SRB’s Surgery for Dental Students Sriram Bhat M
INDEX
Page numbers followed by “f” or “t” indicate figure or table respectively
A
Abdominal compartment syndrome 226
Abdominal esophagus 392
Abdominal trauma 223224
Achalasia cardia
clinical features 395
etiology 394
investigations 395
treatment 395
Achondroplasia 416
Acid-base balance 191192
acidosis
metabolic 192
respiratory 192
alkalosis
metabolic 191192
respiratory 192
Acidosis
metabolic 192
respiratory 192
Acinic cell tumor
Acrocyanosis 84
Actinomyces israelii 4546
Actinomycosis 4546
clinical features 4546
clinical types 45
differential diagnosis 46
investigation of 46
pathogenesis 45
sulfur granules in 45
treatment 46
Acute arterial occlusion 99100
Acute osteomyelitis 412
Acute pharyngitis 371
Acute pyomyositis 52
Acute suppurative tenosynovitis
complications 213214
surgical anatomy 213
treatment 213
Adenoid cystic carcinoma 319
Adenolymphoma 317, 317f
Adrenal glands 302304
Adventitious bursa 74
Aggressive fibromatosis 72
Ainhum 111, 111f
Alkalosis
metabolic 191192
respiratory 192
Allis tissue holding forceps 466
Allograft 177. See also Grafts
Alveolar abscess 382
Ameloblastoma 379380
Anaphylactic shock 150, 152153
Anaplastic carcinoma 291, 291f
Aneurysm
intracranial 452
needle 476
Ankylosing spondylitis 419
Anesthesia
caudal 497
complications in 494
instruments in 493
preoperative assessment 491492
regional 495
spinal 496497
steps in 494
volatile 492
Aneurysms 103107
abdominal 104106
classification 105
complications of 106f
infrarenal, repairing of 105f
management of 105
carotid artery 107108, 108f
cirsoid 114
clinical features of 104
differential diagnosis of 104
dissecting 106107, 107f
clinical features of 107
complications of 107
DeBakey's classification 107
features of 107
hypertension and 106
investigation of 107
treatment of 107
false 103f, 104
fusiform 104f
investigations of 104
peripheral 106
popliteal 106
radial artery 106f
saccular 104f
sites of 104
treatment of 104
true 103, 103f
Anion gap 193
Ankle-brachial pressure index 91
Anthrax 4950
diagnosis 49
treatment 50
types 49
Anticoagulants 131133
heparin 131132
complications of 132
dosage of 132
indications for 131
low molecular weight 132
vs. oral anticoagulants 133t
oral 132133
indication of 132
side effects of 132133
types of 132
vs. heparin 133t
Antimalignancy drugs 461
Antisepsis 479
‘Apoplectic cyst’ 65
ARS. See Horse antirabies serum (ARS)
Arterial diseases 8793. See also Specific arterial diseases
arterial/venous grafts in 97, 97f
atherectomy in 96
atherosclerosis 9394
evaluation of 94
features of 94
management of 94
pathogenesis of 9394
risk factors 93
bypass graft 97f
aortofemoral 97f
femoropopliteal 98f
chemical sympathectomy in 98
critical limb ischemia 8891
Adson's test (scalene maneuver) in 90
Allen's test 90
Buerger's postural test for 90
costoclavicular compression maneuver 90
delayed capillary filling 89
delayed venous refilling 89
disappearing pulse syndrome 90
dry gangrene 88
elevated arm stress test for 90
features of 8990, 89f
gangrene 88
hyperabduction maneuver (Halsted test) 90
line of demarcation in 89, 89f
palpation of blood vessels in 9091
paresthesia 89
pregangrene 88
sensation in 89
systolic bruit 90
wet gangrene 89
endarterectomy in 96
intermittent claudication 8788
Boyd's classification of 88
Leriche's syndrome 88
site of pain 8788
intraluminal stent for 96
investigations for 9193
abdomen ultrasound 93
angiography 9192, 92f
ankle-brachial pressure index 91
lumbar sympathectomy in 9798
omentoplasty 9899
complications of 99
indications for 9899
for lower limb 99f
procedure of 99
profundaplasty in 96, 96f
rest pain 88, 88f
saphenous vein graft in
reverse 96
in situ 96
thrombectomy in 96
thromboangiitis obliterans 9495, 9496
with large ischemic ulcers 94f
pathogenesis 95
treatment of 9596
transluminal balloon angioplasty in 96
treatment of 9699
medical 96
surgical 9699
upper limb ischemia. See Upper limb ischemia
Arterial/ischemic ulcers 15f, 22, 22f
Arteries
of lower limb 87
of upper limb 7677
Arteriovenous fistula (AVF) 114117, 116f
acquired 115f, 116117
investigation of 116
pathophysiology of 116
therapeutic 116
traumatic 116
treatment of 116117
congenital 114115, 115f
clinical features of 114115
complications of 115
investigation of 115
sites of 114
treatment of 115
in cranial cavity 115f
grafting of 116f
hypertrophic changes in 115f
quadruple ligation of 117f
Artery forceps (Hemostat) 466
Arthritis 417
Arthrodesis 410
Arthroplasty, types 411412
Artificial blood 166
Atherosclerosis 9394
evaluation of 94
features of 94
management of 94
pathogenesis of 9394
risk factors 93
Autograft 177
AVF. See Arteriovenous fistula (AVF)
Axial pattern flaps 180
Axillary nerve injury 205
Axonotmesis 197
B
Babcock's forceps 467
Bacillus anthracis 49
Bacteremia 38
Bake's dilator 470
Basal cell carcinoma 24f, 246247, 246f247f
Basal cell papilloma 63
Basedow's disease 281
Bazin's ulcer 15
Bilateral cleft lip 373
Blood clotting factors 159160
Blood coagulation, mechanism of 158160
blood clotting factors 159160
coagulation cascade system 159
hemophilia A and 160
hemophilia B and 160
platelet adhesion 158
platelet aggregation 158
von Willebrand's disease and 160
Blood fractions 164165
Blood substitutes 165166
Blood transfusion 163164
autologous 166
blood collection 164
complications of 164165
donor criteria 164
indications for 163
massive 165
Boerhaave's syndrome 400
Boil 3536
complications of 36
of hair follicle with perifolliculitis 36f
treatment of 35
Bone
anatomy of 404
Paget's disease 414
