BOOK
Principles and Practice of Surgery E-Book
O. James Garden | Andrew W. Bradbury | John L. R. Forsythe | Rowan W Parks
(2012)
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.
- 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 text version as part of Student Consult
- The contents have been restructured into three sections – Principles of Perioperative care, Gastrointestinal Surgery, and Surgical Specialties.
- Two new chapters have rationalised and amalgamated information on the Metabolic response to injury and Ethics and pre-operative considerations to avoid repetition.
- Throughout the text has been altered to reflect changes in understanding, evidence and practice, and to keep the contents in line with undergraduate and postgraduate surgical curricula
- A substantial number of new illustrations have been added to give better consistency and improved image quality.
- The evidence-based revision boxes that focus on major international guidelines have been thoroughly updated.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Principles & Practice of Surgery | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Preface | vii | ||
| Contributors | ix | ||
| 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 | 4 | ||
| Afferent nerve impulses and sympathetic activation | 4 | ||
| The endocrine response to surgery | 4 | ||
| Consequences of the metabolic response to injury | 4 | ||
| Hypovolaemia | 4 | ||
| Fluid-conserving measures | 5 | ||
| Blood flow-conserving measures | 6 | ||
| Increased energy metabolism and substrate cycling | 6 | ||
| Catabolism and starvation | 7 | ||
| Catabolism | 7 | ||
| Carbohydrate metabolism | 7 | ||
| Fat metabolism | 8 | ||
| Protein metabolism | 8 | ||
| Starvation | 8 | ||
| Changes in red blood cell synthesis and coagulation | 8 | ||
| Factors modifying the metabolic response to injury | 9 | ||
| Anabolism | 9 | ||
| Fluid and electrolyte balance | 10 | ||
| Normal water and electrolyte balance | 10 | ||
| 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 | 11 | ||
| Intravenous fluid administration | 11 | ||
| Types of intravenous fluid | 11 | ||
| Crystalloids | 11 | ||
| Colloids | 12 | ||
| Maintenance fluid requirements | 13 | ||
| Treatment of postoperative hypovolaemia and/or hypotension | 13 | ||
| Specific water and electrolyte abnormalities | 13 | ||
| Sodium and water | 13 | ||
| Water depletion | 13 | ||
| Water excess | 13 | ||
| Hypernatraemia | 13 | ||
| Hyponatraemia | 14 | ||
| Potassium | 14 | ||
| Hyperkalaemia | 14 | ||
| Hypokalaemia | 14 | ||
| Other electrolyte disturbances | 15 | ||
| Calcium | 15 | ||
| Magnesium | 15 | ||
| Phosphate | 16 | ||
| Acid–base balance | 16 | ||
| Metabolic acidosis | 16 | ||
| Metabolic alkalosis | 16 | ||
| Respiratory acidosis | 17 | ||
| Respiratory alkalosis | 17 | ||
| Mixed patterns of acid–base imbalance | 17 | ||
| Shock | 17 | ||
| Definition | 17 | ||
| Types of shock | 18 | ||
| Septic shock | 18 | ||
| Cardiogenic shock | 18 | ||
| Anaphylactic shock | 18 | ||
| Neurogenic shock | 19 | ||
| Pathophysiology | 19 | ||
| Macrocirculation | 19 | ||
| Microcirculation | 20 | ||
| Cellular function | 20 | ||
| The effect of shock on individual organ systems | 21 | ||
| Cardiovascular | 22 | ||
| Respiratory | 22 | ||
| Renal | 22 | ||
| Nervous system | 22 | ||
| Gastrointestinal | 22 | ||
| Hepatobiliary | 22 | ||
| Management | 23 | ||
| General principles | 23 | ||
| Airway and breathing | 23 | ||
| Circulation | 23 | ||
| Hypovolaemic shock | 23 | ||
