bluuebunny/crossref_metadata_2025 huggingface dataset:
Bleeding and Transfusion
Authors: Utter Garth H. , Gosselin Robert C. , Owings John T.
Published: January 2021

This review describes the approaches taken for patient with massive hemorrhage, a derangement of hemostasis, and anemia. For hemorrhage, control of the source of bleeding, restoration of the blood volume, and management of the coagulopathy is presented. Exclusion of technical causes of bleeding, an initial assessment of potential coagulopathy, and an interpretation of coagulation parameters is described for derangements of hemostasis. For anemia, acute coronary artery ischemic syndromes and neurologic conditions are described. Additionally, bleeding disorders are presented. Figures depict various algorithms related to decision-making and treatment. Tables show the management of the patient with an increased International Normalized Ratio, coagulopathy scores, classification and management of Von Willebrand disease, and tests of platelet function. This review contains 83 references.
Preparation of the Operating Room
Authors: Dagi T. Forcht
Published: January 2021

The history and general principles of OR design are discussed, including physical layout and design standards, which encompass the layout and storage of devices and equipment. As both patient and staff safety are paramount, all of the risks that can be mitigated by good design are discussed: biologic, ergonomic, chemical, and physical. Environmental issues in the OR are listed and include temperature, humidity, and lighting. The proper use, storage, and risks of electronic and mechanical devices are discussed. Infection control is addressed and includes hand hygiene, gloves and protective barriers, antimicrobial prophylaxis and nonpharmacologic preventive measures. A housekeeping section discusses the benefits of segregating clean, clean-contaminated, and dirty cases. OR scheduling is noted. Tables outline International Commission on Radiological Protection–recommended radiation dose limits; key principles of the Joint Commission Universal Protocol; devices used in the operating room; standard equipment for endovascular operating rooms; benefits of voice activation technology in the laparoscopic operating room; criteria for defining a surgical site infection; factors that contribute to the development of surgical site infection (SSI); Centers for Disease Control and Prevention hand hygiene guidelines; distribution of pathogens isolated from surgical site infections: operating room cleaning schedules; classification of operations in relation to the epidemiology of SSIs; and basic principles of OR efficiency. Figures depict patient positioning and basic components of an ultrasound transducer,
This review contains 3 figures, 12 tables, and 214 references.
Chest Wall Procedures
Authors: Force Seth D , Muesse Jason L.
Published: January 2021

Chest wall procedures are an important component of any thoracic surgeon’s practice. The approach to these procedures is somewhat different from the approach to esophageal or pulmonary resections and requires specific knowledge of thoracic musculoskeletal anatomy, as well as of the different types of autologous and artificial grafts available for chest wall reconstruction. This review covers chest wall procedures, broadly divided into procedures for congenital chest wall disease and procedures for acquired chest wall disease. The major surgical techniques in both categories are described, and the pitfalls that may accompany them are reviewed. Figures show the various steps used in repair of pectus excavatum (Ravitch procedure and Nuss procedure), transaxillary first rib resection, chest wall resection, manubrial resection and reconstruction, and open chest drainage (Eloesser flap), as well as a chest computed tomographic scan revealing a large pulmonary and chest wall mass.
This review contains 16 figures and 49 references.
Keywords: Pectus repair, Chest wall reconstruction, First rib resection, Sternoclavicular osteomyelitis
Pulmonary Resection
Authors: Dhupar Rajeev , Vaporciyan Ara
Published: January 2021

Anatomic resections of the lung (including pneumonectomy and lobectomy) are the standard operative techniques employed to treat both neoplastic and nonneoplastic diseases of the lung. Preoperative evaluation is described. Once assessment of sufficient pulmonary reserve to tolerate the procedure is made, guidance is provided for anesthesia (bilateral or unilateral lung ventilation); placement of catheters; positioning in the lateral decubitus position; and type of incision to be made (posterior lateral thoracotomy or small incisions). Special intraoperative issues are also touched upon, especially resections that begin with the finding of benign- or malignant-appearing adhesions. The operative techniques are described for a right and left hilar dissection; a right and left upper lobectomy; a right middle lobectomy; a right lower lobectomy; and a right and left pneumonectomy. For each technique described, the chapter addresses the anatomical considerations of the pulmonary veins and arteries; the fissure between the upper and lower lobes; and the bronchi. Figures indicate the various steps of the hilar dissection and upper, middle, and lower lobectomy of both the right and left lung and a left pneumonectomy.
This review contains 13 figures, 5 tables, and 6 additional readings.
Surgical Management of Benign and Malignant Colorectal Disease in the Immunocompromised Patient
Authors: Kin Cindy , Welton Mark , Lightner Amy
Published: January 2021

