bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary surgery
Authors: Stamenkovic Sasha 
Published: August 2016

Abstract
Thoracic surgeons manage patients with many conditions other than lung cancer, and the spectrum of operations is from tracheal resection for post-tracheostomy stenosis to chest wall reconstruction for cosmetic reasons. There is an increasing use of minimally invasive techniques. Success relies on careful attention to every detail of the patient’s journey, commencing with history taking and going through to postoperative care. In this chapter, each of these stages is addressed individually with discussion on the rationale of treatments, the types of operations performed, preoperative imaging and work-up, surgical anatomy, operative techniques and pitfalls, and postoperative management and complications. Video-assisted thoracoscopic techniques can aid the surgeon and also help to minimize postoperative pain. The importance of systematic lymph node dissection in cancer cases is discussed.
Stones and infections
Authors: Hughes Benjamin , Burgess Neil 
Published: August 2016

Abstract
The lifetime risk of developing a urinary tract stone is 10–20% with a peak incidence occurring between the ages of 30 and 50 years. The recurrence rate is 50% and the incidence is increasing. Renal colic is one of the most common emergency urological presentations and is excruciatingly painful. This chapter covers the epidemiology and mechanisms of stone formation and treatment options. It also provides a practical guide to managing renal colic and obstruction. Urinary tract infection (UTI) affects females more than males except at the extremes of age when the incidence is similar. The lifetime risk of a UTI for a female is approximately 30% and so UTI represents a significant proportion of emergency and outpatient urological referrals. This chapter provides the relevant definitions associated with urological infections, describes the microbial aetiology, and covers diagnosis and management of general and specific urinary tract infections.
Genitourinary malignancies
Authors: Noon Aidan , Catto James 
Published: August 2016

Abstract
Genitourinary cancers include some of the most common (prostate adenocarcinoma is the most common male cancer) and expensive (urothelial carcinoma is one of the most expensive human cancers to manage) human malignancies. Changes in healthcare practice, such as screening for prostate cancer and the use of abdominal imaging for the identification of incidental renal cancer, have increased the detection of these cancers and produced a migration to low-stage disease at diagnosis. Refinements in treatment, such as systemic chemotherapy for testis cancer, have improved the prognosis for many genitourinary cancers, with the exception being bladder cancer. Surgery plays a key role in the treatment of most genitourinary cancers and is often performed using traditional or robot assisted laparoscopy (and increasingly through single incision surgery (LESS)). Molecular biological research has led to targeted molecular therapies for patients with metastatic renal cell carcinoma and urinary biomarkers for bladder cancer.
Benign prostatic hyperplasia and obstructive uropathy
Authors: Garthwaite Mary 
Published: August 2016

Abstract
Benign prostatic hyperplasia (BPH) is a chronic, complex disease that is often progressive. The term BPH refers to the actual histological changes of stromal-glandular hyperplasia seen within the prostate. The condition becomes clinically significant when this overgrowth of benign tissue is associated with bothersome lower urinary tract symptoms (LUTS). Based on an overall European prevalence of LUTS of 30%, approximately four million men aged &gt;40 years will have LUTS in the UK. Although the causes of LUTS are multifactorial a significant proportion will be secondary to BPH. With the prevalence of LUTS and BPH increasing with age, the need for medical treatment will continue to increase. Progression of the disease can result in complications such as obstructive uropathy (acute or chronic urinary retention), urinary tract infection, and bladder stone formation. The need for BPH-related surgery is also classed as a complication of BPH progression. Risk factors for progression include age and prostate volume. Serum prostate-specific antigen (PSA) is correlated to prostate volume and can therefore be used to help determine the risk of progression. The aims of treatment are to alleviate LUTS and to prevent complications. Medical therapy is the now the most commonly used treatment modality for BPH. Rapid symptomatic relief can be gained from the use of alpha-blockers, whereas 5-alpha-reductase inhibitors have the added benefit of reducing the risk of developing urinary retention and the need for BPH-related surgery. Combination therapy, with both an alpha-blocker and a 5-alpha-reductase inhibitor, has been shown to provide greater and more durable benefits than monotherapy alone. Surgery is indicated if maximal medical therapy is insufficient to alleviate symptoms and improve quality of life, or if complications arise despite medical management. The initial management of obstructive uropathy involves catheterization, either urethral or suprapubic, to swiftly alleviate the obstruction, ensure the patient is comfortable and allow the resolution of any secondary renal impairment. Catheterization is usually temporary until surgery can be performed as definitive management, but may be required in the long-term if the patient is unfit for surgery or there is detrusor failure secondary to the chronic retention of urine.
Benign scrotal and penile conditions
Authors: Eardley Ian 
Published: August 2016