| Septic shock | 25 | ||
| Cardiogenic shock | 26 | ||
| Anaphylactic shock | 26 | ||
| Chapter 2: Transfusion of blood components and plasma products | 27 | ||
| Introduction | 27 | ||
| Blood donation | 27 | ||
| Blood components | 27 | ||
| Red blood cells in additive solution | 27 | ||
| Platelets | 28 | ||
| Fresh frozen plasma (FFP) | 29 | ||
| Cryoprecipitate | 29 | ||
| Plasma products | 29 | ||
| Human albumin | 29 | ||
| Factor VIII and Factor IX concentrates | 29 | ||
| Prothrombin complex concentrates | 29 | ||
| Immunoglobulin preparations (90% IgG) | 29 | ||
| Red cell serology | 30 | ||
| ABO antigens | 30 | ||
| Rhesus antigens (RH) | 30 | ||
| Other red cell antigens | 30 | ||
| Pretransfusion testing | 30 | ||
| Maximal Surgical Blood Ordering Schedule (MSBOS) | 30 | ||
| Indications for transfusion | 31 | ||
| Blood administration | 31 | ||
| Adverse effects of transfusion | 32 | ||
| Autologous transfusion | 34 | ||
| Preoperative donation | 34 | ||
| Isovolaemic haemodilution | 34 | ||
| Cell salvage | 34 | ||
| Transfusion requirements in special surgical settings | 34 | ||
| Massive transfusion | 34 | ||
| Cardiopulmonary bypass | 34 | ||
| Methods to reduce the need for blood transfusion | 36 | ||
| Acute volume replacement | 36 | ||
| Mechanisms for reducing blood use in surgery | 36 | ||
| Preoperative | 36 | ||
| Intraoperative | 36 | ||
| Postoperative | 36 | ||
| Better blood transfusion | 37 | ||
| Future trends | 37 | ||
| Chapter 3: Nutritional support in surgical patients | 38 | ||
| Introduction | 38 | ||
| Assessment of nutritional status | 38 | ||
| Assessment of nutritional requirements | 40 | ||
| Causes of inadequate intake | 40 | ||
| Methods of providing nutritional support | 40 | ||
| Enteral nutrition | 41 | ||
| Oral route | 41 | ||
| Methods of administration of enteral feeds | 41 | ||
| Nasogastric or nasojejunal tubes | 41 | ||
| Gastrostomy and jejunostomy | 41 | ||
| Complications of enteral nutrition | 41 | ||
| Parenteral nutrition | 42 | ||
| Indications for TPN | 42 | ||
| Composition of TPN solutions | 42 | ||
| Administration of TPN | 42 | ||
| Complications of TPN | 43 | ||
| Catheter problems | 43 | ||
| Thrombophlebitis | 43 | ||
| Infection | 43 | ||
| Metabolic complications | 44 | ||
| Peripheral venous nutrition | 44 | ||
| Monitoring of nutritional support | 44 | ||
| Chapter 4: Infections and antibiotics | 45 | ||
| Importance of infection | 45 | ||
| Biology of infection | 45 | ||
| Bacterial factors | 45 | ||
| Host defence systems | 45 | ||
| Preventing infection in surgical patients | 47 | ||
| Preoperative MRSA screening | 47 | ||
| Aseptic technique | 47 | ||
| Hand decontamination | 48 | ||
| Personal protective equipment (PPE) for staff | 48 | ||
| Skin preparation | 48 | ||
| Surgical instruments | 48 | ||
| Terminology | 48 | ||
| Creutzfeldt–Jakob disease (CJD) and other prion diseases | 49 | ||
| Prophylactic use of antibiotics | 49 | ||
| Timing and dose | 49 | ||
| Antibiotic choice | 49 | ||
| Carriage of resistant organisms and prophylaxis | 49 | ||
| Prophylaxis for immunosuppressed patients | 49 | ||
| Management of surgical infections | 49 | ||
| Diagnosis | 49 | ||
| Antibiotic therapy | 50 | ||
| Specific infections in surgical patients | 51 | ||
| Surgical site infection (SSI) | 51 | ||
| Diagnosis | 52 | ||
| Treatment | 52 | ||
| Prevention | 52 | ||
| Urinary tract infections (UTI) | 52 | ||
| Respiratory tract infections | 53 | ||
| Clostridium difficile infection (CDI) | 53 | ||