Patients who are immunosuppressed either due to an underlying disease process or medications to treat a disease require important perioperative considerations. Preoperative evaluation mandates a higher index of suspicion for pathology given that peritoneal and systemic markers of illness may be masked. Intraoperatively, consideration should be given for diversion more frequently than in a nonimmunosuppressed patient. Postoperatively, patients should be managed in a multidisciplinary fashion. This review largely focuses on the immunosuppressive mediations used for the treatment of inflammatory bowel disease, benign colorectal disease in an immunosuppressed patient, and colorectal malignancies in immunosuppressed patients to highlight important considerations for this patient population.
This review contains 4 figures, 5 tables, and 78 references.
Key words: anal squamous cell carcinoma, appendicitis versus typhlitis, biologic therapy, corticosteroids, human papillomavirus, immunosuppression, neutropenic enterocolitis
Intestinal Anastomosis
Authors: Mortensen Neil J. , Ashraf Shazad
Published: January 2021

The creation of a join between two bowel ends is an operative procedure that is of central importance in the practice of a general surgeon. Leakage from an intestinal anastomosis can be disastrous, resulting in prolonged hospital stays and increased risk of mortality. To minimize the risk of potential complications, it is important to create a tension-free join with good apposition of the bowel edges in the presence of an excellent blood supply. This review discusses the factors that influence intestinal anastomotic healing, the various technical operations for creating anastomoses, and operative techniques currently used in constructing anastomoses. Tables review the principles of successful intestinal anastomosis, consequences of postoperative dehiscence, factors linked with dehiscence, anastomotic techniques ranked by best blood flow to the healing site, comparison of hand and stapled techniques, leak rates from the Rectal Cancer Trial on Defunctioning Stoma and the Contant and colleagues mechanical bowel obstruction trial, leak and wound infection rates from mechanical bowel obstruction meta-analyses, diseases and systemic factors associated with poor anastomotic healing, lifestyle-associated leakage rates, salvage after anastomotic leakage, standard checks for creation of anastomoses, and steps for left-sided stapled colorectal anastomoses for cancer. Figures show the phases of wound healing, the tissue layers of the jejunum, interrupted and continuous suture techniques, stitches commonly used in fashioning intestinal anastomoses, double-layer end-to-end anastomosis, traction sutures, anatomic relations between the colon and the retroperitoneal organs, single-layer sutured side-to-side enteroenterostomy, Finney strictureplasty, double-layer sutured end-to-side enterocolostomy, double-stapled end-to-end coloanal anastomosis, use of a “glove” port in laparoscopic surgery, and perfusion assessment at the time of anastomotic creation.
This review contains 14 figures, 13 tables, and 85 references.
Process Improvement in Surgery
Authors: Millham Frederick H
Published: January 2021

Process improvement is a skill all physicians need to be familiar with. This is particularly true for surgeons, who work in complex systems requiring multidisciplinary care in the health care system’s most expensive location: the operating room. Surgical leaders need to be familiar with the techniques and themes of process improvement. The current literature suggests that formal process improvement programs can be effective in improving clinical, operational, and financial performance of hospitals. This review outlines a general approach to process improvement, in addition to providing evidence for the efficacy of process improvement in health care, a definition of processes, and the history of process improvement. Tables outline forms of waste applied to health care and heuristic approaches to project improvement. Figures include a project charter, control chart, X-bar control chart, Pareto table and chart, Fishbone cause-and-effect diagram, diagrams of the Plan-Do-Study-Act process and cost/payoff matrix, statistical software control charts, and process flow maps.
This review contains 10 figures, 3 tables, and 22 references
Keywords: Operating room, surgery, surgical leader, multidisciplinary team, waste, project carter, control chart, Pareto table, health care improvement
Venous Thromboembolism
Authors: Escobar Guillermo A. , Henke Peter K. , Wakefield Thomas W.
Published: January 2021

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE.
 