Abstract
Benign disorders of the penis and scrotum are common. Congenital problems include hypospadias and testicular maldescent. The most common penile problem is phimosis, or tight foreskin. It is important to avoid overtreatment of a non-retractile foreskin in children, but if there is true phimosis with scarring, then circumcision is usually required. Penile conditions that affect sexual function include penile curvature, erectile dysfunction and priapism. The most common cause of acute testicular pain in children is testicular torsion. Scrotal swellings are a common reason for men to present to surgeons. The most common causes of painless swellings are hydrocoele and epididymal cyst. Careful assessment of a scrotal swelling is important since testicular tumours can also present in this way. Ultrasound scanning is a useful adjunct in the assessment of scrotal swelling.
Joint and bone infections
Authors: Mahaluxmivala Jehangir , Makki Daoud 
Published: August 2016

Abstract
Septic arthritis is the infection of native or prosthetic joints. In native joints, bacterial infection is commonly caused by Staphylococcus aureus through haematogenous spread. Prompt recognition is essential to prevent destruction of articular cartilage. Diagnosis is confirmed by microbiological studies on joint aspirate but preliminary results can be negative. Treatment consists of surgical washout followed by antibiotics. Prosthetic joint infections are managed by washout with retention of prosthesis or two-stage revision depending on the time since initial surgery. Acute osteomyelitis is infection of bone caused often by haematogenous spread but can result from contamination of deep wounds, ulcers or previous surgery (internal fixation of fractures). Symptoms might be nonspecific and therefore a thorough history helps reach the diagnosis. MRI and bone scan identify the affected bony segment but diagnosis is confirmed through histological studies from biopsies. Treatment consists of intravenous antibiotics but surgical drainage might be required when antibiotherapy fails.
Benign and malignant skin lesions
Authors: Kang Mandeep , Ward David 
Published: August 2016

Abstract
Early determination between the diagnosis of benign and malignant skin lesions allows for appropriate management regimes to achieve the best long-term prognosis. A presumptive diagnosis can be made by considering the patient’s risk factors, history of the lesion, and its location and appearance. The definitive diagnosis is made by histological examination of biopsy specimens. The three common types of malignant skin lesions are: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. BCC comprises 60% of primary skin neoplasms. It is slow-growing and rarely metastasizes, and carries the best long-term prognosis. SCC comprises 20% of malignant skin lesions and metastatic disease is more common. MM comprises 1% of malignant skin neoplasms but accounts for over 60% of skin cancer deaths. It metastasizes to remote sites early with a poor prognosis in latter stages. Benign skin lesions generally do not require definitive treatment. Treatment for primary skin malignancies includes surgical excision with adjuvant therapy if required.
Upper airway obstruction
Authors: Swami Himanshu , Hawthorne Maurice 
Published: August 2016