| Fungal infections | 53 | ||
| Infections of prosthetic devices | 53 | ||
| Infections primarily treated by surgical management | 53 | ||
| Necrotizing fasciitis | 53 | ||
| Diabetic foot infections | 54 | ||
| Gas gangrene | 54 | ||
| Infections following trauma | 54 | ||
| Tetanus | 54 | ||
| HEALTHCARE Associated Infections (HCAI) | 55 | ||
| Chapter 5: Ethics, preoperative considerations, anaesthesia and analgesia | 56 | ||
| Ethical and legal principles for surgical patients | 56 | ||
| Principles in surgical ethics | 56 | ||
| Principalism | 56 | ||
| Autonomy | 56 | ||
| Beneficence: doing good | 57 | ||
| Non-malfeasance: avoiding harm | 57 | ||
| Justice: promoting fairness | 57 | ||
| Informed consent | 57 | ||
| General considerations | 57 | ||
| Consent in specific circumstances | 58 | ||
| Children | 58 | ||
| Mental illness | 58 | ||
| Transient / irreversible cognitive impairment | 58 | ||
| Confidentiality | 59 | ||
| Specific topics | 59 | ||
| Euthanasia and ‘end-of-life’ issues | 59 | ||
| Abortion | 59 | ||
| Negligence | 59 | ||
| Human Tissue Act | 59 | ||
| Completion of a death certificate | 60 | ||
| Post-mortem examination | 60 | ||
| Research governance | 60 | ||
| Ethics committees | 60 | ||
| Preoperative assessment | 60 | ||
| Assessment of operative fitness and perioperative risk | 60 | ||
| Oxygen delivery in minimizing operative risk | 61 | ||
| Systematic preoperative assessment | 62 | ||
| Cardiovascular system | 62 | ||
| Respiratory system | 62 | ||
| Smoking | 62 | ||
| Preoperative exercise | 62 | ||
| Alcohol | 62 | ||
| Nutritional status | 62 | ||
| Obesity | 62 | ||
| Drug therapy | 63 | ||
| Long-term steroid therapy | 63 | ||
| Antiplatelet therapy and anticoagulants | 63 | ||
| Oral contraceptives and hormone replacement therapy | 63 | ||
| Psychiatric drugs | 63 | ||
| Allergies | 63 | ||
| Pregnancy | 63 | ||
| Previous operations and anaesthetics | 63 | ||
| Preoperative investigations | 64 | ||
| Haematology | 64 | ||
| Full blood count | 64 | ||
| Coagulation screen | 65 | ||
| Cross matching | 65 | ||
| Biochemistry | 65 | ||
| Urea and electrolytes | 65 | ||
| Liver function tests | 65 | ||
| Cardiac investigations | 65 | ||
| Respiratory investigations | 66 | ||
| The high risk patient | 66 | ||
| Preoperative MRSA screening | 67 | ||
| Assessment of the patient for emergency surgery | 67 | ||
| The preoperative ward round | 67 | ||
| Venous thromboembolism prophylaxis | 67 | ||
| Antibiotic prophylaxis | 68 | ||
| Preoperative anxiolytic medication | 69 | ||
| Preoperative fasting | 69 | ||
| Perioperative implications of chronic disease | 69 | ||
| Cardiovascular disease | 69 | ||
| Ischaemic heart disease | 69 | ||
| Myocardial infarction | 69 | ||
| Angina | 69 | ||
| Coronary artery bypass graft (CABG), percutaneous angioplasty and stenting | 69 | ||
| Congestive cardiac failure | 70 | ||
| Valvular heart disease | 70 | ||
| Pacemakers | 70 | ||
| Hypertension | 71 | ||
| Perioperative management of patients with cardiovascular disease | 71 | ||
| Drug therapy | 71 | ||
| Beta-blockers | 71 | ||
| Angiotensin-converting enzyme (ACE) inhibitors | 71 | ||
| Cardiovascular management | 71 | ||
| Minimizing myocardial oxygen demand | 71 | ||
| Maximizing myocardial oxygen supply | 71 | ||
| Respiratory disease | 71 | ||
| Anaesthetic technique | 71 | ||
| Postoperative analgesia | 71 | ||
| Physiotherapy | 72 | ||
| Postoperative ventilation | 72 | ||
| Diabetes mellitus | 72 | ||
