bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular Disease
Authors: McBane Robert D.
Published: August 2016

Aneurysms of the ascending aorta are typically due to medial degeneration, whereas aneurysms of the descending thoracic aorta are primarily due to atherosclerosis. Men and women are equally affected, and the prevalence of thoracic aortic aneurysm (TAA) increases with advancing age. Overall, the incidence is approximately 1 per 10,000 individuals, and 20% of patients with TAA have at least 1 affected first-degree relative. Typical risk factors include tobacco exposure, hypertension, infection, and trauma.
Calcium and Bone Metabolism Disorders
Authors: Stan Marius N.
Published: August 2016

The causes of hypercalcemia are categorized as either parathyroid hormone (PTH) dependent or PTH independent. Primary hyperparathyroidism is the most common cause of hypercalcemia in ambulatory patients. A single parathyroid adenoma is the cause in 85% of patients, and multiglandular disease is the cause in the remainder. Parathyroid carcinoma is a rare cause of hypercalcemia. Primary hyperparathyroidism may be sporadic or familial. Familial hyperparathyroidism is usually multiglandular and most commonly a manifestation of multiple endocrine neoplasia (MEN) type 1 or type 2 syndromes.
Diabetes Mellitus
Authors: Kapoor Ekta
Published: August 2016

Diabetes mellitus, characterized by increased levels of plasma glucose (fasting or postprandial or both), is the most common metabolic disorder, affecting approximately 10% of the US population. Type 1 diabetes mellitus (T1D), previously known as insulin-dependent diabetes mellitus, is caused by autoimmune destruction of insulin-producing beta cells of the pancreatic islets, resulting in an absolute insulin deficiency. About 10% of diabetic patients have T1D. It usually occurs in children or lean young adults, but T1D can develop at any age.
Pituitary Disorders
Authors: Shah Pankaj
Published: August 2016

Hypopituitarism usually results from a deficiency of anterior pituitary hormones or, rarely, from tissue resistance to these hormones. Deficiency may be from primary pituitary disease, pituitary stalk disorders, hypothalamic disease, or an extrasellar disorder impinging on, or infiltrating, the hypothalamic-pituitary unit. Primary pituitary disease results from the loss of anterior pituitary cells and may be congenital or acquired. Common causes are pituitary tumors and their surgical or radiotherapeutic ablation. Infrequent causes include pituitary infarction (eg, postpartum pituitary necrosis, also known as Sheehan syndrome), pituitary apoplexy, lymphocytic hypophysitis, infiltrative diseases (eg, hemochromatosis), and metastatic disease (eg, from breast or lung).
Thyroid Disorders
Authors: Stan Marius N.
Published: August 2016

Current assays measure thyrotropin (previously called thyroid-stimulating hormone) concentrations as low as 0.01 mIU/L, allowing differentiation between low-normal values and suppressed values. In patients with normal pituitary, thyrotropin levels are increased in primary hypothyroidism, during recovery from nonthyroid illness, and with thyroid hormone resistance. Thyrotropin levels are low in hyperthyroidism, in nonthyroidal illness, in the first trimester of pregnancy, and with the use of certain drugs (eg, somatostatin, dopamine, and glucocorticoids). Measurement of the thyrotropin level is the best single test of thyroid function in these patients.
Esophageal and Gastric Disorders
Authors: Oxentenko Amy S.
Published: August 2016

The main functions of the esophagus are to transport food and prevent reflux. To transport food from the mouth to the stomach, the esophagus must work against a pressure gradient, with negative pressure in the chest and positive pressure in the abdomen. The lower esophageal sphincter helps to prevent reflux of gastric contents back into the esophagus.
Pancreatic Disorders
Authors: Loftus Conor G.
Published: August 2016

Acute pancreatitis is a reversible inflammation. The 2 varieties are interstitial pancreatitis and necrotizing pancreatitis. Interstitial pancreatitis, in which perfusion of the pancreas is intact, accounts for 80% of cases, with less than 1% mortality. Necrotizing pancreatitis is more severe and results when perfusion is compromised. It accounts for 20% of cases, with 10% mortality if sterile and 30% if infected.
Clinical Epidemiology
Authors: Litin Scott C. , Bundrick John B.
Published: August 2016

Diagnostic tests are tools that either increase or decrease the likelihood of disease. The sensitivity, specificity, and predictive values of normal and abnormal test results can be calculated with even a limited amount of information. Some physicians prefer interpreting diagnostic test results by using the likelihood ratio. This ratio takes properties of a diagnostic test (sensitivity and specificity) and makes them more helpful in clinical decision making. It helps the clinician determine the probability of disease in a specific patient after a diagnostic test has been performed.
Complementary and Alternative Medicine
Authors: Chon Tony Y. , Bauer Brent A.
Published: August 2016