This review contains 11 highly rendered figures, 5 tables, and 167 references.
Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT
Surgical Treatment of Carotid Artery Disease
Authors: Moore Wesley S.
Published: January 2021

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery.
This review contains 17 figures, and 25 references
Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR
Carotid Artery Stenting
Authors: Weinkauf Craig , Zhou Wei
Published: January 2021

In addition to medical therapy and carotid endarterectomy (CEA), carotid artery stenting (CAS) is a treatment option for carotid stenosis. Multi-centered clinical trials showed that CAS has a similar composite outcome of stroke, death, and MI to CEA.  However,  CAS has a higher stroke complication than CEA.  Although controversy remains regarding appropriate patient selection for CAS, consensus is that CAS is a good option in patients who need an intervention and are at high risk for endarterectomy. New technology, techniques, and treatments continue to develop with resultant controversy and slow changes in practice.  Although long-term follow-up is still needed. current data showed Transcarotid Carotid Revascularization (TCAR) has similar perioperative stroke risk compared to CEA, suggesting TCAR is a promising technique for CAS.
This review 11 figures, 3 tables, and 36 references.
Key Words: carotid artery angiogram, carotid artery stenting, carotid endarterectomy, Carotid Revascularization Endarterectomy versus Stenting Trial, cerebrovascular disease, transcarotid artery revascularization
Aortoiliac Reconstruction
Authors: Eskandari Mark K. , Nooromid Michael J
Published: January 2021

This review outlines the preoperative evaluation, clinical decision making, and surgical treatment options for patients with aortoiliac occlusive disease. It also details the open surgical techniques for the treatment of aortoiliac occlusive disease and reviews endovascular treatment options. The discussion of treatment options includes the potential complications and expected outcomes, as well as steps that can be taken to optimize surgical results.
Key words: aortobifemoral bypass, aortoiliac reconstruction, atherosclerotic occlusive disease, endovascular reconstruction, femoral endarterectomy, iliac angioplasty, iliac stenting, peripheral vascular disease
Lower Extremity Ulcers
Authors: Galiano Robert D. , Neville Richard F.
Published: January 2021

Acknowledging and addressing common features of lower extremity ulcers will allow the surgeon to heal the vast majority of leg ulcers, either surgically or nonsurgically. The involvement of a surgeon interested in lower extremity preservation ensures the patient is offered a comprehensive set of management options. The authors discuss chronic and problem wounds, incidence and epidemiology, anatomic considerations, clinical evaluation and investigative studies, and general and specific management of the main types of leg ulcer (arterial, diabetic, venous, and inflammatory). Tables describe types and causes of lower extremity ulcers, common characteristics, members of the multidisciplinary team, conditions that interfere with healing, angiosomes of the foot, components of a leg ulcer that must be removed by débridement, benefits of hyperbaric oxygen and well-performed débridement, commonly used local pedicled flaps, staging systems for diabetic foot ulcer, and classes of compression stockings. Figures illustrate angiosomes of the anterior tibial, dorsalis pedis, peroneal, posterior tibial, lateral plantar, and medial plantar arteries; interplay between bacterial levels; types of wound dressing; ulcer locations as an indication of etiology; and management of arterial insufficiency ulcers, diabetic foot ulcers, and venous stasis ulcers.
This review contains 11 figures, 11 tables, and 138 references.
Pelvic Floor Dysfunction
Authors: Valente Michael A. , Hull Tracy L.
Published: January 2021

Pelvic floor dysfunction encompasses a broad spectrum of disorders and symptoms, including pelvic organ prolapse, fecal incontinence, dysfunctional bowel and/or bladder evacuation, urinary incontinence, and chronic pain. Challenges in treating these patients are due, in part, to inconsistent definitions and diagnostic criteria, an underreporting of symptoms, and complexities in understanding the underlying pathophysiology. Pelvic floor dysfunction is a multisystem process requiring a multidisciplinary team approach. This review describes the incidence, prevalence, and etiologic factors relating to pelvic floor dysfunction, as well as the clinical evaluation process, which includes history, physical examination, physiologic and neurophysiologic assessment, and anatomic assessment. Management of pelvic floor dysfunction is discussed. Tables include potential contributing factors in the development of pelvic floor dysfunction and anatomic and physiologic tests for pelvic floor dysfunction. Figures show an anal manometry apparatus; anorectal physiology report for a patient with fecal incontinence; pudendal nerve-stimulating electrode; pudendal nerve terminal motor latency tracing; surface electrode electromyography; anorectal ultrasound equipment; sonogram of the middle anal canal; ultrasound view of the puborectalis muscle; sonogram showing a defect in the external anal sphincter; defecography showing normal anatomy, rectocele and enterocele, sigmoidocele, and rectoanal intussusception; colonic transit study; rectocele; and enterocele.
This review contains 19 figures, 2 tables, and 81 references.
Shock
Authors: Bright Andrew C , Lee Yann-Leei L , Simmons Jon D
Published: January 2021