Abstract
Common causes of sudden onset upper airway obstruction include allergy, trauma, infection, inhaled foreign body; slow onset obstruction is usually due to tumours. Speedy assessment of the severity and level of the obstruction is a key skill. Poiseulle’s equation indicates that small changes in diameter of the airway have dramatic effects on the flow of air through the upper airway. This as lead to the aphorism—‘if you are thinking about a tracheostomy you probably should be doing one right now.’ It is important to recognize prodromal symptoms in airway-threatening infections (e.g. pain and swallowing problems) before the airway is compromised and stridor starts. Valuable time can be bought in the acute situation with administration of oxygen, (or heliox), steroids while preparations are made to secure the airway. It should be remembered that since Hib vaccination, acute epiglottitis leading to death is now nearly always a disease of adults.
Acute neurosurgical emergencies
Authors: Wilson Mark , Sabin Ian 
Published: August 2016

Abstract
Neurosurgical emergencies often progress rapidly hence emergency management is essential to minimize further neurological damage. The brain can be injured in many ways, the most common being through direct traumatic brain injury. In the Western world, the most common mechanisms of these injuries are road traffic collisions, falls from height, and assaults. Ischaemic injury through embolic stroke or haemorrhagic injury from ruptured vascular malformations (e.g. cerebral aneurysms) are also common causes of neurosurgical emergencies. Acute hydrocephalus and infection problems (e.g. abscesses) are other conditions where prompt intervention is required. Similarly, acute spinal injuries can be traumatic, compressive, and infective.
Cancer screening
Authors: Sutton Paul , Dunne Declan , Hargreaves Anita , Poston Graeme J. 
Published: August 2016

Abstract
Cancer screening is now offered in most countries with an established health service for cervical, breast, and colorectal cancer. The premise on which cancer screening is employed is that early detection is commensurate with better survival. Subjecting an otherwise healthy population to investigation can however be associated with both physical and psychological harm. Clinicians must have an understanding of cancer screening, and the evidence upon which it is based. The World Health Organization published clear guidance in 1968 as to the acceptability of screening tests. At the heart of this is the ability of the test to detect at an earlier stage a disease that is treatable and would confer survival benefit, while remaining acceptable to the population being screened.
General principles of radiation oncology
Authors: Lee Chris D. , Den Dulk Marcel , Myint Arthur Sun 
Published: August 2016

Abstract
The aim of radiotherapy is to deliver optimal dose of radiation to either cure or control the cancer within the tolerance of normal surrounding tissues. The treatment is based on the principle that cancer cells are less likely to recover from the radiation damage compared to normal cells. The response to radiation depends on the radio sensitivity of cancer type treated. There are different types of radiation delivery methods; broadly external or internal (brachytherapy). There are early (acute) and delayed (late) side effects from radiation and the potential benefits of treatment need to be balanced carefully against the possible side effects. All new cases with cancer should be discussed at the local multidisciplinary team meeting to assess the need for radiation to improve surgical outcomes
Principles of safe surgery
Authors: Mishra Amitabh , McCulloch Peter 
Published: August 2016

Abstract
Surgery by its nature involves inflicting injury upon the patient, and thus carries the risk of unintentional injury to both patient and staff. Over 10% of hospital admissions1 experience an adverse event and of these approximately 7% result in permanent disability and 14% in death2. Half of hospital adverse events affect surgical patients and half are thought preventable. In a complex environment maintaining safety requires a culture of vigilance, mutual support and co-operation, well-designed standardized working practices that are adhered to in a disciplined fashion, and well-functioning technology and a high degree of technical knowledge. All surgeons must be aware of the specific hazards of the operating theatre and how to mitigate or avoid them. The emphasis of surgical training has shifted from developing surgeons who are technically competent to include other skills of leadership, teamwork, situational awareness and communication.
Surgical wounds
Authors: Crinnion James N. 
Published: August 2016

Abstract
The primary aim of most surgical incisions is to allow adequate unobstructed access to the operative site. Following completion of the procedure the incision must heal securely with an acceptable scar. The uncomplicated healing of surgical incisions is critically dependent on the adherence to sound technical principles. Poor surgical technique will predispose to wound breakdown, infection and ultimately excessive scarring. Surgical incisions that are made precisely and closed carefully usually heal without problems, unless there is a problem with the underlying pathology or procedure, such as an anastomotic leak. This chapter will describe the basic knowledge and surgical techniques that enable the surgeon to produce neat wounds that heal well.
Simulation and assessment
Authors: Sirimanna Pramudith , Lee Grace , Arora Sonal , Aggarwal Rajesh 
Published: August 2016