Complementary and alternative medicine (CAM) has many meanings, each derived in part from its context. From a physician perspective (ie, the biomedical model), CAM has often been defined as “those therapies utilized by patients but not taught in medical school.” Traditionally, CAM has encompassed treatments such as acupuncture, herbs and dietary supplements, massage, and chiropractic. Yet, in recent decades, the explosive growth of research in this arena has led to a number of therapies increasingly being incorporated into conventional training and practice.
Genetics
Authors: Collins C. Scott , Wittich Christopher M.
Published: August 2016

Chromosome abnormalities occur in 1 in 180 live births. One-third of these abnormalities are due to autosomal aneuploidy—an abnormal number of chromosomes. Risk factors for autosomal aneuploidy are maternal age 35 years or older and having had an affected child. The most common autosomal aneuploidy syndrome in term infants is Down syndrome.
Men’s Health
Authors: Beckman Thomas J.
Published: August 2016

Benign prostatic hyperplasia (BPH) is common among older men. The prostate is the size of a walnut (20 cm3) in men younger than 30 years and gradually increases in size, leading to BPH in most men older than 60 years. BPH results from epithelial and stromal cell growth in the prostate, which in turn causes urinary outflow resistance. Over time, this resistance leads to detrusor muscle dysfunction, urinary retention, and lower urinary tract symptoms, such as urgency, frequency, and nocturia.
Otolaryngology and Ophthalmology
Authors: Collins Nerissa M.
Published: August 2016

Benign prostatic hyperplasia (BPH) is common among older men. The prostate is the size of a walnut (20 cm3) in men younger than 30 years and gradually increases in size, leading to BPH in most men older than 60 years. BPH results from epithelial and stromal cell growth in the prostate, which in turn causes urinary outflow resistance. Over time, this resistance leads to detrusor muscle dysfunction, urinary retention, and lower urinary tract symptoms, such as urgency, frequency, and nocturia.
Preventive Medicine
Authors: Wang Amy T. , Mauck Karen F.
Published: August 2016

Mortality associated with anesthesia and surgery has decreased markedly in the past several decades. Today the overall mortality is 1:250,000 even though more complex surgical procedures are performed on sicker patients. The American Society of Anesthesiologists classification, with broadly defined categories, is used to estimate overall risk of mortality within 48 hours postoperatively.
Quality Improvement and Patient Safety
Authors: Kautz Jordan M. , Wittich Christopher M.
Published: August 2016

Preventive medicine focuses on preventing disease and keeping patients healthy. There are 3 levels of prevention: 1.Primary prevention: preventing disease before it occurs (eg, immunization to prevent disease, use of condoms to prevent sexually transmitted diseases); 2.Secondary prevention: detecting preclinical disease to start early treatment for better outcomes (eg, cancer screening, treating hypertension to prevent cardiovascular disease); and 3. Tertiary prevention: improving outcomes (quality of life, disease progression) in known disease (eg, use of aspirin after myocardial infarction to decrease recurrence, rehabilitation after a stroke).
Hemostatic Disorders
Authors: Pruthi Rajiv K.
Published: August 2016

Anemia is a reduction in the mass of healthy circulating red blood cells (RBCs). It results from 1 of 3 mechanisms: 1) inadequate production of RBCs by the bone marrow (ie, marrow failure, intrinsic RBC synthetic defects, or lack of essential RBC components such as vitamins); 2) blood loss; or 3) premature destruction of RBCs (ie, hemolysis). Microcytic anemia indicates the presence of small RBCs (mean corpuscular volume <80 fL). The most common forms of anemia are microcytic.
Thrombotic Disorders
Authors: Pruthi Rajiv K.
Published: August 2016

The hematologic neoplasms include the following:
HIV Infection
Authors: Kasten Mary J. , Temesgen Zelalem
Published: August 2016

Acute bacterial meningitis is an infectious disease emergency. The incidence of bacterial meningitis is estimated to be 3.0 cases per 100,000 person-years, and its overall case fatality rate is 25% in adults. Common predisposing conditions for community-acquired meningitis include acute otitis media, altered immune states, alcoholism, pneumonia, diabetes mellitus, sinusitis, and a cerebrospinal fluid leak. Risk factors for death among adults with community-acquired meningitis include age 60 years or older, altered mental status at presentation, pneumococcal cause, and occurrence of seizures within 24 hours of symptom onset.
Pulmonary and Mycobacterial Infections
Authors: Tosh Pritish K. , Berbari Elie F.
Published: August 2016

Hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care–associated pneumonia (HCAP) cause 25% of all infections in the intensive care unit and are the basis for 50% of all antimicrobials prescribed in the hospital. These are primarily bacterial infections and are associated with high morbidity and mortality rates. However, pneumonias occurring before the fifth day of hospitalization are generally caused by organisms that are more susceptible to antimicrobials and have a better prognosis than those occurring on or after the fifth hospital day. The diagnostic and therapeutic approaches to HAP, VAP, and HCAP are similar.
Skin, Soft Tissue, Bone, and Joint Infections
Authors: Berbari Elie F.
Published: August 2016

Sexually transmitted infections (STIs) remain a major public health burden. About 19 million STIs occur annually in the United States. Rates of STIs are higher in young African American women and in men who have sex with men. The most common STIs are human papillomavirus (HPV) infection, chlamydia, herpes simplex virus infection, and trichomoniasis. Although selected types of HPV are preventable with vaccination, other STIs require effective barriers to prevent transmission. These infections are characterized by their clinical presentations: 1) genital ulcers and lesions, 2) urethritis, 3) pelvic inflammatory disease, 4) vulvovaginitis and cervicitis, and 5) urinary tract infections.
Acute Kidney Injury
Authors: Norby Suzanne M. , Kashani Kianoush B.
Published: August 2016

Simple acid-base disorders are defined by changes in pH and the initial change in 1 of the 2 variables, serum bicarbonate (HCO3-) and PCO2. Low pH indicates acidosis, and high pH indicates alkalosis. If 1 of the 2 components (HCO3-or PCO2) decreases, the other component also decreases (a compensatory change that minimizes the change in the ratio and the pH) and vice versa, as shown in the Henderson-Hasselbalch equation. Emphasis has been placed on the Henderson-Hasselbalch equation because the equation describes the 4 acid-base disorders and their compensatory changes.
Electrolyte Disorders
Authors: Qian Qi
Published: August 2016

Chronic kidney disease (CKD) is a worldwide public health problem. In the United States, the prevalence of end-stage renal disease is increasing, especially among patients older than 65 years. More than 20 million people in the United States are thought to have CKD, and this population consumes a disproportionate amount of health care resources. CKD is also associated with increased mortality, particularly from cardiovascular causes.
Inflammatory and Autoimmune Central Nervous System Diseases and the Neurology of Sepsis
Authors: McKeon Andrew
Published: August 2016

Headache is considered to be a nearly universal experience. Approximately 98% of the population will experience some form of headache in a lifetime. The number of migraineurs worldwide is approximately 1 billion, and nearly 1 in every 4 households in the United States has at least one family member who experiences migraine. Persons with headache disorders also present frequently to outpatient clinics; they are the reason for approximately 1 in every 10 consultations with a primary care physician. Migraine, in particular, poses a considerable economic burden because it typically affects persons during ages associated with peak productivity.
Seizure Disorders
Authors: Wong-Kisiel Lily C.
Published: August 2016

Brain tumors may manifest with focal progressive neurologic deficits, increased intracranial pressure (causing headache, vomiting, and papilledema), new-onset seizures, or progressive cognitive and behavioral changes. The most common primary brain tumors in adults are meningioma, astrocytoma, oligodendroglioma, and lymphoma.
Spinal, Peripheral Nerve, and Muscle Disorders
Authors: Jones Lyell K. , Crum Brian A.
Published: August 2016

Seizures are electroclinical events, and epilepsy indicates a tendency for recurrent unprovoked seizures. The proper treatment of epilepsy depends on accurate diagnosis of the seizure type, identification of the cause (if possible), and management of psychosocial problems. Electroencephalography (preferably after the patient is sleep deprived) can be important in the classification of seizure type. Magnetic resonance imaging is also used to evaluate for focal or structural lesions. Much of the diagnosis rests on a supportive history.
Breast Cancer
Authors: Haddad Tufia C. , Moynihan Timothy J.
Published: August 2016

Diseases affecting the spinal cord, peripheral nerves, and skeletal muscles are common in clinical practice. These conditions may present in isolation or as an associated feature (or complication) of nonneurologic disease. The clinical history and examination provide the greatest usefulness for establishing the diagnosis, which can be firmly established with diagnostic testing. Electrodiagnostic tests (nerve conduction studies and electromyography) are among the most useful in patients with nerve or muscle disease. Treatments are targeted to the underlying mechanism of disease.
Cancer of Unknown Primary Origin and Paraneoplastic Syndromes
Authors: Wittich Michelle A. Neben
Published: August 2016

In the United States, approximately 235,000 new cases of breast cancer are diagnosed annually. Breast cancer will develop in approximately 1 in 8 women who achieve a normal life expectancy and is the second most common cause of cancer death among women in the United States (lung cancer is the most common). The incidence decreased in the early 2000s and has leveled off since then.
Gynecologic Cancers: Cervical, Uterine, and Ovarian Cancers
Authors: Hendrickson Andrea E. Wahner
Published: August 2016

