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LIC - Sabiston Textbook of Surgery

LIC - Sabiston Textbook of Surgery

Courtney M. Townsend Jr. | R. Daniel Beauchamp | B. Mark Evers | Kenneth L. Mattox

(2015)

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LIC - Sabiston Textbook of Surgery

Table of Contents

Section Title Page Action Price
Front cover cover
Inside front cover ifc
Sabiston Textbook of Surgery i
Copyright page iv
Dedication v
Contributors vii
FOREWORD xv
Preface xvii
ACKNOWLEDGMENTS xix
Table of contents xxi
Video Contents xxv
Section 1 Surgical Basic Principles 1
Chapter 1 History of Surgery 2
Importance of Understanding Surgical History 2
Historical Relationship Between Surgery and Medicine 2
Knowledge of Human Anatomy 3
Method of Controlling Hemorrhage 3
Pathophysiologic Basis of Surgical Diseases 4
Anesthesia 4
Antisepsis, Asepsis, and Understanding the Nature of Infection 5
X-Rays 6
Early 20th Century 6
Ascent of Scientific Surgery 7
Internationalization, Surgical Societies, and Journals 8
World War I 8
American College of Surgeons 9
Women Surgeons 9
African American Surgeons 10
Modern ERA 11
Last Half of the 20th Century 12
Cardiac Surgery and Organ Transplantation 12
Political and Socioeconomic Influences 14
20th Century Surgical Highlights 15
Future Trends 17
Selected References 17
Chapter 2 Ethics and Professionalism in Surgery 19
The Importance of Ethics in Surgery 19
End-of-Life Care 20
Resuscitation in the Operating Room 20
Cultural Sensitivity 20
Shared Decision Making 21
Professionalism 22
Conclusion 22
Selected References 22
References 22
Chapter 3 Molecular and Cell Biology 24
Human Genome 24
Structure of Genes and DNA 24
DNA Replication and Repair 25
RNA and Protein Synthesis 25
Control of Gene Expression 26
Recombinant DNA Technology 27
Restriction Nucleases 27
Polymerase Chain Reaction 28
DNA Sequencing 29
DNA Cloning 29
DNA Engineering 29
Transgenic Animals 30
RNA Interference 30
Cell Signaling 31
Ligands and Receptors 31
G Protein–Coupled Receptors 31
Enzyme-Coupled Receptors 32
Cell Division Cycle 32
Regulation of the Cell Division Cycle by Cyclin, Cyclin-Dependent Kinase, and Cdk Inhibitory Proteins 33
Cell Cycle Checkpoints 33
Oncogenes and Tumor Suppressor Genes 33
Cell Death 33
Apoptosis 33
Autophagy 34
Human Genome Project 35
Transplantation 35
Oncology 36
Pediatric and Fetal Surgery 36
Proteomics 36
Novel Treatment Strategies 36
Gene Therapy 36
Short Interfering RNA 37
Drug Design 37
Genetic Engineering of Antibodies 37
Ethical, Psychological, and Legal Implications 38
Selected References 38
References 38
Chapter 4 The Inflammatory Response 40
The Danger Hypothesis: Danger-Associated Molecular Patterns, Pathogen-Associated Molecular Patterns, and Alarmins 40
Lipopolysaccharide 41
Toll-Like Receptors 42
Other Families of Pattern Recognition Receptors 42
High-Mobility Group Box 1 42
Heat Shock Proteins 44
Cytokines and Chemokines 44
Interferon-γ and Granulocyte-Macrophage Colony-Stimulating Factor 44
Interleukin-1 and Tumor Necrosis Factor 47
Interleukin-1 and the Interleukin-1 Receptor 48
Tumor Necrosis Factor 51
Interleukin-1 and Tumor Necrosis Factor as Targets for Anti-Inflammatory Therapeutic Agents 52
Interleukin-6 and Interleukin-11 54
Interleukin-8 and Other Chemokines 54
Interleukin-12 55
Interleukin-17 and Related Cytokines 55
Interleukin-18 56
Interleukin-4, Interleukin-10, and Interleukin-13 56
Transforming Growth Factor-β 57
Macrophage Migration Inhibitory Factor 58
Complement 58
Eicosanoids: Thromboxane, Prostaglandins, and Leukotrienes 60
Nitric Oxide 60
Carbon Monoxide 61
Hydrogen Sulfide 61
Reactive Oxygen Species 61
Neuroendocrine Control of the Inflammatory Response 62
Corticosteroids 62
Catecholamines 63
Cholinergic Anti-Inflammatory Pathway 63
Selected References 63
References 64
Chapter 5 Shock, Electrolytes, and Fluid 66
History 66
Resuscitation 66
Shock 67
Fluids 70
Blood Transfusions 71
Physiology of Shock 72
Bleeding 72
Lactate and Base Deficit 74
Compensatory Mechanisms 75
Lethal Triad 75
Acidosis 76
Hypothermia 76
Coagulopathy 78
Oxygen Delivery 79
Optimization (Supernormalization) 81
Global Perfusion Versus Regional Perfusion 82
Septic Shock 85
Other Supportive Therapeutic Options for Severe Sepsis 85
Blood Product Administration 85
Mechanical Ventilation of Sepsis-Induced Acute Lung Injury or Acute Respiratory Distress Syndrome 86
Sedation, Analgesia, and Neuromuscular Blockade 86
Glucose Control 86
Renal Replacement 86
Bicarbonate Therapy 86
Deep Vein Thrombosis Prophylaxis 86
Stress Ulcer Prophylaxis 86
Consideration for Limitation of Support 86
Resuscitation 87
Problems With Resuscitation 87
Bleeding 88
Trauma Immunology and Inflammation 89
Evolution of Modern Resuscitation 91
Detrimental Impact of Fluids 91
Damage Control Resuscitation 94
Whole Blood Resuscitation 94
Resuscitation With 1 : 1 : 1 95
Massive Transfusion Protocol 95
Current Status of Fluid Types 97
Crystalloids 97
Hypertonic Saline 98
Colloids 100
Future Resuscitation Research 100
Blood Substitutes 100
Perfluorocarbons 102
Novel Fluids 102
Freeze-Dried Plasma 103
Pharmacologic Agents 103
Suspended Animation 104
Perioperative Fluid Management 104
Body Water 104
Maintenance Fluids 105
Adrenal Gland 108
Antidiuretic Hormone and Water 108
Electrolytes 109
Sodium 109
Hyponatremia 109
Hypernatremia 110
Potassium 110
Hypokalemia 110
Treatment of Acute Hypokalemia 111
Hyperkalemia 111
Treatment of Hyperkalemia 112
Calcium 112
Hypocalcemia 113
Treatment of Hypocalcemia 113
Hypercalcemia 114
Treatment 115
Magnesium 115
Hypomagnesemia 116
Treatment 116
Hypermagnesemia 116
Treatment 117
Selected References 117
References 118
Chapter 6 Metabolism in Surgical Patients 120
Nutritional Requirements 120
Carbohydrate Metabolism 122
Lipid Metabolism 123
Protein Metabolism 123
Regulation of the Amino Acid Pool 124
Glucose-Alanine and Glucose-Lactate Amino Acid Cycles 124
Intestinal Health 125
Protein Turnover 125
Proteolysis 125
Vitamins and Micronutrients 126
Nutritional Assessment and Monitoring 126
Malnutrition and Starvation 128
Physical Body Measurements 128
Body Weight 128
Anthropometric Measurements 128
Ideal Body Weight 128
Body Mass Index 128
Interpretation of Body Mass Index 128
Evaluating Caloric Requirements 129
Energy Expenditure Equations 129
Harris-Benedict Equation 129
Indirect Calorimetry 129
Dual-Energy X-Ray Absorptiometry 129
Monitoring Nutritional Status 129
Nitrogen Balance 130
Pediatric Assessment 130
Serum Proteins 130
Nutritional Support 130
Initiating Nutritional Support 132
Principles Guiding Routes of Nutrition 132
Enteral Nutrition 132
Formulations 135
Complications 135
Parenteral Nutrition 137
Formulations 138
Ordering Parenteral Nutrition 138
Complications 140
Carbohydrate Content 140
Lipid Content 141
Protein Content 141
Fluid and Electrolytes 141
Special Considerations 141
Burn Injury and the Metabolic Stress Response 141
Immunonutrition 143
Omega-3 and Omega-6 Fatty Acids 144
Optimal Omega-6-to-Omega-3 Ratio in the Diet 144
Organ Transplantation 144
Inflammatory Bowel Disease 144
Short Bowel Syndrome 144
Malnutrition States 145
Marasmus 145
Kwashiorkor 145
Sepsis 145
Hepatic Insufficiency 145
Gastric Bypass Surgery 146
Intensive Insulin and Glycemic Control 146
Pancreatitis 146
Obesity 146
Comorbidities and Preexisting Conditions 147
Type 2 Diabetes Mellitus 147
Cardiovascular Disease 147
Deep Vein Thrombosis and Embolism 147
Hepatobiliary Disease 147
Osteoarthritis 147
Metabolic Syndrome 148
The Surgical Obese Patient 148
Summary 148
Selected References 148
References 149
Chapter 7 Wound Healing 151
Tissue Injury and Response 151
Wound-Healing Phases 151
Inflammatory Phase 151
Hemostasis and Inflammation 151
Increased Vascular Permeability 151
Chemokines 152
Polymorphonuclear Cells 153
Macrophages 154
Lymphocytes 157
Proliferative Phase 158
Angiogenesis 158
Fibroplasia 159
Epithelialization 159
Extracellular Matrix 159
Collagen Structure 160
Collagen Synthesis 161
Elastic Fibers 161
Glycosaminoglycans and Proteoglycans 162
Basal Lamina 163
Degradation of the Extracellular Matrix 163
Maturational Phase 163
Remodeling 164
Abnormal Wound Healing 164
Hypertrophic Scars and Keloids 164
Chronic Nonhealing Wounds 165
Infection 167
Other Causes of Abnormal Wound Healing 167
Hypoxia 167
Diabetes 167
Ionizing Radiation 168
Aging 168
