Additional Information
Book Details
Abstract
Principles and Practice of Surgery is the surgical companion textbook to the international medical bestseller Davidson’s Principles and Practice of Medicine. It is a comprehensive textbook for both the surgical student and trainee, guiding the reader through key core surgical topics which are encountered throughout an integrated medical curriculum as well as in subsequent clinical practice. Although sharing the same format and style as Davidson’s Principles and Practice of Medicine, this text is complete in itself, thus enabling the student to appreciate both the medical and surgical implications of diseases encountered in surgical wards.
- A three-section textbook of surgical principles and regional clinical surgery.
- The textbook presents a comprehensive account of international surgical practice, taking into account variations in the disease patterns and management approaches throughout the world.
- Superbly presented with line drawings, high quality radiographic images and colour photographs.
- Presented in similar form to its sister textbook Davidson’s Principles and Practice of Medicine.
- Full online and ebook version available as part of Student Consult.
- A new chapter on Evidence-based practice and professional development.
- An expanded chapter on Surgical preparation includes an account of the main issues surrounding day case surgery.
- A new International Advisory Board based in India, South Africa, South-east Asia and Europe has advised throughout on the structure and content of the book.
- Consequently the text has been updated to reflect changes in understanding, evidence and practice, and to keep the contents in line with undergraduate and postgraduate surgical curricula
- The evidence-based revision boxes that focus on major international guidelines have been thoroughly updated.
- The text on tropical conditions such as tropical pancreatitis, tuberculosis affecting the various organ systems and filarial lymphoedema has been expanded.
- Innovations useful in the practice of surgery in resource-poor environments have been included.
- The text gives a global emphasis on epidemiological and cultural issues such as problems associated with directed transfusion of blood products from first degree relatives, the issues of informed consent and patient autonomy.
- A comparison of SI and non-SI reference ranges for commonly used laboratory values has been added.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Principles and Practice of Surgery | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Preface | vii | ||
| Acknowledgements | viii | ||
| Contributors | ix | ||
| International Advisory Board | xi | ||
| Section 1: Principles of perioperative care | 1 | ||
| Chapter 1: Metabolic response to injury, fluid and electrolyte balance and shock | 3 | ||
| The metabolic response to injury | 3 | ||
| Features of the metabolic response to injury | 3 | ||
| Factors mediating the metabolic response to injury | 3 | ||
| The acute inflammatory response | 3 | ||
| The endothelium and blood vessels | 3 | ||
| Afferent nerve impulses and sympathetic activation | 4 | ||
| The endocrine response to surgery | 4 | ||
| Consequences of the metabolic response to injury | 5 | ||
| Hypovolaemia | 5 | ||
| Fluid-conserving measures | 5 | ||