tumors 420
types 404405
Bone marrow transplantation 187
Bowen's disease 243
Brachial plexus injuries
investigation of 200
treatment of 200
types of 199200
Brachytherapy 236, 459
Branchial cyst 255, 255f
Branchial fistula 255
Bulbar tetanus 40
Burkitt's lymphoma 146147
investigation of 146147
sites of 146
treatment of 147
types of 146t
Burns 167176
biobrane for 172
burns contracture 173174
complications of 173
in elbow 173f
hypertrophic burn scar with 173f
management of, problems in 173174
Marjolin's ulcer and 173
prevention of development of 173
treatment for 173
chemical 175176
acid burns 175
alkali burns 175
external 176
treatment of 176
classification of 167169
percentage of burns, based on 167168, 168f
thickness of skin involved, based on 68169
clinical features of 169, 169f
death in 171
effects of 170
electrical 174175
fractures and dislocations in 174
gas gangrene in 174
mafenide acetate for 175
mannitol for 175
wound of entry in 174f, 175f
eschar 172173
first degree 168, 168f
inhalation 175
integra for 172
major 167
management of 171172
definitive treatment 171
dressing of wounds 172
first aid 171
fluid resuscitation 171
local 171172
mild 167
moderate 167
opsite for 172
pathophysiology of 169170
rule of nine 167, 168f
second degree 168169, 169f
sepsis in 170
third degree 169
transcyte for 172
treatment of 172
types of 167
Burns contracture 173174
complications of 173
in elbow 173f
hypertrophic burn scar with 173f
management of, problems in 173174
Marjolin's ulcer and 173
prevention of development of 173
treatment for 173
Bursa anserina 74
Bursae 7374
adventitious 74, 74f
anatomical 7374, 73f
bursa anserina 74
infrapatellar 73f
near elbow joint 73f
prepatellar 73f
psoas bursa 73
retrocalcaneum bursitis 74
semimembranosus 74
C
Café au lait spots 71f
Caisson's disease 103
Calcinosis cutis 75, 75f
Callous ulcer 14, 14f15f
Capillary hemangioma 112113
associated syndromes 112113
port-wine stain 112
salmon patch 112
in infant 112f
strawberry hemangioma 112
treatment of 112
types 112
Carbuncle 3637, 36f
complications of 36
investigation of 36
treatment of 3637
Carcinomatous ulcers 2223
Cardiac arrest 156158
cardiac massage
external 157, 157f
internal open 158, 158f
critical period 157158
defibrillation technique in 158, 158f
features of 157
immediate measures in 157
mouth-to-mouth respiration 157f
sequelae of 158
Cardiogenic shock 149150, 154
Carotid artery aneurysm 107108, 108f
Carpal tunnel 201
Carpal tunnel syndrome 201
Cat scratch fever 142
Causalgia 200
Cavernous hemangioma 113114
clinical features of 113
complications of 113
investigations of 113
of knee 113f
sites of 113
of tongue 113f
treatment of 114
Cellulitis 2729
causative agents of 27
clinical features 28
complications 29
of face 28f
investigation of 28
Ludwig's angina 28, 29f
management of 28
orbital 28
sequelae 27
treatment of 29
vs. pyogenic abscess 31t
Central venous pressure (CVP) 154155
angle of Louis and 154
complications of 154
for monitoring patient 155f
vs. pulmonary capillary wedge pressure 156t
Cephalic tetanus 40
Cervical lymphadenopathy 141f
acute suppurative lymphadenitis 141
cat scratch fever 142
chronic nonspecific lymphadenitis 141
differential diagnosis for 140142
infectious mononucleosis 141
lymphomas 142
secondaries in lymph nodes in 142
toxoplasmosis 141
tuberculous lymphadenitis 141
Cervical rib 8183
anatomy of 82f
clinical features of 8182
definition of 81
differential diagnosis of 82
investigations of 82
pathology of 81, 82f
treatment of 8283
types of 81
Cervicoaxillary canal 76
Chemical burns 175176
acid burns 175
alkali burns 175
external 176
treatment of 176
Chordoma 75
Cimino fistula 187
Cirsoid aneurysm 114
Claudication, intermittent 8788
Boyd's classification of 88
Leriche's syndrome 88
site of pain 8788
Claw hand 202203
clinical features of 203
investigation of 203
MCP joint 202
median 203
treatment of 203
ulnar 203, 203f
Clean contaminated wound 4, 4f
Clean wound 34, 4f
Cleft lip and cleft palate
diseases of 375
treatment for 375
Clergyman's knee 73f
Clostridium histolyticus 41
Clostridium oedematiens 41
Clostridium septicum 41
Clostridium tetani 39, 40
Clostridium welchii 41
Coagulation cascade system 159
Cock‘s peculiar tumor 68
Cold abscess 3335
differential diagnosis 35
features of 34
in HIV patient 54f
investigation of 3435
in neck 147f
sequelae of 35
sites of origin 34
treatment 35
tuberculous 35f
vs. pyogenic abscess 35t
Common peroneal nerve 204205
Compartment syndrome 7, 100
fasciotomy done for 7f
Compound palmar ganglion
clinical features 215
investigations 215
pathology 215
treatment 215
Contaminated wound 4, 4f
Cortisol ulcers 15
Costoclavicular space 76
Covert compensated hypovolemia 152
Creatine phosphokinase 52
Critical limb ischemia 8891
Adson's test (scalene maneuver) in 90
Allen's test 90
Buerger's postural test for 90
costoclavicular compression maneuver 90
delayed capillary filling 89
delayed venous refilling 89
disappearing pulse syndrome 90
dry gangrene 88
elevated arm stress test for 90
features of 8990, 89f
gangrene 88
hyperabduction maneuver (Halsted test) 90
line of demarcation in 89, 89f
palpation of blood vessels in 9091
paresthesia 89
pregangrene 88
sensation in 89
systolic bruit 90
wet gangrene 89
Cross leg flap 184, 184f
Crush syndrome
effects of 7
of finger 8f
treatment of 8
Cryoprecipitate 164
Cutaneous flap 180
CVP. See Central venous pressure (CVP)
Cyclosporin-A 186
Cryosurgery
advantages 485
disadvantages 485
indications 485
mode of action 485
Cysts 6465
apoplectic 65
classification of 65t