Abstract
An increased emphasis on patient safety and outcomes, coupled with the negative effect of work-hours restrictions, has contributed to the need for a paradigm shift in surgical training. Simulation has emerged as an adjunct to traditional training by providing a safe environment in which errors can be made and learned from. Modes of simulation include synthetic, virtual reality, animal tissue, and human models. The translational benefits on technical skills acquisition are well established, particularly for minimal access techniques such as laparoscopy. Simulation training has been demonstrated to be beneficial for training key non-technical skills that are critical for the development of expertise. To quantify performance gains from simulation training, validated assessment methods assess dexterity, procedural performance, and non-technical skills. Despite the documented benefits, the uptake of simulation into formal surgical training programs is lacking. Further studies regarding the cost effectiveness and effect on patient outcomes are required. Simulation also needs to be properly integrated into the curriculum at the appropriate stages of training.
Physical examination of the vasculature and joints
Authors: Woodley Caroline , Reed Malcolm W. R. 
Published: August 2016

Abstract
Consent is the permission obtained by a clinician from a patient to carry out a procedure on them. The need to obtain consent is rested on the fundamental ethical premise that any adult human has autonomy, the right of self-determination, and therefore the right to decide whether or not they allow another to invade their being. In order to make the decision of whether to give or refuse consent a patient must understand the treatment for which consent is being requested and the possible consequences of refusing treatment. In other words, they must be capable of making the decision and must be free to make the decision without coercion. The concept and requirements of consent are defined by common law, case law, and statutes that may vary between legal jurisdictions. A surgeon’s ethical responsibilities with respect to consent may extend beyond those required by law and those recommended by national bodies.
Preoperative assessment
Authors: Berthoud Mireille 
Published: August 2016

Abstract
There are three primary goals of preoperative assessment. The first is to assess perioperative risk. This requires a detailed knowledge of the patient’s underlying fitness, the level of their functional reserve, and the risks of the surgical and anaesthetic procedure that is planned. The second is to minimize perioperative risk by developing an appropriate care plan, which may include medical or social optimization. The third is to educate the patient about the choices he or she has before, during and after their procedure, both to relieve anxiety and to enable the patient to give informed consent. To achieve this pre-assessment needs to be timely, allowing for the possibility of medical optimization prior to surgery.
Enhanced recovery after surgery
Authors: Lobo Dileep N. , Ljungqvist Olle 
Published: August 2016

Abstract
A patient, once accepted for surgery, takes a complex journey through various departments and seeing a range of medical professionals. As a result, continuity of care may not be optimal when the care package is considered as a whole. The concept of Enhanced Recovery after Surgery (ERAS) addresses this lack of continuity by proposing that combining a series of treatments would substantially improve outcomes. The original ideas have been refined and the concept of ERAS is gaining acceptance. ERAS protocols have been published in thoracic, urological, gynaecological, and orthopaedic surgery, which have led to substantially faster recovery times and major reductions in postoperative complications and hospital stay. This chapter covers the broad perioperative principles that underpin ERAS as related to abdominal surgery, although the principles hold for other situations.
Principles of transfusion and haemostasis
Authors: Garner Jeff , Fletcher Andrew , Groves Jeremy 
Published: August 2016

