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Recent Advances in Surgery 36
Colin D Johnson, Irving Taylor
CHAPTER 1:
Recent Advances in Perioperative Fluid Therapy
INTRODUCTION
A POTENTIAL PROBLEM
THE CONCEPT OF A STATE OF ZERO FLUID BALANCE
BALANCED CRYSTALLOIDS VERSUS 0.9% SALINE
COLLOIDS VERSUS CRYSTALLOIDS
INTRAOPERATIVE FLOW-DIRECTED FLUID THERAPY
THE FUTURE
CHAPTER 2:
Local Anaesthetics in Surgical Practice
INTRODUCTION
PHARMACOLOGICAL ADVANCES
Ropivacaine
Levobupivacaine
Short-Acting Local Anaesthetics for Spinal Anaesthesia
Heavy Prilocaine
2-Chloroprocaine
Lipid Emulsion for Toxicity
THE FUTURE
Liposomes
Microspheres
Implant
DELIVERY
REGIONAL ANAESTHESIA
Ultrasonography
Catheters and Elastomeric Pumps
LOCAL ANAESTHETIC FOR LAPAROSCOPIC SURGERY
SUMMARY
CHAPTER 3:
Safer Surgery
INTRODUCTION
What Do We Mean by “Safer Surgery”?
How Safe is Surgery?
Effect of Harm
Why do Patients Suffer Avoidable Harm?
Patients Themselves
Disease Management is Complex
Healthcare Professionals
Healthcare System
Barriers to Harm
How Can Surgery be Made Safer?
Right Surgeon, Right Place, Right Time
Standardisation of Processes
Communication
Learning from Incidents
IMPLEMENTATION OF SAFER SURGERY INITIATIVES
CHAPTER 4:
Definitions of Severity in Acute Pancreatitis
INTRODUCTION
PREDICTION OF SEVERITY
REVISED DEFINITIONS IN ACUTE PANCREATITIS
PERSISTENT ORGAN FAILURE
MORPHOLOGY OF LOCAL COMPLICATIONS
ACUTE FLUID COLLECTION
PANCREATIC AND PERIPANCREATIC NECROSIS
SYSTEMIC COMPLICATIONS
GRADES OF SEVERITY
SEVERE ACUTE PANCREATITIS
CONCLUSION
CHAPTER 5:
Enhanced Recovery Programmes in Hepatobiliary and Pancreatic Surgery
INTRODUCTION
ENHANCED RECOVERY EXPERIENCE IN COLORECTAL SURGERY
PUBLISHED EVIDENCE FOR ERP
Laparoscopic Resections and ERP
PREOPERATIVE ERP MEASURES
Preoperative Optimisation
Preoperative Nutrition
Preoperative Biliary Drainage
INTRAOPERATIVE ERP MEASURES
Blood Loss
Goal-Directed Fluid Therapy
POSTOPERATIVE ERP MEASURES
Nutrition and Return of Gut Function
Postoperative Analgesia
Drains
Nasogastric Tubes and Urinary Catheter Removal
Postoperative Medications
Early Mobilisation
Discharge Criteria
REDUCTION IN POSTOPERATIVE LENGTH OF STAY
AUDIT AND SUITABILITY FOR CLINICAL STUDY
CONCLUSION
CHAPTER 6:
Management of Hepatocellular Carcinoma
INTRODUCTION
INVESTIGATIONS
SURVEILLANCE
IMAGING
ALPHA FETO PROTEIN
ASSESSMENT OF LIVER FUNCTION
STAGING
TREATMENT
Resection
Liver Transplantation
Ablation
Transcatheter Therapies
Transarterial Chemoembolisation
Radioembolisation
Systemic Treatment
FUTURE DIRECTIONS
CHAPTER 7:
Indications for and Management of the Open Abdomen
BACKGROUND
INDICATIONS FOR OPEN ABDOMEN MANAGEMENT
Damage Control Surgery
Management of Severe Abdominal Sepsis
Abdominal Hypertension and Compartment Syndrome
MANAGEMENT OF THE PATIENT WITH AN OPEN ABDOMEN
Principles of Critical Care
Analgesia
Nutrition
Wound Management
COMPLICATIONS OF OPEN ABDOMINAL MANAGEMENT
Infection
Bleeding
Fistulation
CLOSURE OF THE OPEN ABDOMEN
CHAPTER 8:
Pseudomyxoma Peritonei
INTRODUCTION
Origin of Pseudomyxoma Peritonei
CLINICAL PRESENTATION
PATHOLOGICAL FEATURES AND TUMOUR BEHAVIOUR
PATHOPHYSIOLOGY OF PSEUDOMYXOMA PERITONEI
The Redistribution Phenomenon
Visceral Sparing by Peristaltic Activity
Tumour Cell Entrapment
SURGICAL MANAGEMENT OF PSEUDOMYXOMA PERITONEI
The Concept of Complete CRS and Peritonectomy Procedures
