum, descending colon, transverse colon, and cecum; pinch biopsy and hot biopsy forceps; snare polypectomy and endomucosal resection of a polyp using the lift and cut and suction cap techniques; Haggitt classification of tissue invasion in a pedunculated polyp; endoscopic clips and their application; self-expanding uncovered metal stents and their method of deployment; an anoscope; and rigid endorectal probes for endoscopic ultrasonography. Tables list indications for colonoscopy, recommendations for screening for colorectal cancer (average risk) from the US Preventive Services Task Force, recommendations from the US Multi-Society Task Force for surveillance after baseline colonoscopy in average-risk individuals, recommendations from the US Multi-Society Task Force for screening and surveillance in colorectal cancer (high risk), bowel preparation scales, agents for bowel preparation prior to colonoscopy, and Haggitt classification of tumor invasiveness in an adenomatous polyp.
 
This review contains 10 highly rendered figures, 7 tables, and 60 references.
Technical Aspects of Laparoscopic Surgery
Authors: Rabl Charlotte , Campos Guilherme M. , IV James G. Bittner
Published: January 2021

Laparoscopic surgery is now an integral part of general surgery and is used in almost all known surgical procedures. There are many advantages to laparoscopic surgery, including faster patient recovery, shorter hospital stay, decreased pain and analgesic requirements, and faster return to work. A thorough understanding of the different technical aspects of laparoscopic surgery is necessary to perform procedures correctly, as well as to avoid certain predictable difficulties and complications that can occur. This review details operating room setup and patient and surgery team positioning; the laparoscope and instruments used; laparoscopic suturing; laparoscopic training and simulators; when and why to convert to open surgery; and the use of single-port or single-incision laparoscopic surgery. Figures show a schematic representation of a ceiling-mounted articulated boom for laparoscopic surgery; blueprints and photographs of the first endoscope; images of an articulated 5 mm scope and high-definition camera head, assorted laparoscopic instruments, 10 and 5 mm LigaSure sealing devices and a 5 mm Harmonic scalpel, an Endoloop ligature with a 2-0 polyglactin tie, various sizes of the 5 mm Nathanson retractor and the round Snake retractor, and 5 mm needle drivers and a 10 mm Endo Stitch suturing device; and an illustration of laparoscopic suturing (using a square knot). Tables list patient positions used for laparoscopic surgical procedures, guidelines for optimal laparoscopic surgery suites, and staple heights and colors.
This review contains 9 figures, 2 tables, and 78 references.
Acid-Base Disorders
Authors: Chen Herbert , Primus Jason , Martin Colin
Published: January 2021

This review is a summary of the acid-base physiology that is essential to understanding acid-base pathophysiology. An acid is defined as a proton donor; a base is defined as a proton acceptor. The body fluids are composed of acids and bases, which are tightly regulated by our organ systems, specifically the respiratory system and kidneys. Derangements in the body’s acid-base homeostatic mechanisms or overloading the capacity of the body’s ability to respond can lead to acid-base disorders. These include acidosis and alkalosis, which can be further classified into respiratory, metabolic, or mixed disorders. The approach to these disorders is to stabilize the patient, focusing on respiratory and circulatory status and treating the underlying cause of the acid-base derangement.
This review contains 4 highly rendered figures, 2 tables, and 26 references.
Key words: acid-base disorders, acid-base homeostasis, acid-base physiology, acidemia, alkalemia, metabolic acidosis, metabolic alkalosis, mixed acid-base disorders, respiratory acidosis, respiratory alkalosis
Fungal Infections
Authors: Buckman Sara , Fernandez Luis A.
Published: January 2021