| Blood flow-conserving measures | 5 | ||
| Increased energy metabolism and substrate cycling | 7 | ||
| Thermogenesis | 7 | ||
| Basal metabolic rate | 7 | ||
| Catabolism and starvation | 7 | ||
| Catabolism | 7 | ||
| Carbohydrate metabolism | 7 | ||
| Fat metabolism | 7 | ||
| Protein metabolism | 7 | ||
| Starvation | 8 | ||
| Changes in red blood cell synthesis and coagulation | 8 | ||
| Anabolism | 8 | ||
| Factors modifying the metabolic response to injury | 9 | ||
| Fluid and electrolyte balance | 9 | ||
| Normal water and electrolyte balance | 9 | ||
| Assessing losses in the surgical patient | 11 | ||
| Insensible fluid losses | 11 | ||
| The effect of surgery | 11 | ||
| The stress response | 11 | ||
| 'Third-space' losses | 11 | ||
| Loss from the gastrointestinal tract | 12 | ||
| Intravenous fluid administration | 12 | ||
| Types of intravenous fluid | 12 | ||
| Crystalloids | 12 | ||
| Dextrose-saline solutions | 13 | ||
| Colloids | 13 | ||
| Maintenance fluid requirements | 13 | ||
| Treatment of postoperative hypovolaemia and/or hypotension | 14 | ||
| Specific water and electrolyte abnormalities | 14 | ||
| Sodium and water | 14 | ||
| Water depletion | 14 | ||
| Water excess | 14 | ||
| Hypernatraemia | 14 | ||
| Hyponatraemia | 15 | ||
| Potassium | 15 | ||
| Hyperkalaemia (K >5.5mmol/L) | 15 | ||
| Hypokalaemia (<3.0mmol/L) | 16 | ||
| Other electrolyte disturbances | 16 | ||
| Calcium | 16 | ||
| Magnesium | 16 | ||
| Phosphate | 17 | ||
| Acid-base balance | 17 | ||
| Metabolic acidosis | 17 | ||
| Metabolic alkalosis | 18 | ||
| Respiratory acidosis | 18 | ||
| Respiratory alkalosis | 18 | ||
| Shock | 18 | ||
| Definition | 18 | ||
| Classification of shock | 19 | ||
| Hypovolaemic shock | 19 | ||
| Septic shock | 19 | ||
| Cardiogenic shock | 20 | ||
| Anaphylactic shock | 20 | ||
| Neurogenic shock | 20 | ||
| Pathophysiology | 20 | ||
| Macrocirculation | 21 | ||
| Microcirculation | 21 | ||
| Cellular function | 22 | ||
| The effect of shock on individual organ systems | 23 | ||
| Cardiovascular | 23 | ||
| Respiratory | 23 | ||
| Renal | 23 | ||
| Nervous system | 23 | ||
| Gastrointestinal | 23 | ||
| Hepatobiliary | 24 | ||
| Management | 24 | ||
| General principles | 24 | ||
| Airway and breathing | 24 | ||
| Circulation | 24 | ||
| Hypovolaemic shock | 25 | ||
| Septic shock | 26 | ||
| Cardiogenic shock | 28 | ||
| Anaphylactic shock | 28 | ||
| Chapter 2: Transfusion of blood components and plasma products | 29 | ||
| Introduction | 29 | ||
| Blood donation | 29 | ||
| Blood components | 29 | ||
| Red blood cells in additive solution | 29 | ||
| Platelets | 30 | ||
| Fresh frozen plasma (FFP) | 31 | ||
| Cryoprecipitate | 31 | ||
| Plasma products | 31 | ||
| Human albumin | 31 | ||
| Factor VIII and factor IX concentrates | 31 | ||
| Prothrombin complex concentrates | 31 | ||
| Immunoglobulin preparations (90% IgG) | 31 | ||
| Red cell serology | 32 | ||
| ABO antigens | 32 | ||
| Rhesus antigens (RH) | 32 | ||
| Other red cell antigens | 32 | ||
| Pretransfusion testing | 32 | ||
| Maximal surgical blood ordering schedule (MSBOS) | 33 | ||
| Indications for transfusion | 33 | ||
| Blood administration | 33 | ||
| Adverse effects of transfusion | 34 | ||
| Autologous transfusion | 35 | ||
| Preoperative donation | 35 | ||
| Isovolaemic haemodilution | 35 | ||