Carcinoma of unknown primary origin (CUP) describes a metastatic disease for which the primary cancer cannot be identified. Of all invasive malignancies, 2% to 6% are CUP. The most common tumor associated with CUP is adenocarcinoma. Squamous cell carcinoma and undifferentiated neoplasms make up a smaller portion of CUP. When a pathologic diagnosis is established, additional evaluation should be tailored according to the patient’s risk factors (eg, smoking and breast cancer risk), symptoms and signs, sites of metastasis, and the histologic diagnosis.
Lung Cancer and Head and Neck Cancer
Authors: Wittich Michelle A. Neben , Price Katharine A.
Published: August 2016

Approximately 233,000 new cases of prostate cancer occur annually in the United States. It is the most common cancer in US men and is the second leading cause of death from cancer in US men (29,000 deaths annually). Risk factors for prostate cancer include older age, race (African American), family history (first-degree relative), and possibly dietary fat. The lifetime probability of prostate cancer developing in a man is 1 in 6.
Oncologic Emergencies and Chemotherapy Complications
Authors: Moynihan Timothy J.
Published: August 2016

Each year in the United States, approximately 220,000 new cases of lung cancer are diagnosed and approximately 158,000 people die of lung cancer. Lung cancer accounts for approximately 27% of all cancer deaths. Most patients with a new diagnosis of lung cancer are older than 65 years. About 95% of lung cancers in men and about 80% of lung cancers in women result from cigarette smoking. Men who smoke 1 to 2 packs per day have up to a 25-fold increased risk for lung cancer compared with men who have never smoked. The risk of lung cancer for a former smoker decreases with time.
Psychotic and Somatic Symptom and Related Disorders
Authors: Palmer Brian A.
Published: August 2016

Since 30% to 40% of ambulatory primary care visits have a psychiatric component, successful patient management often hinges on successful treatment of comorbid psychiatric illness. The key concept when assessing psychiatric symptoms is whether the symptom interferes with a patient’s functioning or causes distress. For example, a patient may have a fear of heights. If this acrophobia never causes an alteration in activity, intervention is unnecessary. If, however, this acrophobia causes distress and interferes with the patient’s functioning, intervention may be warranted.
Cystic Fibrosis, Bronchiectasis, and Pleural Effusion
Authors: Iyer Vivek N.
Published: August 2016

Effective functioning of the respiratory system requires 1) normal central nervous system control, 2) intact neuromuscular transmission and bellows function, 3) patent airways, and 4) normal gas exchange at the alveolar-capillary level. Respiratory failure may be caused by dysfunction at any of these levels, resulting in failure of oxygenation (hypoxemic respiratory failure) or ventilation (hypercapnic respiratory failure).
Interstitial Lung Diseases
Authors: Maldonado Fabien , Aksamit Timothy R.
Published: August 2016

Cystic fibrosis (CF) is the most common autosomal recessive disease among whites, with a frequency of 1 in 2,000 to 1 in 3,000 live births. The disease is caused by a mutation in the gene that encodes for the CF transmembrane conductance regulator on chromosome 7. This mutation causes production of thick, sticky secretions that clog the airways and the pancreatic and biliary ducts, resulting in chronic cough, frequent sinus and lower respiratory tract infections, progressive bronchiectasis, end-stage lung disease, pancreatic insufficiency, diabetes mellitus, biliary disease, and malabsorption.
Obstructive Lung Diseases
Authors: Iyer Vivek N.
Published: August 2016

An estimated 1 in 3,000 to 1 in 4,000 persons in the general population have a diagnosis of interstitial lung disease (ILD), and ILDs account for about 15% of all consultations for general pulmonologists. These diseases encompass a group of heterogeneous lung conditions characterized by diffuse involvement of the lung parenchyma and pulmonary interstitium. By convention, infections, pulmonary edema, lung malignancies, and emphysema are excluded, but they should be carefully considered as part of the differential diagnosis.
Pulmonary Vascular Disease
Authors: Cartin-Ceba Rodrigo
Published: August 2016

Cough is one of the most common reasons for outpatient medical consultation. Cough can be classified according to duration as acute (<3 weeks), subacute (3-8 weeks), and chronic (>8 weeks). Acute cough is usually related to an infectious cause, and symptomatic management usually suffices. Chronic cough, in contrast, is mainly related to postnasal drip, asthma, or gastroeseophageal reflux disease. Angiotensin-converting enzyme inhibitors have been implicated in up to 10% of patients with chronic cough.
Musculoskeletal Disorders
Authors: Mohabbat Arya B. , Wittich Christopher M.
Published: August 2016

