bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper gastro-oesophageal surgery
Authors: Allum William 
Published: August 2016

Abstract
This chapter describes the common presentations of surgical conditions of the oesophagus and stomach, which map to the general surgery specialty content of the core curriculum in the United Kingdom. The first section describes the specific aspects of anatomy and physiology of the oesophagus and stomach including topographical and surgical anatomy and the motility, secretory, and digestive functions. The second section describes the pathophysiology of each of the common conditions including oesophageal cancer, gastric cancer, gastro-oesophageal reflux disease, and peptic ulceration. Each discussion includes details of incidence, aetiology, predisposing factors, gross and microscopic pathology, as well as treatment outcomes. The final section describes the common elective and emergency symptomatic presentations of dysphagia, dyspepsia, heartburn, epigastric pain, and upper gastrointestinal haemorrhage.
Degenerative and inflammatory joint disease
Authors: Nasr Pierre , Khanduja Vikas 
Published: August 2016

Abstract
Degenerative and inflammatory joint disease encompasses a variety of chronic, destructive conditions. The normal structure and function of articular cartilage, at a cellular level, is of great importance in understanding the disease processes and treatment strategies aimed at preventing joint destruction. Osteoarthritis causes a mechanical defect that initiates an inflammatory cascade. Rheumatoid arthritis is an autoimmune process that has local effects on large and small joints and systemic effects on many body systems. . Seronegative spondyloarthritides, such as Ankylosing Spondylitis and Psoriatic arthritis, are a group of disorders, which have a strong genetic component and commonly affect the spine and peripheral joints. Treatment strategies are aimed at treating the cause of inflammatory joint disease and relieving symptoms via a stepwise approach. Surgical intervention is aimed at improving pain, function and the quality of life for a patient but must be balanced with the risk of complications.
Back pain and sciatica
Authors: Sharp David 
Published: August 2016

Abstract
Back pain is common in the general population and may be caused by a wide variety of pathologies. Only a small proportion of patients suffering from back pain require surgery. A systematic approach should be adopted to diagnose the underlying cause and to identify those patients with serious pathology who require surgical treatment or urgent non-surgical treatment. Potential spinal causes of back pain include developmental causes, trauma, degeneration, inflammation, infection, and tumour. Back pain can also be caused by non-spinal conditions. Sciatica is caused by lesions affecting the components of the sciatic nerve and should be distinguished from referred pain in the lower limb; the neurological compromise may occur either within the spinal canal or outside it. The treatment plan is dependent on the cause of the sciatic symptoms. Cauda equina syndrome constitutes a surgical emergency and the early diagnosis of this condition is paramount to a successful outcome.
Malignant and metastatic bone disease
Authors: Cattermole Helen 
Published: August 2016

Abstract
Cancer involving bone is a common presentation to the orthopaedic team, and requires a structured team approach with careful preoperative and perioperative care. Metastatic or secondary cancer is the most common malignant disease involving bone, but haematological cancers involving the bone marrow can also present challenges to the surgical team. This article describes the investigation, decision and treatment options for metastatic bone disease. Primary bone cancer is rare and requires a specialist team approach to maximize survival and minimize complications. The management of primary bone cancer is summarized here.
Benign and malignant lesions of the head and neck
Authors: Ramakrishnan Yujay , Hawthorne Maurice 
Published: August 2016

Abstract
Head and neck cancer is an interesting field, not only due its diverse pathology, but also because there is a myriad of treatment options aided by recent technologic advances (e.g. trans-oral lasers, robotic surgery, intensity modulated radiation treatment). Improved understanding of the biology of tumours on a molecular level has also added a new dimension to treatment through biological agents. To a novice, this area can be bewildering and complex, but underpinning the management of any lesion are certain key basic principles. Initial adequate assessment of the tumour and the patient are fundamental. The treatment options depend on a number of factors related to the tumour, patient and clinical expertise. The chapter describes the major head and neck cancer malignancies. National guidelines are discussed in the clinical context to convey the salient points to the reader. As a prelude, a summary of the clinical assessment is presented.
Neuro-oncology
Authors: Sabin Ian 
Published: August 2016