clinical features of 65
effects of 65
false 6465
sebaceous 6768
true 64
D
Day care surgery
advantages 485
precautions 485
Decompensated hypovolemia 152
Decompression disease 103
Decubitus ulcers 1920, 19f
predisposing factors in 20
sites of 19
treatment of 20
Deep vein thrombosis (DVT) 119121. See also Embolism
axillary vein thrombosis and 120
clinical features of 120
effects of 121t
etiology of 119
investigation of 120
phlegmasia alba dolens 120
phlegmasia cerulea dolens 120
postoperative thrombosis and 120
prevention of 121
sequelae of 121t
sites of 120
spontaneous thrombosis and 120
treatment of 121
Deep palmar space infection
causes 212213
surgical anatomy 212
treatment 213
Degloving injury, of thigh and leg 6f
Deltopectoral flaps 182, 182f
Demodex folliculorum 67
Dercum‘s disease 61
Dermatofibroma 241, 241f
Dermatofibrosarcoma protuberance 241242
Dermoids 6567
angular 66, 66f
implantation 6667
clinical features of 66
differential diagnosis of 66
of foot 67f
of hand 67f
postauricular 66f
sequestration 6566
clinical features of 66
common sites for 65
differential diagnosis of 66
investigation of 66
treatment of 66
teratomatous 67
tubulodermoids 66
Desmoid tumor 72
DEV. See Duck embryo vaccine (DEV)
Dextrans 165166
Diabetic foot 110111, 110f
clinical features of 111
investigation of 111
Meggitt's classification of 110t
pathogenesis of 110
problems in 110
treatment of 111
Diabetic ulcers 2021, 20f
investigation of 21
sites of 2021
treatment of 21, 21f
Diathermy
types 483
uses 483484, 483f
Differentiated thyroid carcinoma (DTC) 288
Dirty infected wound 4, 4f
Disappearing pulse syndrome 90
Drains
advantages of 472
classification of 472
types 471
Duck embryo vaccine (DEV) 48
Dupuytren's contracture
complications 216
etiology 215216
treatment 216, 216f
Dyshormonogenesis 276
Dysplasia 228
E
Electrical burns 174175
fractures and dislocations in 174
gas gangrene in 174
mafenide acetate for 175
mannitol for 175
wound of entry in 174f, 175f
Elephantiasis 137f, 138f
Embolism 101103. See also Deep vein thrombosis (DVT)
and acute upper limb ischemia 7778
air 103
arterial 101102
effects of 101
embolectomy for 101, 101f
investigations for 101
treatment of 101102
fat 102103
clinical features of 102
treatment of 102103
saddle embolus 102, 102f
therapeutic embolization 103
types of 101
Epignathus 75, 75f
Erysipelas 30
Erythrocyanosis frigida 15
Erythromelalgia/erythralgia 86
Eschar 172173
circumferential 172173
third degree burn with 172f
Esmarch rubber tourniquet 166, 166f
Esophagus
anatomy 391, 391f
nerve supply
stricture of 398399
types 391392
Esophagoscopy
indications 393
types 394
Exotoxins 41
F
Face, dangerous area of 30, 30f
Facial nerve palsy 323324
Faciocutaneous flap 180
Fibrinogen 164
Fibroma 7172
hard 72
soft 71
treatment of 72
Fine Needle Aspiration Cytology (FNAC) 231
Fistula 1012, 11f
clinical features 11
discharges in 12
fecal
of abdominal wound 11f
with discharging fecal matter 12f
investigation of 12, 12f
treatment of 12
types of 11t
Flaps 177, 180185
advantages of 181
anatomy of skin 180f
axial pattern 180
blood supply of skin 180f
cross leg 184, 184f
cutaneous 180
deltopectoral 182, 182f
disadvantages of 181
faciocutaneous 180
forehead 181182, 182f
free 181, 184185
groin 183, 183f
indications for 180
muscle 180
myocutaneous 180, 180f
pectoralis major myocutaneous 183184, 184f
radial forearm 185
raising 180f
random pattern 180
saltatory 181
types of 180181
Fluids, electrolyte
acid-base balance 191192
acidosis
metabolic 192
respiratory 192
alkalosis
metabolic 191192
respiratory 192
anion gap 193
hyperkalemia 191
hypernatremia 190
hypokalemia 190191
clinical features 191
gradual 191
sudden 190
treatment 191
hyponatremia 189190
clinical features of 189
hypervolemic 189190
hypovolemic 190
investigation of 190
normovolemic 190
pseudohyponatremia 190
treatment of 190
physiology of 188
water intoxication 188189
water loss 188
Foot drop, with claw toes 204f
Forehead flaps 181182, 182f
Fracture
causes of 405
complications of 407410
types of 405407
Free flaps 184185
Fresh frozen plasma 164
Frey's syndrome 323
Furuncle. See Boil
G
Ganglion 7273
clinical features of 72
common sites of 72
differential diagnosis of 72
pathogenesis 72
transilluminant 72f
treatment of 7273
on wrist 72f
Ganglioneuroma 6970
Gangrene 108110
clinical features 108109
absence of pulse 109
change in color 108
line of demarcation 109
proximal ischemic features 109
definition of 108
diabetic foot and 110111, 110f
clinical features of 111
investigation of 111
Meggitt's classification of 110t
pathogenesis of 110
problems in 110
treatment of 111
dry 109, 109f
gas. See Gas gangrene
investigations of 109
knee amputation in 109110
of toes 89f
treatment of 109110
life-saving procedures 109110
limb-saving methods 109
wet 109
Gas gangrene 4142
clinical features of 42
clinical types of 42
effects of 41
exotoxins in 41
of forearm and hand 42f
investigation of 42
organisms in 41
polyvalent antiserum for 42
treatment of 42
Gastrostomy 194, 194f
Gelatin 166
Gel foam 163f
Glomus tumor 68
Goiter
classification of 277, 278f
diffuse hyperplastic 278
nodular 278
retrosternal 280
Gonorrhea 56
Grafts 177
contracture of 179
mesh 179f
rejection 187
split skin 177179
tendon 207
Wolfe 179180
Granuloma pyogenicum. See Pyogenic granuloma
Gravitational ulcer. See Venous ulcers
Groin glap 183, 183f
H
Hamartomata 111112
definition of 111
pathogenesis of 111
problems with 112
treatment of 112
Hand 208218
infections 209210
injuries 214215
surgical anatomy of 208209
Hand held Doppler 91f