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that affects multiple organ systems. Disease susceptibility is conferred by an interaction between genetics, aberrant immunologic mechanisms, hormonal influences, and environmental factors. SLE has a wide range of heterogeneous clinical manifestations and is characterized by disease flares and remissions. There is a broad spectrum of disease severity, leading to significant morbidity and increased mortality.
Osteoarthritis, Gout, and Infectious Arthritis
Authors: Michet Clement J. , Ernste Floranne C.
Published: August 2016

Cervicothoracic complaints can be classified into 3 categories on the basis of etiology: mechanical, neurogenic, and pain secondary to other systemic processes. Mechanical neck complaints are often secondary to trauma, overuse injury, malposture, and osteoarthritis. Neurogenic neck complaints are experienced acutely after trauma or gradually as a result of progressive osteoarthritis with subsequent nerve root impingement. Neck pain secondary to systemic disease often is associated with systemic symptoms such as fever, chills, weight loss, rash, polyarthralgia, or polymyalgia.
Rheumatoid Arthritis and Spondyloarthropathies
Authors: Michet Clement J.
Published: August 2016

Osteoarthritis is the failure of articular cartilage and subsequent degenerative changes in subchondral bone, bony joint margins, synovium, and para-articular fibrous and muscular structures. Osteoarthritis is the most common joint disease; 80% of patients have some limitation of their activities, and 25% are unable to perform major activities of daily living. Hyperuricemia occurs in 2% to 18% of normal populations. It is associated with hypertension, renal insufficiency, obesity, and arteriosclerotic heart disease. Clinical gouty arthritis ranges in prevalence from 0.1% to 0.4%; it is the most common form of inflammatory arthritis in men. Septic arthritis is a medical emergency; rapid recognition and treatment can reduce joint morbidity and patient mortality. A high index of suspicion is required when a patient presents with acute monarticular arthritis and fever.
Questions and Answers
Authors: Wittich Christopher M.
Published: August 2016

This section consist of question and answers for the section
Questions and Answers
Authors: Beckman Thomas J. , Szostek Jason H. , Wang Amy T. , Wittich Christopher M.
Published: August 2016

This section consist of question and answers for the section
Questions and Answers
Authors: Collins Nerissa M.
Published: August 2016

This section consist of question and answers for the section
Questions and Answers
Authors: Szostek Jason H.
Published: August 2016

This section consist of question and answers for the section
Anatomy of the pelvis and perineum
Authors: Mahadevan Vishy
Published: August 2016

The roof of the abdominopelvic cavity is the diaphragm and the floor is the pelvic diaphragm. It is conventional to divide the abdominopelvic cavity into two regions: the abdominal cavity and the pelvic cavity. The two are continuous with each other through the pelvic brim. Below the pelvic floor lies the perineum. Surgical conditions involving pelvic viscera and structures in the perineum account for a very considerable part of surgical and gynaecological practice. A clear understanding of pelvic and perineal anatomy is fundamental to the proper clinical management of these conditions. The perineum refers to the lowest part of the trunk. It lies immediately below the pelvic floor (levator ani) and is flanked by the inner aspects of the proximal ends of the thighs and also by the inferior aspects of the buttocks. The perineum may be pictured as lying within a diamond-shaped outline. The perineum is divisible anatomically into two regions: the urogenital triangle anteriorly and a posterior region termed the anal triangle.
Introduction to Section 1.2: ‘Applied surgical physiology’
Authors: Adams David A.
Published: August 2016

Knowledge of normal structure and function is essential when trying to understand the consequences of disease. This chapter acts as an introduction to the other ten chapters in Section 1.2, which describe general physiological principles considered to be important in surgical practice. This chapter introduces the topics covered in the following chapters: ‘Metabolic pathways, nutrition, and abnormalities’ (Chapter 1.2.2), ‘Blood loss, hypovolaemic shock, and septic shock’ (Chapter 1.2.3), ‘Fluid and electrolyte balance and replacement acid–base balance’ (Chapter 1.2.4), ‘Haemostasis and thrombosis’ (Chapter 1.2.5), ‘Cardiovascular’ (Chapter 1.2.6), ‘Respiratory’ (Chapter 1.2.7), ‘Gastrointestinal’ (Chapter 1.2.8), ‘Urinary’ (Chapter 1.2.9), ‘Endocrine’ (Chapter 1.2.10), and ‘Neurology’ (Chapter 1.2.11).
Neurology
Authors: Jeevaratnam Kamalan
Published: August 2016

The nervous system remains one of the most widely studied systems yet much is still unknown about the intricate workings of this system. The nervous system spans the entire body and works through a set of afferent and efferent nerves. Input is generally received by sensory receptors and transmitted to the central nervous system via various ascending pathways. Appropriate responses are sent back via the descending motor pathways. Many of these activities occur at the conscious level but there are equally significant functions that occur below the level of consciousness which are controlled by the autonomic nervous system. The nervous system also plays an important role in pain perception as well as the interpretation of sensory information from our special senses such as the eyes and ears.
Essential pharmacology for surgeons
Authors: Brearton Chris
Published: August 2016