Malnutrition 168
Drugs 168
Relationship Between Immunity and Wound Repair or Regeneration 168
Fetal Wound Healing 168
Wound Dressings 170
Other Therapies 172
Hyperbaric Oxygen 172
Negative Pressure–Assisted Wound Closure 173
New Horizons 174
Tissue Engineering 174
Scaffolds 174
Gene and Stem Cell Therapy 174
Selected References 175
References 176
Chapter 8 Regenerative Medicine 178
Stem Cell Sources 178
Embryonic Stem Cells 178
Somatic Cell Nuclear Transfer 180
Induced Pluripotent Stem Cells 180
Fetal Stem Cells 180
Adult Stem Cells 181
Tissue-Specific Stem Cells 181
Adult Multipotent Stem Cells 181
Hematopoietic Stem Cells 181
Mesenchymal Stem Cells 181
Adipose-Derived Stromal Cells 182
Endothelial Progenitor Cells 183
Stem Cells and Cancer 183
Bioengineering for Regenerative Medicine 183
Research Applications 183
Biomaterials as Constructs for Cell Delivery and Directed Differentiation 183
Organ-Level Tissue Engineering 184
Clinical Applications of Stem Cells 184
Embryonic Stem Cells 184
Fetal Stem Cells 184
Multipotent Adult Stem Cells 184
Selected References 185
References 186
Chapter 9 Evidence-Based Surgery: 188
What is the Purpose of the Study? 188
What is being Compared? 188
Misclassification 188
Time-Varying Exposures 189
What is the Outcome of Interest? 190
Safety 190
Effectiveness and Efficacy 190
Patient-Reported Outcomes 190
Resource Utilization 190
Costs 191
Surrogate End Points 191
What is the Study Design? 192
Randomized Controlled Trials 192
Meta-Analysis 193
Cohort Study 193
Case-Control 193
Case Reports and Case Series 194
What is the Source of Data? 194
Are there Nonanalytic Issues Worthy of Consideration? 194
Confounding 194
Generalizability 194
Determining Causality Using Observational Data 195
How were the Data Analyzed? 195
Variable Types and Descriptive Statistics 195
Hypothesis Testing 195
Multivariable Analysis 196
Propensity Score Analysis 196
Instrumental Variable Analysis 196
Missing Data 197
Correlated Data 197
Are there Ethical Considerations? 197
Conclusions 198
Selected References 199
References 199
Chapter 10 Perioperative Patient Safety 201
History and Perspective 201
Surgical Infection Prevention and Surgical Care Improvement Project 201
Use of Quality Data to Improve Outcomes of Surgical Patients 202
Effective Teams and Communication 203
Handoffs and Surgical Safety 204
Phases in Perioperative Care 205
Preoperative Phase 205
Intraoperative Phase 205
Postoperative Phase 205
Physician Fatigue and Surgical Safety 205
Use of Information Technology to Enhance Surgical Patient Safety 206
Computerized Order Entry 206
Other Applications for Information Technology in Surgical Patient Safety 207
Creating an Organizational Structure to Promote Patient Safety and Quality Care 207
Selected References 207
References 208
Section 2 Perioperative Management 210
Chapter 11 Principles of Preoperative and Operative Surgery 211
Preoperative Preparation of the Patient 211
Principles of, and Preparation for, Operative Surgery 211
Determining the Need for Surgery 211
Perioperative Decision Making 211
Preoperative Evaluation 211
Systems Approach to Preoperative Evaluation 213
Cardiovascular System 213
Pulmonary System 216
Renal System 216
Hepatobiliary System 219
Endocrine System 221
Perioperative Diabetic Management 221
Management of Other Endocrinopathies 221
Immune System 222
Human Immunodeficiency Virus–Infected Patients and Surgery 223
Hematologic System 223
Additional Preoperative Considerations 225
Age 225
Nutritional Status 225
Obesity 226
Preoperative Checklist 226
Antibiotic Prophylaxis 226
Review of Medications 229
Preoperative Fasting 229
Potential Causes of Intraoperative Instability 230
Myocardial Infarction 230
Pulmonary Embolism 230
Pneumothorax 230
Anaphylaxis and Latex Allergy 230
Malignant Hyperthermia 230
Wrong-Site Surgery and Universal Protocol 231
The Operating Room 231
Maintenance of Normothermia 232
Preoperative Skin Preparation 232
Hemostasis 232
Wound Closure 233
Staplers 234
Surgical Adhesives 235
Surgical Devices and Energy Sources 235
Electrosurgery and Electrocautery 235
Lasers 235
Argon Beam Coagulator 236
Photodynamic Therapy 236
High-Frequency Sound Wave Techniques 236
Harmonic Scalpel 236
Ultrasonic Cavitation Devices 236
Radiofrequency Ablation 236
Cryoablation 237
Microwave Ablation and Radiosurgery 237
Outpatient Surgery 237
Selected References 238
References 238
Chapter 12 Surgical Infections and Antibiotic Use 240
Risk Factors for Infection 240
Host Factors 240
Genetics and Genomics of Trauma and Sepsis 240
Interactions Between the Host and Therapy 242
Blood Transfusion 242
Control of Blood Sugar 242
Infection Control 243
Catheter Care 243
Specific Infections 244
Surgical Site Infection 244
Postoperative Pneumonia 246
Central Line–Associated Bloodstream Infection 249
Urinary Tract Infection 249
Intra-Abdominal Infection 250
Antibiotic Use 250
Pharmacokinetic and Pharmacodynamic Principles 250
Antibiotic Prophylaxis 251
Principles of Antibiotic Therapy 252
Evaluation of Possible Infection 252
Blood Cultures 254
Empirical Antibiotic Therapy 254
Choice of Antibiotic 255
Duration of Therapy 255
Disease-, Pathogen-, and Antibiotic-Specific Considerations 256
Pneumonia 256
Central Line–Associated Bloodstream Infection 256
Intra-Abdominal Infection 256
Clostridium difficile–Associated Disease 257
Complicated Skin and Soft Tissue Infections 257
Antibiotic Activity Spectra 257
Cell Wall Active Agents 259
β-Lactam Antibiotics 259
Penicillins 259
Cephalosporins 259
Monobactams 259
Carbapenems 259
Lipoglycopeptides 260
Cyclic Lipopeptides 260
Polymyxins 260
Protein Synthesis Inhibitors 261
Aminoglycosides 261
Tetracyclines 261
Oxazolidinones 261
Macrolide-Lincosamide-Streptogramin Family 261
Clindamycin 261
Drugs That Disrupt Nucleic Acids 262
Fluoroquinolones 262
Cytotoxic Antibiotics 262
Metronidazole 262
Trimethoprim-Sulfamethoxazole 262
Antibiotic Toxicities 262
β-Lactam Allergy 262
Red Man Syndrome 262
Nephrotoxicity 263
Ototoxicity 263
Avoiding Toxicity: Adjustment of Antibiotic Dosage 263
Hepatic Insufficiency 263
Renal Insufficiency 263
Important Pathogens of Critically Ill Patients 264
Vancomycin-Resistant Enterococci 264
Staphylococcus aureus 264
Pseudomonas aeruginosa 264
Multidrug-Resistant Enterobacteriaceae, Including Klebsiella Species 264
Stenotrophomonas maltophilia 264
Acinetobacter baumannii Complex 264
Fungal Infections 265
Risk Factors 265
Diabetes Mellitus 265
Neutropenia 265
Organ Transplantation and Immunosuppression 265
Malignant Disease 266
Central Venous Catheters 266
Prediction of Invasive Candida Infection 266
Intensive Care Unit and Invasive Mechanical Ventilation 266
Fungal Pathogens 266
Candida albicans 266
Non–albicans Candida 268
Aspergillus 268
Other Emerging Fungal Pathogens 268
Prophylaxis 268
Antifungal Prophylaxis of Solid Organ Transplant Recipients 268
Antifungal Therapy 269
References 271
Chapter 13 Surgical Complications 281
Surgical Wound Complications 281
Seroma 281
Causes 281
Section 3 Trauma and Critical Care 429
Chapter 18 Management of Acute Trauma 430
Overview and History 430
Trauma Systems 431
Injury Scoring 432
Prehospital Trauma Care 433
Initial Assessment and Management 435
Airway 435
Breathing 437
Circulation 437
Disability and Exposure 438
Resuscitative Thoracotomy 438
Secondary Survey 438
Management of Specific Injuries 438
Damage Control Principles 438
Injuries to the Brain 439
Mechanism and Pathophysiology 439
Immediate Management 440
Evaluation 440
Management 441
Injuries to the Spinal Cord and Vertebral Column 441
Immediate Management 441
Evaluation 442
Management 443
Injury to the Maxillofacial Region 444
Immediate Management 444
Evaluation 444
Management 444
Injuries to the Neck 445
Immediate Management 445
Evaluation 445
Management 446
Injuries to the Chest 447
Immediate Management 448
Evaluation 449
Management 449
Chest Wall and Pleural Space Injuries 449
Pulmonary Injuries 451
Cardiac Injuries 451
Thoracic Aortic Injuries 452
Tracheobronchial Injuries 453
Esophageal Injuries 453
Diaphragmatic Injuries 454
Injuries to the Abdomen 455
Immediate Management 455
Blunt Abdominal Trauma Evaluation 455
Penetrating Abdominal Trauma Evaluation 456
Management 457
Splenic Injuries 457
Hepatic Injuries 459
Gastric Injuries 461
Duodenal Injuries 462
Pancreatic Injuries 462
Small Bowel Injuries 463