Shock represents hypoperfusion leading to cellular metabolic failure, with attendant clinical and biochemical markers indicating shock severity and response to therapy. While identifying and treating the underlying cause (source control for sepsis, hemostasis for exsanguination, etc) is paramount, the approach to shock is fundamentally straightforward. Assessment of volume responsiveness or volume tolerance, correction of vasoplegia, and modulation of pump function to improve forward flow aim to recover tissue perfusion at the macroscopic level and facilitate metabolic recovery. These strategies often must be applied simultaneously despite the traditionally used etiology-based classifications of shock. The intensivist should thus be familiar with a variety of invasive and noninvasive tools to determine the approach of greatest perceived yield and evaluate efficacy of interventions.
 This review contains 4 figures, 1 table, and 50 references.
Key Words: anaerobic metabolism, fluid responsiveness, hemorrhagic shock, lactic acidosis, measurement of intravascular volume, neurogenic shock, septic shock, shock, Swan-Ganz catheter, treatment of shock
Cancer Epidemiology and Prevention
Authors: Contreras Carlo M.
Published: January 2021

Cancer remains a significant public health problem in the United States and is now the leading cause of death for men and women younger than 85 years of age. The etiology of cancer development is often multifactorial, although direct links have been made between specific cancer types and environmental exposures, infections, pharmaceutical agents, and hereditary syndromes. There has been a slight decrease in both incidence and mortality over the past decade, but there is significant room for progress with respect to cancer prevention, screening for early detection, and treatment. This review covers cancer epidemiology, cancer prevention, and screening and early detection. The tables list known human carcinogens, radiation doses for common diagnostic radiology evaluations, common hereditary cancer syndromes, risk-reducing surgery and associated clinical entities, and American Cancer Society screening recommendations for individuals of average risk.
 
This review contains 5 tables and 65 references
Severity of Illness Scoring Systems in Critical Care
Authors: Keegan Mark T.
Published: January 2021

Critical care consumes about 4% of national health expenditure and 0.65% of United States gross domestic product. There are approximately 94,000 critical care beds in the United States, and provision of critical care services costs approximately $80 billion per year. The enormous costs and the heterogeneity of critical care have led to scrutiny of patient outcomes and cost-effectiveness by a variety of governmental and nongovernmental organizations; furthermore, individual critical care practitioners and their hospitals should evaluate the care delivered. This review discusses scoring systems in medicine, critical care systems, development, validation, performance, and customization of the models, adult intensive care unit (ICU) prognostic models, model use, limitations, prognostic models in trauma care, perioperative scoring systems, assessment of organ failure, severity of illness and organ dysfunction scoring in children, and future directions. Figures show the distribution of predicted risk of death using two different prediction models among a population of patients who ultimately are observed to either live or die, a comparison of  “expected” deaths (based on the expectation that the predicted probability from the model is correct) to observed deaths within each of the 10 deciles of predicted risk, the importance of disease in the risk of death equation,  and the revised Rapaport-Teres graph for ICUs in the Project IMPACT validation set. Tables list three main ICU prognostic models, study characteristics and performance of the fourth-generation prognostic models, variables included in the fourth-generation prognostic models, potential uses of adult ICU prognostic models, variables included in the calculation of the organ failure scores, and sequential organ failure assessment.
 
This review contains 4 highly rendered figures, 6 tables, and 293 references
Viral Infection
Authors: Castellanos Jason A. , Merchant Nipun B.
Published: January 2021

Although surgeons are seldom required to treat viral infections, viral infection exposure should still be a topic of concern to surgeons, because infection can cause illness in patients after surgery, and can spread to the hospital staff. This review discusses the prevention of transmission of HIV and hepatitis B and C viruses and the management of exposure to these viruses. A discussion of virus size and structure is presented, and six methods for detection are reviewed: serologic testing, isolation of virus, histologic examination, detection of viral antigens, detection of viral nucleic acid, and electron microscopy. Also discussed are viral infections that are of interest to surgeons, including HIV, hepatitis, herpes viruses, and viral infections from animal bites.
This review contains 5 figures, 10 tables, 1 diagnostic HIV algorithm, and 137 references.
Pilonidal Disease
Authors: Yang George P. , Rombeau John L. , Hwa Kimberly J.
Published: January 2021