Abstract
This chapter summarizes the modes of presentation of intracranial and spinal lesions with reference to some of the less rare tumours. The principles of oncology surgery, en-bloc resection of tumour with clearance of the margins, does not apply to the central nervous system where attempts are made to reduce significant deficits from damage to neural tissue by central debulking of tumours, and if appropriate, by subtotal resection. Histologically benign tumours do not necessarily behave in a clinically benign fashion, and their location within the brain and spine is crucial. A diffusely infiltrating lesion in the optic nerve or brainstem may be slowly growing but can have devastating effects in terms of progressive neurological deficits Advances in adjuvant radiotherapy and chemotherapy have, in some cases, reduced the need for radical surgical resection, whereas radiosurgery (five or less fractions of stereotactic radiotherapy) has replaced surgical resection for some benign skull base tumours.
Anaesthetic techniques
Authors: Bryden Daniele , Wilson Stephen 
Published: August 2016

Abstract
The development of anaesthetic techniques has helped to revolutionize surgical practice. Techniques include local anaesthetic infiltration, regional anaesthesia and general anaesthesia. Local anaesthetics can cause life-threatening toxicity and therefore a surgeon who administers these must have a thorough understanding of the agents used. An ability to recognize and manage local anaesthetic toxicity is essential. For more invasive surgical procedures, an anaesthetist is required to provide regional and/or general anaesthesia. Factors that influence the anaesthetic technique used include patient preference, co-morbidities, and medication, as well as the site and duration of the proposed surgery. Although the overall risks of death in hospital from surgery are low (&lt;1%), for many groups of patients and types of surgery these risks are considerably higher. It is important for surgeons to understand the importance of pre-operative assessment, patient risk stratification, and anaesthetic risk if optimal surgical outcomes are to be achieved.
Basic surgical techniques
Authors: Smith David , Young Jamie 
Published: August 2016

Abstract
This chapter aims to introduce the trainee to the fundamental skills necessary to perform surgery. This includes knot tying, different forms of knot (e.g. reef knots, surgeons knot, and slip knot) and their indications, suturing techniques (e.g simple interrupted stitch, horizontal and vertical mattress stitches, continuous suturing and purse strings), the choice of suture material and an introduction to surgical instruments. The need to practice knotting techniques and suturing cannot be emphasized enough. The time spent practising will be rewarded with further experience in theatre for the adept. It is important to be familiar with the instruments and sutures in the hospital where you are working, as these can vary greatly.
Surgical haemostasis
Authors: Qureshi Yassar A. , Tai Nigel R. M. 
Published: August 2016

Abstract
It is crucial to minimize blood loss intraoperatively to maintain the patient’s physiology and to enable the surgeon to preserve a clear operative field. A degree of haemorrhage is a normal part of most surgical interventions. Managing unanticipated or uncontrolled bleeding is a vital skill for a surgeon to acquire, so that haemostatic manoeuvres become second nature. Primary bleeding may arise during an operation or as a consequence of non-iatrogenic traumatic injury. Bleeding following surgery is classified as reactionary (up to 48 hours) or secondary (days after). The threshold for suspecting bleeding as a cause of a surgical patient’s postoperative deterioration should be low. A thorough understanding of the principles underlying all methods of haemostasis, in conjunction with other facets of operative surgery, should enable a surgeon to be better equipped to manage all eventualities from minor bleed to a major haemorrhage.
Principles of surgical endoscopy and minimal access surgery
Authors: Schwab Katie , Singh-Ranger Deepak , Rockall Timothy 
Published: August 2016

Abstract
Endoscopic examination of body cavities dates back many centuries but it is only in the last few decades that minimal access surgery (MAS) has made a real impact on surgical technique and has revolutionized modern surgery. Almost every surgical specialty now utilizes a form of endoscopy, such as arthroscopy in orthopaedics and laparoscopy in general and gynaecological surgery. Technological advances and development of surgical techniques have allowed even the most complex abdominal surgery to be accomplished laparoscopically. The benefits are reduced trauma to the patient, improved recovery and reduced complications. MAS does, however, pose technical challenges for surgeons, which often results in a longer procedure time and an extended learning process. Recent advances in technology such as robotics, 3D-vision systems and energy devices, have expanded the procedures amenable to MAS techniques.
Physical examination of body systems
Authors: Woodley Caroline , Reed Malcolm W. R. 
Published: August 2016

Abstract
Information sharing is an important aspect of medicine, and surgeons share information with many people, including patients, relatives, other members of the medical team and members of the wider healthcare team. Poor information sharing is one of the most common causes of patient complaints about the NHS. In this chapter we will consider how to share information effectively so that the patient understands their diagnosis and treatment plan and has realistic expectations regarding the plan. We will also consider how to share accurate information with colleagues in an efficient manner in specific situations and also how to generally enhance team working. The final section covers written communication, which takes many forms within medicine, including referral letters, emails, entries in patient’s notes and increasingly, the use of social media.
Intraoperative care
Authors: Cressey David M. 
Published: August 2016