Colon Injuries 465
Abdominal Great Vessel Injuries 466
Genitourinary Injuries 467
Injuries to the Pelvis and Lower Extremities 467
Rehabilitation 467
Selected References 468
References 469
Chapter 19 The Difficult Abdominal Wall 471
Acute Presentation 471
Definitions and Management 471
Intra-Abdominal Hypertension or Abdominal Compartment Syndrome Complicating the Difficult Abdominal Wall 471
Abdominal Catastrophe Complicating the Difficult Abdominal Wall 473
Other Conditions Complicating the Difficult Abdominal Wall 473
Temporary Abdominal Closure 473
Techniques 473
Assessing Readiness for Abdominal Closure 474
Abdominal Closure or Planned Ventral Hernia? 474
Elective Planned Ventral Hernia Repair 475
Dynamic Abdominal Wall Reconstruction 475
Component Separation 475
Summary 476
Selected References 477
References 478
Chapter 20 Emergency Care of Musculoskeletal Injuries 480
Epidemiology of Orthopedic Injuries 480
Terminology 480
Fracture Types 480
Other Injuries 483
Fixation Principles 483
External Fixation 483
Internal Fixation 485
Pins and Screws 485
Plates 486
Tension Bands 486
Intramedullary Nails 486
Patient Evaluation 487
History 487
Trauma Room Evaluation 490
Diagnostic Imaging 491
Shoulder 491
Elbow 491
Pelvis and Acetabulum 492
Hip 493
Knee 493
Ankle 493
Foot 494
Spine 495
Intra-Articular Fractures 495
Stress Radiographs 495
Vascular Injuries 495
Initial Management 496
Wound Management 496
Reduction and Immobilization 496
Traction 496
Prioritization of Surgical Care 498
Orthopedic Emergencies 499
Open Fractures 499
Classification 499
Initial Management 500
Limb Salvage Versus Primary Amputation 500
Skeletal Stabilization 501
Acute Compartment Syndrome 502
Pathogenesis 502
Diagnosis 502
Tissue Pressure Measurements 503
Surgical Treatment 503
Pelvic Ring Disruption 504
Classification 504
Hemorrhage in Pelvic Fracture 507
Stabilization 507
Management 509
Spinal Injuries 509
Dislocations 510
Patient Evaluation 510
Treatment 512
Vascular Injuries 512
Incidence 512
Management 513
Common Long Bone Fractures 513
Femur Fractures 513
Epidemiology and Significance 513
Initial Management 513
Definitive Stabilization 513
Tibial Shaft Fractures 514
Epidemiology and Significance 514
Blood Supply 514
Associated Soft Tissue Injuries 514
Management and Treatment 514
Humeral Shaft Fractures 515
Epidemiology and Significance 515
Treatment 515
Challenges and Complications 515
Missed Injuries 515
Drug and Alcohol Use 515
Thromboembolic Complications 516
Pulmonary Failure: Fat Emboli Syndrome and Adult Respiratory Distress Syndrome 517
Postoperative Mobilization 517
Summary 518
Selected References 518
References 519
Chapter 21 Burns 521
Causes 521
Pathophysiology of Burn Injuries 521
Local Changes 521
Burn Depth 522
Burn Size 523
Systemic Changes 523
Hypermetabolic Response to Burn Injury 524
Inflammation and Edema 526
Effects on the Cardiovascular System 527
Effects on the Renal System 527
Effects on the Gastrointestinal System 528
Effects on the Immune System 528
Management 529
Basic Treatment 529
Prehospital Management 529
Initial Assessment 529
Initial Wound Care 529
Transport 529
Resuscitation 529
Escharotomies 531
Specific Treatment 531
Inhalation Injury 531
Wound Care 532
Antimicrobials 532
Topical Antibiotics 533
Systemic Antimicrobials 534
Burn Wound Excision 534
Tangential Excision 534
Full-Thickness Excision 534
Fascial Excision 534
Burn Wound Coverage 534
Multiorgan Failure 535
Causative Factors and Pathophysiology 535
Prevention 536
Organ Failure 536
Renal Failure 536
Pulmonary Failure 537
Hepatic Failure 537
Hematologic Failure 537
Central Nervous System Failure 537
Attenuation of the Hypermetabolic Response 537
Nonpharmacologic Modalities 537
Nutritional Support 537
Environmental Support 538
Exercise and Adjunctive Measures 538
Pharmacologic Modalities 539
Recombinant Human Growth Hormone 539
Insulin-Like Growth Factor 539
Oxandrolone 540
Propranolol 540
Attenuation of Postburn Hyperglycemia 541
Insulin 541
Metformin 542
Novel Therapeutic Options 542
Special Considerations: Electrical and Chemical Burns 542
Electrical Burns 542
Initial Treatment 542
Delayed Effects 543
Chemical Burns 543
Alkali 543
Acids 543
Hydrocarbons 544
Outcomes 544
Burn Units 545
Summary 545
Selected References 546
References 546
Chapter 22 Bites and Stings 548
Snakebites 548
Epidemiology 548
Species 548
Toxicology 548
Clinical Manifestations 548
Local 548
Systemic 548
Management 549
Field Treatment 549
Hospital Management 549
Antivenom Therapy 550
Wound Care and Blood Products 550
Fasciotomy 551
Mammalian Bites 551
Epidemiology 551
Treatment 551
Evaluation 551
Wound Care 551
Microbiology 552
Antibiotics 553
Rabies 553
Arthropod Bites and Stings 553
Black Widow Spiders 553
Section 4 Transplantation and Immunology 616
Chapter 26 Transplantation Immunobiology and Immunosuppression 617
The Immune Response 617
Acquired Immunity 617
Major Histocompatibility Locus: Transplantation Antigens 618
Human Histocompatibility Complex 619
Class I Major Histocompatibility Complex 620
Class II MHC 621
HLA Typing: Implications for Transplantation 621
Cellular Components of the Acquired Immune System 622
T Cells 622
T Cell Receptor 622
T Cell Activation 627
Costimulation 627
T Cell Effector Functions 629
B Cells 632
B Cell Receptor and Antibody 632
B Cell Activation 632
Innate Immunity 634
Monocytes 634
Dendritic Cells 635
Natural Killer Cells 635
Cytokines 635
Transplantation Immunity 636
Rejection 637
Hyperacute Rejection 637
Acute Rejection 637
Chronic Rejection 641
Immunosuppression 641
Corticosteroids 641
Antiproliferative Agents 642
Azathioprine 642
Mycophenolate Mofetil 643
Calcineurin Inhibitors 643
Cyclosporine 643
Tacrolimus 643
Lymphocyte Depletion Preparations 644
Antilymphocyte Globulin 644
Muromonab-CD3 645
Anti–Interleukin-2 Receptor Antibodies 645
Other Immunoglobulin Therapies 646
Rituximab 646
Alemtuzumab 646
Intravenous Immunoglobulin 646
Newer Immunosuppressive Agents 646
Mammalian Target of Rapamycin Inhibitors 646
Beletacept 646
Fingolimod 647
Deoxyspergualin 647
Complications of Immunosuppression 647
Risk of Infection 647
Risk for Malignancy 648
Nonimmune Side Effects 648
Tolerance 648
T Cell Ablation 649
Costimulation Blockade 649
Mixed Chimerism 649
Xenotransplantation 650
Concordant Xenografts 650
Discordant Xenografts 650
New Areas of Transplantation 651
Islet Cell Transplantation 651
Composite Tissue Transplantation 651
Conclusion 651
Selected References 653
References 653
Chapter 27 Liver Transplantation 655
History 655
Indications and Contraindications 655
Indications 655
Fulminant Hepatic Failure 656
Hepatitis C and Liver Transplantation 656
Hepatitis B 656
Primary Biliary Cirrhosis 657
Primary Sclerosing Cholangitis 657
Alcoholic Liver Disease 657
Nonalcoholic Steatohepatitis 657
Biliary Atresia 657
Contraindications 657
Organ Shortage, Model for End-Stage Liver Disease, and Liver Distribution 658
Model for End-Stage Liver Disease Formula 658
Live Donor Liver Transplantation 658
Technical Aspects of Liver Transplantation 659
Split Liver Transplant 660
Live Donor Operation 660
Segment 2-3 Hepatectomy 660
Right Lobe Dissection for Live Donor Liver Transplantation 661
Left Lobe Dissection for Live Donor Liver Transplantation 661
Implantation of Partial Liver Graft 661
Early Complications of Liver Transplantation 661
Outcome 662
Extended Criteria Donors 662
Evaluation of Abnormal Liver Function Test Results 662
Immunosuppression after Liver Transplantation 662
Retransplantation and Recurrent Disease 663
Role of Liver Transplantation for Hepatocellular Carcinoma 663
Role of Cellular Transplantation in Liver Replacement 663
Selected References 664
References 664
Chapter 28 Kidney and Pancreas Transplantation 666
Historical Perspective 666
Kidney Transplantation 666
Indications 666
Patient Selection 666
Living Donor Selection 668
Laparoscopic Surgical Technique 669
Open Surgical Technique 669
Postoperative Care and Follow-Up 670
Deceased Donors 670
Kidney Procurement and Preparation 670
Preservation and Storage 672
Recipient Operation 672
Postoperative Surgical Complications 672
Hemorrhage 672
Venous Thrombosis 672
Arterial Thrombosis 673
Arterial Stenosis 673
Urologic Complications 673
Lymphocele 674
Infections 674
Outcomes 674
Pancreas Transplantation 675
Patient Selection 675
Pancreas Donor 675