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant patients, and sick neonates all being especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients, developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients, organ transplantation has evolved dramatically, and the use of invasive therapies has increased markedly. With these changes has come an increase in the incidence of serious Candida infections, as well as an increase in the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. This review covers fungal colonization versus infection, types of fungal infection, epidemiology and risk factors, clinical evaluation, investigative studies, management of acute candidemia and acute disseminated candidiasis, management of nonhematogenous candidiasis, peritonitis and intra-abdominal abscess, management of other fungal infections (Aspergillus, Cryptococcus, Mucor, Rhizopusi), systemic antifungal agents, and the pathogenesis of Candida infection. Tables describe the clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candida infections, antifungal chemotherapy, and characteristics of currently available antifungals. Figures show Candida endophthalmitis; superficial candidiasis; biopsy samples of chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis; and the various forms of Candida. Algorithms demonstrate the approach to the surgical patient at risk for candidiasis, aspergillosis, and other types of fungal infection.
This review contains 5 figures, 4 tables, and 189 references.
Venomous Bites and Stings
Authors: Walker J Patrick
Published: January 2021

Approximately 8000 persons are bitten by venomous snakes in the US each year.  Mortality is low (4 to 6/yr), but morbidity can be significant, treatment costly. Overuse of surgery and antivenom is common. Simply cutting the wound with attempted aspiration is not indicated. Fasciotomy should only be used for patients with elevated compartment pressures. CroFab is a highly effective (but expensive) treatment useful for serious envenomation. Antivenom should be used in patients with life-threatening symptoms (hypotension, clinical coagulopathy) or rapid advancement of local signs, and to reduce compartment pressures to avoid fasciotomy. The most significant morbidity from insect envenomation is secondary to anaphylaxis. A bite from the black widow spider can induce abdominal cramping and pain that can mimics an acute abdomen. Brown recluse envenomation can produce tissue necrosis and long-term complications. Most events are seen rarely by the average physician; this review can be a useful guide in management. 
Key words: antivenom, copperhead bite, CroFab, insect bite, rattlesnake bite, snakebite, water moccasin bite
Plastic Surgery Considerations for the General Surgeon
Authors: Agnew Sonya P , Dumanian Gregory A.
Published: January 2021

Plastic surgery does not claim a specific region of the body, a tissue type, a disease process, or a technique. Instead, plastic surgery holds central to its core the concepts of tissue perfusion and tissue rearrangement to restore function and appearance. Rather than being at the fringes of medicine and surgery, mastery of these issues allows the plastic surgeon to become a generalist and consultant to all of the surgical disciplines. Reconstructive surgery, wound healing, tissue perfusion, and vascularity are the general themes first discussed by the authors. Plastic surgery considerations for surgery of the abdomen, the breast, and the soft tissues are then covered in order, with all relevant procedures described. The authors discuss scar revisions and the principles of wound closure that favorably impact the final appearance in their conclusion. 
This review contains 5 figures, 9 tables and 15 references
Keywords: Plastic surgery, reconstructive surgery, tissue perfusion, wound healing, panniculectomy, mammaplasty, omental flap, scar revision
Electrolytes
Authors: Rosengart Matthew R
Published: January 2021

Cell function and thus life depend on the preservation of several electrochemical gradients. Evolutionary pressures have developed several regulatory mechanisms, the penultimate goal of which is to maintain total body and distribution of each electrolyte within the intracellular and extracellular compartments at concentrations compatible with life. Ultimately, patient survival depends on this balance despite the continual changes imposed by both internal physiologic processes and external stressors. During periods of critical illness, however, these mechanisms can be overwhelmed, necessitating additional support. Indeed, disorders of electrolyte homeostasis are highly prevalent among intensive care unit patients, and severe disturbances are associated with elevated mortality. As has been previously learned, merely normalizing laboratory abnormalities without addressing the underlying pathophysiology does little to improve outcome. Thus, for those providing this care, an in-depth understanding of the biochemistry and physiology of electrolyte disorders and a systematic approach to diagnosis and therapy are complementary components essential for patient survival. This chapter discusses the major electrolytes—sodium, potassium, calcium and phosphate, and magnesium—and covers the hyper- and hypodeficiencies and disturbances for each electrolyte.
This review contains 7 Figures, 6 Tables, 5 Etiologic Algorithms, and 106 References.
Quality Improvement in the Surgical Intensive Care Unit
Authors: Hemmila Mark R. , Wahl Wendy L
Published: January 2021