Incomplete CRS: Maximal Tumour Removal
HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
SELECTION OF PATIENTS FOR SURGICAL INTERVENTION
PERITONEAL CARCINOMATOSIS INDEX
IMAGING
SERUM TUMOUR MARKERS
COMPLICATIONS OF PSEUDOMYXOMA PERITONEI SURGERY
OUTCOME
Early- and Long-Term Outcome
Quality of Life
FOLLOW UP AFTER TREATMENT
CHAPTER 9:
Intestinal Failure
INTRODUCTION
EPIDEMIOLOGY AND AETIOLOGY OF INTESTINAL FAILURE
TYPE 2 INTESTINAL FAILURE: MANAGEMENT OF THE ACUTE INTESTINAL CATASTROPHE
Sepsis
Nutrition
Resuscitation, Fluid balance and Electrolytes
Reduce Fistula/Stoma Output
Mode of Nutrition
Anatomy
Planned Procedure
Recent Advances in the Closure of the Enteroatmospheric Fistulae
Component Separation Technique
Prosthetic and Biological Meshes
Complex Fascial Flaps
TYPE 3 INTESTINAL FAILURE
Recent Advances in the Management of Type 3 Intestinal Failure
Medical Options
Surgical Options
CHAPTER 10:
Advances in Surgery: Locally Recurrent Rectal Cancer
INTRODUCTION
PRESENTATION
STAGING
CLASSIFICATION
MANAGEMENT STRATEGY
SURGERY
Conventional Resection of LRRC
High Sacrectomy
Pelvic Sidewall Involvement
Extension Through the Greater Sciatic Notch
Vascular Involvement
Multimodal Treatments
Re-Recurrent Disease: A Paradigm Shift
CONCLUSION
CHAPTER 11:
Management of Maxillofacial Trauma
IMMEDIATE MANAGEMENT
Airway Management
Cervical Spine
Haemorrhage Control
Ophthalmic Assessment
Retrobulbar Haemorrhage
Traumatic Optic Neuropathy
Secondary Survey
PRIMARY RECONSTRUCTION
Timing of Treatment
Soft Tissue Injuries
Hard Tissue Injuries
General Considerations
Investigation and Planning
Lower Face
Dento-Alveolar Injuries
Mandibular Fractures
Symphyseal, Body and Angle Fractures
Condylar Fractures
Mid-Face Fractures
Nasoethmoid Fractures
Zygomatic Complex Fractures
Mid-Face Fractures
Upper Face
SECONDARY RECONSTRUCTION
CHAPTER 12:
Outcomes Following Lower Limb Angioplasty
INTRODUCTION
HISTORY OF ANGIOPLASTY
THE BASICS OF ANGIOPLASTY
Indications
The Procedure
Complications
Failure of Angioplasty
Patient Characteristics
Lesion Characteristics
TASC CLASSIFICATIONS AND LITERATURE LIMITATIONS
Disease Classification and TASC Guidelines
Limitations of the Literature
ANGIOPLASTY FOR SITE-SPECIFIC DISEASE
Aorto-Iliac Disease
Infrainguinal Disease
Crural Disease
CONCLUSION
CHAPTER 13:
Breast Surgery after Neoadjuvant Chemotherapy
INTRODUCTION
INDICATIONS FOR NEOADJUVANT CHEMOTHERAPY
SURGERY AFTER NEOADJUVANT CHEMOTHERAPY
SURGERY ON THE AXILLA
CONCLUSION
CHAPTER 14:
Personalised Cancer Surgery
INTRODUCTION
PATIENT FACTORS
Health and Fitness
Genetic Risk Factors for Disease
Patient Metaboliser Status (Metabolomics)
TUMOUR FACTORS
Tumour Stage and Anatomic Extent
Tumour Phenotype and Proteomics
Tumour Morphology
Single Protein Expression
Tumour Genomics
Single Gene Assays
Multigene Arrays
Microarrays for Estimating Recurrence Risk
Gene Sequencing
Circos Plots
Epigenetics
MOLECULARLY TARGETED THERAPIES IN PERSONALISED MEDICINE
Small Molecule Therapies
Monoclonal Antibodies
Cancer Vaccines
SUMMARY
CHAPTER 15:
Randomised Controlled Trials and Meta-analyses in Surgery
INTRODUCTION
GENERAL
LAPAROSCOPIC SURGERY
HEPATO-PANCREATIC-BILIARY SURGERY
UPPER GASTROINTESTINAL SURGERY
LOWER GASTROINTESTINAL SURGERY
ENDOCRINE
BREAST
BARIATRIC SURGERY
INDEX
TOC
Index
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