The legal ability to prescribe any medication is still one of the major differences between the medically qualified practitioner and other providers of healthcare within the multidisciplinary team. Lack of knowledge of the basic science behind drug action will not prevent drugs from working, but lack of basic knowledge can increase the risk to our patients and does not fit with the duty of care which we owe to them. A working knowledge of the basic principles of pharmacology such as pharmacokinetics and pharmacodynamics allows understanding of their action and interaction within the body. Drugs including analgesics, antimicrobials, and anticoagulants are used very commonly in the perioperative period and so are discussed in detail. General and local anaesthetic agents are key to surgical procedures and knowledge of their pharmacology, interactions, and limitations allows for a more accurate risk assessment in the perioperative period.
Sepsis
Authors: Raza Muhammad
Published: August 2016

Sepsis occurs in patients in both surgical and medical specialties and is caused by a variety of bacteria. It comprises of a systemic inflammatory response syndrome, with evidence or signs of infection. Study of its pathophysiology informs that sepsis involves most of the organs/systems in the body in a process characterized by derangement of vascular endothelium and organ parenchyma, driven by bacterial toxins and the inflammatory process. Sepsis can vary in its presentation based on severity and owing to individual polymorphism. Because of the variations in individual responses, it has been difficult to put together a completely consistent approach advising on management. Early clinical suspicion, rigorous diagnostic measures, aggressive initiation of appropriate antimicrobial therapy, comprehensive supportive care, and measures aimed at reversing predisposing causes are the cornerstones of successful management. Measures to prevent acquisition or spread of infection in critically ill patients is of paramount importance
Essential interventional radiology for surgeons
Authors: Kusumawidjaja Daniel , Gaines Peter A.
Published: August 2016

Interventional radiology refers to minimally invasive image-guided procedures that are often therapeutic but can also be diagnostic. Imaging modalities employed include fluoroscopy, computed tomography, magnetic resonance imaging, and ultrasound, used either singly or in combination. While the majority of interventional radiology procedures involve the vasculature (termed ‘endovascular’ procedures), other body systems are also frequently treated. In this chapter, brief outlines of the principles and potential indications of commonly performed and surgically relevant interventional procedures are discussed. These include trauma, gastrointestinal (embolization for bleeding, gastrointestinal stents, gastrostomy), arterial (angioplasty and stenting, therapies for acute emboli and stent grafting), venous (deep venous thrombosis therapies, inferior vena cava filters, superior vena cava stenting), vascular malformations (embolization, sclerotherapy), oncological (transarterial chemoembolization, radioembolization, ablation), hepatobiliary (transjugular intrahepatic portosystemic shunt, percutaneous biliary procedures), renal/urological (dialysis fistula techniques, nephrostomy, varicocele embolization), and other relevant procedures (image-guided drainage and biopsies, central venous access).
Assessing the acute abdomen
Authors: Wiggins Tom , Crinnion James N.
Published: August 2016

The rapid diagnosis and treatment of abdominal emergencies will save lives. Therefore, all practising surgeons irrespective of their specialty must have the skills to be able to competently assess a patient with acute abdominal pain. The emergency general surgical take will typically consist of a mixture of patients, of which a few will require surgical treatment but many can be managed conservatively. A number of patients in the latter group have pain of uncertain aetiology, which can clearly be managed non-operatively. This cohort of patients is often labelled as having ‘non-specific abdominal pain’. The small group of patients who require urgent operative intervention will usually present with either clinical signs of peritonitis, or a distended abdomen due to bowel obstruction. These worrying clinical features must be promptly recognized, investigated, and treated if a favourable outcome is to be achieved. This chapter discusses the pathophysiology, differential diagnosis, and assessment of acute abdominal pain. It also provides an overview of the management of the broad clinical presentations of peritonitis, abdominal distension, and non-specific abdominal pain.
Chronic arterial insufficiency
Authors: Butler Christopher M.
Published: August 2016

Chronic arterial insufficiency (CAI) is a common condition affecting predominantly older patients. It normally involves the lower limbs and is usually due to progressive furring up and hardening of the arteries due to atherosclerosis. It typically presents with intermittent claudication (IC) and calf pain on walking, relieved by rest. A relatively small number of patients presenting with IC will progress to the more serious condition of critical limb ischaemia (CLI). Several modifiable risk factors for CAI have been demonstrated, including smoking, diabetes, hypertension, and lipid problems. Management of IC includes risk factor modification, supervised exercise training, and antiplatelet agents. Patients with severe IC and all those with CLI should be investigated under the supervision of a multidisciplinary team with a view to revascularization of the affected limb. Interventions may include angioplasty and/or vascular surgery. Prognosis for patients presenting with CLI remains poor with only 45% being alive with two legs a year after presentation. Of the remainder, 30% will be alive having had a major amputation, and 25% will have died.
Venous and lymphatic disease
Authors: Darvall Katy A. L. , Bradbury Andrew W.
Published: August 2016

