OXFORD MEDICAL PUBLICATIONSOxford Handbook of Clinical Surgery... Oxford Handbook for the Foundation Programme 3eOxford Handbook of Acute Medicine 3e Oxford Handbook of Anaesthesia 3e Ox
Trang 2OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of Clinical Surgery
Trang 3Oxford Handbook for the Foundation Programme 3e
Oxford Handbook of Acute Medicine 3e
Oxford Handbook of Anaesthesia 3e
Oxford Handbook of Applied Dental Sciences
Oxford Handbook of Cardiology 2e
Oxford Handbook of Clinical and Laboratory Investigation 3e Oxford Handbook of Clinical Dentistry 5e
Oxford Handbook of Clinical Diagnosis 2e
Oxford Handbook of Clinical Examination and Practical Skills Oxford Handbook of Clinical Haematology 3e
Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine – Mini Edition 8e Oxford Handbook of Clinical Medicine 8e
Oxford Handbook of Clinical Pathology
Oxford Handbook of Clinical Pharmacy 2e
Oxford Handbook of Clinical Rehabilitation 2e
Oxford Handbook of Clinical Specialties 9e
Oxford Handbook of Clinical Surgery 4e
Oxford Handbook of Complementary Medicine
Oxford Handbook of Critical Care 3e
Oxford Handbook of Dental Patient Care 2e
Oxford Handbook of Dialysis 3e
Oxford Handbook of Emergency Medicine 4e
Oxford Handbook of Endocrinology and Diabetes 2e
Oxford Handbook of ENT and Head and Neck Surgery
Oxford Handbook of Epidemiology for Clinicians
Oxford Handbook of Expedition and Wilderness Medicine Oxford Handbook of Gastroenterology & Hepatology 2e Oxford Handbook of General Practice 3e
Oxford Handbook of Genetics
Oxford Handbook of Genitourinary Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Medicine
Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence
Oxford Handbook of Medical Dermatology
Oxford Handbook of Medical Imaging
Oxford Handbook of Medical Sciences 2e
Oxford Handbook of Medical Statistics
Oxford Handbook of Nephrology and Hypertension
Oxford Handbook of Neurology
Oxford Handbook of Nutrition and Dietetics 2e
Oxford Handbook of Obstetrics and Gynaecology 2e
Oxford Handbook of Occupational Health 2e
Oxford Handbook of Oncology 3e
Oxford Handbook of Ophthalmology 2e
Oxford Handbook of Oral and Maxillofacial Surgery
Oxford Handbook of Paediatrics 2e
Oxford Handbook of Pain Management
Oxford Handbook of Palliative Care 2e
Oxford Handbook of Practical Drug Therapy 2e
Oxford Handbook of Pre-Hospital Care
Oxford Handbook of Psychiatry 3e
Oxford Handbook of Public Health Practice 2e
Oxford Handbook of Reproductive Medicine & Family Planning Oxford Handbook of Respiratory Medicine 2e
Oxford Handbook of Rheumatology 3e
Oxford Handbook of Sport and Exercise Medicine 2e
Oxford Handbook of Tropical Medicine 3e
Trang 4Oxford Handbook of Clinical
Consultant Colorectal Surgeon,
Cheltenham General Hospital,
Trang 5Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford
It furthers the University’s objective of excellence in research, scholarship,and education by publishing worldwide Oxford is a registered trade mark ofOxford University Press in the UK and in certain other countries
© Oxford University Press, 2013
The moral rights of the authors have been asserted
First Edition published 1990
Second Edition published 2002
Third Edition published 2007
Fourth Edition published 2013
Impression: 1
All rights reserved No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above
You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
ISBN 978–0–19–969947–6 (fl exicover: alk.paper)
Printed in China by
C&C Offset Printing Co Ltd
Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers, and the most recent codes of conduct and safety regulations The authors and the publishers do not accept responsibility or legal liability for any errors in the text, or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages
Trang 6Preface to the fourth
edition
Sometimes we have to look backward to look forward Since 1990, gery has witnessed cataclysmic changes In our Trust, the fi rst laparoscopic cholecystectomy was performed in 1992, and has now become the pro-cedure of choice for most gall bladder disease and many other surgical operations in the western world With the expansion of laparoscopic surgery, we have encountered a whole new range of complications with
sur-an escalation in the demise of general surgery as the result of cialization There are many surgical trainees who have scant experience
hyperspe-of open surgery and who have, due to European directives, limited time exposure to surgical procedures In fact, most technical training is now obtained from emergency on call such that a new speciality of emergency
surgery is developing A recent British Medical Journal (BMJ) article
recom-mended a training programme for surgeons wishing to work in remote and rural surgery—not only in the Developing World, but in remote and isolated communities in the United Kingdom! General surgery may largely have gone, but it should not be forgotten Most countries in the world do not have access to these recent innovations and there is still a case in the developed world for experience in open and general surgery to be incor-porated in the formal training programmes of junior surgeons
G R McLatchieHartlepool, September 2012
Trang 7Preface to the third
edition
This, the third edition of the Oxford Handbook of Clinical Surgery, refl ects
the changes which have occurred in general surgery over the 17 years since the fi rst edition was published
Firstly, we have recruited the services of two new editors, a stark trast to the original, which was written by a single author with the assis-tance of a surgical registrar
con-Secondly, each chapter has been written by a specialist consultant or registrar in the subject and, therefore, presents a modern, state-of-the-art treatise on each topic
Again, each condition is covered in the original two-page format with blank pages for accompanying notes
I am particularly grateful for the commitment that Jo Chikwe and Neil Borley have made, and also wish to thank staff at Oxford University Press for their support and patience I am also grateful for the contribution and support given by many colleagues
G R McLatchieHartlepool, March 2007
Trang 8Preface to the fi rst
edition
The idea of this book was fi rst suggested by Mr Gordon McBain, ant surgeon at the Southern General Hospital, Glasgow We have received considerable support from the staff of Oxford University Press, and are also indebted to Mr J Rhind and Dr J Daniel for their contributions and our surgical teachers, especially Mr J S F Hutchison, Mr M K Browne,
consult-Mr J Neilson, consult-Mr D Young, consult-Mr A Young, and the late consult-Mr I McLennan whose practical advice and anecdotes pepper the pages…
G R McLatchie
S Parameswaran
1990
Trang 10Detailed contents xi
Contributors xxiii
Symbols and abbreviations xxv
6 Breast and endocrine surgery 239
7 Upper gastrointestinal surgery 271
8 Liver, pancreatic, and biliary surgery 311
Trang 12Detailed contents
Contributors xxiii
Symbols and abbreviations xxv
1 Good surgical practice 1
History taking and making notes 26
Common surgical symptoms 28
Examination and investigation of the patient:
Evaluation of breast disease 30
Evaluation of the neck 32
Evaluation of the abdomen 34