Pancreas Procurement, Preparation, and Transplantation 676
Drainage Techniques: Endocrine and Exocrine Secretions 677
Bladder Drainage or Enteric Drainage 677
Systemic Drainage Versus Portal Drainage 677
Surgical Complications 677
Leak 677
Vascular Complications 677
Thrombosis 677
Bleeding 678
Other Considerations 678
Infection 678
Pancreatitis 678
Bowel Obstruction 678
Section 5 Surgical Oncology 691
Chapter 30 Tumor Biology and Tumor Markers 692
Epidemiology 692
Global Burden of Cancer 692
Aging and Cancer 692
Obesity and Cancer 693
Tumor Biology 693
Self-Sufficiency in Growth Signals 695
Insensitivity to Antigrowth Signals 696
Evasion of Cell Death 698
Limitless Replication Potential 699
Sustained Angiogenesis 699
Tissue Invasion and Metastasis 700
Outgrowth at Preferred Sites 701
Immunosurveillance and Immunoediting 702
Immunosurveillance 702
Immunoediting 702
Carcinogenesis 703
Cancer Genetics 703
Familial Cancer Syndromes 704
Retinoblastoma 704
Li-Fraumeni Syndrome 705
Familial Adenomatous Polyposis 706
Hereditary Nonpolyposis Colorectal Cancer 707
BRCA1 and BRCA2 707
Multiple Endocrine Neoplasia 707
Type 1 707
Type 2 708
Von Hippel-Lindau Syndrome 708
Cancer Epigenetics 708
Carcinogens 708
Chemical Agents 708
Radiation Carcinogens 710
Infectious Carcinogens 710
Viral Carcinogenesis 710
Principles of Viral Carcinogenesis 711
Small DNA Tumor Viruses 711
Hepatitis B Virus 711
RNA Viruses: Human T Cell Lymphotropic Virus Type 1 and Hepatitis C Virus 712
Hepatitis C Virus 712
Helicobacter pylori 712
Chronic Inflammation 712
Tumor Markers 712
Protein Tumor Markers 713
Carcinoembryonic Antigen 713
Section 6 Head and Neck 792
Chapter 35 Head and Neck 793
Normal Histology 793
Epidemiology 793
Carcinogenesis 794
Staging 795
Clinical Overview 796
Evaluation 796
Positron Emission Tomography 796
Lymphatic Spread 796
Therapeutic Options 797
Anatomic Sites 798
Lip 798
Oral Cavity 799
Oral Tongue 800
Floor of the Mouth 800
Alveolus 800
Buccal Mucosa 801
Palate 801
Oropharynx 801
Hypopharynx 802
Larynx 802
Nasal Cavity and Paranasal Sinuses 807
Nasopharynx 808
Pituitary Surgery 810
Ear and Temporal Bone 810
Salivary Gland Neoplasms 811
Neck and Unknown Primary 813
Tracheotomy 815
Vocal Cord Paralysis 816
Reconstruction 817
Selected References 821
References 821
Section 7 Breast 823
Chapter 36 Diseases of the Breast 824
Anatomy 824
Microscopic Anatomy 826
Breast Development And Physiology 827
Normal Development and Physiology 827
Fibrocystic Changes and Breast Pain 827
Abnormal Development and Physiology 828
Absent or Accessory Breast Tissue 828
Gynecomastia 828
Nipple Discharge 828
Galactocele 828
Diagnosis Of Breast Disease 828
Patient History 828
Physical Examination 829
Biopsy 830
Fine-Needle Aspiration Biopsy 830
Core Needle Biopsy 830
Interpretation of Core Needle Biopsy Results 831
Breast Imaging 831
Screening Mammography 831
Ultrasonography 832
Magnetic Resonance Imaging 832
Nonpalpable Mammographic Abnormalities 832
Wire-Localized Surgical Excision 833
Identification And Management Of High-Risk Patients 834
Identification of High-Risk Patients 834
Risk Factors for Breast Cancer 834
Age and Gender 834
Personal History of Breast Cancer 834
Histologic Risk Factors 834
Family History and Genetic Risk Factors 835
Reproductive Risk Factors 836
Exogenous Hormone Use 836
Risk Assessment Tools 836
Management of High-Risk Patients 837
Close Surveillance 837
Chemoprevention for Breast Cancer 837
Prophylactic Mastectomy 838
Summary: Risk Assessment and Management 838
Benign Breast Tumors And Related Diseases 838
Breast Cysts 838
Fibroadenoma and Other Benign Tumors 839
Hamartoma and Adenoma 839
Breast Abscess and Infections 839
Papillomas and Papillomatosis 840
Sclerosing Adenosis 840
Radial Scar 840
Fat Necrosis 840
Epidemiology And Pathology Of Breast Cancer 840
Epidemiology 840
Pathology 840
Noninvasive Breast Cancer 840
Invasive Breast Cancer 842
Molecular Markers and Breast Cancer Subtypes 842
Other Tumors of the Breast 845
Phyllodes Tumors 845
Angiosarcoma 845
Staging Of Breast Cancer 846
Surgical Treatment Of Breast Cancer 846
Historical Perspective 846
Initial Surgical Trials of Local Therapy for Operable Breast Cancer 846
Radical Mastectomy Versus Total Mastectomy, With or Without Radiation Therapy 846
Clinical Trials Comparing Breast-Conserving Therapy With Mastectomy 848
NSABP B-06: Mastectomy Versus Lumpectomy With Irradiation Versus Lumpectomy Alone 848
Milan I Trial 849
Other Trials of Breast Conservation 849
Planning Surgical Treatments 849
Selection of Surgical Therapy 850
Eligibility for Breast Conservation 850
Tumor Size 851
Margins 851
Histology 851
Patient Age 851
Surgical Procedures for Breast Cancer 851
Breast-Conserving Surgery 851
Technical Aspects 851
Cosmetic Challenges 852
Extent of Breast Resection 852
Breast Size and Body Habitus 852
Tumor Location 852
Timing of Oncoplastic Surgery 852
Mastectomy 852
Indications 852
Breast Reconstruction 852
Technical Details 852
Simple and Modified Radical Mastectomy 852
Lymph Node Staging 853
Sentinel Node Technique 854
Treatment Of Ductal Carcinoma In Situ (Intraductal Carcinoma) 855
Mastectomy 855
Breast Conservation Therapy 856
Role of Tamoxifen 857
Sentinel Node Biopsy 858
Radiation Therapy For Breast Cancer 858
After Breast-Conserving Surgery 858
Postmastectomy Radiation Therapy 858
Systemic Therapy For Breast Cancer 859
Goals of Therapy and Determination of Risk of Harm 859
Chemotherapy 860
Trastuzumab-Based Chemotherapy Regimens 862
Endocrine Therapy 862
Tamoxifen 862
Ovarian Ablation 863
Aromatase Inhibitors 863
Summary of Medical Therapy for Early-Stage Breast Cancer 863
Neoadjuvant Systemic Therapy for Operable Breast Cancer 863
Treatment Of Locally Advanced And Inflammatory Breast Cancer 864
Treatment Of Special Conditions 865
Breast Cancer in Older Adults 865
Paget’s Disease 865
Male Breast Cancer 865
Interpreting Results Of Clinical Trials 866
Selected References 867
References 867
Chapter 37 Breast Reconstruction 870
Role of the General Surgeon in Breast Reconstruction 870
History 870
Patient Selection 871
Timing 871
Procedure Selection and Surgical Planning 871
Implant-Based Reconstructions 872
Combination Reconstruction 873
Autologous Reconstruction 875
Pedicled Flap 875
Abdominal-Based, Gluteal-Based, and Inner Thigh–Based Flaps 875
Abdominal-Based Flaps 875
Gluteal-Based Flaps 877
Inner Thigh–Based Flaps 877
Oncoplastic Surgery 878
Complications 879
Nipple-Areolar Reconstruction 882
Management of the Contralateral Breast 882
Surveillance 882
Conclusions 882
Selected References 883
References 883
Section 8 Endocrine 885
Chapter 38 Thyroid 886
Historical Perspective 886
Anatomy 886
Embryology 886
Adult Surgical Anatomy 886
Laryngeal Nerves 887
Recurrent Laryngeal Nerve 887
Superior Laryngeal Nerve 888
Blood Supply 888
Lymphatic System 888
Parathyroid Glands 889
Physiology of the Thyroid Gland 889
Iodine Metabolism 889
Thyroid Hormone Synthesis 890
Thyroglobulin 891
Calcitonin 891
Regulation of Thyroid Hormone Secretion 891
Peripheral Action of Thyroid Hormones 892
Inhibition of Thyroid Synthesis 893
Drugs 893
Iodine 893
Tests of Thyroid Function 893
Evaluation of the Pituitary-Thyroid Feedback Loop 893
Serum Triiodothyronine and Thyroxine Levels 893
Calcitonin 893
Radioactive Iodine Uptake 893
Thyroid Autoantibody Levels 894
Disorders of Thyroid Metabolism— Benign Thyroid Disease 894
Hypothyroidism 894
Metabolic Consequences of Iodine Deficiency 894
Postradiation Hypothyroidism 894
Postsurgical Hypothyroidism 894
Pharmacologic Hypothyroidism 895
Antithyroid Drugs 895
Amiodarone, Lithium, Cytokines 895
Diagnosis 895
Treatment 895
Thyroiditis 895
Hashimoto’s Thyroiditis 895
Acute Suppurative Thyroiditis 895
Subacute Thyroiditis 895
Riedel’s Struma 896
Hyperthyroidism 896
Hyperthyroid Disorders 896
Graves’ Disease 896
Toxic Nodular Goiter and Toxic Adenoma 896
Diagnosis 897
Treatment 897
Nonfunctioning Goiter 898
Multinodular Goiter 898
Substernal Goiter 898
Special Considerations for Patients With Goiter 898
Workup and Diagnosis of a Solitary Thyroid Nodule 899
Incidence 899
Initial Evaluation 899
Laboratory Evaluation 900
Thyroid Imaging 900
Ultrasound 900
Radioisotope Scanning 901
Computed Tomography and Magnetic Resonance Imaging 901
Fine-Needle Aspiration Biopsy 901
Decision Making and Treatment 902
Thyroid Malignancies 904