Varicose veins (VV) are common and are part of a spectrum of disease known as chronic venous insufficiency (CVI), with the more severe manifestations of CVI being skin changes and chronic venous ulceration (CVU). The relationship between symptoms and VV is complex. Duplex ultrasound allows a ‘map’ of the abnormal veins to be obtained to guide treatment. Treatment has evolved from open surgery to minimally invasive options such as endothermal ablation and ultrasound-guided foam sclerotherapy. CVU has a prevalence of around 1%, frequently recurs, impairs quality of life, and has a significant health and social care cost. The mainstay of treatment remains graduated multilayer compression bandaging (having excluded arterial disease) and ablation of superficial venous reflux. There are several causes of a chronically swollen limb, the most common being CVI and lymphoedema. Lymphoedema can be primary or secondary. Lymphoedema is incurable and managed conservatively with skin care, massage, and compression.
Aneurysms
Authors: Davies Robert , Sayers Robert
Published: August 2016

An arterial aneurysm is defined as a 50% or greater increase in the diameter of a vessel. The infrarenal aorta and popliteal artery are the commonest locations for arterial aneurysms accounting for more than 12 000 hospital admissions per year in England. The majority of arterial aneurysms are asymptomatic at the time of presentation having been identified incidentally during routine health checks or investigations for other pathologies.
Ear pain and hearing loss
Authors: Hawthorne Maurice
Published: August 2016

The pitfall for the non-ear specialist is to think that ear symptoms can only be due to ear disease—this is far from the case. Due to its complex nerve supply, pain and paraesthesia often have an origin away from the ear but symptoms are referred to the ear; consequently earache in the presence of a normal eardrum is due to a malignancy until proven otherwise. In additional to referral to the ear of symptoms from regional disease, systemic disease can also present with earache, a good example of which is Wegener’s granulomatosis and the painless deafness associated with vitamin D deficiency. While unrelenting pain with aural discharge can be a presenting symptom of life-threatening condition such as osteitis of the skull base or a malignancy of the ear, unrelenting discharge without pain can also be a sign of life-threatening disease such as cholesteatoma, tuberculosis, and tertiary syphilis. Assessment of the patient with an ear problem should include a thorough history to include symptoms of systemic and regional disease as well as auditory and neural symptoms. Examination should include the ear but also the head and neck and upper respiratory mucosal surfaces as well as looking for signs of systemic disease. Investigation should include assessment of the hearing, search for systemic conditions and local imaging of the head and neck. Treatment of hearing loss is not just confined to hearing aids but advice should be given on prevention, and the use of environmental aids or surgery considered.
Endocrine surgery
Authors: Fraser Sheila , Lansdown Mark
Published: August 2016

As well as an understanding of the principles of endocrine surgery, the MRCS requires a sound knowledge of endocrinology and of the impact of endocrine disorders as co-morbidities affecting the preparation of patients for theatre and their recovery from surgery. Symptoms associated with overfunction or underfunction of an endocrine gland may be classic or suggestive, but none are pathognomonic. Patients may go for many years with mild symptoms before a diagnosis is made. This chapter focuses primarily on surgery of the endocrine glands, for the control of abnormal function and tumours of these glands, which may, or may not, themselves be functional.
Principles of surgical oncology
Authors: Gomez Dhanny , Malik Hassan Z. , Fenwick Stephen , Poston Graeme J.
Published: August 2016

Surgery is the oldest and remains the most effective treatment for solid cancers. Sixty per cent of people cured of cancer are cured by surgery alone. Furthermore, the surgeon is frequently the first point of contact for the patient thought to have cancer and, frequently is the key clinician in establishing the diagnosis and initial staging assessment prior to commencement of treatment. Surgery increasingly also plays a major role in the management of advanced (metastatic cancer) and also in symptom control for incurable disease. In order to be effective in cancer management, surgeons must have a sound working grasp of cancer biology, how cancers spread (and the principles of staging) and the complementary roles of systemic (chemo- and biological) and radiation (external beam and targeted) therapies in the management of the cancer patient.
Anastomoses, stomas, and drains
Authors: Burke Dermot
Published: August 2016