| Diabetic comorbidity | 72 | ||
| Vascular disease | 72 | ||
| Renal disease | 72 | ||
| Neuropathy | 72 | ||
| Infection | 72 | ||
| Effect of surgical stress on diabetic control | 72 | ||
| Principles of perioperative diabetes management | 72 | ||
| Methods of insulin administration | 72 | ||
| Chronic renal failure | 72 | ||
| Dialysis dependent patients | 72 | ||
| Non-dialysis dependent patients | 73 | ||
| Jaundice | 73 | ||
| Hepatitis | 74 | ||
| Coagulopathy | 74 | ||
| Acute renal failure | 74 | ||
| Cirrhosis | 74 | ||
| Abnormal coagulation | 74 | ||
| Anticoagulant therapy | 74 | ||
| Inherited disorders of coagulation | 74 | ||
| Acquired coagulopathy | 74 | ||
| Anaemia | 75 | ||
| Musculoskeletal disease | 75 | ||
| Miscellaneous conditions | 75 | ||
| Anaesthesia and the operation | 75 | ||
| General anaesthesia | 75 | ||
| Local anaesthetic agents | 75 | ||
| Spinal and epidural anaesthesia | 76 | ||
| Spinal anaesthesia | 76 | ||
| Epidural anaesthesia | 76 | ||
| Peripheral nerve block | 77 | ||
| Local infiltration | 77 | ||
| Topical anaesthesia | 77 | ||
| Postoperative analgesia | 77 | ||
| Pain assessment | 77 | ||
| Postoperative analgesic strategy | 78 | ||
| Epidural analgesia | 78 | ||
| Patient-controlled analgesia (PCA) | 78 | ||
| Parenteral and oral opioid regimens | 78 | ||
| Strong opioids | 78 | ||
| Weak opioids | 78 | ||
| Paracetamol, NSAIDs and selective Cox-2 inhibitors | 78 | ||
| Neuropathic pain | 79 | ||
| Postoperative nausea and vomiting | 79 | ||
| Chapter 6: Principles of the surgical management of cancer | 80 | ||
| The biology of cancer | 80 | ||
| The adenoma–carcinoma progression | 80 | ||
| Invasion and metastasis | 81 | ||
| Natural history and estimate of cure | 82 | ||
| The management of patients with cancer | 83 | ||
| Screening | 83 | ||
| Screening for inherited cancer | 83 | ||
| The cancer patient's journey | 84 | ||
| Symptoms that may initiate a patient's ‘cancer journey’ | 84 | ||
| Local effects | 84 | ||
| Systemic effects | 85 | ||
| Consultation with the GP | 85 | ||
| Referral to a specialist/cancer centre | 85 | ||
| Investigations | 85 | ||
| Diagnostic investigations | 85 | ||
| Staging investigations | 86 | ||
| Treatment | 87 | ||
| Benign tumours | 87 | ||
| Malignant tumours | 87 | ||
| Adjuvant treatment | 87 | ||
| Surgery for metastases | 89 | ||
| Follow-up | 89 | ||
| Palliation of advanced cancer | 89 | ||
| Prognosis and counselling | 89 | ||
| Care of the dying | 89 | ||
| Chapter 7: Trauma and multiple injury | 90 | ||
| Trauma epidemiology | 90 | ||
| Injury biomechanics and accident prevention | 91 | ||
| Alcohol and drugs | 92 | ||
| Wounds | 92 | ||
| Classification and production | 92 | ||
| Gunshot wounds | 92 | ||
| Falls | 93 | ||
| Injury severity assessment | 93 | ||
| Prehospital care and transport | 94 | ||
| Trauma centres | 94 | ||
| Resuscitation in the emergency department | 95 | ||
| The first 10 minutes | 95 | ||
| Airway | 95 | ||
| Control of the cervical spine | 96 | ||
| Advanced airway techniques | 96 | ||
| Breathing | 96 | ||
| Circulation | 97 | ||
| Analgesia | 99 | ||
| The next phase | 99 | ||
| Imaging and other diagnostic AIDS | 100 | ||
| After the resuscitation room | 101 | ||
| Chapter 8: Practical procedures and patient investigation | 103 | ||
| Introduction | 103 | ||
| General precautions | 103 | ||
| Aseptic technique | 103 | ||
| Local anaesthesia | 103 | ||
| Suturing | 104 | ||
| Suture materials | 104 | ||
| Non-absorbable sutures | 104 | ||