Abdominal investigations 36
Evaluation of pelvic disease 38
Evaluation of peripheral vascular disease 40
Evaluation of the skin and subcutaneous tissue disease 42 Surgery at the extremes of age 44
Day case and minimally invasive surgery 46
Preoperative care:
Surgery in pregnancy 48
Surgery and the contraceptive pill 50
Surgery in endocrine disease 52
Trang 13Surgery and heart disease 54
Surgery and respiratory disease 58
Surgery in renal and hepatic disease 60
Surgery in neurological disease 62
Pre-optimization of the patient:
Fluid optimization 64
Nutrition in surgical patients 66
Enhanced recovery after surgery 68
Perioperative care:
Getting the patient to theatre 70
Prophylaxis—antibiotics and thromboprophylaxis 72 In-theatre preparation 74
Positioning the patient 76
Sterilization, disinfection, and antisepsis 78
Trang 14Surgically important organisms 174
Soft tissue infections 176
Blood-borne viruses and surgery 178
Bleeding and coagulation 180
Anaemia and polycythaemia 182
Arterial puncture and lines 196
Insertion of central venous catheter 198
Trang 15Chest drain insertion 200
Management of chest drains 202
Intercostal nerve block 220
5 Head and neck surgery 221
Thyroglossal cyst, sinus, and fi stula 222
Branchial cyst, sinus, and fi stula 224
Salivary calculi 226
Acute parotitis 228
Salivary gland tumours 230
Head and neck cancer 232
Facial trauma 234
Neck space infections 236
6 Breast and endocrine surgery 239
Breast cancer 240
Surgical treatment of breast cancer 242
Breast cancer screening 244
Benign breast disease 246
Acute breast pain 248
Goitre 250
Thyrotoxicosis 252
Thyroid tumours—types and features 254
Thyroid tumours—diagnosis and treatment 256
Post-thyroid surgery emergencies 258
Trang 167 Upper gastrointestinal surgery 271
Upper gastrointestinal endoscopy 272
Oesophageal motility disorders 274
Chronic intestinal ischaemia 288
Surgery for morbid obesity 290
Small bowel tumours 292
Acute haematemesis 294
Acute upper GI perforation 296
Acute appendicitis 298
Acute peritonitis 300
Acute abdominal pain 302
Gynaecological causes of lower abdominal pain 306
Intra-abdominal abscess 308
8 Liver, pancreatic, and biliary surgery 311
Jaundice—causes and diagnosis 312
Jaundice—management 314
Gall bladder stones 316
Common bile duct stones 318
Chronic pancreatitis 320
Portal hypertension 322
Cirrhosis of the liver 324
Pancreatic cancer 326
Cancer of the liver, gall bladder, and biliary tree 328
Acute variceal haemorrhage 330
Trang 17Incisional hernias 344
Other types of hernia 346
Rectus sheath haematoma 347
Groin disruption 348
Acute groin swelling 350
Symptoms and signs in urology 354
Investigations of urinary tract disease 356
Urinary tract stones 358
Obstruction of the ureter 360
Benign prostatic hyperplasia 362
Stricture of the urethra 364
Scrotal swellings 366
Disorders of the foreskin 368
Common conditions of the penis 370
Erectile dysfunction 372
Adenocarcinoma of the kidney 374
Transitional cell tumours 376
Adenocarcinoma of the prostate 378
Carcinoma of the penis 380
Testicular tumours 382
Haematuria 384
Acute urinary retention (AUR) 386
Acute testicular pain 388
Restorative pelvic surgery 402
Minimally invasive colorectal surgery 403
Diverticular disease of the colon 404
Rectal prolapse 406
Pilonidal sinus disease 408
Fistula-in-ano 410
Haemorrhoids 412
Trang 18Acute anorectal pain 414
Acute rectal bleeding 416
Acute severe colitis 418
Post-operative anastomotic leakage 420
12 Paediatric surgery 423
Principles of managing paediatric surgical cases 424
Acute abdominal emergencies—overview 426
Rare causes of intestinal obstruction 438
Abdominal wall defects 440