| Cell salvage | 36 | ||
| Transfusion requirements in special surgical settings | 36 | ||
| Blood component use in major haemorrhage | 36 | ||
| Cardiopulmonary bypass | 38 | ||
| Methods to reduce the need for blood transfusion | 38 | ||
| Acute volume replacement | 38 | ||
| Mechanisms for reducing blood use in surgery | 39 | ||
| Preoperative | 39 | ||
| Intraoperative | 39 | ||
| Postoperative | 39 | ||
| Better blood transfusion | 39 | ||
| Future trends | 39 | ||
| Chapter 3: Nutritional support in surgical patients | 40 | ||
| Introduction | 40 | ||
| Assessment of nutritional status | 40 | ||
| Assessment of nutritional requirements | 42 | ||
| Causes of inadequate intake | 42 | ||
| Methods of providing nutritional support | 42 | ||
| Enteral nutrition | 43 | ||
| Oral route | 43 | ||
| Methods of administration of enteral feeds | 43 | ||
| Nasogastric or nasojejunal tubes | 43 | ||
| Gastrostomy and jejunostomy | 43 | ||
| Complications of enteral nutrition | 44 | ||
| Parenteral nutrition | 44 | ||
| Indications for total parenteral nutrition | 44 | ||
| Composition of total parenteral nutrition solutions | 45 | ||
| Administration of total parenteral nutrition | 45 | ||
| Complications of total parenteral nutrition | 46 | ||
| Catheter problems | 46 | ||
| Thrombophlebitis | 46 | ||
| Infection | 46 | ||
| Metabolic complications | 46 | ||
| Peripheral venous nutrition | 47 | ||
| Monitoring of nutritional support | 47 | ||
| Chapter 4: Infections and antibiotics | 48 | ||
| Importance of infection | 48 | ||
| Biology of infection | 48 | ||
| Bacterial factors | 48 | ||
| Host defence systems | 48 | ||
| Preventing infection in surgical patients | 50 | ||
| Preoperative MRSA screening | 50 | ||
| Aseptic technique | 50 | ||
| Hand decontamination | 50 | ||
| Personal protective equipment for staff | 51 | ||
| Skin preparation | 51 | ||
| Surgical instruments | 51 | ||
| Maintaining patient homeostasis | 51 | ||
| Creutzfeldt-Jakob disease and other prion diseases | 52 | ||
| Prophylactic use of antibiotics | 52 | ||
| Timing and dose | 52 | ||
| Antibiotic choice | 52 | ||
| Carriage of resistant organisms and prophylaxis | 52 | ||
| Prophylaxis for immunosuppressed patients | 52 | ||
| Management of surgical infections | 53 | ||
| Diagnosis | 53 | ||
| Antibiotic therapy | 53 | ||
| Specific infections in surgical patients | 55 | ||
| Surgical site infection (SSI) | 55 | ||
| Diagnosis | 55 | ||
| Treatment | 55 | ||
| Prevention | 55 | ||
| Urinary tract infections | 55 | ||
| Emergence of multiresistant bacteria | 56 | ||
| Respiratory tract infections | 56 | ||
| C. difficile infection (CDI) | 56 | ||
| Diagnosis | 57 | ||
| Treatment | 57 | ||
| Infection control | 57 | ||
| Fungal infections | 57 | ||
| Risk factors | 57 | ||
| Infections of prosthetic devices | 57 | ||
| Infections primarily treated by surgical management | 57 | ||
| Abscess | 57 | ||
| Necrotising fasciitis | 58 | ||
| Diabetic foot infections | 58 | ||
| Gas gangrene | 58 | ||
| Infections following trauma | 58 | ||
| Tetanus | 58 | ||
| Healthcare-associated infections | 59 | ||
| Chapter 5: Ethics, preoperative considerations, anaesthesia and analgesia | 60 | ||
| Ethical and legal principles for surgical patients | 60 | ||
| Principles in surgical ethics | 60 | ||
| Principalism | 60 | ||
| Autonomy | 60 | ||