Despite having been described nearly 200 years ago, pilonidal disease (PD) continues to produce considerable morbidity and loss of work productivity, and the optimal treatment remains elusive. Surgeons must choose among numerous operative and nonoperative options that overlap and often confound therapeutic strategies. This review provides an overview of PD with an emphasis on operative treatments. Every attempt is made to guide selection of the best treatment for the specific variant of disease.
This review contains 7 figures, 4 tables, and 69 references.
Geriatric Trauma
Authors: Burruss Sigrid , Min Lillian , Tillou Areti
Published: January 2021

The geriatric trauma population continues to grow as life expectancy and unintentional injury increase. Age-related physiologic changes and complex comorbidities may not only lead to injury but also may precipitate a downward spiral. The injury patterns, presentation of life-threatening injury, and response to injury are unique in the elderly trauma population, and dedicated evaluation of elderly trauma patients at a trauma center may be beneficial. Aggressive, early intervention with a focus on geriatric-specific needs and care coordination are an integral part of the management to reduce morbidity and mortality. Much of the unintentional injuries may be preventable with identification of risk factors for falls and fall prevention programs. Frailty measurements may be used to predict morbidity and functional status. Surgeons must become familiar with geriatric-specific issues and how best to treat the geriatric trauma population.
 This review contains 3 figures, 2 tables, and 133 references.
Key Words: care coordination, elderly, frailty, geriatric, injury, prevention, risk factors, trauma, triage
The Renal System
Authors: Locke Jayme E. , Killian Jr John T
Published: January 2021

This updated review on the renal system provides a concise overview of the topics most important to the general surgeon. Anatomic topics have been expanded to also include variant anatomy and surgical approaches. There is a new focus on the accuracy and utility of equations for estimating the glomerular filtration rate, as well as supplementation and pharmacology for the general surgeon with discussions of vitamin D and erythropoietin. Acute kidney injury is defined; its pathophysiology is discussed; and its management is outlined, highlighting evidence-based practice. Finally, urologic surgery is addressed with a focus on donor nephrectomy and its consequences, as well as the management of iatrogenic ureteral injuries.
Key words: acute kidney injury; contrast nephropathy; erythropoiesis-stimulating agents; estimated glomerular filtration rate; iatrogenic ureteral injury; laparoscopic donor nephrectomy; renal surgical anatomy; vitamin D supplementation
Metabolic Response to Critical Illness - Part 1
Authors: Bessey Palmer Q.
Published: January 2021

A wide variety of factors and processes are involved in the metabolic response to critical illness; this chapter reviews some of these factors and metabolic responses in the critically ill surgical patient to help the clinician minimize patient debility. The features of critical illness that can cause debility include wounds, pain, inflammation, infection, and iatrogenic factors. The three major features of the metabolic response are discussed: the hyperdynamic or hypermetabolic state, muscle wasting, and glucose intolerance. Other topics considered include altered temperature regulation, the role of the central nervous system, the role of the gut, manipulating the response to critical illness, altered protein metabolism, altered carbohydrate metabolism, and systemic mediators (e.g., hormones and cytokines). 
This review contains 3 highly rendered figures, 17 tables, and 59 references
Keywords: Critical illness, metabolic response, thermoregulation, muscle wasting, glucose intolerance, burn victim, sepsis
Transplantation Ethics and Policy
Authors: Wall Anji Elizabeth , Millis J. Michael
Published: January 2021

Addressing all of the ethical and policy challenges in the field of organ transplantation is a daunting task for a short review. Rather than focusing on each issue, this review starts with a discussion of the underlying ethical principles that drive transplantation ethics and proceeds to address a few of the important ethical challenges in transplantation, recognizing that it is not a comprehensive overview of every issue. Just as policy should follow the underlying ethical principles, the second part of the review addresses policy development and implementation in the United States and selected challenges worldwide. Of note, this review covers underlying ethical principles, the dead donor rule, the allocation of scarce resources, organ allocation, deceased organ donors, living organ donors, speculation for the future, and transplantation policies.
 