Necrotizing enterocolitis (NEC) 442
Inguinal hernia and scrotal swellings 444
Other childhood hernias 446
Prepuce (foreskin) and circumcision 448
Undescended testis 450
Solid tumours of childhood 452
Neck swellings 454
13 Paediatric orthopaedic 457
Developmental dysplasia of the hip (DDH) 458
Slipped upper femoral epiphysis (SUFE) 460
The limping child 462
The child with a fracture 464
Non-accidental injury (NAI) 466
Legg–Calvé–Perthes disease 468
Motor development 470
Club foot or congenital talipes equinovarus (CTEV) 471
Flat feet (pes planus) 472
The osteochondritides 474
14 Major trauma 477
Management of major trauma 478
Thoracic injuries 480
Trang 19Reduction and fi xation of fractures 498
The skeletal radiograph 502
Injuries of the phalanges and metacarpals 504
Wrist injuries 508
Fractures of the distal radius and ulna 510
Fractures of the radius and ulnar shaft 512
Fractures and dislocations around the elbow in children 514 Fractures of the humeral shaft and elbow in adults 518 Dislocations and fracture dislocations of the elbow 522 Fractures around the shoulder 524
Dislocations of the shoulder region 526
Fractures of the ribs and sternum 530
Fractures of the pelvis 532
Femoral neck fractures 536
Femoral shaft fractures 538
Fractures of the tibial shaft 540
Fractures of the ankle 544
Fractures of the tarsus and foot 546
Injuries and the spinal radiograph 550
Spinal injuries 554
Acute haematogenous osteomyelitis 558
Chronic osteomyelitis 560
Septic arthritis 562
Peripheral nerve injuries 564
Brachial plexus injuries 566
Osteoarthrosis (osteoarthritis) 568
Carpal tunnel syndrome 570
Ganglion 572
Bone tumours 574
Low back pain 578
Paget’s disease (osteitis deformans) 582
The great toe 584
Trang 20Principles of cardiac surgery 622
Coronary artery disease 626
Valvular heart disease 628
18 Peripheral vascular disease 641
Acute limb ischaemia 642
Chronic upper limb ischaemia 644
Chronic lower limb ischaemia 647
Trang 21Vascular developmental abnormalities 656
Basic transplant immunology 676
Immunosuppression and rejection 678
Small bowel transplantation 698
20 Surgery in tropical diseases 701
Medicine in the tropics 702
Typhoid 704
Amoebiasis and amoebic liver abscess 706
Anaemias in the tropics 708
Tuberculosis in the tropics 722
Leprosy (‘Hansen’s disease’) 724
Guinea worm infestation 726
Threadworms 727
Mycetoma (madura foot) 728
Trang 22Inguinal hernia repair 738
Perforated peptic ulcer repair 740
Wide local excision—breast 752
Below knee amputation 754
22 Eponymous terms and rarities 757
Anatomy and physiology key revision points index 777
Index 779
Trang 24North Tees and Hartlepool NHS
Trust, University Hospital of
Hartlepool, UK
Khalid A Al-Hureibi
Specialist Registrar,
Department of General Surgery,
Lister Hospital, Stevenage, UK
John Asher
Consultant Transplant Surgeon,
Transplant Unit, Western
Infi rmary, Glasgow, UK
David Chadwick
Consultant Urological Surgeon,
The James Cook University
Hospital, Middlesbrough, UK
Lucy Cogswell
Specialist Registrar,
Department of Plastic &
Reconstructive Surgery, John
Radcliffe Hospital, Oxford, UK
of Trauma and Orthopaedics, University Hospital of North Tees, Stockton, UK
Alan Middleton
Consultant Orthopaedic Surgeon,Department of Hand and Wrist Surgery, University Hospital of North Tees, Stockton, UK
Rob Milligan
ST3 General Surgery, Northern Deanery, UK
Sandrasekeram Parameswaran
General Surgeon,Cold Lake Healthcare Centre, Visiting Surgeon, Canadian forces base, 4 Wing, Cold Lake, Alberta, Canada
Trang 25Lakshmi Parameswaran
Senior House Offi cer,
Mater Misericordiae University
Hospital, Dublin, Ireland