| Beneficence: doing good | 60 | ||
| Nonmalfeasance: avoiding harm | 60 | ||
| Justice: promoting fairness | 61 | ||
| Informed consent | 61 | ||
| General considerations | 61 | ||
| Consent in specific circumstances | 62 | ||
| Children | 62 | ||
| Mental illness | 62 | ||
| Transient/irreversible cognitive impairment | 62 | ||
| Confidentiality | 62 | ||
| Specific topics | 63 | ||
| Euthanasia and 'end-of-life' issues | 63 | ||
| Abortion | 63 | ||
| Negligence | 63 | ||
| Human Tissue Act | 63 | ||
| Completion of a death certificate | 63 | ||
| Postmortem examination | 64 | ||
| Research governance | 64 | ||
| Ethics committees | 64 | ||
| Preoperative assessment | 64 | ||
| Assessment of operative fitness and perioperative risk | 64 | ||
| Perioperative medicine | 65 | ||
| Oxygen delivery in minimising operative risk | 65 | ||
| Systematic preoperative assessment | 65 | ||
| Cardiovascular system | 65 | ||
| Respiratory system | 66 | ||
| Smoking | 66 | ||
| Preoperative exercise | 66 | ||
| Alcohol | 66 | ||
| Nutritional status | 66 | ||
| Obesity | 66 | ||
| Drug therapy | 66 | ||
| Long-term steroid therapy | 66 | ||
| Antiplatelet therapy and anticoagulants | 67 | ||
| Oral contraceptives and hormone-replacement therapy | 67 | ||
| Psychiatric drugs | 67 | ||
| Allergies | 67 | ||
| Pregnancy | 67 | ||
| Previous operations and anaesthetics | 68 | ||
| Preoperative investigations | 68 | ||
| Haematology | 68 | ||
| Full blood count | 68 | ||
| Coagulation screen | 68 | ||
| Cross-matching | 69 | ||
| Biochemistry | 69 | ||
| Urea and electrolytes | 69 | ||
| Liver function tests | 69 | ||
| Cardiac investigations | 69 | ||
| Respiratory investigations | 70 | ||
| Cardiopulmonary exercise testing | 70 | ||
| Patients where there is increased risk of transmission of blood borne viruses or other infection | 70 | ||
| Preoperative screening for methicillin-resistant Staphylococcus aureus or other resistant organisms | 71 | ||
| Assessment of the patient for emergency surgery | 71 | ||
| Preoperative review | 71 | ||
| Venous thromboembolism prophylaxis | 71 | ||
| Antibiotic prophylaxis | 72 | ||
| Preoperative anxiolytic medication | 73 | ||
| Preoperative fasting | 73 | ||
| Perioperative implications of chronic disease | 73 | ||
| Cardiovascular disease | 73 | ||
| Ischaemic heart disease | 73 | ||
| Myocardial infarction | 73 | ||
| Heart failure | 74 | ||
| Valvular heart disease | 74 | ||
| Pacemakers | 75 | ||
| Hypertension | 75 | ||
| Perioperative management of patients with cardiovascular disease | 75 | ||
| Drug therapy | 75 | ||
| β-Blockers | 75 | ||
| Angiotensin-converting enzyme (ACE) inhibitors | 75 | ||
| Perioperative haemodynamic therapy | 75 | ||
| Respiratory disease | 75 | ||
| Anaesthetic technique | 76 | ||
| Intraoperative ventilatory management | 76 | ||
| Postoperative analgesia | 76 | ||
| Physiotherapy | 76 | ||
| Postoperative ventilation | 76 | ||
| Diabetes mellitus | 76 | ||
| Diabetic comorbidity | 76 | ||
| Vascular disease | 76 | ||
| Renal disease | 76 | ||
| Neuropathy | 76 | ||
| Infection | 76 | ||
| Effect of surgical stress on diabetic control | 76 | ||
| Principles of perioperative diabetes management | 76 | ||
| Methods of insulin administration | 77 | ||
| Chronic renal failure | 77 | ||
| Dialysis-dependent patients | 77 | ||