Thyroid Oncogenesis 904
Genetic Alterations 904
Ionizing Radiation 906
Papillary Carcinoma 906
Pathologic Classification 906
Clinical Features 906
Treatment 907
Follicular Carcinoma 909
Pathologic Classification 910
Clinical Features 910
Treatment 911
Postoperative Treatment 911
Hürthle Cell Carcinoma 912
Prognosis and Treatment 912
Medullary Carcinoma 912
Clinical Features 912
Section 9 Esophagus 1011
Chapter 43 Esophagus 1012
History 1012
Embryology 1013
Formation of the Gut Tube 1013
Molecular Regulation of the Gut Tube 1013
Differentiation of the Endoderm 1013
Muscular Development from the Mesoderm 1014
Anatomy 1014
Esophageal Inlet 1014
Esophageal Layers 1015
Anatomic Narrowing 1015
Gastroesophageal Junction 1016
Vasculature 1016
Lymphatics 1016
Innervation 1016
Physiology 1017
Swallowing 1018
Esophageal Phase 1018
Upper Esophageal Sphincter 1018
Peristalsis 1019
Lower Esophageal Sphincter 1019
Reflux Mechanism 1021
Neuromuscular Disorders of the Esophagus 1023
Diverticula 1023
Pharyngoesophageal (Zenker’s) Diverticulum 1023
Symptoms and Diagnosis 1023
Section 10 Abdomen 1087
Chapter 45 Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum, and Retroperitoneum 1088
Abdominal Wall And Umbilicus 1088
Embryology 1088
Anatomy 1088
Subcutaneous Tissues 1088
Muscle and Investing Fascias 1088
Preperitoneal Space and Peritoneum 1090
Vessels and Nerves of the Abdominal Wall 1090
Vascular Supply 1090
Innervation 1092
Abnormalities of the Abdominal Wall 1093
Congenital Abnormalities 1093
Umbilical Hernias 1093
Omphalocele 1093
Gastroschisis 1093
Infantile Umbilical Hernia 1093
Acquired Umbilical Hernia 1093
Abnormalities Resulting from Persistence of the Omphalomesenteric Duct 1093
Abnormalities Resulting from Persistence of the Allantois 1094
Acquired Abnormalities 1094
Diastasis Recti 1094
Anterior Abdominal Wall Hernias 1094
Rectus Sheath Hematoma 1094
Malignancies of the Abdominal Wall 1095
Desmoid Tumor 1095
Abdominal Wall Sarcoma 1096
Metastatic Disease 1096
Symptoms of Intra-Abdominal Disease Referred to the Abdominal Wall 1096
Peritoneum And Peritoneal Cavity 1097
Anatomy 1097
Physiology 1097
Peritoneal Disorders 1098
Ascites 1098
Pathophysiology and Cause 1098
Clinical Presentation and Diagnosis 1099
Ascitic Fluid Analysis 1099
Treatment of Ascites in Cirrhotic Patients 1099
Chylous Ascites 1100
Peritonitis 1100
Spontaneous Bacterial Peritonitis 1101
Tuberculous Peritonitis 1101
Peritonitis Associated With Chronic Ambulatory Peritoneal Dialysis 1102
Malignant Neoplasms of the Peritoneum 1102
Pseudomyxoma Peritonei 1102
Malignant Peritoneal Mesothelioma 1103
Mesentery And Omentum 1103
Embryology and Anatomy 1103
Physiology 1104
Diseases of the Omentum 1104
Omental Cysts 1104
Omental Torsion and Infarction 1104
Omental Neoplasms 1104
Omental Grafts and Transpositions 1104
Diseases of the Mesentery 1104
Mesenteric Cysts 1104
Acute Mesenteric Lymphadenitis 1105
Sclerosing Mesenteritis 1105
Intra-Abdominal (Internal) Hernias 1106
Internal Hernias Caused by Developmental Defects 1106
Mesocolic (Paraduodenal) Hernias 1106
Mesenteric Hernias 1106
Acquired Internal Hernias 1106
Malignancies of the Mesentery 1106
Mesenteric and Intra-Abdominal Desmoid Tumors 1106
Retroperitoneum 1108
Anatomy 1108
Operative Approaches 1108
Retroperitoneal Disorders 1108
Retroperitoneal Abscesses 1108
Retroperitoneal Hematomas 1109
Retroperitoneal Fibrosis 1109
Retroperitoneal Malignancies 1110
Retroperitoneal Sarcoma 1110
Selected References 1111
References 1112
Chapter 46 Hernias 1114
Inguinal Hernias 1114
Incidence 1114
Anatomy of the Groin 1115
External Oblique Muscle and Aponeurosis 1116
Internal Oblique Muscle and Aponeurosis 1116
Transversus Abdominis Muscle and Aponeurosis and Transversalis Fascia 1116
Pectineal (Cooper’s) Ligament 1117
Inguinal Canal 1117
Preperitoneal Space 1118
Femoral Canal 1119
Diagnosis 1119
Classification 1119
Treatment 1119
Nonoperative Management 1119
Operative Repair 1120
Anterior Repairs 1120
Tissue Repairs 1121
Tension-Free Anterior Inguinal Hernia Repair 1122
Preperitoneal Repair 1123
Laparoscopic Repair 1123
Results of Hernia Repair 1125
Femoral Hernias 1126
Special Problems 1126
Sliding Hernia 1126
Recurrent Hernia 1127
Strangulated Hernia 1127
Bilateral Hernias 1127
Complications 1127
Surgical Site Infection 1127
Nerve Injuries and Chronic Pain Syndromes 1127
Ischemic Orchitis and Testicular Atrophy 1128
Injury to the Vas Deferens and Viscera 1128
Hernia Recurrence 1128
Quality of Life 1128
Ventral Hernias 1128
Incidence 1129
Anatomy 1129
Diagnosis 1129
Classification 1130
Umbilical Hernia 1130
Epigastric Hernia 1131
Incisional Hernia 1131
Treatment: Operative Repair 1131
Prosthetic Materials for Ventral Hernia Repair 1131
Synthetic Materials 1131
Biologic Materials 1132
Operative Technique 1132
Ventral Hernias 1132
Intraperitoneal Mesh Placement 1133
Retromuscular Mesh Placement 1133
Component Separation 1133
Endoscopic Component Separation 1134
Results of Incisional Hernia Repairs 1135
Unusual Hernias 1135
Types 1135
Spigelian Hernia 1135
Obturator Hernia 1137
Lumbar Hernia 1137
Interparietal Hernia 1137
Sciatic Hernia 1137
Perineal Hernia 1137
Loss of Domain Hernias 1137
Parastomal Hernia Repair 1138
Complications 1138
Mesh Infection 1138
Seromas 1138
Enterotomy 1138
Selected References 1138
References 1139
Chapter 47 Acute Abdomen 1141
Anatomy and Physiology 1141
History 1142
Physical Examination 1145
Evaluation and Diagnosis 1147
Laboratory Studies 1147
Imaging Studies 1148
Intra-Abdominal Pressure Monitoring 1150
Diagnostic Laparoscopy 1150
Differential Diagnosis 1151
Preparation for Emergency Operation 1152
Atypical Patients 1152
Pregnancy 1152
Critically Ill Patients 1153
Immunocompromised Patients 1154
Morbidly Obese Patients 1155
Algorithms in the Acute Abdomen 1155
Summary 1156
Selected References 1157
References 1158
Chapter 48 Acute Gastrointestinal Hemorrhage 1160
Approach to the Patient 1160
Initial Assessment 1160
Risk Stratification 1161
Resuscitation 1161
History and Physical Examination 1162
Localization 1162
Treatment 1163
Acute Upper GI Hemorrhage 1164
Specific Causes of Upper Gastrointestinal Hemorrhage 1164
Nonvariceal Bleeding 1164
Peptic Ulcer Disease 1164
Treatment 1165
Medical Management 1165
Endoscopic Management 1166
Surgical Management 1166
Mallory-Weiss Tears 1167
Stress Gastritis 1167
Esophagitis 1168
Dieulafoy’s Lesion 1168
Gastric Antral Vascular Ectasia 1168
Malignancy 1168
Aortoenteric Fistula 1169
Hemobilia 1170
Hemosuccus Pancreaticus 1170
Iatrogenic Bleeding 1170
Bleeding Related to Portal Hypertension 1170
Treatment 1171
Medical Management 1171
Endoscopic Management 1171
Other Management 1171
Prevention of Rebleeding 1172
Acute Lower Gastrointestinal Hemorrhage 1173
Diagnosis 1173
Colonoscopy 1173
Radionuclide Scanning 1174
Mesenteric Angiography 1174
Treatment 1175
Specific Causes of Lower GI Bleeding 1175
Colonic Bleeding 1175
Diverticular Disease 1175
Angiodysplasia 1175
Neoplasia 1176
Anorectal Disease 1176
Colitis 1176
Mesenteric Ischemia 1177
Obscure Causes of Acute Gastrointestinal Hemorrhage 1177
Diagnosis 1178
Repeat Endoscopy 1178
Conventional Imaging 1178
Endoscopy 1178
Small Bowel Endoscopy 1178
Video Capsule Endoscopy 1178
Intraoperative Endoscopy 1179
Treatment 1179
Specific Causes of Small Bowel Bleeding 1179
Angiodysplasias 1179
Neoplasia 1179
Crohn’s Disease 1179
Meckel’s Diverticulum 1179
Diverticula 1179
Selected References 1179
References 1179
Chapter 49 Stomach 1182
Anatomy 1182
Gross Anatomy 1182
Divisions 1182
Blood Supply 1182
Lymphatic Drainage 1182
Innervation 1183
Gastric Morphology 1184
Gastric Microscopic Anatomy 1184
Physiology 1185
Regulation of Gastric Function 1185
Gastric Peptides 1185
Gastrin 1185
Somatostatin 1186
Gastrin-Releasing Peptide 1186
Histamine 1186
Ghrelin 1186
Gastric Acid Secretion 1187
Stimulated Acid Secretion 1187
Cephalic Phase 1187
Gastric Phase 1187
Intestinal Phase 1187
Activation and Secretion by the Parietal Cell 1187
Pharmacologic Regulation 1189
Other Gastric Secretory Products 1189
Gastric Juice 1189
Intrinsic Factor 1189
Pepsinogen 1189
Mucus and Bicarbonate 1189
Gastric Motility 1190
Fasting Gastric Motility 1190
Postprandial Gastric Motility 1190
Abnormal Gastric Motility 1190
Gastric-Emptying Studies 1191
Gastric Barrier Function 1191
Peptic Ulcer Disease 1191
Epidemiology 1191