Consultant Paediatric Orthopaedic
and Trauma Surgeon,
Depatment of Orthopaedic and
Trauma Surgery, Addenbrooke’s
Hospital, Cambridge University
Hospitals NHS Trust, Cambridge,
UK
David Talbot
Consultant Transplant and Hepatobiliary Surgeon,Transplant Institute, Freeman Hospital, Newcastle Visiting Professor, University of Sunderland Reader, University of Newcastle upon Tyne, UK
Mark Whyman
Consultant General and Vascular Surgeon,
Department of Surgery, Cheltenham General Hospital, Cheltenham, UK
Trang 26Symbols and abbreviations
t equal to or greater than
d equal to or less than
AAA abdominal aortic aneurysm
ABG arterial blood gas
A&E Accident and Emergency Department
ABPI ankle–brachial pressure index
ACAS Asymptomatic Carotid Artery Stenosis Study
ACE angiotensin-converting enzyme
ACh acetylcholine
AChE acetylcholinesterase
ACJ acromioclavicular joint
ACL anterior cruciate ligament
ACST Asymptomatic Carotid Surgery Trial
ACTH adrenocorticotropic hormone
ADH antidiuretic hormone
ADP adenosine diphosphate
Trang 27AF atrial fi brillation
AFP alpha-fetoprotein
AIDS acquired immunodefi ciency syndrome
AIN anal intraepithelial neoplasia
AKA above-knee amputation
ALI acute lung injury
ALS advanced life support
a.m ante meridiem
ANF antinuclear factor
APA aldosterone-producing adenoma
APACHE Acute Physiology And Chronic Health Evaluation APC antigen-presenting cell or argon plasma coagulation
APER abdominoperineal resection
APTR activated partial thromboplastin time ratio
APTT activated partial thromboplastin time
AR aortic regurgitation
ARDS acute respiratory distress syndrome
ARR absolute risk reduction or aldosterone/renin ratio
5-ASA 5-aminosalicyclic acid
ASB assisted spontaneous breathing
ATG anti-thymocyte globulin
ATLS advanced trauma life support
ATP adenosine triphosphate
AUR acute urinary retention
AV arteriovenous or atrioventricular
AVM arteriovenous malformation
AVN avascular necrosis
AVS adrenal venous sampling
AXR abdominal X-ray
BCC basal cell carcinoma
BCG Bacillus Calmette–Guérin
BCR B-cell receptor
B-HCG beta-human chorionic gonadotrophin
BiPAP biphasic positive airway pressure
BKA below-knee amputation
Trang 28BMI body mass index
BNF British National Formulary
BP blood pressure
BPH benign prostatic hyperplasia
BSA body surface area
BXO balanitis xerotica obliterans
Ca calcium
CABG coronary artery bypass graft
CAD coronary artery disease
CAPD continuous ambulatory peritoneal dialysis
CAVH continuous arteriovenous haemofi ltration
CBP cardiopulmonary bypass
CCF congestive cardiac failure
CD cellular differentiation (molecule)
CDH congenital dysplasia of the hip
CEA carcinoembryonic antigen or carotid endarterectomy
CF cystic fi brosis
CI confi dence interval
Cl chloride
CLI critical limb ischaemia
cm centimetre
CMI cell-mediated immune (reaction)
CMV cytomegalovirus or controlled mechanical ventilation
CNI calcineurin inhibitor
CNS central nervous system
CNST criminal negligence scheme for Trusts
CO cardiac output
COAD chronic obstructive airway disease
COC combined oral contraceptive
COPD chronic obstructive pulmonary disease
CPAP continuous positive airway pressure
CPB cardiopulmonary bypass
C,P,&O cysts, parasites, and ova
CPR cardiopulmonary resuscitation
Cr creatinine
Trang 29CRCa colorectal cancer
CVA cerebrovascular accident
CVP central venous pressure
CVVH continuous venovenous haemofi ltration
DALM dysplasia-associated lesion or mass
DBD donor after brainstem death
DCD donor after circulatory death
DCIS ductal carcinoma in situ
DDAVP 1-deamino-8-D-arginine vasopressin
DDH developmental dysplasia of the hip
DHS dynamic hip screw