Hansen's disease. See Leprosy
Harvey's sign 89
Hashimoto's thyroiditis 293
HDCV. See Human diploid cell vaccine (HDCV)
Head and Neck
anatomy of lymphatics of 253255
levels of 264f
types of 266267
Head injuries
extradural 447449
mechanism 443445
subdural 449450
Healing ulcers 14, 14f
Heberden's nodes 216
Hemangiosarcoma 238
Hemangioma 112114
capillary 112113
associated syndromes 112113
port-wine stain 112
salmon patch 112, 112f
strawberry hemangioma 112
treatment of 112
types 112
cavernous 113114
clinical features of 113
complications of 113
investigations of 113
of knee 113f
sites of 113
of tongue 113f
treatment of 114
of cheek 114f
classification of 112
of face 113f
strawberry 112
Hematoma
on leg post-trauma 2f
subungual 3f
Hemolysin 41
Hemophilia A 160
Hemophilia B 160
Hemorrhage 160163
acute 161
acute on chronic 161
arterial 160
blood loss, measurement of 161
capillary 160
chronic 161
clinical features of 161
effects of 161
hemorrhagic shock, classification of 161
pathophysiology of 162
primary 160
reactionary 160
secondary 160
treatment of 162163
venous 160
Hibernoma 61
HIV infection/AIDS 5256
anti-HIV antibody 53
antiviral therapy for 55
clinical classification of 53t
cold abscess with discharging sinus in 54f
general features in 54t
GI problems in 54
history of 52
hospital and surgeon in, measures for 5556, 56f
immunotherapy for 55
management of 55
mode of transmission 53
neurological problems in 5455
pathogenesis 5354
prevention of 55
psychotherapy for 55
pulmonary problems in 54
tests for 53
tumors in 54t
universal precautions against 55t
Hodgkin's lymphoma (HL) 142145, 142f
Ann-Arbor clinical staging in 143
clinical features of 143
differential diagnosis of 143
investigation of 144145, 145f
Reed-Sternberg cells in 142143
Rye's classification 142
sites of 143
treatment for 144145
vs. non-Hodgkin's lymphoma 145t
in young boy 143f
Horner's syndrome, ptosis right eye in 83
Horse antirabies serum (ARS) 4849
Hospital acquired infection. See Nosocomial infection
Housemaid's knee 73f
HRIG. See Human rabies immunoglobulin (HRIG)
Human albumin 164
Human diploid cell vaccine (HDCV) 48
Human rabies immunoglobulin (HRIG) 49
Humby's knife 178f
Hunterian chancre 44
Hutchinson's triad 45t
Hyaluronidase 41
Hydrophobia. See Rabies
Hyperbaric oxygen 156
Hyperkalemia 191
Hypernatremia 190
Hyperparathyroidism 300
clinical features 300
investigations 300301
treatment 301
Hyperthyroidism
clinical features 281
signs of 282284
symptoms of 281
types 281
Hypertrophic scar 7, 9
complication of 9
diagrammatic representation of 9f
over thigh 9f
vs. keloid 10
Hypokalemia 190191
clinical features 191
gradual 191
sudden 190
treatment 191
Hyponatremia 189190
clinical features of 189
hypervolemic 189190
hypovolemic 190
investigation of 190
normovolemic 190
pseudohyponatremia 190
treatment of 190
Hypothyroidism 297
Hypovolemic shock 149, 152
I
Incised wound 2
in leg 2f
over eyebrow 2f
Infectious mononucleosis 141
Inhalation burns 175
Injury
blast 223
bullet 222223
colonic 225
duodenal 224
liver 225
neck 222
pancreatic 225
penetrating 223
renal 226
small bowel 225
spinal 222
splenic 226
Internal organs, injury to 3, 3f
Isograft 177
Isotope lymphoscintigraphy 134135
J
Jaw
fibrous dysplasia of 384385
osteomyelitis of 382
tumors 377
Jejunostomy 194195
needle 194f, 195
Witzel 195
K
Kaposi's sarcoma 238239
Kasabach-Merritt syndrome 112
Keloid 7, 89
diagrammatic representation of 9f
in ear 8f
over sternum 9f
in shoulder and arm area 8f
sites of 8f9f, 9
treatment of 9
vs. hypertrophic scar 10
Keratoacanthoma 241
Klebsiella 50
Klippel-Trenauny-Weber syndrome 112
Kuntz nerve 84
L
Lacerated wound 2
in leg 2f
on scalp 2f
Lasers
disadvantage 484
precautions 484
uses 484
Laryngectomy 365f, 366
Laryngocele 257258
Larynx
anatomy of 362f
benign lesions of 360362
carcinoma 365f
surgical anatomy of 358360
view of 363f
Latent tetanus 40
Lecithinase 41
Leiomyosarcoma 238
Lepromatous leprosy 43
Leprosy 4344
investigation of 43
lepromatous 43
Mycobacterium leprae 43
surgical complications in 44
treatment of 43
tuberculoid 43
types 43
Leriche's syndrome 88
Leukoplakia 329
histology 330
incidence 330
types 329
Lipoma 6163
clinical features 62
complications in 62
differential diagnosis 62
over nape of neck 62f
over shoulder region 63f
pedunculated 62f
sites of 6162
treatment of 62, 63f
types of 61
Liposarcoma 63t, 237
Lips 325
carcinoma of 340341, 341f
neoplasm of 340
Livedo reticularis 86
Liver transplantation 186187
Long thoracic nerve 205
Ludwig's angina 28, 29f, 259f
Lupus vulgaris 26
Lymphangiography 134
Lymphangitis 2930, 135, 135f
chronic 30
features of 2930
of leg 30f
management of 30
Lymph cyst 6869
common sites of 69
transilluminant 69f
Lymphedema 30, 135140
Brunner's grading of 138
classification of
Kinmoth 135
lymphangiographic 134
clinical features of 137
complication of 138
differential diagnosis of 138
elephantiasis 137f, 138f
investigation of 138
pathology of 136137
primary 135136
Ram's horn penis 137f
of right leg 137f
secondary 136
sites of 137t
surgery for 139140, 139f
bypass procedure 139
Charle's operation 140, 140f
combined 139
excisional 139
Homan's operation 139
Kondolean's operation 140
nodovenous and lymphovenous shunt in 139f
physiological 139
Sistrunk operation 139
Thompson's operation 139140, 140f
treatment of 138139
Lymphomas 142
Burkitt's 146147
death in 145
Hodgkin's 142145, 142f
mediastinal 144f
non-Hodgkin's 145146
prognostic factors in 145
Lysol 480
M
Madura foot 10, 4647, 46f
clinical features 47
differential diagnosis 47