Pathogenesis 1191
Helicobacter pylori Infection 1191
Nonsteroidal Anti-inflammatory Drugs 1192
Acid 1192
Duodenal Ulcer 1193
Clinical Manifestations 1193
Abdominal Pain 1193
Diagnosis 1193
Helicobacter pylori Testing 1193
Serology 1193
Urea Breath Test 1193
Rapid Urease Assay 1193
Histology 1193
Culture 1193
Upper Gastrointestinal Radiography 1193
Fiberoptic Endoscopy 1194
Treatment 1194
Medical Management 1194
Antacids 1194
H2 Receptor Antagonists 1194
Proton Pump Inhibitors 1194
Sucralfate 1194
Treatment of Helicobacter pylori Infection 1194
Complicated Ulcer Disease 1195
Hemorrhage 1195
Perforation 1196
Gastric Outlet Obstruction 1196
Intractable Peptic Ulcer Disease 1197
Surgical Procedures for Peptic Ulcers 1197
Truncal Vagotomy 1197
Highly Selective Vagotomy (Parietal Cell Vagotomy) 1197
Truncal Vagotomy and Antrectomy 1198
Gastric Ulcers 1198
Clinical Manifestations 1199
Diagnosis and Treatment 1199
Type I Gastric Ulcer 1200
Type II or Type III Gastric Ulcers 1200
Type IV Gastric Ulcers 1200
Bleeding Gastric Ulcers 1200
Perforated Gastric Ulcer 1200
Giant Gastric Ulcers 1201
Zollinger-Ellison Syndrome 1201
Stress Gastritis 1201
Pathophysiology 1202
Presentation and Diagnosis 1202
Treatment 1202
Prophylaxis 1202
Postgastrectomy Syndromes 1202
Dumping Syndrome 1203
Metabolic Disturbances 1203
Afferent Loop Syndrome 1203
Efferent Loop Obstruction 1203
Alkaline Reflux Gastritis 1204
Gastric Atony 1204
Gastric Cancer 1204
Epidemiology and Risk Factors 1204
Incidence 1204
Risk Factors 1204
Helicobacter pylori Infection 1204
Dietary Factors 1205
Hereditary Risk Factors and Cancer Genetics 1205
Other Risk Factors 1206
Polyps 1206
Proton Pump Inhibitors 1206
Pathology 1206
Diagnosis and Workup 1207
Signs and Symptoms 1207
Staging 1207
Staging Workup 1209
Endoscopy and Endoscopic Ultrasound 1209
Computed Tomography 1211
Positron Emission Tomography 1212
Laparoscopy 1212
Treatment 1212
Surgical Therapy 1212
Clinical Decision Making 1215
Lymph Node Dissection 1215
Adjuvant and Neoadjuvant Therapy 1215
Palliative Therapy and Systemic Therapy 1216
Complicated Gastric Cancer 1217
Locally Advanced Gastric Cancer 1217
Complications 1217
Outcomes 1217
Recurrence 1218
Surveillance 1218
Gastric Lymphoma 1218
Epidemiology 1218
Pathology 1218
Evaluation 1218
Staging 1218
Treatment 1219
Mucosa-Associated Lymphoid Tissue Lymphomas 1219
Treatment 1220
Gastrointestinal Stromal Tumors 1220
Adjuvant Therapy 1220
Other Neoplasms 1221
Gastric Carcinoid 1221
Heterotopic Pancreas 1222
Other Gastric Lesions 1222
Hypertrophic Gastritis (Ménétrier’s Disease) 1222
Mallory-Weiss Tear 1222
Dieulafoy’s Gastric Lesion 1222
Gastric Varices 1222
Gastric Volvulus 1223
Bezoars 1224
Selected References 1224
References 1225
Chapter 50 Small Intestine 1227
Embryology 1227
Anatomy 1227
Gross Anatomy 1227
Neurovascular-Lymphatic Supply 1228
Microscopic Anatomy 1229
Physiology 1230
Digestion and Absorption 1230
Carbohydrates 1230
Protein 1232
Fats 1233
Emulsification 1233
Micelle Formation 1233
Intracellular Processing 1233
Enterohepatic Circulation 1233
Water, Electrolytes, and Vitamins 1233
Motility 1234
Endocrine Function 1234
Gastrointestinal Hormones 1234
Receptors 1234
Immune Function 1236
Obstruction 1236
Causes 1237
Pathophysiology 1238
Clinical Manifestations and Diagnosis 1239
History 1239
Physical Examination 1239
Radiologic and Laboratory Studies 1239
Simple Versus Strangulating Obstruction 1241
Treatment 1242
Fluid Resuscitation and Antibiotics 1242
Tube Decompression 1242
Operative Management 1242
Management of Specific Problems 1243
Recurrent Intestinal Obstruction 1243
Acute Postoperative Obstruction 1243
Ileus 1244
Inflammatory Diseases 1244
Crohn’s Disease 1244
History 1244
Incidence and Epidemiology 1244
Causes 1245
Infectious Agents 1245
Immunologic Factors 1245
Genetic Factors 1245
Pathology 1245
Gross Pathologic Features 1245
Microscopic Features 1246
Clinical Manifestations 1247
Diagnosis 1248
Management 1249
Medical Therapy 1249
Aminosalicylate 1249
Corticosteroids 1249
Antibiotics 1250
Immunosuppressive Agents 1250
Anticytokine and Cytokine Therapies 1250
Novel Therapies 1250
Nutritional Therapy 1250
Smoking Cessation 1250
Surgical Treatment 1250
Specific Problems 1251
Acute Ileitis (Nonstricturing, Nonpenetrating) 1251
Stricturing Disease 1251
Penetrating Disease 1252
Perforation 1252
Gastrointestinal Bleeding 1253
Urologic Complications 1253
Cancer 1253
Colorectal Disease 1253
Perianal Disease 1253
Duodenal Disease 1253
Prognosis 1253
Typhoid Enteritis 1254
Enteritis in the Immunocompromised Host 1254
Protozoa 1254
Bacteria 1254
Mycobacteria 1254
Viruses 1255
Fungi 1255
Neoplasms 1255
General Considerations 1255
Clinical Manifestations 1256
Diagnosis 1256
Benign Neoplasms 1257
Leiomyomas 1257
Adenomas 1257
Lipomas 1258
Peutz-Jeghers Syndrome 1258
Hemangiomas 1258
Malignant Neoplasms 1258
Carcinoid Tumors 1259
Pathology 1259
Clinical Manifestations 1259
Malignant Carcinoid Syndrome 1260
Diagnosis 1260
Treatment 1261
Surgical Therapy 1261
Medical Therapy 1262
Prognosis 1262
Adenocarcinomas 1262
Lymphoma 1263
Gastrointestinal Stromal Tumors 1264
Metastatic Neoplasms 1264
Diverticular Disease 1264
Duodenal Diverticula 1265
Incidence and Cause 1265
Clinical Manifestations 1265
Treatment 1266
Jejunal and Ileal Diverticula 1266
Incidence and Cause 1266
Clinical Manifestations 1266
Treatment 1267
Meckel’s Diverticulum 1268
Incidence and Cause 1268
Clinical Manifestations 1268
Diagnostic Studies 1269
Treatment 1269
Miscellaneous Problems 1270
Small Bowel Ulcerations 1270
Ingested Foreign Bodies 1270
Small Bowel Fistulas 1270
Clinical Manifestations 1271
Treatment 1271
Stabilization 1271
Staging and Supportive Care 1271
Definitive Management 1272
Pneumatosis Intestinalis 1272
Blind Loop Syndrome 1273
Radiation Enteritis 1273
Short Bowel Syndrome 1274
Treatment 1275
Vascular Compression of the Duodenum 1276
Selected References 1276
References 1277
Chapter 51 The Appendix 1279
Embryology and Anatomy 1279
Appendicitis 1279
Historical Perspective 1279
Pathophysiology 1279
Bacteriology 1280
Diagnosis 1280
History 1280
Physical Examination 1280
Laboratory Studies 1280
Radiographic Studies 1281
Diagnostic Laparoscopy 1282
Special Patient Populations 1282
Diagnostic Algorithm 1283
Treatment 1284
Perforated Appendicitis 1286
Appendiceal Abscess 1286
Chronic or Recurrent Appendicitis 1286
Normal-Appearing Appendix 1288
Appendicitis in Older Patients 1288
Treatment Algorithm 1289
Outcomes 1289
Neoplasms 1289
Selected References 1291
References 1291
Chapter 52 Colon and Rectum 1294
Embryology of the Colon and Rectum 1294
Anatomy of the Colon, Rectum, and Pelvic Floor 1294
Pararectal Fascia 1296
Pelvic Floor 1296
Arterial Supply and Venous and Lymphatic Drainage 1298
Nerves 1303
Physiology of the Colon 1303
Recycling of Nutrients 1303
Colonic Flora 1303
Prebiotics and Probiotics 1303
Fermentation 1304
Short-Chain Fatty Acids 1306
Urea Recycling 1306
Absorption 1306
Secretion 1307
Motility 1307
Formation of Stool 1307
Defecation 1307
Bowel Preparation Before Surgery 1308
Diverticular Disease 1309
Pathogenesis 1309
Diverticulitis 1310
Uncomplicated Diverticulitis 1311
Complicated Diverticulitis 1312
Abscess 1312
Fistula 1313
Generalized Peritonitis 1313
Obstruction 1314
Diverticular-Associated Colitis 1314
Colonic Volvulus 1314
Large Bowel Obstruction and Pseudo-Obstruction 1317
Inflammatory Bowel Disease 1319
Ulcerative Colitis 1319
Epidemiology and Cause 1319
Pathologic Features 1320
Gross Appearance 1320
Histologic Appearance 1321
Clinical Presentation 1322
Extraintestinal Manifestations 1322
Diagnosis 1322
Risk for Carcinoma 1322
Treatment 1324
Medical Therapy 1324
Aminosalicylates 1324
Corticosteroids 1324
Immunomodulatory Medications 1324
Indications for Surgery 1324
Fulminant Colitis and Toxic Megacolon 1324
Massive Bleeding 1325
Intractability 1325
Dysplasia or Carcinoma 1325
Surgical Procedures 1325
Total Proctocolectomy With End Ileostomy 1326
Total Proctocolectomy With Continent Ileostomy 1326
Total Proctocolectomy With Ileal Pouch–Anal Anastomosis 1326
Summary of Elective Operations 1329
Postoperative Care 1329
Crohn’s Colitis 1330
Epidemiology and Cause 1330
Pathologic Features 1330
Gross Appearance 1330
Histologic Appearance 1330
Clinical Presentation 1330
Diagnosis 1331
Treatment 1331
Medical Therapy 1331