Abstract
Adequate haemostasis and an understanding of coagulation is a prerequisite of safe surgery. Numerous medical and pharmacological interventions render the surgical patient more likely to bleed and the surgeon must be aware of these. Transfusion of blood or blood products can facilitate surgical procedures and prove lifesaving but the practitioner must be aware of the pros and cons of their use. There must be fastidious attention to detail throughout the transfusion process to prevent transfusion incidents, clerical mistakes remaining a common source of transfusion related harm. Adjuncts to transfusion, such as cell salvage, are available and their role must be understood. Massive transfusion presents its own challenges and has its own side effect profile and the role of near patient testing utilizing thromboelastography will be considered.
Venous thromboembolism: deep vein thrombosis and pulmonary embolism
Authors: Maclean Rhona M. , Makris Michael 
Published: August 2016

Abstract
Thrombosis is the formation of a clot within a blood vessel, thus preventing the flow of blood. There are distinct differences in the pathophysiology, prevention, and treatment of thrombosis occurring in arteries and veins. Arterial thrombosis takes place in a high pressure system where platelets are of primary importance and antiplatelet drugs are central to its prevention and treatment. Venous thrombosis, which occurs in a low-pressure system and primarily involves the coagulation cascade, is prevented by and treated with anticoagulants. While platelets and coagulation factors are closely interlinked, these differences can help to explain the presentation and treatment of thrombosis.
Skin loss
Authors: Al-Hadithy Nada 
Published: August 2016

Abstract
Trauma injuries vary in type and severity, but most commonly involve burns, lacerations, fractures, and crush injuries. Plastic surgeons have always been involved in the treatment of trauma, and in the UK plastic surgery grew out of the surgical treatment of facial injuries during the world wars. A collaborative, multidisciplinary approach is recognized as being crucial to success in this area. The advancement of reconstructive plastic surgery techniques has revolutionized the treatment of trauma. The ability to repair and reconstruct soft tissue defects has led to vastly improved patient outcomes, particularly in cases involving open fractures of the lower limb. This chapter gives an overview of approaches to managing wounds and skin loss in the trauma patient.
Burns: classification and principles of management
Authors: Al-Hadithy Nada 
Published: August 2016

Abstract
The consequences of a large surface area burn are far reaching with physiological, psychological, physical, social, and economic sequelae. Most burns are thermal with the largest proportion being scalds, particularly in the paediatric population. Thermal burns also include contact, flame, and flash injuries. Chemical and electrical injuries can cause deeply destructive damage to underlying muscle and bone with life threatening systemic effects under a deceptively small area of involved skin. Assessment, referral and management of burns requires a systematic approach with attention to the changing clinical presentation of the patient and understanding of the underlying pathophysiology. A multidisciplinary team is essential in providing the best clinical care. This chapter gives an overview of the patient journey from presentation to final outcome with insights into burns prognostication.
Trauma in conflict zones
Authors: Singleton James , Clasper Jon 
Published: August 2016

Abstract
This chapter describes the specific trauma prevalent in conflict zones – in broad terms these can be considered as ballistic and/or blast injuries. Gunshot injuries are covered, both in terms of the well-known ability to cause penetrating trauma and the emerging phenomenon of behind armour blunt trauma (BABT). Blast injuries are also discussed, including the different mechanisms capable of causing blast injury (i.e. the blast wave, fragments, the blast wind, and other mechanisms) and their effects on each body system. Finally, an overview of the clinical management of conflict casualties is provided from a surgical perspective. This covers general patterns of injury, emergent management of the combat casualty as well as specific treatment for ballistic and blast wounds sustained in a conflict environment.
Vascular injury
Authors: Raza Zahid 
Published: August 2016

Abstract
The incidence and type of vascular injury differs in different geographical locations. Blunt and iatrogenic injuries are the two most common causes of vascular trauma in most European countries including the United Kingdom. However, in the United States, most vascular injuries are the result of stab or gunshot wounds. Vascular injuries are associated with high morbidity and mortality. They require a clear concept of the management and timely intervention in order to avoid early and late complications. The management of patients with vascular trauma is complex in view of the diagnostic difficulties and planning the appropriate management strategy. The choice of treatment depends upon the nature and extent of the underlying injury and may require expertise ranging from interventional vascular radiology to specialist vascular surgery.