DHT dihydrotestosterone
DIC disseminated intravascular coagulation
DIEP deep inferior epigastric perforator (fl ap)DIPJ distal interphalangeal joint
DOH Department of Health
DP distal phalanx or diastolic pressure
2,3-DPG 2,3-diphosphoglycerate
DPL diagnostic peritoneal lavage
DRUJ distal radioulnar joint
DSA digital subtraction angiography
Trang 30DTPA diethylene triamine pentaacetic acid
DVT deep venous thrombosis
EBV Epstein–Barr virus
ECF extracelllular fl uid
ECG electrocardiogram
ECST European Cardiac Surgery Trial
ED erectile dysfunction
e.g exempli gratia (for example)
ELISA enzyme-linked immunosorbent assay
EMD electromechanical delay
EMG electromyography
EMR endocospic mucosal resection
EOCP (o)estrogen-containing contraceptive pill
EPL extensor pollicis longus
EPO erythropoietin
ER (o)estrogen receptor
ERAS enhanced recovery after surgery
ERCP endoscopic retrograde cholangiopancreatography
ES endoscopic sphincterotomy
ESD endoscopic submucosal dissection
ESR erythrocyte sedimentation rate
ESWL extracorporeal shock wave lithotripsy
EUA examination under anaesthetic
EUS endoscopic ultrasound
EVAR endovascular aneurysm repair
EVLT endovenous laser therapy
FAP familial adenomatous polyposis
FAST focused abdominal sonography for trauma
FBC full blood count
FDP fl exor digitorum profundus
FDS fl exor digitorum superfi cialis
FEV1 forced expiratory volume in 1 second
FFP fresh frozen plasma
FiO2 fraction of oxygen in inspired air
FLC fi brolamellar carcinoma
FNAB fi ne needle aspiration biopsy
FNAC fi ne needle aspiration cytology
FPL fl exor pollicis longus
FSH follicle-stimulating hormone
Trang 31GFR glomerular fi ltration rate
GGT gamma glutamyl transferase
GI gastrointestinal
GIP gastric inhibitory polypeptide
GIST gastrointestinal stromal tumour
GMC General Medical Council
GORD gastro-oesophageal refl ux
HDU high dependency unit
HGV heavy goods vehicle
HHD handheld Doppler
HIDA hepatobiliary iminodiacetic acid
HIT heparin-induced thrombocytopenia
HITT heparin-induced thrombocytopenia and thrombosisHIV human immunodefi ciency virus
HLA human leucocyte antigen
HMMA 4-hydroxy-3-methoxymandelic acid
HNPCC hereditary non-polyposis colorectal cancerH2O water
HPV human papilloma virus
HRT hormone replacement therapy
HSV herpes simplex virus
Trang 325-HT 5-hydroxytryptamine (serotonin)
HTLV human T-cell lymphocytotrophic virus
HVA homovanillic acid
IABP intra-aortic balloon pump
IC intermittent claudication
ICA internal carotid artery
ICD intracardiac defi brillator
ICP intracranial pressure
ICU intensive care unit
i.e id est (that is)
IF intrinsic factor
IGF insulin growth factor
IHD ischaemic heart disease
IM intramuscular
IMA inferior mesenteric artery
IMHS intramedullary hip screw
in inch
INPV intermittent negative pressure ventilation
INR international normalized ratio
IPJ interphalangeal joint
IPPV intermittent positive pressure ventilation
IPSS international prostate symptom score
ITA internal thoracic artery
ITU intensive treatment unit
IVU intravenous urogram
J joule
JCHST Joint Committee on Higher Surgical Training
JVP jugular venous pressure
LA local anaesthetic or left atrium/atrial
LAD left anterior descending (artery)
LAP left atrial pressure
Trang 33LatexAT latex agglutination test
lb pound
LDH lactate dehydrogenase
LDL low density lipid
LESS laparoscopic and endoscopic single site (surgery)LFT liver function test
LH luteinizing hormone
LHRH luteinizing hormone releasing hormone
Li lithium
LIF left iliac fossa
LITA left internal thoracic artery
LMS left main stem
LMWH low molecular weight heparin
LOS lower oesophageal sphincter