Programs to support clinical benchmarking of surgical outcomes have grown dramatically over the past decade. Selection of an appropriate project and preplanning with regard to strategy are often more important than management skill alone when undertaking and performing successful quality improvement in the intensive care unit (ICU) setting. This review covers an overview of a medical and surgical quality system, development of an ICU quality improvement program, scoring systems: risk assessment, evidence-based medicine and protocols, and a quality improvement framework. Figures show structure of the ICU quality improvement team, the C-index statistic reflecting the ability of a model to predict which patients will have the outcome of interest, a Shewhart statistical process control chart, venous thromboembolism (VTE) events by report number, and changes in the type of VTE prophylaxis agent administered over time.  Tables list Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored, registry-based collaborative quality initiatives, critical care societies’ collaborative-based quality improvement task force priorities for performance measurement, possible ICU quality measures, predictive scoring systems, and multivariate and propensity score analysis of the Michigan Trauma Quality Improvement Program pilot data for VTE events and type of VTE prophylaxis.
 
This review contains 5 highly rendered figures, 5 tables, and 59 references
Adjuvant and Neoadjuvant Management of Colorectal Cancer
Authors: Bailey Christina E , Vilar Eduardo , You Y. Nancy
Published: January 2021

Colorectal cancer (CRC) is the third most common and lethal cancer in men and women in the United States. At presentation, a significant proportion of patients with CRC are able to undergo resection with curative intent, but up to 50% of these patients will develop recurrent disease. Fortunately, recurrence rates for both colon and rectal cancer have improved with the introduction of multimodality therapies, which include chemotherapy, chemoradiation therapy, and radiation therapy. These therapies are adjuncts to surgery and can be administered before (i.e. neoadjuvant) or after (i.e. adjuvant) surgery. This review summarizes the current evidence for the use of adjuvant and neoadjuvant therapies in colon and rectal cancer.
This review contains 2 figures, 7 tables, and 77 references.
Keywords: Colon cancer, rectal cancer, neoadjuvant therapy, adjuvant therapy, total neoadjuvant therapy, induction chemotherapy in rectal cancer, chemoradiation, organ preservation, non-operative management
Endovascular Techniques in Mesenteric Ischemia
Authors: Strot Sarah E , Mansour M Ashraf
Published: January 2021

Mesenteric ischemia is a rare cause of abdominal pain but is a highly morbid and life-threatening condition. Despite significant improvements in diagnostic and therapeutic options, diagnosis continues to be a challenge and contributes to the high-mortality rate. Open exploration and revascularization should not be delayed if peritonitis or bowel ischemia is present, but with advances in technology and available endovascular devices, endovascular therapy has become a feasible option. It is being used to treat acute mesenteric ischemia in select patients and is now often the standard of care in many institutions for the treatment of chronic mesenteric ischemia. The use of aspiration embolectomy, thrombolytics, and angioplasty with stenting offers very sick patients a less invasive treatment option and may reduce the time to revascularization, reducing bowel ischemia. Additionally, a hybrid approach can offer the best of both open and endovascular treatments, allowing evaluation of the intra-abdominal contents for ischemia while avoiding a traditional arterial bypass.
 