This chapter outlines the basic approach to the construction of anastomoses, stomas, and the use of drains. Careful surgical technique is vital to the success, or failure, of an anastomosis. The types of anastomosis, the materials used, and the configurations applied vary considerably between surgeons. Complications that might arise from an anastomosis are presented and discussed. The ability to create an effective stoma is an essential component of the practicing acute abdominal surgeon. The classification of stomas, their uses, the techniques used for their creation and the complications that may arise, despite a careful surgical technique, are described in an attempt to make progress in this sensitive area. The correct use of drains is another area in which judgement and experience is required in undertaking acute surgery. The different types of available drains, together with their potential complications are presented.
The physical examination
Authors: Woodley Caroline , Reed Malcolm W. R.
Published: August 2016

When learning physical examination, it is essential that a structured and systematic approach is employed. Here, the fundamental techniques of examining a lump and an ulcer are presented, followed by a systematic approach to the examination of the abdomen, including the hernial orifices and scrotal contents. The examination of the acute abdomen follows the same basic structure, with the addition of the interpretation of key clinical signs such as guarding and rigidity. When taking a clinical history and performing a physical examination of the patient, a differential diagnosis must be generated. The combination of a structured approach (e.g. the surgical sieve), pattern recognition, and knowledge of the incidence and prevalence of disease in the local population, will enable a logical differential diagnosis to be developed and to indicate the appropriate diagnostic tests.
Metabolic and endocrine disorders in the perioperative period
Authors: Robinson Robert , Chadwick David , Hunt Leanne
Published: August 2016

This chapter covers the common metabolic and endocrine conditions encountered in the perioperative period. These disorders present potentially serious risks to the surgical patient that can be prevented or ameliorated by appropriate management. Close cooperation between the surgeon, anaesthetist, and endocrine team is essential in avoiding harm by omission or under treatment with hormone replacement. This is particularly important for patients with type 1 diabetes where under or over treatment with insulin must be avoided and those with adrenal insufficiency who need significant increases in glucocorticoid therapy to cope with the stresses of surgery.
Abdominal trauma
Authors: Tulloh Bruce
Published: August 2016

Early decision making in abdominal trauma hinges on whether or not the patient needs a laparotomy, which can generally be decided clinically. If a decision against urgent surgery has been made then the surgeon must diagnose the injuries by other means. Ultrasound, CT scanning and laparoscopy each suit certain clinical scenarios and part of the clinician’s role is to choose the most appropriate investigation. Treatment involves initial resuscitation, then checking the response. Transient- and non-responders are likely to need urgent surgery for ongoing bleeding unless it is non-hypovolaemic shock, such as cardiac tamponade or spinal injury. Many specific injuries can be managed non-operatively but ongoing observation remains important to detect deterioration mandating a change in management plan. Unconscious patients, those with spinal injury, pregnant women and small children require extra vigilance although the underlying principles of trauma care still apply.
Statistics for surgeons
Authors: Gokani Vimal J. , Bown Matthew J.
Published: August 2016

Medical statistics form an important part of the curriculum. An understanding of this topic facilitates critical reading of the medical literature, and its application to patients. This chapter aims to outline the basics of medical statistics, starting from concepts such as describing and displaying data. Relative risk, odds ratio, and absolute risk reduction are defined before detailing the steps in choosing the correct statistical tool for hypothesis testing. The importance of statistical versus clinical significance must be remembered: small statistically significant changes may not translate to meaningful changes in clinical practice. Correlation, regression, and survival analyses are considered. The accuracy of diagnostic tests is reviewed in a discussion about sensitivity, specificity, and positive and negative predictive values. Finally, in the era or evidence-based medicine, an introduction to systematic reviews and meta-analyses is presented, with a guide on how to read forest plots.
Introduction to aphasia
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Introduction to aphasia from the Higher Functions section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Crossed aphasia
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Crossed aphasia from the Higher Functions section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Aphemia
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Aphemia from the Higher Functions section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Spastic dysarthria
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Spastic dysarthria from the Higher Functions section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Introduction to disconnection syndromes
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Introduction to disconnection syndromes from the Higher Functions section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Introduction to tremor
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Introduction to tremor from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Kinetic tremor
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Kinetic tremor from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Childhood tremors
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Childhood tremors from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Orthostatic tremor
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Orthostatic tremor from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Generalized dystonia (pediatric)
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Generalized dystonia (pediatric) from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Blepharospasm
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Blepharospasm from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Golfer’s “yips”
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Golfer’s “yips” from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Dopa induced dystonia
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Dopa induced dystonia from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Dysphonia
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Dysphonia from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Dystonic dysarthria
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Dystonic dysarthria from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Tremor
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Tremor from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Posture
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Posture from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Parkinsonian speech
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Parkinsonian speech from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Eye signs
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Eye signs from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.
Frontal signs
Authors: Morris John G. , Grattan-Smith Padraic J.
Published: August 2016

This is a chapter on Frontal signs from the Movement Disorders section of A Manual of Neurological Signs. Most of the chapters contain a description of the sign, associated signs, and cases, supported by clinical videos and figures.