organisms in 46
pathogenesis 4647
treatment of 47
Maffucci syndrome 113
Malignant edema. See Gas gangrene
Malignant lymphoma of Africa. See Burkitt's lymphoma (NHL)
Malignant mixed tumor (MMT) 319
Malignant salivary tumors, management of 320321
Malignant tumors
etiology 362
spread of 229230
staging 364
treatment 364
types 362364
Mallet finger (Base ballfinger) 216
Marjolin's ulcers 23, 23f
Martorell‘s hypertensive ulcer 15
Median mental sinus 10, 1213, 13f
Median nerve injuries 200201
clinical features of 200201
investigation of 201
treatment of 201
Melanotic ulcers 24, 24f
Meleney's ulcer 2122
MEN syndrome (MEA syndrome) 302
Mercurochrome (Merbromin) 178f
Merkel cell carcinoma 241
Mesh graft 179f
Metabolic acidosis 192
Metabolic alkalosis 191192
Milian's ear sign 30
MODS. See Multiorgan dysfunction syndrome (MODS)
Mononucleosis, infectious 141
Morrant Baker cyst 7475
clinical features 7475
management of 75
treatment of 75
Mucoepidermoid tumor 318, 318f
clinical features 318
types 318
Multiorgan dysfunction syndrome (MODS) 38
Multiple endocrine neoplasia syndrome 61
Muscle flap 180
Muscle necrosis 7
Mycetoma pedis. See Madura foot
Mycobacterium bovis 42
Mycobacterium fortuitum 42
Mycobacterium kansasii 42
Mycobacterium leprae 43
Mycobacterium marinum 42
Mycobacterium tuberculosis 42, 147
Mycobacterium ulcerans 42
Myelinic neuroma 70
Myer's stripper 128f
Myocutaneous flap 180, 180f
N
Necrotizing fasciitis 5152
on chest wall and over sternum 51f
clinical features 52
of leg 51f
management of 52
types of 52
Neoplasm
classification 227
components 227
investigations for 230232
Nerve injuries
axillary 205
median 200201
peripheral 197199
ulnar 202
Neurilemmomas 71
Neurofibromas 7071
complications of 71
elephantiatic neurofibromatosis 71
generalized neurofibromatosis 71
multiple 71f
nodular 70
plexiform 7071, 70f
sites of 70
treatment of 71
Neurogenic shock 150
Neuromas 6970
end 69, 69f
false 69, 69f
lateral 69, 69f
myelinic 70
true 6970
Neuropraxia 197
Neurotmesis 197
Nevus flammeus 112
Nocardia asteroides 46
Nocardia brasiliensis 46
Nocardia madurae 46
Non-Hodgkin's lymphoma (NHL) 145146, 146f
treatment of 146
types of 145
vs. Hodgkin's lymphoma 145t
Nosocomial infection 50
Nutrition 193194
assessment 193
caloric requirement 193
feeding methods 193194
gastrostomy for 194, 194f
jejunostomy for 194195, 194f
nutritional support, indications for 193
obesity 195196
classification of 196
complications of 196
definition of 195196
surgery and 196
treatment for 196
total parenteral 195
O
Obesity 195196
classification of 196
complications of 196
definition of 195196
surgery and 196
treatment for 196
Onychocryptosis
causes 217
clinical features 217218, 218f
treatment 218, 218f
Opportunistic infections 5051
investigation of 51
organisms in 5051
treatment of 51
Orbital cellulitis 28
Osteomyocutaneous flaps 181
Overt compensated hypovolemia 152
Oxidized regenerated cellulose 163f
Oxygen therapy 156
P
Pachydermatocele 7071
Packed cells 164
Papilloma 6364
complications of 64t
differential diagnosis 64
infective 63
pedunculated 64f
on right waist 64f
skin 63
of tongue 64f
treatment of 64
true 6364, 64f
Parathyroid, anatomy of 299
Paronychia
acute 210
chronic 210211
Parotid fistula 312
causes 312
clinical features 312
diagnosis 312
treatment 312
PCWP. See Pulmonary capillary wedge pressure (PCWP)
Pectoralis major myocutaneous flap (PMMF) 183184, 184f
Perfluorocarbon 166
Peripheral nerve injuries
clinical features of 198
management of 198
nerve suturing, types of 198199, 198f199f
Seddon's classification 197198
Tinel's sign 199
Phlegmasia alba dolens 120
Phlegmasia cerulea dolens 120
Phenol 480
Pheochromocytoma 305
Pilonidial sinus 10
Plantar fasciitis (Policeman's Heel) treatment 217
Plasma 164
Platelet concentrate 164
Platelet rich plasma 164
Plummer disease 281
PMMF. See Pectoralis major myocutaneous flap (PMMF)
Pneumatic tourniquet 166
Polyarteritis nodosa 8485
Port-wine stain 112
Postphlebitic limb 131
Pott's puffy tumor 37, 37f
Proteinase 41
Pseudohyponatremia 190
Psoas bursa 73
Ptosis right eye, in Horner's syndrome 84f
Pulmonary capillary wedge pressure (PCWP) 155156, 155f
complications of 155
vs. central venous pressure 156t
Pyemia 38
Pyogenic abscess 3033, 31f
bacterial 31
clinical features of 31
complications of 32
differential diagnosis for 33
in forehead region and face 32f
Hilton's method of draining 33f
investigation of 3132
modes of infection 30
sites of 31
in suboccipital region 32f
treatment of 3233
vs. cellulitis 31t
vs. cold abscess 35t
Pyogenic granuloma 17, 17f, 3738
clinical features 37
differential diagnosis 38
in nose 38f
sites of 38
treatment of 38
R
Rabies 4749
clinical features 47
in dogs 49
immunization 4849
in animals 49
horse antirabies serum 4849
human rabies immunoglobulin 49
Negri bodies in 47
passive immunity 4849
pathogenesis 47
postexposure prophylaxis 4748
vaccines for 48
wounds in 48
Radial forearm flap 185
Radial nerve lesions 203204
in arm 203
brachial plexus 203
clinical features of 204
deep branch 204
investigation of 204
superficial branch 203204
treatment of 204
wrist drop 204, 204f
Ram's horn penis 137f
Random pattern flaps 180
Ray fungus 45
Raynaud's disease 78, 83
Raynaud's phenomenon 8384
cervical sympathectomy for 84
collagen vascular diseases and 83
investigations of 83
Raynaud's disease 83
Raynaud's syndrome 83
treatment of 8384
types of 83
and upper limb ischemia 78
Raynaud's syndrome 78, 83
Recurrent fibroid of Paget's 72
Recycled blood 166
Red rubber catheter 473
Red-rubber tracheostomy tube 386