| Absorbable sutures | 104 | ||
| Suturing the skin | 104 | ||
| Airway procedures | 105 | ||
| Maintaining the airway | 105 | ||
| Section 2: Gastrointestinal surgery | 135 | ||
| Chapter 11: The abdominal wall and hernia | 137 | ||
| Umbilicus | 137 | ||
| Developmental abnormalities | 137 | ||
| Persistent vitello-intestinal duct | 137 | ||
| Urachus | 137 | ||
| Umbilical sepsis | 137 | ||
| Umbilical tumours | 137 | ||
| Disorders of the rectus muscle | 137 | ||
| Haematoma of the rectus sheath | 137 | ||
| Desmoid tumour | 137 | ||
| Abdominal hernia | 138 | ||
| Inguinal hernia | 138 | ||
| Surgical anatomy | 139 | ||
| Indirect inguinal hernia | 140 | ||
| Clinical features | 140 | ||
| Direct inguinal hernia | 141 | ||
| Clinical features | 141 | ||
| Management of uncomplicated inguinal hernia | 141 | ||
| Indirect inguinal hernia | 141 | ||
| Direct hernia | 141 | ||
| Sportsman's hernia | 142 | ||
| Femoral hernia | 142 | ||
| Clinical features | 143 | ||
| Surgical repair of femoral hernia | 143 | ||
| Ventral hernia | 143 | ||
| Epigastric hernia | 143 | ||
| Umbilical hernia | 144 | ||
| Para-umbilical hernia | 144 | ||
| Incisional hernia | 144 | ||
| Parastomal hernia | 144 | ||
| Rare external hernia | 145 | ||
| Internal hernia | 145 | ||
| Complications of hernia | 146 | ||
| Irreducibility | 146 | ||
| Obstruction | 146 | ||
| Strangulation | 146 | ||
| Management of complicated hernia | 146 | ||
| Chapter 12: The acute abdomen and intestinal obstruction | 147 | ||
| Introduction | 147 | ||
| Aetiology | 147 | ||
| Pathophysiology of abdominal pain | 147 | ||
| Somatic pain | 147 | ||
| Visceral pain | 148 | ||
| Pathogenesis | 149 | ||
| Inflammation | 149 | ||
| Peritonitis | 150 | ||
| Clinical features | 150 | ||
| Infarction | 150 | ||
| Section 3: Surgical specialties | 279 | ||
| Chapter 18: Plastic and reconstructive surgery | 281 | ||
| Introduction | 281 | ||
| Structure and functions of skin | 281 | ||
| Wounds | 281 | ||
| Types of wound | 281 | ||
| Principles of wound healing | 282 | ||
| Lag phase | 282 | ||
| Incremental phase | 282 | ||
| Plateau or maturation phase | 283 | ||
| Hypertrophic scars | 283 | ||
| Keloids | 283 | ||
| Epidermis | 283 | ||
| Primary and secondary intention | 283 | ||
| Factors influencing wound healing | 283 | ||
| Blood supply | 283 | ||
| Infection | 283 | ||
| Age | 285 | ||
| Site of wound | 285 | ||
| Nutritional status | 285 | ||
| Intercurrent disease | 285 | ||
| Surgical technique | 285 | ||
| Choice of suture and suture materials | 285 | ||
| Wound infection | 285 | ||
| Classification | 285 | ||
| Clinical features | 286 | ||
| Prevention | 286 | ||
| Management | 286 | ||
| Involvement of other structures | 286 | ||
| Devitalized skin flaps | 287 | ||
| Wounds with skin loss | 287 | ||
| Skin grafts | 287 | ||
| Flaps | 288 | ||
| Crushing/degloving injuries and gunshot wounds | 288 | ||
| Burns | 289 | ||
| Mechanisms | 289 | ||
| Local effects of burn injury | 289 | ||
| General effects of burn injury | 290 | ||
| Classification | 290 | ||
| Superficial partial-thickness burns | 290 | ||
| Deep partial-thickness burns | 290 | ||
| Full-thickness burns | 290 | ||
| Determination of burn depth | 291 | ||
| Mechanisms | 291 | ||
| Appearance | 291 | ||
| Sensation | 291 | ||
| Prognosis | 291 | ||
| Extent of the burn | 291 | ||
| Depth of the burn | 291 | ||
| Site of the burn | 291 | ||
| Associated respiratory injury | 291 | ||
| Management | 291 | ||
| First aid | 291 | ||