Indications for Surgery 1332
Intractability 1332
Intestinal Obstruction 1332
Intra-Abdominal Abscess 1332
Fistulas 1332
Fulminant Colitis and Toxic Megacolon 1332
Massive Bleeding 1332
Cancer 1332
Extracolonic Manifestations 1332
Growth Retardation 1332
Surgical Procedures 1333
Ileocecal Resection 1333
Total Proctocolectomy With End Ileostomy 1333
Total Abdominal Colectomy With Ileorectal Anastomosis or End Ileostomy 1333
Segmental Colon Resection 1333
Postoperative Recurrence 1334
Infectious Colitis 1334
Colonic Ischemia 1335
Neoplasia 1337
Colorectal Cancer Genetics 1338
Specific Genes and Mutations 1338
Tumor Suppressor Genes 1338
MYH Mutations and MYH-Associated Polyposis 1340
Mismatch Repair Genes 1341
Oncogenes 1341
Adenoma-Carcinoma Sequence 1341
Colorectal Polyps 1342
Hereditary Cancer Syndromes 1345
Sporadic Colon Cancer 1350
Staging 1353
Rules for Classification 1354
Clinical Staging 1354
Pathologic Staging 1354
Tumor Regression Grade 1354
Treatment and Follow-Up 1354
Rectal Cancer 1356
Local Excision 1358
Transanal Endoscopic Microsurgery 1358
Fulguration 1359
Abdominal Perineal Resection 1359
Low Anterior Resection 1359
Sphincter-Sparing Abdominal Perineal Resection With Coloanal Anastomosis 1360
Colorectal Cancer Prevention and Screening 1360
Intestinal Stomas 1362
Basic Types 1362
Physiologic Considerations and Practical Implications 1363
Section 11 Chest 1563
Chapter 58 Lung, Chest Wall, Pleura, and Mediastinum 1564
Anatomy 1564
Selection Of Patients For Thoracic Operations 1568
Physiologic Evaluation 1568
Cardiopulmonary Exercise Testing 1570
Thoracic Incisions 1570
Lung 1571
Congenital Lesions 1571
Cystic Lesions 1571
Congenital Bronchopulmonary Malformations 1571
Congenital Abnormalities of the Trachea and Bronchi 1572
Congenital Vascular Disorders 1573
Lung Cancer 1573
Pathology 1573
Screening 1574
Diagnosis 1574
Staging 1575
Evaluation of Stages 1575
T (Tumor) Stage 1575
N (Nodal) Stage 1575
Current American Joint Committee on Cancer Staging System 1577
Tumor (T) 1577
Lymph Nodes (N) 1578
Metastases (M) 1578
Results of Treatment of Lung Cancer According to Stage 1578
Local Therapy for Early-Stage Non–Small Cell Lung Cancer 1581
Neoadjuvant and Adjuvant Therapy 1582
Treatment of Metastatic Disease 1582
Trachea 1583
Tracheal Trauma 1583
Pulmonary Infections 1586
Bronchiectasis 1586
Lung Abscess 1586
Other Bronchopulmonary Disorders 1586
Mycobacterial Infections 1586
Fungal and Parasitic Infections 1587
Massive Hemoptysis 1589
Emphysema And Diffuse Lung Disease 1589
Emphysema 1589
Diffuse Lung Disease 1590
Adult Respiratory Distress Syndrome 1590
Pulmonary Metastases 1591
Surgical Treatment 1591
Miscellaneous Lung Tumors 1591
Chest Wall 1592
Pectus Excavatum 1592
Chest Wall Tumors 1593
Bone Tumors 1593
Soft Tissue Tumors 1593
Metastatic Tumors 1593
Reconstruction 1594
Chest Wall Infections 1594
Chest Wall Trauma 1594
Thoracic Outlet Syndrome 1594
Diagnosis 1594
Diagnostic Tests 1595
Adson (Scalene) Test 1595
Halsted (Costoclavicular) Test 1595
Wright (Hyperabduction) Test 1595
Roos Test 1595
Treatment 1595
Pleura 1595
Pleural Effusions 1595
Benign Pleural Effusions 1596
Malignant Pleural Effusion 1596
Empyema 1597
Chylothorax 1598
Pneumothorax 1599
Mesothelioma 1599
Mediastinum 1600
Anatomy 1601
Anterosuperior Compartment 1601
Middle Compartment 1601
Posterior or Paravertebral Sulci Compartment 1601
Mediastinal Masses and Tumors 1602
Clinical Manifestations and Diagnosis 1602
Evaluation and Diagnostic Imaging 1602
Histologic Diagnosis 1602
Types of Mediastinal Cysts and Tumors 1602
Primary Cysts 1602
Primary Mediastinal Neoplasms 1603
Thymoma 1603
Germ Cell Tumors 1604
Teratomas 1604
Malignant Nonteratomatous Germ Cell Tumors 1604
Seminomas 1604
Nonseminomatous Tumors 1604
Neurogenic Tumors 1605
Ganglion Tumors 1605
Paraganglioma (Pheochromocytoma) 1605
Lymphomas 1605
Endocrine Tumors 1606
Thyroid Tumors 1606
Parathyroid Tumors 1606
Neuroendocrine Tumors 1606
Selected References 1606
References 1607
Chapter 59 Congenital Heart Disease 1611
History and Other Considerations 1611
Pathways For Practicing Congenital Heart Surgery 1611
Anatomy, Terminology, and Diagnosis 1612
Anatomy and Terminology 1612
Diagnosis 1613
Physical Examination 1613
Diagnostic Tests 1614
Pulse Oximetry 1614
Plain Radiography 1614
Electrocardiography 1614
Echocardiography 1614
Magnetic Resonance Imaging and Computed Tomography 1614
Cardiac Catheterization 1615
Perioperative Care 1616
Anesthesia Pitfalls 1616
Neurologic Outcomes 1617
Lesion Overview 1617
Defects Associated With Increased Pulmonary Blood Flow 1617
Persistent Arterial Duct (Patent Ductus Arteriosus) 1617
Aortopulmonary Septal Defect (Aortopulmonary Window) 1618
Atrial Septal Defect 1618
Ventricular Septal Defect 1620
Perimembranous Ventricular Septal Defect 1620
Muscular Ventricular Septal Defect 1620
Subarterial (Supracristal or Outlet) Ventricular Septal Defect 1620
Atrioventricular Septal Defect (Atrioventricular Canal Defect) 1621
Adult Patient With Atrioventricular Septal Defect 1622
Persistent Arterial Trunk (Truncus Arteriosus) 1623
Abnormalities of Venous Drainage 1624
Total Anomalous Pulmonary Venous Return 1624
Obstructed Total Anomalous Pulmonary Venous Return 1625
Cor Triatriatum 1625
Anomalous Systemic Venous Drainage 1626
Cyanotic Congenital Heart Disease 1626
Tetralogy of Fallot 1626
Pulmonary Atresia and Intact Ventricular Septum 1628
Pulmonary Atresia With Ventricular Septal Defect 1629
Valvular Pulmonic Stenosis 1630
Conotruncal Anomalies 1630
Transposition of the Great Arteries 1630
Transposition of the Great Arteries–Intact Ventricular Septum 1631
Transposition of the Great Arteries–Ventricular Septal Defect With or Without Arch Hypoplasia 1632
Transposition of the Great Arteries–Ventricular Septal Defect With Pulmonary Stenosis–Left Ventricular Outflow Tract Obstruction or Pulmonary Atresia 1632
Transposition of the Great Arteries in Adults 1632
Double-Outlet Right Ventricle 1632
Congenitally Corrected Transposition of the Great Arteries (l-Transposition) 1632
Congenitally Corrected Transposition of the Great Arteries With Intact Ventricular Septum 1633
Congenitally Corrected Transposition of the Great Arteries With Ventricular Septal Defect and Pulmonic Stenosis 1633
Left Ventricular Outflow Tract Obstruction 1633
Valvular Aortic Stenosis 1634
Fibromuscular Subaortic Stenosis 1635
Tunnel Subaortic Stenosis 1635
Aortic Arch Anomalies 1635
Aortic Coarctation 1635
Interrupted Aortic Arch 1636
Single Ventricle 1637
Tricuspid Atresia 1638
Hypoplastic Left Heart Syndrome 1638
Neonatal Cardiac Transplantation 1639
Norwood Reconstruction 1639
Sano Modification of Norwood’s Operation 1640
Hybrid Procedure 1640
Fontan Operation 1641
Miscellaneous Anomalies 1643
Vascular Rings and Pulmonary Artery Slings 1643
Vascular Rings 1643
Complete Vascular Rings 1643
Partial Vascular Rings 1643
Pulmonary Artery Slings 1643
Section 12 Vascular 1696
Chapter 62 The Aorta 1697
Aneurysmal Disease 1697
Diagnosis 1697
Risk of Rupture 1698
Screening and Surveillance Recommendations 1699
Treatment 1699
Medical Therapy 1699
Surgical Treatment 1699
Preoperative Evaluation 1699
Technique of Open Surgical Repair of Abdominal Aortic Aneurysms 1701
Postoperative Management 1705
Endovascular Repair 1707
Thoracic and Thoracoabdominal Aortic Aneurysms 1707
Open Repair of Thoracic and Thoracoabdominal Aneurysms 1707
Endovascular Management of Thoracic and Thoracoabdominal Aneurysms 1708
Aortoiliac Occlusive Disease 1710
Presentation and Evaluation 1712
Treatment 1712
Technique of Open Reconstruction 1712
Aortofemoral Bypass Grafting 1712
Axillofemoral Bypass Grafting 1713
Femorofemoral Artery Bypass Grafting 1713
Iliofemoral Artery Bypass Grafting 1713
Aortoiliac Endarterectomy 1713
Complications of Aortic Surgery 1715
Surgical Treatment of Anastomotic Pseudoaneurysms 1717
Aortic Dissection 1718
References 1722
Chapter 63 Peripheral Arterial Occlusive Disease 1725
Epidemiology 1725
Basic Science of Vascular Disease 1725
Vascular Wall Microanatomy 1725
Atherosclerosis 1726
Evaluating And Treating The Patient With Peripheral Arterial Disease 1727
History and Physical Examination 1727
Chronic Arterial Insufficiency 1727
Physiologic Testing and Imaging 1729
Imaging Studies 1733
Angiography 1733
Computed Tomography Angiography 1735
Magnetic Resonance Angiography 1735