This review contains 16 figures and 65 references
Key Words: acute mesenteric ischemia, celiac artery, chronic mesenteric ischemia, embolism, endovascular, hybrid technique, mesenteric arteriography, mesenteric vascular occlusion, superior mesenteric artery, thrombosis
Bedside Procedures for General Surgeons: Part 2
Authors: Cogbill Thomas H. , Marcos Basem S
Published: January 2021

This review focuses on four procedures that are commonly performed by general surgeons in the emergency department and critical care unit and three procedures that are usually performed in the outpatient clinic. Although considered basic procedures, all have their own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures and pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on a careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged.
This review contains 24 figures, 9 tables, and 33 references.
Key words: extended focused assessment with sonography for trauma, focused assessment with sonography for trauma, pericardiocentesis for trauma, pigtail tube thoracostomy, skeletal muscle biopsy, superficial abscess drainage, temporal artery biopsy, tube thoracostomy
Stereotactic Body Radiation and Other Ablative Therapies
Authors: Sridhar Praveen , Fernando Hiran C
Published: January 2021

Lung cancer is the leading cause of cancer death in both men and women. This is related to the high prevalence and high mortality particularly when presenting at an advanced stage. Surgical resection remains the standard curative therapy for early-stage lung cancer. However, many patients are not able to tolerate resection secondary to poor respiratory reserve and other comorbid diseases. Stereotactic body radiation therapy (SBRT) and percutaneous thermal ablation are minimally invasive techniques that have been used to treat other solid tumors with curative intent. Over the past decade, there has been an expansion in the roles of both SBRT and thermal ablation in the treatment of early-stage lung tumors. The encouraging results from several studies have led to the incorporation of these therapies, particularly SBRT, as the standard of care for curative-intent treatment of patients with medically inoperable early-stage lung cancer. This chapter presents an overview of the approach to patient selection as well as provides a review of the current evidence for SBRT, percutaneous thermal ablation, and bronchoscopic ablation for early-stage nonsmall cell lung cancers.

This review contains 3 figures, 4 tables, and 28 references
Key Words: stereotactic body radiation therapy, percutaneous thermal ablation, cryoablation, microwave ablation, endoscopic ablation, bronchoscopic ablation, radiofrequency ablation, early stage NSCLC therapy
Constipation: Medical and Surgical Treatment
Authors: Knowles Charles H
Published: January 2021

This review follows the general review entitled “Constipation,” which introduced the definition, classification, epidemiology, etiology, clinical evaluation, and investigation of constipation. This review addresses the medical and surgical management of constipation with a focus on surgical management. The latter is a subject of much controversy, and this review aims to provide a balanced view between those who favor radical surgery for the colon (colectomy) and rectum/pelvic floor (forms of rectopexy, rectal excision, and reinforcement) and those who have concerns that the unpredictable outcomes of such procedures push the risk–benefit analysis against surgical intervention for most patients.

This review contains 5 figures, 2 tables and 80 references
Key Words: chronic constipation, colectomy, constipation, ileorectal, intussusception, pelvic floor, rectocele, rectocele repair, rectopexy, slow-transit, stapled transanal rectal resection
Breast Benign Findings and Disease
Authors: Cappuccino Helen , Bonaccio Ermelinda
Published: January 2021

Patients often seek the opinion of physicians for benign breast conditions, because of substantial concern about cancer. It is important that general surgeons are armed with the necessary information to thoroughly evaluate and treat benign breast conditions. In this chapter, the more common benign breast complaints and benign breast pathology are reviewed and appropriate management is discussed. The workup and management of masses, cysts, breast pain, nipple discharge, fibrocystic changes, various fibroepithelial lesions (including fibroadenoma) will be reviewed. Borderline lesions including atypical hyperplasias radial scars, and lobular neoplasia will also be discussed with special attention directed to the comparative risks of upgrade to malignancy and the need for surgical excision.  Gynecomastia will also be reviewed, along with the various causes, treatments and distinctions from malignancy. Lastly, we will review the management of breast infections and inflammatory conditions, as well as more uncommon breast lesions.