Reflux esophagitis 398
Reidel's thyroiditis 293294
Reinke's edema 361
Renal transplantation 186
Reperfusion injury 100101
Respiratory acidosis 192
Respiratory alkalosis 192
Rest pain 88, 88f
Retrocalcaneum bursitis 74
Risus sardonicus 39
Rodent ulcers 2324, 24f
Rubber tourniquet 166
Ryle's tube 473
S
Saddle embolus 102, 102f
SAG-M blood 164
Salivary calculus
presentation 309
investigations 310
Salivary glands
adenocarcinoma of 319
anatomy 306307
facial nerve 307308
minor 322
squamous cell carcinoma of 319
submandibular 308
Salivary neoplasms 313
classification 314
etiology 313314
incidence 314315
investigations 316
treatment 316317, 316f
Salmon patch 112, 112f
Saltatory flap 181
Scalene triangle 76
Scalenus anticus muscle 76
Schwannoma 71
Scleroderma 85
Sebaceous cyst 6768
clinical features of 6768
complications of 68
in face 67f
infected 67f
on scalp 67f
treatment of 68, 68f
Secondaries in lymph nodes in 142, 144f
SEPS. See Subfascial endoscopic perforator ligation surgery (SEPS)
Septicemia 38
Septic shock 150, 152153
hyperdynamic 152
hypodynamic hypovolemic 152
stages of 152153
Shock 149153
anaphylactic 150, 152153
cardiogenic 149150, 154
clinical features of 153
effects of 151152
hypovolemic 149, 152
investigation of 153
neurogenic 150
pathophysiology of 150151
respiratory 150
septic 150, 152153
stages of 151
treatment of 153
Trendelenburg position in 153f
Sialectasis 311
Sialography, indications 308309
Sialosis 311
Sick cell syndrome 151
Sinus 10, 10f
discharges in 12
persistence of 11
pilonidal 10
tuberculous 10
types of 11t
clinical examination of 509510
forceps 471
median mental 10, 1213, 13f
SIRS. See Systemic inflammatory response syndrome (SIRS)
Sjögren's syndrome
clinical features 313
investigations 313
types 313
Skin grafting 177180
harvesting 178f
Mesher in 179f
split skin graft 177179
advantages of 179
contraindications of 178
disadvantages of 179
Humby's knife in 178f
indications for 177178
pre-requisite for 178
stages of 178
Wolfe graft 179180
advantages of 179
disadvantages of 180
Skin tumors
adnexal tumors 240, 240f
classification of 240
Spina ventosa 217
Spreading ulcers 14
Squamous cell carcinoma 243, 243f244f
Squamous cell papilloma 63
SSI. See Surgical site infection (SSI)
Staphylococcus aureus 50, 52, 57
Strawberry hemangioma 112
Streptococcus epidermidis 50
Streptococcus pneumoniae 50
Streptococcus pyogenes 27, 30, 51, 52
Student's elbow 73f
Sturge-Weber syndrome 113
Subclavian steal syndrome 8687, 87f
Subfascial endoscopic perforator ligation surgery (SEPS) 128129, 129f
Surgical site infection (SSI) 5760
classification of 5859, 59f
common sources of 57
factors related to 57
identification system in 58
management of 60
NNIS system as risk index 58t
organisms in 57
physical status classification 58
prevention of 5960
risk classification in 58
sequence of events in 57
surgical wounds, classification of 58
variable influences 58t
Suture materials
classification 476478
types of 478
Syndactyly
causes 216
treatment 216
types 216, 216f
Syphilis 4445
congenital 45
early 44
investigation of 44
late (tertiary) 44
latent 44
primary 44
secondary 44
treatment of 4445
Systemic inflammatory response syndrome (SIRS) 156
Systemic sclerosis 85
Systolic bruit 90
T
Temporal arteritis 86
Tendon 205206
grafts for 207
healing of 206
repairing of 206
suturing of 206, 206f
transfer of 206
Terminal pulp space infection (FELON)
complications 212
investigation 211
surgical anatomy 211, 211f
treatment 211, 211f
Tetanus 3841
ascending 40
clinical features of 39
Clostridium tetani 39
descending 40
differential diagnosis of 40
early 40
late 40
pathogenesis 3940
incubation period 39
period of onset 3940
respiratory system, effects on 40
postures in 40t
staging of 40t
treatment of 4041
antitetanus globulin in 40
antitetanus serum in 40
crystalline penicillin in 41
nursing care 41
tetanus toxoid in 40
types of 40
Tetanus neonatorum 40
Thakayasu's pulseless arteritis 8586
Thoracic outlet, surgical anatomy of 76
Thoracic outlet syndrome (TOS) 8081
clinical features of 8081
differential diagnosis of 80t
investigations of 81
scalene triangle 80
treatment of 81
Thromboangiitis obliterans (TAO) 9496
investigations of 9495
with large ischemic ulcers 94f
pathogensis 95
treatment of 9596
Thrombophlebitis 131
Thyrocardiac 287
Thyroid function tests 276277
Thyrotoxicosis 280281
Thyroid 270
anatomy 272274
development 272
ectopic 274, 274f
FNAC of 277
lingual 274275, 275f
medullary carcinoma of 292293
solitary nodule 279280
Thyroglossal cyst 275276
Thyroglossal fistula 276
Thyroidectomy
complications of 295296
procedure 294
types 294
Tinel's sign 199
Tongue 326, 343, 344f
benign tumors of 345346
fissure, 346
tie 347, 347f
Tonsillectomy
indications 370
procedure 370, 370f
Tonsils
acute 368
anatomy of 367368
Torticollis (Wry neck) 262, 262f
TOS. See Thoracic outlet syndrome (TOS)
Total parenteral nutrition (TPN) 195
Torticollis (Wry neck) 262, 262f
Toxic nodule 284
Tourniquets 166
Toxoplasma gondii 141
Toxoplasmosis 141
TPN. See Total parenteral nutrition (TPN)
Tracheoesophageal fistula 400
Tracheostomy
approaches for 389
complications of 390
functions of 389
indications for 387388
technique of 388
tubes 386, 386f, 471
types 386
Transplantation 185186
bone marrow 187
donor criteria 185186
cadaver donor 185
living donor 185
requirements for 185186
liver 186187
renal 186
Traumatic acute arterial occlusion 99100
clinical features 99
investigation of 99
treatment of 100
Traumatic ulcers 15, 22
Treponema pallidum 44
Triage 219
algorithm 219