LSV long saphenous vein
LUQ left upper quadrant
LUTS lower urinary tract symptoms
LV left ventricle
LVEDP left ventricular end-diastolic pressure
LVEDV left ventricular end-diastolic volume
LVF left ventricular failure
m metre
MAG3 99mTc-mercaptoacetyltriglycine
MALT mucosa-associated lymphoid tissue
MAO monoamine oxidase
MAP mean arterial pressure
Trang 34MIP minimally invasive parathyroidectomy
MIST mechanism of injury/injuries identifi ed/(vital)signs at
MMR mismatch repair (genes)
MMV mandatory minute ventilation
Mn manganese
MODS multiple organ dysfunction syndrome
mph mile per hour
MR mitral regurgitation
MRA magnetic resonance angiography
MRC Medical Research Council (scale)
MRCP magnetic resonance cholangiopancreatogram
MRI magnetic resonance imaging
ms millisecond
MRSA methicillin (or multiply) resistant Staphylococcus aureus
MSU midstream urine
MTC medullary thyroid carcinoma
mTOR mammalian target of rapamycin
NaHCO3 sodium bicarbonate
NAI non-accidental injury
NASCET North American Symptomatic Carotid Endarterectomy TrialNBM nil by mouth
NCEPOD National Confi dential Enquiry into Patient Outcomes
NHS National Health Service
NICE National Institute for Health and Clinical Excellence
Trang 35NIPPV non-invasive intermittent positive pressure ventilation
NK natural killer (cell)
NNT number needed to treat
NSAID non-steroidal anti-infl ammatory drug
NSF National Service Framework
NSGCT non-seminomatous germ cell tumour
NSPCC National Society for the Prevention of Cruelty to ChildrenNSTEMI non-ST segment elevation myocardial infarctionNVB neurovascular bundle
nvCJD new variant Creutzfeldt–Jakob disease
NYHA New York Heart Association
O2 oxygen
OCP oral contraceptive pill
OGD oesophago-gastro-duodenoscopy
OPT orthopantomogram
ORIF open reduction with internal fi xation
PA pulmonary artery or posterior-anterior
PAC plasma aldosterone concentration
PaCO2 arterial carbon dioxide tension
PAF platelet-activating factor
PAL primary hyperaldosteronism
PaO2 arterial oxygen tension
PAP pulmonary artery pressure or placental alkaline phosphatase
PAS patient administration system
PAWP pulmonary artery wedge pressure
PCA patient-controlled analgesia
PCI percutaneous coronary intervention
PCNL percutaneous nephrolithotomy
PCO2 carbon dioxide tension
PCR polymerase chain reaction
PCV packed cell volume or pressure control ventilation
PDA posterior descending artery
PDGF platelet-derived growth factor
PE pulmonary embolism
PEEP positive end-expiratory pressure
PEFR peak expiratory fl ow rate
PEG percutaneous endoscopic gastrostomy
Trang 36PEP post-exposure prophylaxis
PET positron emission tomography
PGME Postgraduate medical education
PH portal hypertension
PHPT primary hyperparathyroidism
PICC peripherally inserted central venous catheter
PID pelvic infl ammatory disease
PIPJ proximal interphalangeal joint
PLL posterior longitudinal ligament
PMETB Postgraduate Medical Education and Training Board
PMN polymorphonuclear neutrophil
PO orally (per os)
PO2 oxygen tension
POSSUM Physiologic and Operative Severity Score for the
enumeration of Mortality and morbidity
PPH procedure for prolapse and haemorrhoids
PPI proton pump inhibitor
PPN peripheral parenteral nutrition
prn pro re rata (as required)
PS pressure support
PSA prostate-specifi c antigen
PSARP posterior sagittal anorectoplasty
PT prothrombin time
PTC percutaneous transhepatic cholangiogram
PTE pulmonary thromboembolism
PTEF polytetrafl uoroethylene
PTH parathyroid hormone
PTLD post-transplant lymphoproliferative disorder
PTT partial prothrombin time
PUJ pelviureteric junction
PVD peripheral vascular disease