Carbon Dioxide Angiography 1735
Intravascular Ultrasound 1735
Treatment 1735
Medical Treatment 1735
Revascularization: Surgical Treatment 1738
Intermittent Claudication 1738
Critical Limb Ischemia 1738
Diabetic Foot 1738
Lower Extremity Amputations 1740
Ray Amputation 1741
Transmetatarsal Amputation 1741
Below-Knee Amputation 1742
Above-Knee Amputation 1742
Surgical Revascularization Procedures 1743
Open Surgical Management 1743
Aortoiliac Disease 1743
Lower Extremity Occlusive Disease 1743
Complications 1747
Endovascular Management 1747
Subintimal Angioplasty 1747
Balloon Angioplasty 1748
Stenting 1748
Stent Graft 1749
Other Variations of Balloon Angioplasty 1751
Cutting Balloon 1751
Cryoplasty 1751
Atherectomy 1751
Acute Limb Ischemia 1751
Other Causes Of Acute And Chronic Limb Ischemia 1752
Nonatherosclerotic Arteriopathies 1752
Buerger’s Disease 1752
Vasculitis 1753
Large-Vessel Vasculitis 1753
Giant Cell Arteritis (Temporal Arteritis) 1753
Takayasu’s Disease 1753
Medium-Vessel Vasculitis 1753
Polyarteritis Nodosa 1753
Kawasaki’s Disease 1753
Behçet’s Disease 1754
Cogan’s Syndrome 1754
Small-Vessel Vasculitis 1754
Antineutrophil Cytoplasmic Antibody–Associated Vasculitides 1754
Vasculitis Associated With Connective Tissue Diseases 1754
Heritable Arteriopathies 1754
Cystic Medial Necrosis 1754
Pseudoxanthoma Elasticum 1754
Arteria Magna Syndrome 1754
Congenital Conditions Affecting the Arteries 1754
Persistent Sciatic Artery 1754
Popliteal Entrapment Syndromes 1755
Adventitial Cystic Disease 1755
Peripheral Artery Aneurysms 1755
Femoral and Popliteal Artery Aneurysms 1755
Evaluating the Success of Revascularization Procedures 1755
Renal Artery Disease 1758
Diagnosis 1758
Magnetic Resonance Angiography 1758
Treatment 1759
Open Renal Artery Bypass 1759
Renal Artery Stenting 1759
Value, Limitations, and Techniques 1759
Renal Angioplasty and Stent Procedure 1760
Renal Artery Access and Guide Sheath Positioning 1760
Renal Angioplasty 1761
Stent Placement 1761
Completion Angiography 1761
Technical Tips 1761
Splanchnic Aneurysms: Splenic, Mesenteric, and Renal Artery Aneuryms 1761
Carotid Artery Disease 1763
Pathophysiology 1763
Clinical Presentation 1763
Diagnosis 1763
Treatment 1764
Carotid Endarterectomy 1764
Indications 1764
Proven Indications 1765
Acceptable But Not Proven Indications 1765
Uncertain Indications 1765
Proven Inappropriate Indications 1766
Technique 1766
Postoperative Care 1767
Complications 1768
Carotid Angioplasty and Stent Procedure 1768
Indications and Contraindications 1768
Technique 1769
Carotid Artery Access and Guide Sheath Positioning 1769
Placement of Embolic Protection Device 1769
Carotid Stent Placement 1769
Carotid Angioplasty 1769
Completion Angiogram 1769
Conclusions 1770
Dialysis Access 1771
Dialysis Outcomes Quality Initiative (DOQI) Guidelines 1771
Dialysis Outcome Quality Initiative Guidelines 1771
Nomenclature 1771
Superficial Venous System of the Upper Extremity 1771
Cephalic Vein 1772
Basilic Vein 1772
Median Antebrachial Vein 1772
Initial Evaluation for New Access 1772
Central Venous Catheters 1772
Types of Venous Transpositions 1773
Upper Arm Venous Transposition 1773
Forearm Venous Transpositions 1773
Lower Extremity Venous Transpositions 1774
Techniques of Venous Transposition 1774
Patient Assessment and Selection of Optimal Site 1774
Superficial Venous Transposition of the Forearm 1775
Superficial Venous Transposition of the Arm 1775
Follow-Up 1776
Patients With Failing or Failed Access 1776
Secondary Interventions in Autogenous Fistulas 1777
Complex Access 1777
Vascular Access Complications 1778
Conclusion 1778
Selected References 1779
References 1779
Chapter 64 Vascular Trauma 1785
General Approach To Vascular Trauma 1785
Mechanism of Injury 1785
Clinical Presentation 1786
Diagnosis 1786
Physical Examination 1786
Treatment 1787
Minimal Vascular Injury and Nonoperative Management 1787
Endovascular Management 1788
Torso Injuries 1788
Cerebrovascular Injuries 1788
Extremity Vascular Injury 1789
Who Should Perform Endovascular Repairs? 1789
Surgical Treatment 1789
Preparation for Operative Management 1789
Vascular Exposure and Control 1790
Vascular Damage Control 1790
Choice of Repair and Graft Material 1791
Intraoperative Imaging and Noninvasive Evaluation 1791
Role of Tissue Coverage 1791
Fasciotomy 1792
Role of Immediate Amputation 1792
Common Errors and Pitfalls 1792
Specific Injuries 1792
Head, Neck, and Thoracic Outlet 1792
Intrathoracic Great Vessel Injuries 1793
Abdominal Vascular Injury 1794
Upper Extremity 1795
Lower Extremity 1797
Operative Techniques For Extremity Fasciotomy 1797
Postoperative Management 1798
Outcomes And Follow-Up 1798
Selected References 1798
References 1799
Chapter 65 Venous Disease 1801
Anatomy 1801
Superficial Venous System 1801
Deep Venous System 1801
Perforating Venous System 1801
Normal Venous Histology and Function 1802
Venous Insufficiency 1803
Primary Venous Insufficiency 1803
Pathology 1804
Mechanical Abnormalities 1804
Cellular Abnormalities 1804
Molecular Abnormalities 1804
Risk Factors 1804
Symptoms 1805
Physical Examination 1805
Diagnostic Evaluation of Venous Dysfunction 1805
Phlebography and Venography 1806
Magnetic Resonance Venous Imaging 1806
Classification Systems 1806
Treatment of Superficial Venous Insufficiency 1806
Nonoperative Management 1806
Venous Ablation of Telangiectasias 1808
Surgical Management 1809
Surgery for Axial Venous Incompetence 1809
Secondary Venous Insufficiency 1811
Treatment 1811
Surgery for Deep Venous Insufficiency 1811
Direct Venous Reconstruction 1812
Deep Venous Thrombosis 1812
Lower Extremity Deep Venous Thrombosis 1812
Causes 1813
Stasis 1813
Hypercoagulable State 1813
Venous Injury 1813
Diagnostic Considerations 1813
Incidence 1813
Clinical Diagnosis 1813
Imaging Studies and Laboratory Tests 1814
Venography 1814
Impedance Plethysmography 1814
Fibrin and Fibrinogen Assays 1814
Duplex Ultrasound 1814
Magnetic Resonance Venous Imaging 1814
Prophylaxis 1814
Treatment 1815
Thrombolysis 1815
Endovascular Reconstruction 1815
Upper Extremity Deep Venous Thrombosis 1816
Treatment 1816
Vena Cava Filter 1816
Retrievable Vena Cava Filters 1816
Superficial Thrombophlebitis 1816
Conclusion 1817
Selected References 1817
References 1817
Chapter 66 The Lymphatics 1819
Embryology and Anatomy 1819
Function and Structure 1819
Pathophysiology and Staging 1820
Differential Diagnosis 1820
Classification 1821
Diagnostic Tests 1821
New Diagnostic Tests 1822
Treatment 1822
General Therapeutic Measures 1822
Specific Treatment Measures 1822
Elevation and Compression Garments 1822
Complex Decongestive Physical Therapy 1822
Compression Pump Therapy 1823
Drug Therapy 1823
Molecular Lymphangiogenesis 1823
Operative Treatment 1823
Lymphatic Disorders 1825
Chylothorax 1825
Chyloperitoneum 1825
Tumors of the Lymphatics 1825
Selected References 1826
References 1826
Section 13 Specialties in General Surgery 1828
Chapter 67 Pediatric Surgery 1829
Newborn Physiology 1829
Cardiovascular System 1829
Pulmonary System 1829
Thermoregulation 1830
Immunologic Function 1830
Fluids, Electrolytes, and Nutrition 1830
Fluid Requirements 1830
Nutrition 1830
Total Parenteral Nutrition 1830
Caloric Requirements 1831
Protein 1831
Carbohydrate 1831
Fat 1831
Neck Lesions 1831
Cervical Lymphadenopathy 1831
Cystic Hygroma 1832
Thyroglossal Duct Cyst 1832
Branchial Cleft Remnants 1833
Torticollis 1833
Extracorporeal Life Support 1833
Indications 1833
Physiologic Considerations 1833
Complications 1834
Congenital Diaphragmatic Hernia 1834
Pathogenesis 1834
Clinical Presentation 1835
Diagnosis 1835
Treatment 1835
Surgical Repair 1835
Outcomes 1836
Bronchopulmonary Malformations 1836
Bronchogenic Cyst 1836
Congenital Pulmonary Airway Malformation 1836
Pulmonary Sequestration 1836
Congenital Lobar Emphysema 1837
Alimentary Tract 1837
Esophageal Atresia and Tracheoesophageal Fistula 1837
Clinical Presentation and Diagnosis 1837
Treatment 1838
Preoperative Management 1838
Surgical Management 1838
Gastroesophageal Reflux 1839
Clinical Presentation 1840
Evaluation 1840
Treatment 1840
Hypertrophic Pyloric Stenosis 1841
Clinical Presentation 1841
Index 2079
A 2079
B 2083
C 2085
D 2091
E 2092
F 2094
G 2095
H 2097
I 2100
J 2102
K 2102
L 2102
M 2104
N 2107
O 2108
P 2108
Q 2113
R 2113
S 2115
T 2119
U 2121
V 2122
W 2123
X 2124
Y 2124
Z 2124