This review contains 11 figures, 6 tables, and 38 references.
Key Words: Breast masses, Breast pain/Mastalgia, Nipple Discharge, Fibrocystic Changes, LCIS, Radial Scar, Atypical Hyperplasia, Lobular neoplasia, Papillomas, gynecomastia
Traumatic Spinal Cord Injury
Authors: Martin Ryan , Zimmermann Lara , Kim Kee D. , Zwienenberg Marike , Shahlaie Kiarash
Published: January 2021

Traumatic spinal cord injury currently affects approximately 285,000 persons in the United States and carries with it significant morbidity and cost. Early management focuses on adequate ventilation and hemodynamic resuscitation of the patient and limiting motion of the spine to prevent a second injury. Medical management targets maintenance of adequate blood flow to the spinal cord, whereas surgical management focuses on decompression, realignment, and stabilization of the vertebral column. In this chapter, we discuss the approach to the patient with traumatic spinal cord injury, injury types, and medical and surgical management.

This review contains 9 figures, 4 tables and 30 references
Key Words: American Spinal Injury Association score, burst fracture, Chance fracture, compression fracture, hangman, mean arterial pressure therapy, odontoid fracture, spinal cord injury, traction
Rectal Prolapse: Abdominal Procedures
Authors: Wexner Steven D. , Cera Susan M. , Valinluck Lao Victoria
Published: January 2021

Rectal prolapse is the full thickness intussusception of the rectal wall with protrusion out of the anus.  It is a benign condition associated with multiple anatomic abnormalities such as a redundant sigmoid colon, attenuation of sacral attachments, diastasis of the levators, a patulous anus, and a deep cul-de-sac.  It often presents with concomitant symptoms of fecal incontinence and constipation, or both.  In this review, we will discuss widely accepted abdominal procedures for the repair of rectal prolapse as well as advances in the arena.  Pre-operative evaluation, management and planning as well as perineal procedures are discussed in a separate review.
This review contains 9 figures, 1 table, and 44 references. 
Key Words:  Rectal prolapse, abdominal procedures, resection, rectopexy, mesh, laparoscopic, robotic
Benign and Malignant Thyroid Diseases
Authors: Kuo Lindsay EY , Nehs Matthew A.
Published: January 2021

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted.

This reviews contains 3 figures, 13 tables, and 56 references.
Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter
Chronic Hepatic Failure
Authors: Erstad Derek J , Qadan Motaz
Published: January 2021

Continued hepatic injury by genetic or environmental factors results in a state of chronic inflammation, fibrosis, and progressive hepatocyte dysfunction that can progress to cirrhosis and end stage liver disease (ESLD). Cirrhosis is the eighth leading cause of mortality in the United States, while the burden of disease is even greater in regions with endemic viral hepatitis. Common risk factors include a history of hepatitis; alcohol or IV drug abuse; use of certain medications; and other risk factors associated with transmission of viral hepatitis, including tattoos, sexual promiscuity, and incarceration. Although many patients with cirrhosis are asymptomatic and remain undiagnosed, many will eventually develop secondary complications from chronic liver failure, which can be difficult to manage and are associated with significant morbidity, including: portal hypertension, variceal bleeding, coagulopathy, hepatic encephalopathy, and renal failure. In addition, hepatocellular carcinoma (HCC) is estimated to be 30 times more common among patients with cirrhosis, which can be an aggressive malignancy with 5-year overall survival of less than 15%. In this chapter, we provide a comprehensive overview of chronic liver failure, including the epidemiology of cirrhosis, pathophysiology of liver injury, and assessment and management of cirrhosis and associated downstream complications. Finally, we discuss the role of liver transplantation for both ESLD and HCC.
This review contains 6 figures, 9 tables, and 53 references.
Key Words: chronic liver failure, cirrhosis, coagulopathy, end stage liver disease, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, liver transplantation, portal hypertension, varices
The Respiratory System: Physiology
Authors: Yerxa John , Vatsaas Cory J , Agarwal Suresh
Published: January 2021

