Surgery RSS feed: Current Issue. Surgery is an authoritative, comprehensive collection of educational reviews that present the current knowledge and practice of surgery Surgery also indicates recent advances that improve the understanding of disease and the safe and effective treatment of patients It comprises concise and systematically updated contributions that are produced over a three-year cycle. Surgery is an excellent didactic tool to help consultant surgeons train their junior staff to become safe and competent surgeons.http://www.surgeryjournal.co.uk/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Surgery0263-9319289September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgeryjournal.co.uk/article/PIIS0263931910001626/abstract?rss=yesContents10.1016/S0263-9319(10)00162-6Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2OFCOFChttp://www.surgeryjournal.co.uk/article/PIIS026393191000164X/abstract?rss=yesEditorial Board10.1016/S0263-9319(10)00164-XSurgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2iihttp://www.surgeryjournal.co.uk/article/PIIS0263931910001195/abstract?rss=yesAbstract: Wound healing is a complicated process, dependent on the patient’s underlying health and nutritional status and also upon the clinician’s ability to recognize stages of wound healing. For appropriate management, an understanding of the basic physiology of wound healing is necessary.Basic science of wound healingPauline Beldon10.1016/j.mpsur.2010.05.007Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Basic science409412http://www.surgeryjournal.co.uk/article/PIIS0263931910001225/abstract?rss=yesAbstract: Malnutrition is a common and often unrecognized problem which increases the risk of postoperative morbidity and mortality. To identify those at risk, all patients should be screened on admission to hospital using a validated reliable tool (e.g. the malnutrition universal screening tool, MUST). Minimal perioperative fasting, carbohydrate loading and early enteral feeding all reduce postoperative complications and enhance recovery. Refeeding syndrome needs to be diagnosed and treated prior to initiating feeding. Enteral is the preferred route of feeding as it provides nourishment directly to the gut. If parenteral nutrition (PN) is indicated then close monitoring and strict guidelines need to be followed to reduce the risk of metabolic complications and line sepsis. PN is an integral part of the management of high output enterocutaneous fistulae (ECF). A high output ileostomy causes malnutrition and electrolyte abnormalities. Alterations to diet and fluids alongside medical management are necessary to reduce the high output stoma.Perioperative nutritional supportMarion J. O’Connor, Julie I. Dehavillande10.1016/j.mpsur.2010.05.010Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Basic science413419http://www.surgeryjournal.co.uk/article/PIIS0263931910001213/abstract?rss=yesAbstract: Cardiac morbidity and mortality account for a significant proportion of complications after non-cardiac surgery. Risk assessment allows selection of patients who would benefit from preoperative optimization, further investigations or intervention. With the increased use of coronary stents and concomitant antiplatelet agents it is important to appraise the risks and benefits of different management strategies prior to non-cardiac surgery. A stepwise approach to preoperative cardiac risk assessment and risk reduction strategies is highlighted.Perioperative management of the patient with cardiovascular disease undergoing non-cardiac surgeryCoralie Carle, Andrew Roscoe10.1016/j.mpsur.2010.05.009Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions420426http://www.surgeryjournal.co.uk/article/PIIS0263931910001201/abstract?rss=yesAbstract: Cardiorespiratory disease is the commonest cause of perioperative morbidity and mortality in the western world. Each year in the UK, around 25,000 to 30,000 patients die within 30 days of surgery. The most important pulmonary complications are exacerbation of existing respiratory disease, pneumonia and respiratory failure. The key to reducing problems in this group of patients is identification of those individuals most at risk and optimization of medical management. A perioperative care plan can then be instituted for each individual patient in order to gain maximum benefit from available therapeutic interventions. While complications can never be totally prevented, a worsening of vital signs generally precedes impending critical illness. Prompt recognition of any physiological deterioration and early intervention are the key to avoiding a poor outcome in such circumstances. Early warning scoring (EWS) systems have been implemented in many postoperative care areas to draw attention to any deterioration in vital signs at an early stage. This article focuses on the perioperative management of patients with respiratory disease.Perioperative management of the patient with respiratory diseaseJanis Shaw10.1016/j.mpsur.2010.05.008Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions427432http://www.surgeryjournal.co.uk/article/PIIS0263931910001183/abstract?rss=yesAbstract: The prevalence of chronic kidney disease (CKD) is increasing. Perioperative management of patients with CKD aims to control modifiable risk factors associated with acute kidney injury (AKI). AKI on the background of CKD may lead to dialysis dependency. CKD has widespread cardiovascular, endocrine, metabolic and haematological effects. Preoperative assessment and preparation require multidisciplinary input from the surgical, anaesthetic and nephrology teams. Perioperative care should ensure the correction of hypovolaemia, maintenance of renal blood flow and perfusion pressure, prevention of radiocontrast-induced nephrotoxicity, avoidance of nephrotoxic drugs and treatment of urinary tract obstruction.Perioperative