| Arrest the burning process | 292 | ||
| Ensure an adequate airway | 292 | ||
| Avoid wound contamination | 292 | ||
| Transfer to hospital | 292 | ||
| Adequate ventilation | 292 | ||
| Initial assessment and management | 292 | ||
| Prevention and treatment of burn shock | 292 | ||
| Water replacement | 293 | ||
| Blood transfusion | 293 | ||
| Organ failure and burn shock | 293 | ||
| Respiratory complications | 293 | ||
| Renal failure | 293 | ||
| Nutritional management | 293 | ||
| Sepsis | 293 | ||
| Curling's ulcer and gastric erosions | 293 | ||
| Local management of burns | 293 | ||
| Initial cleansing and debridement | 293 | ||
| Prevention of contamination | 293 | ||
| Exposure | 294 | ||
| Evaporative dressings | 294 | ||
| Semi-occlusive and occlusive dressings | 294 | ||
| Topical antibacterial agents | 294 | ||
| ‘Biological’ dressings | 294 | ||
| Relief of constriction (escharotomy) | 294 | ||
| Restoration of epidermal cover | 294 | ||
| Functional and cosmetic result | 294 | ||
| Skin and soft tissue lesions | 294 | ||
| Diagnosis of skin swellings | 294 | ||
| Cysts | 295 | ||
| Sebaceous cysts | 295 | ||
| Dermoid cysts | 295 | ||
| Tumours of the skin | 295 | ||
| Epidermal neoplasms arising from basal germinal cells | 295 | ||
| Papillomas | 295 | ||
| Infective warts | 295 | ||
| Senile warts | 296 | ||
| Pedunculated papillomas | 296 | ||
| Keratoacanthoma (molluscum sebaceum) | 296 | ||
| Actinic (solar) keratosis | 296 | ||
| Intraepidermal cancer (carcinoma in situ) | 296 | ||
| Cancer of the epidermis | 297 | ||
| Basal cell carcinoma (rodent ulcer) | 297 | ||
| Squamous cell carcinoma | 297 | ||
| Epidermal neoplasms arising from melanocytes | 297 | ||
| Benign pigmented moles | 297 | ||
| Common moles | 297 | ||
| Giant hairy naevus | 298 | ||
| Blue naevus | 298 | ||
| Halo naevus | 298 | ||
| Malignant melanoma | 298 | ||
| Hutchison's melanotic freckle (lentigo maligna) | 298 | ||
| Superficial spreading melanoma | 299 | ||
| Nodular melanoma | 299 | ||
| Other types of malignant melanoma | 299 | ||
| Spread of malignant melanoma | 299 | ||
| Clinical and pathological staging | 300 | ||
| Management of malignant melanoma | 300 | ||
| Sentinel lymph node biopsy | 300 | ||
| Vascular neoplasms (haemangiomas) | 300 | ||
| Involuting haemangiomas | 301 | ||
| Non-involuting haemangiomas | 301 | ||
| Port-wine stain | 301 | ||
| Cavernous haemangioma | 301 | ||
| Tumours of nerves | 301 | ||
| Neurilemmoma | 301 | ||
| Neurofibroma | 301 | ||
| Tumours of muscle and connective tissues | 301 | ||
| Lipoma | 301 | ||
| Liposarcoma | 301 | ||
| Fibrosarcoma | 301 | ||
| Rhabdomyosarcoma | 301 | ||
| Chapter 19: The breast | 302 | ||
| Anatomy and physiology | 302 | ||
| Overview | 302 | ||
| Anatomy | 302 | ||
| Congenital abnormalities | 302 | ||
| Hormonal control of breast development and function | 303 | ||
| Evaluation of the patient with breast disease | 303 | ||
| Clinical features | 303 | ||
| Clinical examination | 303 | ||
| Assessment of regional nodes | 304 | ||
| Imaging | 304 | ||
| Mammography | 304 | ||
| Ultrasonography | 304 | ||
| Magnetic resonance imaging (MRI) | 305 | ||
| Ductoscopy, ductography and nipple cytology | 305 | ||
| Fine needle cytology and biopsy | 306 | ||
| Core biopsy | 306 | ||
| Fine-needle aspiration cytology | 306 | ||
| Open biopsy | 306 | ||
| Frozen section | 306 | ||
| One-stop clinics | 306 | ||
| Accuracy of investigations | 306 | ||
| Disorders of development | 306 | ||