Respiratory system uses an elegant physiologic mechanism to support the metabolic demands of the body through oxygenation and ventilation. Oxygen must be absorbed and delivered to the tissues to sustain oxidative metabolism, whereas carbon dioxide must be expelled in a delicate balance to maintain an acid-base equilibrium. Complete understanding of oxygen content, delivery, consumption, and carbon dioxide elimination is essential as a provider caring for the critically ill patient.
This review contains 13 figures and 25 references.
Key Words: oxygenation, respiratory system, ventilation, gas exchange, haemoglobin, respiratory physiology, respiratory anatomy, oxidative metabolism, dead space.
Upper Gastrointestinal Endoscopy: Advanced Endoscopic Techniques
Authors: Marks Jeffrey , Soe-Lin Hahn , Jiang Boxiang
Published: January 2021

Advanced endoscopy techniques use the same principles as basic upper endoscopy but involve more complex maneuvers and additional imaging modalities. Most endoscopists after mastering basic upper endoscopy will pursue additional training to become adept with advanced endoscopy techniques. This chapter reviews these techniques.

This review contains 9 images, 8 tables, 1 video and 26 references.
Key words: endoscopic submucosal dissection, organ sparing endoscopic surgery, submucosal tunneling endoscopic resection, endoluminal bariatric procedures, over the scope clips, endoscopic suturing techniques, endoluminal lumen apposing metal stents
Pregnancy-Related Emergencies
Authors: Kaji Amy Hideko
Published: January 2021

This review provides an overview of spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease or molar pregnancy, hyperemesis gravidarum, placental abruption, placental previa, hypertensive disorders of pregnancy, and amniotic fluid embolism. Assessment and stabilization, diagnosis, treatment and disposition, and outcomes are discussed. Tables include classifications of abortion or miscarriage, differential diagnosis of patients presenting with vaginal bleeding during pregnancy, risk factors for ectopic pregnancy, treatment modalities for hyperemesis gravidarum, classification of hypertensive disorders of pregnancy, and risk factors for preeclampsia and eclampsia. Figures show ectopic pregnancy on a sonogram, free fluid in hepatorenal fossa on a focused abdominal sonogram in trauma, double decidual sign in a normal intrauterine pregnancy, pseudogestational sac in an ectopic pregnancy, and “snowstorm” appearance of molar pregnancy on a sonogram.

This review 5 figures, 13 tables, and 68 references.
Keywords: abortion, ectopic, gestational trophoblastic disease, abruption, previa, ecclampsia
Endoscopic Retrograde Cholangiopancreatography
Authors: Abidi Wasif , Lee Linda S.
Published: January 2021

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic procedure to view the biliary and pancreatic ducts fluoroscopically. First introduced in the 1970s as a diagnostic tool, ERCP has since evolved primarily into a therapeutic modality and is today regarded as the premier tool for performing therapeutic interventions involving the biliary and pancreatic ductal systems. Relatively complex, ERCP requires advanced training. Although generally considered safe, it does carry a risk of significant complications, including pancreatitis; thus, the most important factor to mitigate complications is to ensure the presence of an appropriate indication for the procedure. This review addresses the indications (e.g., disorders of the major duodenal papilla, biliary diseases, and pancreatic diseases), contraindications, protocol, and complications of ERCP, as well as an overview of the tools available for ERCP procedures. Figures show ampullary adenomas, choledocholithiasis, Mirizzi syndrome, benign common bile duct stricture, primary sclerosing cholangitis, malignant biliary stricture, bile leak, type I and III choledochal cysts, chronic pancreatitis, pancreatic ductal disruption, classic fish-mouth appearance of the papilla in a patient with main duct intraductal papillary mucinous neoplasm, pancreas divisum, side-viewing duodenoscope used for ERCP, and selected tools of ERCP. Tables list the Rome III criteria, risk-stratifying patients for choledocholithiasis, diagnostic criteria for acute cholangitis, choledochal cyst classification, and the Cambridge classification system for chronic pancreatitis.
This review contains 15 highly rendered figures, 5 tables, and 77 references.