This review contains 15 references.
Benign Diseases of the Peritoneum and Retroperitoneum
Authors: Arrington Amanda K.
Published: January 2021

The peritoneum and retroperitoneum, once considered just spaces, are now recognized as primary locations for trauma, inflammation, infection, benign neoplasms, and malignancies. To understand the spread of disease in these locations, one must first understand their anatomy, physiology, and relationship. As both the peritoneum and retroperitoneum contain multiple organs, the relationships of the abdominal organs within these spaces are critical. This review defines both the peritoneum and retroperitoneum and then describes the most common disease states and spread of disease within these spaces. Spread of disease, in particular, spread of malignancy, within the peritoneum is complex but predictable and can be treated in certain instances with heated intra-abdominal chemotherapy intraoperatively.
This review contains 5 figures, 5 tables, and 37 references.
Key words: ascites, carcinomatosis, desmoid, hyperthermic intra-abdominal chemotherapy, peritoneum, peritonitis, retroperitoneal sarcoma, retroperitoneum
Malignant Diseases of the Peritoneum and Retroperitoneum
Authors: Arrington Amanda K.
Published: January 2021

The peritoneum and retroperitoneum, once considered just spaces, are now recognized as primary locations for malignancies. Spread of disease, in particular, spread of malignancy, within the peritoneum is complex but predictable. This review covers the pathophysiology, diagnosis, and treatment of malignant peritoneal tumors such as peritoneal metastases and peritoneal carcinomatosis, pseudomyxoma peritonei, and mesothelioma, including a section on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. In addition, primary malignant disease of the retroperitoneum is discussed, with particular emphasis on retroperitoneal sarcomas.
This review contains 9 figures, 3 tables, and 33 references.
Key words: hyperthermic intraperitoneal chemotherapy, peritoneal carcinomatosis, peritoneal malignancy, peritoneal mesothelioma, peritoneal metastasis, peritoneal tumors, pseudomyxoma peritonei, retroperitoneal malignancy, retroperitoneal sarcoma
Principles of Wound Management and Soft Tissue Repair I
Authors: Friedstat Jonathan S. , Coriddi Michelle R , Halvorson Eric G , Disa Joseph J
Published: January 2021

Principles of initial wound management include adequate debridement, bacterial contamination assessment, nutritional optimization, and moist wound healing versus the use of negative-pressure wound therapy. The main goals of coverage procedures are to achieve a healed wound and avoid infection. Aside from allowing to heal by secondary intention, options for wound closure include primary closure, skin grafting, local flaps, and free flaps. Each wound should be evaluated on an individual basis to determine which method of coverage is most appropriate.

This review contains 13 figures, 2 tables, and 22 references.
Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps
Breast Screening and Evaluation, High Risk Patients
Authors: Cappuccino Helen , Bonaccio Ermelinda
Published: January 2021

The fundamental tasks facing surgeons evaluating patients’ breasts are to rule out malignancy, ameliorate breast symptoms, and manage premalignant breast conditions and risk factors to minimize a patient’s chances of developing cancer. Woman presenting to a surgeon should receive thorough and appropriate breast evaluation, breast cancer risk assessment, and treatment, which minimizes risks going forward. In this review, we focus on screening recommendations for (both average and high-risk) patients for breast cancer, Breast Imaging, Reporting and Data System categories, the performance of a thorough breast history and physical examination. We also discuss various breasts imaging modalities and their strengths and weaknesses. We review breast density as a confounding factor and increased risk factor, and the grading of breast density. Finally, different ways of performing breast biopsies are discussed as well as the evaluation of risk for breast cancer with interventions for enhanced screening and risk reduction.

This review contains 12 figures, 7 tables, and 35 references. 
Key Words: BI-RADs, breast cancer risk factors, breast cancer risk reduction, breast core biopsy, breast screening, enhanced screening, BRCA, chemoprevention, mammography
Surgical Treatment of Diverticulitis
Authors: Weidner Tiffany K , Kidwell John T , Etzioni David A
Published: January 2021

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis.
 This review contains 8 figures, 4 tables, and 67 references.
Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis
Mechanical Ventilation: Respiratory Physiology and Conventional Ventilation
Authors: Maung Adrian A. , Kaplan Lewis J
Published: January 2021

This three-part review is intended to enable the reader to manage the fundamentals of mechanical ventilation in both the urgent and the nonurgent setting. This first chapter provides a functional understanding of basic pulmonary physiology as a prerequisite knowledge base prior to reviewing the concepts central to basic, traditional, and cyclical ventilation that is regularly employed in the air or ground ambulance, emergency department, operating room, and intensive care unit. Subsequent chapters will review advanced ventilation modes, adjuncts, and special problems encountered in patients with respiratory failure requiring mechanical ventilation. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.  

This review contains 5 Figures and 10 references
Key Words: acute respiratory failure, acute respiratory distress syndrome, hypercapnia/therapy, hypoxia/therapy, mechanical ventilation, pulmonary gas exchange
Mechanical Ventilation: Approaches and Special Considerations
Authors: Maung Adrian A. , Kaplan Lewis J
Published: January 2021

In this chapter, we complete the discussion of mechanical ventilation by examining approaches to mechanical ventilation for different patient populations and how to assess whether a patient is ready for liberation from mechanical ventilation. Each of the three chapters is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion. 