| Juvenile hypertrophy | 307 | ||
| Fibroadenoma | 307 | ||
| Disorders of cyclical change | 307 | ||
| Cyclical mastalgia | 308 | ||
| Nodularity | 308 | ||
| Non-cyclical breast pain | 308 | ||
| Disorders of involution | 308 | ||
| Palpable breast cysts | 308 | ||
| Sclerosis | 308 | ||
| Duct ectasia | 308 | ||
| Epithelial hyperplasia | 309 | ||
| Benign neoplasms | 309 | ||
| Duct papillomas | 309 | ||
| Lipomas | 309 | ||
| Phyllodes tumours | 309 | ||
| Breast infection | 309 | ||
| Lactating infection | 310 | ||
| Non-lactating infection | 310 | ||
| Central (periareolar) infection | 310 | ||
| Mammary duct fistula | 310 | ||
| Peripheral non-lactating abscesses | 310 | ||
| Skin-associated infection | 311 | ||
| Breast cancer | 311 | ||
| Epidemiology | 311 | ||
| Types of breast cancer | 312 | ||
| Non-invasive | 312 | ||
| Invasive | 312 | ||
| Hormone and growth factors receptors | 313 | ||
| Screening for breast cancer | 313 | ||
| Mammographic features of breast cancer | 313 | ||
| Staging | 313 | ||
| The curability of breast cancer | 314 | ||
| Prognostic factors | 314 | ||
| Presentation of breast cancer | 315 | ||
| Management of operable breast cancer | 317 | ||
| In situ breast cancer | 317 | ||
| Operable breast tumours | 317 | ||
| Local therapy | 317 | ||
| Breast-conserving treatment (wide local excision and radiotherapy) | 317 | ||
| Mastectomy | 318 | ||
| Systemic therapy | 318 | ||
| Adjuvant chemotherapy | 318 | ||
| Adjuvant hormone therapy | 319 | ||
| Adjuvant anti- HER2 therapy | 319 | ||
| Primary systemic therapy | 320 | ||
| Complications of treatment | 320 | ||
| Radiotherapy | 320 | ||
| Chemotherapy | 320 | ||
| Hormonal treatments | 320 | ||
| Psychological aspects | 320 | ||
| Follow-up | 321 | ||
| Management of locally advanced breast cancer | 321 | ||
| Breast cancer in pregnancy | 322 | ||
| Pregnancy after treatment for breast cancer | 322 | ||
| Management of metastatic or advanced breast cancer | 322 | ||
| Chemotherapy | 322 | ||
| Hormonal treatment | 322 | ||
| Anti- HER2 therapy | 322 | ||
| Specific problems | 323 | ||
| Bone disease | 323 | ||
| Hypercalcaemia | 323 | ||
| Marrow infiltration | 323 | ||
| Spinal cord compression | 323 | ||
| Pleural effusion | 323 | ||
| Liver metastases | 323 | ||
| Brain metastases | 323 | ||
| Miscellaneous tumours of the breast | 323 | ||
| Lymphoma | 323 | ||
| Sarcomas | 323 | ||
| Malignant phyllodes tumours | 324 | ||
| Secondary tumours | 324 | ||
| Male breast | 324 | ||
| Gynaecomastia | 324 | ||
| Male breast cancer | 324 | ||
| Chapter 20: Endocrine surgery | 325 | ||
| Introduction | 325 | ||
| Thyroid gland | 325 | ||
| Surgical anatomy and development | 325 | ||
| Thyroid function | 325 | ||
| Assessment of thyroid disease | 326 | ||
| ‘Physiological’ enlargement | 327 | ||
| Enlargement of the thyroid gland (goitre) | 326 | ||
| Non-toxic nodular goitre | 327 | ||
| Aetiology | 327 | ||
| Pathology | 327 | ||
| Clinical features | 327 | ||
| Investigations | 327 | ||
| Management | 327 | ||
| Thyrotoxic goitre | 327 | ||
| Thyroiditis | 328 | ||
| Subacute thyroiditis (de Quervain's disease) | 328 | ||
| Autoimmune thyroiditis (Hashimoto's disease) | 328 | ||
| Aetiology | 328 | ||
| Clinical features | 328 | ||
| Investigations | 328 | ||
| Management | 328 | ||
| Riedel's thyroiditis | 328 | ||
| Solitary thyroid nodules | 328 | ||
| Other forms of neoplasia | 328 | ||
| Hyperthyroidism | 328 | ||
| Primary thyrotoxicosis (Graves' disease) | 329 | ||
| Index | 491 |