Abstract
Any surgical procedure performed will carry a number of definable risks. Some risks are generic and these may be dependent or independent of the type of anaesthetic used. Many can be minimized or even removed by following standard operating procedures. Several nationally recognized policies, some from the National Institute of Health and Care Excellence, exist to guide practice in operating theatres. From ensuring the right patient receives the right operation using all the appropriate equipment (the World Health Organization checklist), to simple measures such as ensuring thermoregulation and patient dignity are maintained, there are many strategies that can and should be employed to enhance intra-operative care.
Postoperative care
Authors: Mills Gary H. , Groves Jeremy 
Published: August 2016

Abstract
If a surgical intervention is to be successful the patient must have meticulous postoperative care, starting as soon as the patient leaves theatre, and following them through to full recovery. Such care needs to be individually tailored to the surgical procedure and the physiological state of the patient. In this chapter we will cover the essence of postoperative care delivered in the hospital environment starting with the recovery area (post anaesthesia care unit [PACU]). Day case (ambulatory) and inpatient surgery will also be considered. Detection of the deteriorating patient and higher levels of care are discussed and the chapter concludes with a discussion of acute pain management.
Assessment of the multiply injured patient
Authors: Middleton Scott , Moran Matthew 
Published: August 2016

Abstract
Rapid and effective evaluation and treatment of the traumatized patient proceeds with an ABCDE approach. Injuries are identified and treated in the order in which they would kill a patient. When multiple casualties present in rapid succession, treatment must be prioritized to those most in need and this is done through the organized process of triage. Shock is commonly encountered in the traumatized patient and the rapid yet balanced treatment of shock is the key to the successful treatment in many patients. Minimizing the effect of the ‘second hit’ on a patient reduces the adverse affects of the body’s response to trauma and the downward spiral to multiorgan failure and adult respiratory distress syndrome.
Assessment and management of patients with major trauma, and major and multiple skeletal injuries
Authors: Keating John 
Published: August 2016

Abstract
Injury to the skeletal system is common and well-established algorithms should be followed to provide optimal care. Classification systems aid in the understanding of complex injuries and facilitate research and audit. Severe trauma results in profound pathophysiologic effects, which must be appreciated in order to institute appropriate early care and minimize the risk of complications. Careful assessment in the primary and secondary survey provides essential information about the nature and distribution of skeletal injuries, which can then be used to develop a tailored management plan. Early stabilization of fractures remains a cornerstone of treatment for most patients. In patients with severe multiple injuries associated with coagulopathy, acidosis, and hypothermia, early definitive stabilization for all fractures may increase the complication rate and a staged approach to fracture stabilization may be preferable in these patients. The key determinant of outcome is the time to definitive care, which influences early mortality and functional outcome.
Common paediatric surgical conditions
Authors: Morecroft James A. , Craigie Ross J. 
Published: August 2016

Abstract
Pyloric stenosis is common in infancy and, with greater awareness, often presents early without the profound metabolic disturbance and emaciation seen in older textbooks. Inguinal hernia is common (2% boys undergo herniotomy). Incarceration is inversely related to age as is the urgency of operation. Undescended testis is less common with 1% boys undergoing orchidopexy. Testicular descent continues in early postnatal life and it is now recommended to place the testis in the scrotum by the age of 1 year to preserve function. Physiological phimosis is a normal condition when the foreskin does not retract and balloons on micturition; circumcision is rarely required before 6 years of age. Separation of the foreskin from the glans normally begins distally; if proximal separation occurs sebaceous material accumulates in the coronal sulcus forming a preputial pearl. Midline abdominal wall hernias rarely cause problems and often resolve spontaneously.
Principles of transplant immunology and immunosuppressive therapy
Authors: Bolton Eleanor M. , Bradley J. Andrew 
Published: August 2016