| Nondialysis-dependent patients | 78 | ||
| Jaundice | 78 | ||
| Hepatitis | 78 | ||
| Coagulopathy | 78 | ||
| Acute renal failure | 78 | ||
| Cirrhosis | 78 | ||
| Abnormal coagulation | 78 | ||
| Anticoagulant therapy | 78 | ||
| Inherited disorders of coagulation | 79 | ||
| Acquired coagulopathy | 79 | ||
| Anaemia | 79 | ||
| Musculoskeletal disease | 79 | ||
| Miscellaneous conditions | 79 | ||
| Anaesthesia and the operation | 79 | ||
| Anaesthesia | 79 | ||
| General anaesthesia | 79 | ||
| Local anaesthetic agents | 79 | ||
| Spinal and epidural anaesthesia | 80 | ||
| Spinal anaesthesia | 80 | ||
| Epidural anaesthesia | 80 | ||
| Peripheral nerve block | 80 | ||
| Local infiltration | 80 | ||
| Topical anaesthesia | 81 | ||
| Postoperative analgesia | 82 | ||
| Pain assessment | 82 | ||
| Postoperative analgesic strategy | 82 | ||
| Epidural analgesia | 82 | ||
| Patient-controlled analgesia | 83 | ||
| Parenteral and oral opioid regimens | 83 | ||
| Strong opioids | 83 | ||
| Weak opioids | 83 | ||
| Paracetamol and NSAIDs | 83 | ||
| Ketamine | 83 | ||
| Neuropathic pain | 83 | ||
| Postoperative nausea and vomiting | 83 | ||
| Day surgery | 83 | ||
| Facilities | 83 | ||
| Patient pathway | 84 | ||
| Admission for day surgery | 85 | ||
| Discharge criteria | 85 | ||
| Chapter 6: Principles of the surgical management of cancer | 86 | ||
| The biology of cancer | 86 | ||
| Carcinogenesis | 87 | ||
| Invasion and metastasis | 88 | ||
| Natural history and estimate of cure | 89 | ||
| The management of patients with cancer | 90 | ||
| Screening | 90 | ||
| Screening for inherited cancer | 90 | ||
| The cancer patient's journey | 91 | ||
| Symptoms that may initiate a patients 'cancer journey' | 91 | ||
| Local effects | 91 | ||
| Systemic effects | 91 | ||
| Consultation with the GP | 92 | ||
| Referral to a specialist/cancer centre | 92 | ||
| Investigations | 92 | ||
| Diagnostic investigations | 92 | ||
| Staging investigations | 93 | ||
| Treatment | 93 | ||
| Benign tumours | 94 | ||
| Malignant tumours | 94 | ||
| Adjuvant treatment | 95 | ||
| Surgery for metastases | 96 | ||
| Follow-up | 96 | ||
| Palliation of advanced cancer | 96 | ||
| Prognosis and counselling | 96 | ||
| Care of the dying | 96 | ||
| Chapter 7: Trauma and multiple injury | 98 | ||
| Introduction | 98 | ||
| The importance of trauma | 98 | ||
| The 'golden hour' | 98 | ||
| The 'platinum 10 minutes' | 98 | ||
| Temporal distribution of trauma deaths | 98 | ||
| Mechanisms of injury | 99 | ||
| Blunt trauma | 99 | ||
| Penetrating trauma | 99 | ||
| Miscellaneous trauma | 99 | ||
| Injury severity | 99 | ||
| Purpose | 99 | ||
| Limitations | 100 | ||
| Trauma scoring systems | 100 | ||
| Physiological scores | 100 | ||
| The Glasgow Coma Scale (GCS) | 100 | ||
| Revised Trauma Score (RTS) | 100 | ||
| Anatomical scores | 100 | ||
| Abbreviated Injury Scale (AIS) | 100 | ||
| Injury Severity Score (ISS) | 100 | ||
| Combination scores | 100 | ||
| Trauma Related Injury Severity Score (TRISS) | 100 | ||
| Trauma systems, centres and teams | 101 | ||
| Trauma system | 101 | ||
| Trauma Centres | 101 | ||
| Trauma team | 101 | ||
| Shock | 102 | ||
| Section 2: Gastrointestinal surgery | 145 | ||
| Chapter 11: The abdominal wall and hernia | 147 | ||
| Umbilicus | 147 | ||
| Developmental abnormalities | 147 | ||