This review contains 1 Figure, 1 Table and 31 references
Key Words: acute respiratory failure, ARDS, mechanical ventilation liberation, spontaneous breathing trial, tracheostomy
Cerebral Metabolism and Blood Flow Following Traumatic Brain Injury
Authors: Martin Ryan , Zimmermann Lara , Zwienenberg Marike , Kim Kee D , Shahlaie Kiarash
Published: January 2021

The management of traumatic brain injury focuses on the prevention of second insults, which most often occur because of a supply/demand mismatch of the cerebral metabolism. The healthy brain has mechanisms of autoregulation to match the cerebral blood flow to the cerebral metabolic demand. After trauma, these mechanisms are disrupted, leaving the patient susceptible to episodes of hypotension, hypoxemia, and elevated intracranial pressure. Understanding the normal and pathologic states of the cerebral blood flow is critical for understanding the treatment choices for a patient with traumatic brain injury. In this chapter, we discuss the underlying physiologic principles that govern our approach to the treatment of traumatic brain injury.

This review contains 3 figures, 1 table and 12 references
Key Words: cerebral autoregulation, cerebral blood flow, cerebral metabolic rate, intracranial pressure, ischemia, reactivity, vasoconstriction, vasodilation, viscosity
Health Economics: Select Concepts of the Health Production Function, Risk, and Insurance
Authors: Hall Bruce L
Published: January 2021

The production of health as an output of various inputs is a key concept of health care economics and a key influence on health care policy. Similarly, the notion of risk—that an outcome might not turn out as expected or hoped—underpins the entire theory of insurance. Insurance, and the benefits it can provide, cannot be understood without understanding risk, or without understanding how the features of an insurance contract transform risk for the individual, the payer, or society. The health economist, policy maker, leader, expert operator, financier, insurer, clinician of any stripe, patient or family or advocate, or other interested stakeholder must always consider the structural, clinical, and economic anatomy of health care in the context of the underlying physiology of these economic concepts.

This review contains 2 figures, 1 table, and 14 references.
Key Words: health economics, health policy, health production, marginal return (diminishing), utility, inputs, QALY, risk (aversion or tolerance), insurance (contract features)
Acute Hepatic Failure
Authors: Erstad Derek J , Qadan Motaz
Published: January 2021

Acute liver failure (ALF) is a rare but highly morbid condition that is optimally managed by a multidisciplinary team of surgeons, hepatologists, and intensivists at a tertiary care center that specializes in liver disorders. ALF is caused by four primary mechanisms, including viral infections (most commonly Hepatitis A and B); toxicity from acetaminophen overdose or other substances; postoperative hepatic failure ; and miscellaneous causes such as autoimmune hepatitis, genetic disorders, or idiopathic etiologies. Unlike chronic liver failure in which the body develops compensatory, protective mechanisms, ALF may be associated with severe multisystem organ involvement, including respiratory distress syndrome, renal failure, and cerebral edema. Fulminant hepatic failure represents a rapidly progressive form of ALF that portends worse prognosis. Prompt diagnosis and management of multisystem organ dysfunction in an intensive care setting is paramount to survival. However, a subset of patients will fail to improve with medical management alone. Early identification of these individuals for emergent transplant listing has been shown to improve outcomes. Multiple predictive models for ALF survival have been developed, which are based on weighted evaluation of clinical and laboratory parameters. These models may be used to facilitate treatment, predict prognosis, and guide transplant listing. In this chapter, we provide an in-depth review these concepts, focusing on the classification, epidemiology, diagnosis, and management of ALF.
This review contains 5 tables and 69 references.
Key Words: acute liver failure, acute respiratory distress syndrome, coagulopathy, cerebral edema, fulminant hepatic failure, hepatic necrosis, liver transplantation, metabolic disarray, multidisciplinary intensive care, prognostication
Endoscopic Management of Postbariatric Fistulae and Leaks
Authors: Cavanagh Yana , Shaikh Sohail N.
Published: January 2021