Abstract
Transplantation of an organ or tissue between individuals stimulates a powerful cell-mediated and humoral immune response that in the absence of immunosuppressive therapy leads to graft failure from acute rejection. ABO blood group compatibility is important in clinical transplantation because anti-ABO blood group antibodies cause hyperacute rejection. In ABO-compatible grafts, the graft rejection response is directed principally against human leukocyte antigens. In kidney and pancreas transplantation attempts are made to avoid transplanting poorly matched grafts that might have poorer survival and cause sensitization, making repeat transplantation difficult. This is not practical in liver transplantation, but graft rejection is less of a problem. All recipients require immunosuppressive therapy, which is usually very effective at preventing acute graft rejection although many grafts fail in the longer term because of chronic graft rejection. Immunosuppression increases the risk of opportunistic infection, particularly viral infection, and increases the risk of malignancy, particularly non-melanoma skin cancer and lymphoma.
Kidney transplantation
Authors: Bradley J. Andrew , Nicholson Michael 
Published: August 2016

Abstract
Patients with end-stage kidney disease require either dialysis or kidney transplantation, if they are to survive. The former requires creation of vascular access to enable haemodialysis or insertion of a peritoneal catheter for peritoneal dialysis. Kidney transplantation offers selected patients with end-stage-renal-failure (ESRF) a survival advantage and improved quality of life compared to dialysis. Many patients with ESRF are frail and elderly with major co-morbidity that precludes transplantation. Careful assessment of suitability for transplantation is important, particularly with respect to cardiovascular disease, malignancy and infection. There is a twofold to threefold shortage of donor kidneys and patients listed for deceased donor kidney transplant wait an average of 3 years. Deceased donor kidneys are allocated through a points-based national allocation scheme that favours HLA matching and recipients who have waited longest. Living donor transplants (genetically related and unrelated) comprise over a third of UK transplants and offer the best chance of long-term rehabilitation. Potential live donors require extensive evaluation to confirm their medical suitability to donate. Nephrectomy is undertaken laparoscopically and has a 5% major per-operative complication rate. At the time of renal transplant, careful attention to pre-operative care and early post-operative management is important for maximising success. The early results of transplantation are very good, but in the longer term chronic allograft nephropathy commonly accounts for graft failure. The half-life of a kidney transplant is around 15 years. Results are less good for recipients of kidneys from expanded criteria donors and best for recipients of living donor kidneys.
Research in surgery
Authors: Montgomery Alan A. , Blazeby Jane M. 
Published: August 2016

Abstract
The high-quality evaluation of standard and innovative surgical interventions is an essential element of surgical practice. Evaluation requires well-designed and well-conducted studies to produce evidence that informs health policy and clinical decision-making. This chapter describes methods for study design and conduct and provides general advice for planning and undertaking high-quality surgical research. The key features for planning and designing trials in surgery are described, including eligibility criteria, internal and external validity, outcome selection and measurement, sample size estimation, types of bias and, methods for data analyses. Trial conduct is discussed, including methods for obtaining informed consent for research participation, randomization, blinding, and how to avoid protocol deviations and optimise retention. The CONSORT Guidance for reporting RCTs is presented. The chapter also underlines the importance of multidisciplinary research teams with surgeons, statisticians, clinicians, health economists, and methodologists working together to design and conduct high-quality research.
Quality improvement
Authors: Bethune Rob , Blazeby Jane M. 
Published: August 2016

Abstract
Healthcare is changing. No longer can doctors and surgeons purely focus on the acquisition of technical skills and clinical knowledge. They must start to appreciate the wider context in which they work and improve the systems within which they are an integral component. To do this, it is necessary to understand and apply quality improvement techniques such as the model for improvement. The chasm between the best possible healthcare and the care delivered in the National Health Service (NHS) is enormous. Up to a fifth of patients admitted to surgical wards experience an adverse event. Systems have and are being developed (for example the Surgical Safety Checklist) to improve quality of care. The relatively new science of human factors will help train the next generation of surgeons to be fully equipped to address these challenges.
Information sharing
Authors: Marshall Michelle 
Published: August 2016

Abstract
Information sharing is an important aspect of medicine, and surgeons share information with many people, including patients, relatives, other members of the medical team and members of the wider healthcare team. Poor information sharing is one of the most common causes of patient complaints about the NHS. In this chapter we will consider how to share information effectively so that the patient understands their diagnosis and treatment plan and has realistic expectations regarding the plan. We will also consider how to share accurate information with colleagues in an efficient manner in specific situations and also how to generally enhance team working. The final section covers written communication, which takes many forms within medicine, including referral letters, emails, entries in patient’s notes and increasingly, the use of social media.
Surgical consent
Authors: Lonsdale Robbie 
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.