| Persistent vitello-intestinal duct | 147 | ||
| Urachus | 147 | ||
| Umbilical sepsis | 147 | ||
| Umbilical tumours | 147 | ||
| Disorders of the rectus muscle | 147 | ||
| Haematoma of the rectus sheath | 147 | ||
| Desmoid tumour | 147 | ||
| Abdominal hernia | 148 | ||
| Inguinal hernia | 148 | ||
| Surgical anatomy | 149 | ||
| Indirect inguinal hernia | 150 | ||
| Clinical features | 150 | ||
| Direct inguinal hernia | 151 | ||
| Clinical features | 151 | ||
| Management of uncomplicated inguinal hernia | 151 | ||
| Indirect inguinal hernia | 152 | ||
| Direct hernia | 152 | ||
| Sportsmans hernia | 153 | ||
| Femoral hernia | 153 | ||
| Surgical anatomy | 153 | ||
| Clinical features | 154 | ||
| Surgical repair of femoral hernia | 154 | ||
| Ventral hernia | 155 | ||
| Epigastric hernia | 155 | ||
| Umbilical hernia | 156 | ||
| Paraumbilical hernia | 156 | ||
| Incisional hernia | 156 | ||
| Parastomal hernia | 156 | ||
| Rare external hernias | 156 | ||
| Internal hernia | 157 | ||
| Complications of hernia | 157 | ||
| Irreducibility | 157 | ||
| Obstruction | 157 | ||
| Strangulation | 157 | ||
| Management of complicated hernia | 158 | ||
| Chapter 12: The acute abdomen | 159 | ||
| Introduction | 159 | ||
| Aetiology | 159 | ||
| Pathophysiology of abdominal pain | 159 | ||
| Somatic pain | 159 | ||
| Visceral pain | 161 | ||
| Pathogenesis | 161 | ||
| Inflammation | 161 | ||
| Peritonitis | 162 | ||
| Section 3: Surgical specialties | 299 | ||
| Chapter 18: Plastic surgery including common skin and subcutaneous lesions | 301 | ||
| Introduction | 301 | ||
| Structure and function of the skin | 301 | ||
| Wounds | 301 | ||
| Types of wound | 301 | ||
| Principles of wound healing | 302 | ||
| Inflammatory phase (Days 1-6) | 302 | ||
| Proliferative phase (Days 3-21) | 302 | ||
| Maturation or remodelling phase (Weeks 3-52+) | 302 | ||
| Abnormal scarring | 303 | ||
| Factors influencing wound healing | 304 | ||
| Blood supply | 304 | ||
| Infection | 304 | ||
| Nutritional status | 304 | ||
| Intercurrent disease | 304 | ||
| Surgical technique | 304 | ||
| Wound infection | 304 | ||
| Classification | 304 | ||
| Clinical features | 305 | ||
| Prevention | 305 | ||
| Management | 305 | ||
| Involvement of other structures | 305 | ||
| Devitalised skin flaps | 305 | ||
| Wounds with skin loss | 306 | ||
| Skin grafts | 306 | ||
| Flaps | 306 | ||
| Burns | 308 | ||
| Mechanisms | 308 | ||
| Local effects of burn injury | 308 | ||
| General effects of burn injury | 308 | ||
| Classification | 309 | ||
| Burn size | 309 | ||
| Burn depth | 310 | ||
| Superficial and superficial partial-thickness burns | 310 | ||
| Deep partial-thickness burns | 310 | ||
| Full-thickness burns | 310 | ||
| Determination of burn depth | 311 | ||
| Mechanism | 312 | ||
| Appearance | 312 | ||
| Sensation | 312 | ||
| Prognosis in burns | 312 | ||
| Associated respiratory injury | 312 | ||
| Management | 312 | ||
| First aid | 312 | ||
| Transfer to hospital | 312 | ||
| Adequate ventilation | 312 | ||
| Initial assessment and management | 312 | ||
| Prevention and treatment of burn shock | 313 | ||
| Oral intake | 313 | ||
| Nutritional management | 313 | ||
| Blood transfusion | 313 | ||
| Organ failure and burn shock | 313 | ||
| Respiratory complications | 313 | ||
| Renal failure | 313 | ||
| Sepsis | 314 | ||