The number of bariatric procedures performed annually is increasing along with the number of complications. Gastrointestinal leak after bariatric surgery generally portends high morbidity and mortality, and its management depends on clinical and radiographic presentation. A leak is defined as an enteric defect with extravasation of luminal contents. Fistulae are abnormal connections between two epithelialized surfaces, are usually chronic, and may develop from long-standing leaks. Endoscopic therapies may offer an attenuated risk profile compared with surgical intervention and play a growing role in the management of postbariatric complications. Leak resolution may require multiple endoscopic sessions and modalities (e.g., stents, adhesives, plugs, clips, suturing, and VAC-assisted closure); therefore, it is critical to have appropriate follow-up and surveillance after therapeutic endoscopic intervention. This review discusses endoscopic leak and fistula management through endoscopic procedures, addressing indications and candidates for procedure, contraindications, recipient evaluation, and aspects of procedure, including proper timing, equipment, and types. Figures show Roux-en-Y gastric bypass, sleeve gastrectomy, management options for leaks after bariatric surgery, a diagnostic algorithm for leaks, upper gastrointestinal series performed with Gastrografin, and computed tomographic scans that demonstrate extraluminal air extending along the diaphragmatic surface of the spleen and a perisplenic gas and fluid-filled collection on the lateral margin. Tables list complications that follow bariatric surgery; an excerpt from the 2008 American Society for Gastrointestinal Endoscopy Guidelines; recommended equipment for endoscopic defect management; classification system based on duration after bariatric surgery; classification and approach to management based on clinical presentation and radiographic findings; summary of recommendations for pre-endoscopy, index endoscopy, therapeutic endoscopy, and posttherapeutic endoscopy; and early and late complications of stent placement.
This review contains 7 highly rendered figures, 7 tables, and 104 references.
End of Life Care and Withdrawal of Life Support
Authors: Chen Craig
Published: January 2021

Despite advances in critical care medicine and resuscitation, many patients who are admitted to the intensive care unit (ICU) will ultimately die. Although outcomes may be better for surgical rather than medical ICU patients, addressing the end of life is a fundamental and necessary aspect of critical care for all patients. Over the last few years, we have increasingly recognized the role of palliative care in the surgical and trauma ICU. Palliative medicine in the surgical ICU setting results in decreased length of stay, improved communication with family and patients, and earlier identification of goals of care. This review covers indications for palliative care consultation, practical considerations at the end of life, withdrawal of mechanical ventilation, and symptoms and symptom management at the end of life. Tables list the American College of Surgeons statement on the principles guiding care at the end of life, guidelines for palliative care consultation in the surgical ICU, ABCDs of dignity-conserving care, palliative care principles on transitioning a patient to comfort measures only, and the process of withdrawing ventilatory support.
This review 5 tables, and 33 references.
Key words: comfort measures; end of life; intensive care unit end-of-life care; palliation; palliative care; palliative care consultation; palliative medicine; quality of dying; withdrawal of life support
Invasive Hemodynamic Monitoring in the Intensive Care Unit
Authors: Chang Michael C , Garland Mary
Published: January 2021

Optimal support of critically ill surgical patients with cardiovascular dysfunction requires that the bedside clinician have both a clear understanding of basic cardiovascular physiology and thorough knowledge of the information available from invasive hemodynamic monitors, including the advantages and pitfalls of each system. Assessment of hemodynamic function in underperfused patients should start with a quantitative assessment of global cardiovascular function. Global variables can be flow derived (e.g., cardiac output), pressure derived (e.g., systolic blood pressure), or both (e.g., ventricular stroke work and power). Any assessment consistent with inadequate global hemodynamic performance should be followed by analysis of the independent determinants of cardiovascular function. These independent determinants include heart rate, preload, afterload, and myocardial contractility. Invasive hemodynamic monitors allow the bedside clinician to measure and quantitate various combinations of global performance and the determinants of cardiac function depending on the monitoring system employed. Central venous lines enable measurement of central venous pressure but limited measure of right ventricular preload. Pulmonary artery catheters offer information pertaining to several global measures and independent determinants. Devices that depend on pulse contour wave analysis, when coupled with a central venous catheter, can measure cardiac output and preload in the context of measurements of stroke volume. However, being invasive, each device carries some degree of risk to the patient, and each monitoring technique employed via these devices carries pitfalls in both measurement and interpretation. It is incumbent upon the bedside clinician to understand the physiologic derangements affecting the patient and the utility and pitfalls of the information available from each device when selecting monitoring systems to be used in any given patient and the supportive therapy that ensues.
This review contains 3 figures, 1 table, and 28 references.
Key words: afterload, cardiac output, central venous catheter, hemodynamic monitor, myocardial contractility, perfusion, preload, pulmonary artery catheter, pulse contour analysis, stroke volume, stroke volume variability, stroke work, ventricular power