definitive care 221
investigations 221
management 220221
Trigeminal neuralgia 205
Trismus 39
Trophic ulcers 19
Tropical ulcers 15, 2425
Tuberculoid leprosy 43
Tuberculosis 4243
features of 43
investigation of 43
organisms in 42
pathogenesis of 4243
treatment of 43
with tuberculous ulcer 42f
Tuberculous lymphadenitis 141, 147148
clinical features of 148
differential diagnosis of 148
investigation of 148
mode of infection of 147148
sites of 147
stages of 147, 147f
treatment of 148
Tuberculous sinus 10
Tuberculous ulcers 14f, 2526, 26f
U
Ulcerated plaque 93
Ulcers 1318, 511514
arterial/ischemic 15f, 22, 22f
Bazin's 15
callous 14, 14f15f
carcinomatous 2223
chilblains and 26
classification of
clinical 14
pathological 1416
cortisol 15
debridement of 18
decubitus 1920, 19f
definition of 13
diabetic 2021, 20f
discharges in 16
dressing of 18
frostbite and 26
granulation tissue in 1618
exuberant 17
healthy 14f, 16, 16f
pyogenic granuloma 17, 17f
unhealthy 16, 16f
unhealthy, pale, flat 16
healing 14, 14f
in leg and shoulder 18f
induration in 17
investigations for 17
maggots in 16f
malignant 15
management of 18
Marjolin's 23, 23f
Martorell‘s hypertensive 15
melanotic 24, 24f
Meleney's 2122
nonspecific 15
parts of 1314, 13f
with Pseudomonas infection 18f
rodent 2324, 24f
spreading 14
traumatic 15, 22
treatment of 1718
trophic 19
tropical 15, 2425
tuberculous 14f, 2526, 26f
venous 25, 25f
Ulnar nerve injuries 202
Ulnar paradox 202
Ultrasound
advantages 486
disadvantages 486
thyroid 486
uses 486
Upper limb ischemia 7783
cervical rib 8183
anatomy of 82f
clinical features of 8182
definition of 81
differential diagnosis of 82
investigations of 82
pathology of 81, 82f
treatment of 8283
types of 81
gangrene of finger in 77f
investigations in 7879, 79f
management of 7980
bypass surgery 80
chronic ischemia, treatment of 7980
embolus, treatment of 79
Raynaud'sphenomenon, treatment of 80
trauma, treatment in 79
Raynaud's phenomenon and 78
thoracic outlet syndrome and 8081
clinical features of 8081
differential diagnosis of 80t
investigations of 81
scalene triangle 80
treatment of 81
types of 7778
acute 7778
chronic 78
Urban tetanus 40
Urinary bladder injury 226
V
Varicose veins 121130
clinical features of 123124
clinical tests for 123124, 124t
Brodie-Trendelenburg test 123, 123f124f
Fegan's test 124
Morrissey's cough impulse test 124
Perthe's test 124
Pratt's test 124
Schwartz test 124
three-tourniquet test 124
complications of 129t130t
etiology of 122123
investigation of 124126
arm-foot venous pressure for 126
duplex scan for 125, 125f
venography for 125
venous Doppler for 124, 125f
of lower limb 121f
CEAP classification of 123t
pathogenesis of 122
sites of 123t
thermoablation of 129
treatment of 126130
Cockett and Dodd subfascial ligation 128, 128f
conservative 126
crepe bandages for 126f
foam sclerotherapy by Tessari 127, 127f
injection-sclerotherapy (Fegan's technique) 126127
microsclerotherapy 127
sclerosants for 126t
stripping of vein 128, 128f
subfascial endoscopic perforator ligation 128129, 129f
surgery 127129
trendelenburg operation 127128, 128f
types of 122, 122f
white cell trapping theory in 122
Veins of lower limb, anatomy of 118119, 118f
blood flow in, physiology of 119
deep veins 118
long saphenous vein 118, 119f
perforator veins 118119, 119f
short saphenous vein 118, 119f
superficial veins 118, 118f
Venous ulcers 25, 25f, 130131
complications of 131t
Gaiter's zone and 130
investigation of 130
of lower limb 130f
pathogenesis of 130
periostitis and 130
treatment of 130131
Vocal (Singer's/Screamer's) nodule 360361
Vocal polyp 361
Volkmann's retractor 467
Volkmann's scoop 475
von Recklinghausen's disease 71
von Willebrand's disease 160
W
Waldeyer's ring 253
Warthin's tumor 317, 317f
Water intoxication 188189
clinical features of 189
ECF excess 189
ECF loss 189
investigation of 189
transurethral resection of prostate 188189
treatment of 189
Water loss 188
Wayne's diagnostic indices 282t
Webspaces, infection of
bacteria 212
clinical features 212
treatment 212
Woolsorter's disease 49
Wound 17
abrasion 2, 3f
clean incised 2, 2f
crush injury 3
definition 1
healing 47
factors affecting 5t
phases of 5
problems with 67
stages of 5
types of 5
hematoma 2f, 3f
lacerated 2, 2f
management of 56
Rank and Wakefield classification 12
tidy wounds 1
untidy wounds 12
surgical classification 34
clean contaminated wound 4, 4f
clean wound 34, 4f
contaminated wound 4, 4f
dirty infected wound 4, 4f
Wound debridement 6
Wound dehiscence 6
Wound infection 6
Wrist drop 204, 204f
X
Xenograft 177
Xeroderma pigmentosa 243
Z
Zadik's/Fowler's operation 218f
Zygomatic complex fracture 429432
management of 432434
mandible 434
×
Chapter Notes

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_FM_1SRB's SURGERY FOR DENTAL STUDENTS_FM_2
_FM_3SRB's SURGERY FOR DENTAL STUDENTS
Second Edition Sriram Bhat M MS (General Surgery) Professor Department of Surgery Kasturba Medical College Mangalore, Karnataka, India Honorary Surgeon Government Wenlock Hospital Mangalore, Dakshina Kanada, Karnataka, India e-mail: meera_sriram2003@yahoo.com Foreword V Surendra Shetty
_FM_4
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SRB's Surgery for Dental Students
First Edition: 2008
Second Edition: 2014
9789351523321
Printed at_FM_5
Dedicated to
My Beloved Father—Mr Sri Krishna Bhat
and also to
My Beloved Father-in-Law—Late Dr Krishna Karanth_FM_6
_FM_7Foreword
I am delightful to write a foreword for this book entitled SRB's Surgery for Dental Students by Dr Sriram Bhat M.