| Curlings ulcer and gastric erosions | 314 | ||
| Initial cleansing and debridement | 314 | ||
| Dressings | 314 | ||
| Exposure | 314 | ||
| Evaporative dressings | 314 | ||
| Semi-occlusive and occlusive dressings | 314 | ||
| Topical antibacterial agents | 314 | ||
| 'Biological' dressings | 314 | ||
| Relief of constriction (escharotomy) | 314 | ||
| Restoration of epidermal cover | 314 | ||
| Long-term functional and cosmetic outcomes | 315 | ||
| Skin and soft tissue lesions | 315 | ||
| Diagnosis | 315 | ||
| Infections | 315 | ||
| Cellulitis | 315 | ||
| Necrotising fasciitis | 315 | ||
| Hidradenitis suppurativa | 316 | ||
| Cysts | 316 | ||
| Epidermoid cysts | 316 | ||
| Dermoid cysts | 316 | ||
| Tumours of the skin | 316 | ||
| Benign lesions | 317 | ||
| Papillomas | 317 | ||
| Squamous cell papillomas (SCC) (viral warts) | 317 | ||
| Seborrhoeic keratoses (senile warts) | 317 | ||
| Fibro-epithelial polyps (acrochordon or skin tags) | 318 | ||
| Dermatofibroma | 318 | ||
| Keratoacanthoma (molluscum sebaceum) | 318 | ||
| Benign naevi (moles) | 318 | ||
| Special types of naevi | 319 | ||
| Premalignant lesions | 319 | ||
| Actinic (solar) keratosis | 319 | ||
| In situ or intraepidermal squamous cell carcinoma (Bowens disease) | 319 | ||
| Malignant lesions | 319 | ||
| Basal cell carcinoma (rodent ulcer) | 320 | ||
| Squamous cell carcinoma | 320 | ||
| Marjolin's ulcer | 320 | ||
| Malignant melanoma (MM) | 320 | ||
| Lentigo maligna (in situ melanoma/Hutchisons melanotic freckle) | 321 | ||
| Superficial spreading melanoma (SSMM) | 321 | ||
| Nodular melanoma | 321 | ||
| Other types of malignant melanoma | 321 | ||
| Spread of malignant melanoma | 321 | ||
| Management of malignant melanoma | 322 | ||
| Clinical and pathological staging | 323 | ||
| Vascular tumours | 323 | ||
| Infantile haemangiomas (strawberry naevi) | 323 | ||
| Tumours of nerves | 324 | ||
| Neurilemmoma (Schwannoma) | 324 | ||
| Neurofibroma | 324 | ||
| Tumours of muscle and connective tissues | 324 | ||
| Lipoma | 324 | ||
| Sarcoma | 324 | ||
| Dermatofibrosarcoma protruberans (DFSP) | 325 | ||
| Dermal sarcoma | 325 | ||
| Liposarcoma | 325 | ||
| Fibrosarcoma | 325 | ||
| Rhabdomyosarcoma | 325 | ||
| Angiosarcoma and Kaposi's sarcoma | 325 | ||
| Chapter 19: The breast | 326 | ||
| Anatomy and physiology | 326 | ||
| Overview | 326 | ||
| Anatomy | 326 | ||
| Congenital abnormalities | 326 | ||
| Hormonal control of breast development and function | 326 | ||
| Assessment of a patient with breast disease | 326 | ||
| History | 327 | ||
| Clinical examination | 327 | ||
| Assessment of regional nodes | 328 | ||
| Imaging | 328 | ||
| Mammography | 328 | ||
| Ultrasonography | 329 | ||
| Magnetic resonance imaging (MRI) | 329 | ||
| Core biopsy and fine needle aspiration (FNA) cytology | 329 | ||
| Core biopsy | 329 | ||
| Punch biopsy | 329 | ||
| Fine-needle aspiration cytology | 329 | ||
| Open biopsy | 330 | ||
| Triple assessment | 330 | ||
| Accuracy of investigations | 330 | ||
| Sentinel lymph node biopsy | 330 | ||
| Nipple discharge | 330 | ||
| Benign breast conditions | 331 | ||
| Fibroadenoma | 331 | ||
| Breast lumpiness and pain | 331 | ||
| Lumpiness or nodularity | 332 | ||
| Other lumps | 332 | ||
| Noncyclical breast pain | 332 | ||
| Breast cysts | 332 | ||
| Duct ectasia | 332 | ||