PVR pulmonary vascular resistance
PVRI pulmonary vascular resistance index
qds quater die sumandus (four times a day)
RA right atrial or rheumatoid arthritis
RAP right atrial pressure
RCA right coronary artery
Trang 37RCT randomized controlled trial
Rh rhesus
rhTSH recombinant human thyroid-stimulating hormoneRIF right iliac fossa
RLN recurrent laryngeal nerve
RR relative risk or risk ratio
RRR relative risk reduction
RSTL relaxed skin tension line
RTA road traffi c accident
RUQ right upper quadrant
RV right ventricle
s second
SAC specialist advisory committee
SaO2 arterial oxygen saturation
SBE subacute bacterial endocarditis
SC subcutaneous
SCAT sheep cell agglutination test
SCC squamous cell carcinoma
SCI spinal cord injury
SCM sternocleidomastoid
SD standard deviation
SEMS self-expanding metal stenting
SEPL subfascial endoscopic perforator ligationSFA superfi cial femoral artery
SFJ saphenofemoral junction
SILS single incision laparoscopic surgery
SIMV synchronized intermittent mandatory ventilationSIRS systemic infl ammatory response syndrome
SL sublingual
SLE systemic lupus erythematosus
SMA superior mesenteric artery
SNP sodium nitroprusside
SPJ saphenopopliteal junction
spp species
STD sodium tetradecyl sulphate
STEMI ST segment elevation myocardial infarctionSTI sexually transmitted infection
SUFE slipped upper femoral epiphysis
Trang 38SVC superior vena cava
SVI stroke volume index
SvO2 percentage oxygen saturation of mixed venous haemoglobinSVR systemic vascular resistance
SVRI systemic vascular resistance index
SVT supraventricular tachycardia
T3 triiodothyronine
T4 thyroxine
TAP transversus abdominis percutaneous
TAPS transabdominal pre-peritoneal surgery
TB tuberculosis
TBSA total body surface area
TCC transitional cell carcinoma
TCR T-cell receptor
TCT transitional cell tumour
tds ter die sumendus (three times a day)
TEDS thromboembolic deterrent stockings
TEMS transanal endoscopic microsurgery
TEPS totally extra-peritoneal surgery
TFCC triangular fi brocartilage complex
TFT thyroid function test
TGF transforming growth factor
THR total hip replacement
TIA transient ischaemic attack
TIBC total iron binding capacity
TIPS transjugular intraparenchymal portosystemic shunt/stentTKA through-knee amputation
TKR total knee replacement
TLSO thoracolumbar spine orthosis
TMT tarsometatarsal
TNF tumour necrosis factor
TNM tumour nodes metastasis (cancer staging)
tPA tissue plasminogen activator
TPN total parenteral nutrition
TRAM transverse rectus abdominis myocutaneous (fl ap)
TRUS transrectal ultrasound
H thyroid-stimulating hormone
TT thrombin time or total thyroidectomy
TTE transthoracic echocardiogram
Trang 39TUIP transurethral incision in the prostate
TURP transurethral resection of the prostate
TVF transversalis fascia
U (international) units
UADT upper aerodigestive tract
U&E urea and electrolytes
UC ulcerative colitis
UCL ulnar collateral ligament
UFH unfractionated heparin
UOS upper oesophageal sphincter
USA United States of America
UTI urinary tract infection
UV ultraviolet
V volts
VACTERL vertebral defects/anorectal atresia/cardiac defects/
tracheo-oesophageal fi stula ± (o)esophageal atresia/renal anomalies/limb defects
VAD ventricular assist device
VATS video-assisted thoracoscopic surgery
VF ventricular fi brillation
VHL von Hippel–Lindau (disease)
VIP vasoactive inhibitory polypeptide
VMA vanillylmandelic acid
VQ ventilation/perfusion (scan)
VRE vancomycin-resistant Enterococcus
VT ventricular tachycardia
VTE venous thromboembolism
VWF von Willebrand factor
WCC white cell count
WHO World Health Organization
y year
Symbols and abbreviat