It is a manual of surgery covering all general surgical topics for dental students with clinical methods in brief. All topics are covered in detail as needed for dental students with adequate diagrams, photographs and illustrations. This book will be very useful to all BDS students as well as MDS students in relation to basic general surgery and topics like wounds, shock, trauma, vascular diseases, burns, thyroid, basic orthopedics, basic ENT topics and instruments.
A comprehensive manual of this standard can be best compiled only by a person with depth of knowledge in the subject and teaching experience to understand the requirements of the dental students. It is very apt that Dr Sriram Bhat, a person to whom the above description applies has come out with this book.
I wish Dr Bhat the very best in this and all his other professional endeavors.
V Surendra Shetty MDS
Pro Vice-Chancellor
Manipal College of Dental Sciences
Mangalore, Karnataka, India_FM_8
_FM_9Preface to the Second Edition
It is now nearing six years since my first edition of book SRB's Surgery for Dental Students has released. I thought it is now necessary to bring out 2nd edition of the title as changes in material and diagrams I found essential. Most of the chapters are meticulously corrected and edited. Many photographs are added in appropriate places. Text material is also added in appropriate needed chapters such as reconstruction, neoplasm, wound, sinus, ulcer, skin tumors, etc. Chapter 35C ‘Clinical Methods in Surgery for Dental Students’ is redone entirely with complete alteration, more detail and more photographs.
I thank all my teachers, colleagues and friends and our beloved Group Chairman Shri Jitendar P Vij of M/s Jaypee Brothers Medical Publishers (P) Ltd for helping and guiding me constantly in my endeavors.
I hope new edition of the book will be much more useful to all dental students who have to learn basic surgery during their dental graduation period. Any suggestions and criticisms are well accepted.
Sriram Bhat M
_FM_11Preface to the First Edition
My first book SRB's Manual of Surgery is well accepted by medical students in our country. But I felt, it will be much comprehensive for dental undergraduate (BDS) students and it should be condensed and be selective. Keeping the surgery subject syllabus of BDS students in mind I wrote SRB's Surgery for Dental Students mainly concentrating on general surgery, head and neck, oral cavity and maxillofacial injuries. I also included Basic Orthopedics, Neurosurgery, Adjuvant Therapy, Sterilization and Instruments in the book. Miscellaneous chapter contains clinical examination of swelling/hernia/hydrocele/arterial diseases/varicose veins/thyroid/oral cavity/salivary gland to complete the fulfillment of the clinical surgical university examinations so that it will be easier for students to get required subject in a single text. I essentially eliminated gastrointestinal and urology topics. Adequate diagrams, photographs, tables and illustrations are added wherever needed. I also discussed about the topics with staff members of few dental colleges. I hope the book will be appreciated by the dental faculty and students. Any suggestions and criticisms are well accepted.
Sriram Bhat M
_FM_13Acknowledgments
I have great pleasure to bring out the 2nd edition of the book – SRB's Surgery for Dental Students.
I thank our Chancellor Dr Ramdas M Pai, Pro-Chancellor Dr HS Ballal, Vice-Chancellor of Manipal Academy of Higher Education (MAHE) Dr Professor Rajashekaran Warrior, our beloved Dean Professor Venkatraya Prabhu, and our Vice-Deans Professor Dr Anand Kini and Professor Dr Vivian D'Souza for their academic support.
I thank Dr Ganapathy, MD, Director, Mangala Hospital, Mangalore for his encouragement.
I thank the Head, Department of Surgery, Kasturba Medical College (KMC), Mangalore, Professor Alfred Augustine for his constant encouragement in academic work and progress.
I acknowledge Dr V Surendra Shetty, Pro Vice-Chancellor, Manipal College of Dental Sciences, Mangalore for writing foreword to this book as well as for encouraging me in my all works.
I thank and remember Dr Dilip Nayak, Dean, Manipal College of Dental Sciences, Mangalore; Dr Rajendra Prasad, Dean, AB Shetty Institute of Dental Sciences, Mangalore; Dr Sripathi Rao, Dean, Yenepoya Dental College, Mangalore; Dr Moksha Nayak, Dean, KVG Dental College, Sullia, Karnataka, and all dental staff members and consultants at various dental colleges of the district and state for their kind help.
I thank Dr Jagadishchandra, MDS, Associate Professor and Dr Veena Jagadischandra, MDS for their affectionate help. Dr Jagadish has provided photographs, X-rays and syllabus for dental students.
I thank District Surgeon for providing enough clinical materials from Government District Wenlock Hospital, Mangalore where I am working.
I thank my dear friend Dr Ashok Pandith, MCh Urology, for his constant guidance to me in all my endeavors.
Dr Ragavendra Bhat and Dr Ravichandra, Radiologists, Balmatta Diagnostic Center, Mangalore have helped me a lot by giving necessary X-rays/CT scans/MRI pictures. I remember them a lot.
Heads of all departments in KMC, Mangalore and colleagues from my department always stood with me for all my work. I remember all of them always for their kind heart.
I remember all staff members of surgery department and postgraduates of KMC, Mangalore for their affection and support.
I appreciate Dr Ishwarkeerthi, MBBS, MS who has helped me by drawing diagrams needed to this book.
My beloved daughter Ananya drew many diagrams beautifully and helped me to reduce my work.
My wife Dr Meera Sriram, MD (Obstetrics and Gynecology) has done the corrections in the script and I owe her a lot.
I thank all my patients and all who have directly or indirectly helped me in bringing out this book.
I thank a lot Group Chairman Shri Jitendar P Vij, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for his constant help and guidance. In spite of his busy schedule he is always in touch with authors for any needed help. I appreciate him and his scintillating active approaches.
I remember everybody working in editing the book in M/s Jaypee Brothers Medical Publishers to bring out book more effectively.