| Epithelial hyperplasia | 332 | ||
| Benign neoplasms | 333 | ||
| Duct papilloma | 333 | ||
| Lipoma | 333 | ||
| Phyllodes tumour | 333 | ||
| Breast infection | 334 | ||
| Lactating infection | 334 | ||
| Nonlactating infection | 334 | ||
| Central (periareolar) infection | 334 | ||
| Mammary duct fistula | 335 | ||
| Peripheral nonlactating abscesses | 335 | ||
| Tubercular mastitis | 335 | ||
| Skin-associated infection | 335 | ||
| Breast cancer | 335 | ||
| Epidemiology | 335 | ||
| Risk factors for breast cancer | 336 | ||
| Age | 336 | ||
| Geographical variation | 336 | ||
| Menstrual and pregnancy factors | 336 | ||
| Breast cancer in developing countries | 336 | ||
| Radiation | 336 | ||
| Benign disease | 336 | ||
| Diet | 336 | ||
| Exogenous hormones | 336 | ||
| Physical activity, weight and height | 337 | ||
| Genetics | 337 | ||
| High risk genes | 337 | ||
| Other genes | 337 | ||
| Genetic testing | 337 | ||
| Management | 337 | ||
| Types of breast cancer | 337 | ||
| Noninvasive cancer | 337 | ||
| Invasive cancer | 338 | ||
| Hormone receptors | 338 | ||
| Growth factor receptors | 338 | ||
| Testing for receptors | 338 | ||
| Cancer types | 338 | ||
| Screening for breast cancer | 338 | ||
| Mammographic features of breast cancer | 339 | ||
| Staging of breast cancer | 339 | ||
| The curability of breast cancer | 340 | ||
| Prognosis of breast cancer | 340 | ||
| Presentation of breast cancer | 341 | ||
| Management of operable breast cancer | 343 | ||
| In situ breast cancer | 343 | ||
| Operable breast tumours | 343 | ||
| Local therapy | 343 | ||
| Breast-conserving surgery | 343 | ||
| Axillary surgery in women with operable invasive breast cancer | 343 | ||
| Radiotherapy | 344 | ||
| Modified radical mastectomy | 344 | ||
| Systemic therapy | 344 | ||
| Adjuvant chemotherapy | 344 | ||
| Adjuvant hormone therapy | 345 | ||
| Anti-HER2 therapy | 345 | ||
| Neoadjuvant therapy | 345 | ||
| Breast cancer in pregnancy | 346 | ||
| Pregnancy after treatment for breast cancer | 346 | ||
| Complications of treatment | 346 | ||
| Radiotherapy | 346 | ||
| Chemotherapy | 346 | ||
| Hormonal treatments | 346 | ||
| Psychological aspects | 346 | ||
| Breast reconstruction | 347 | ||
| Follow-up | 347 | ||
| Management of locally advanced breast cancer | 347 | ||
| Management of metastatic or advanced breast cancer | 348 | ||
| Chemotherapy | 348 | ||
| Hormonal treatment | 348 | ||
| Anti-HER2 therapy | 348 | ||
| Local treatments in metastatic breast cancer | 348 | ||
| Specific problems in patients with metastatic breast cancer | 348 | ||
| Bone disease | 348 | ||
| Hypercalcaemia | 349 | ||
| Marrow infiltration | 349 | ||
| Spinal cord compression | 349 | ||
| Pleural effusion | 349 | ||
| Liver metastases | 349 | ||
| Brain metastases | 349 | ||
| Miscellaneous tumours of the breast | 349 | ||
| Secondary tumours | 349 | ||
| Male breast | 349 | ||
| Gynaecomastia | 349 | ||
| Male breast cancer | 350 | ||
| Chapter 20: Endocrine surgery | 351 | ||
| Introduction | 351 | ||
| Thyroid gland | 351 | ||
| Surgical anatomy and development (see also Chapter 26) | 351 | ||
| Thyroid function | 351 | ||
| Assessment of thyroid disease | 352 | ||
| Enlargement of the thyroid gland (goitre) | 353 | ||
| Appendix: Laboratory reference ranges | 548 | ||
| Index | 551 |