management of the patient with chronic kidney diseaseMark Dougherty, Stephen T. Webb10.1016/j.mpsur.2010.05.006Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions433436http://www.surgeryjournal.co.uk/article/PIIS0263931910001249/abstract?rss=yesAbstract: The gastrointestinal system is responsible for digestion of food, absorption of nutrients and excretion of waste. It consists of the mouth, oesophagus, stomach, small intestine, large intestine, liver, gall bladder and pancreas. Many patients managed by surgical teams will suffer from some form of gastrointestinal disease.To aid with the management of these patients we will look at a logical, systemic approach to the assessment of gastrointestinal disease and common signs and symptoms found. We will discuss the investigation of gastrointestinal disease and the common abnormalities found.This article will then discuss in further detail the perioperative management of some common gastrointestinal problems, namely fluid therapy, nutrition, gastrointestinal bleeding, hepatic dysfunction, bowel obstruction, inflammatory bowel disease and pancreatitis.The patient with gastrointestinal diseaseJohn McKenna, Chris Sadler10.1016/j.mpsur.2010.06.002Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions437440http://www.surgeryjournal.co.uk/article/PIIS0263931910001250/abstract?rss=yesAbstract: Stroke, neuromuscular disorders, epilepsy and psychiatric disease are amongst the most common neurological conditions encountered in patients presenting for surgery. In some instances, patients may require surgery as a direct result of their neurological disease. Both anaesthesia and surgery may exacerbate pre-existing disease, and there may be important interactions between drugs used to treat neurological disease and drugs used in the perioperative period. Patients with muscular weakness, immobility, sensory and autonomic neuropathy, or cognitive impairment are in an increased risk of perioperative complications. This article focuses on commonly encountered conditions and their management in the perioperative period.Management of patients with neurological and psychiatric disordersTony Veenith, Rowan M. Burnstein10.1016/j.mpsur.2010.06.003Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions441445http://www.surgeryjournal.co.uk/article/PIIS0263931910001158/abstract?rss=yesAbstract: Endocrine diseases are increasingly common and are often either the primary indication for surgery or coexist in patients undergoing unrelated surgical procedures. Surgeons should have a clear understanding of the problems that the patient with endocrine disease encounters during the perioperative period and how to manage any related emergencies that may occur. This article covers the perioperative management of diabetic, thyroid and adrenal disease, including preoperative preparation and postoperative complications. It also discusses the emergency management of related endocrinological crises that may occur in patients with undiagnosed or diagnosed endocrine disease.The patient with endocrine diseaseAmi Jones, Sue Catling10.1016/j.mpsur.2010.05.003Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions446451http://www.surgeryjournal.co.uk/article/PIIS0263931910001171/abstract?rss=yesAbstract: Musculoskeletal disease may exist as a single or multi-system disorder and affects patients in all age groups. Pre-anaesthetic assessment should be focussed on defining the extent of both musculoskeletal disease and systemic disease, and consideration will need to be given to the management of medications in the perioperative period. Limited joint mobility can hinder dynamic preoperative assessment of cardiorespiratory reserve. The range of neck movement will influence the choice of anaesthetic technique and this should be planned well in advance of surgery. The need for postoperative high dependency or intensive care should be anticipated. Patients with burns present many potential problems in both the acute and longer term. Protecting the airway from rapid swelling is an urgent priority in the acute phase. Large burn injuries cause systemic changes in fluid balance, temperature control and metabolic rate. Long-term changes in physiology, pharmacokinetics and mental state need to be considered when planning perioperative care.The perioperative management of patients with musculoskeletal disease and for the burns patientPeter Berry, Patricia Richardson10.1016/j.mpsur.2010.05.005Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions452456http://www.surgeryjournal.co.uk/article/PIIS0263931910001146/abstract?rss=yesAbstract: The perioperative management of patients with complex medical problems such as morbid obesity, immunosuppression and those who take anticoagulants can pose a dilemma for surgeons and anaesthetists alike. This article will attempt to address some of the clinical issues such patients present and outline some of the latest evidence to aid the decision-making process.Perioperative management of the patient with challenging comorbiditiesBarbara Stanley, Daniel Wheeler10.1016/j.mpsur.2010.05.002Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Perioperative management of co-morbid conditions457460http://www.surgeryjournal.co.uk/article/PIIS0263931910001237/abstract?rss=yesFor questions 1–4, select the statements which are true and which are false. The correct answers are given below. When considering the basic science of wound healing:Test yourself: MCQ and extended matchingMichael G. Wyatt10.1016/j.mpsur.2010.06.001Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Test yourself461462http://www.surgeryjournal.co.uk/article/PIIS026393191000116X/abstract?rss=yesSimulated surgery: the virtual reality of surgical trainingLydia Hanna10.1016/j.mpsur.2010.05.004Surgery 28, 9 (2010)2010-09-01Surgery2010-09-01289S0263-9319(10)X0010-2Surgery journal prize-winning essay463468