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Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum and Retroperitoneum

Abdominal Wall And Umbilicus Embryology The abdominal wall begins to develop in the earliest stages of embryonic differentiation from the lateral plate of the embryonic mesoderm. At this stage, the embryo consists of three principal layers—an outer protective layer termed the ectoderm ; an inner nutritive layer, the endoderm ; and the mesoderm. The mesoderm becomes divided by clefts on each side of the lateral plate…

Gastroesophageal Reflux Disease and Hiatal Hernia

Gastroesophageal reflux disease (GERD) is the most common benign medical condition of the stomach and esophagus. In patients with GERD who experience persistent life-limiting symptoms despite maximal medical therapy, antireflux surgery should be strongly considered. The application of laparoscopy to antireflux surgery has decreased perioperative morbidity, hospital length of stay, and cost compared with open operations. Conceptually, laparoscopic antireflux surgery (LARS) is straightforward; however, the correct…

Esophagus

An organ that spans the distance of neck to stomach, the esophagus for all of its tube-like simplicity is in actuality a complex and relatively durable organ. It traverses the outside world and passes through precious territory in the mediastinum. The esophagus functions within areas that transition through pressure changes ranging from atmospheric to vacuum. Yet, the precision of a normal esophagus is virtually unrecognized. We…

The Multiple Endocrine Neoplasia Syndromes

The multiple endocrine neoplasia (MEN) syndromes occur as a result of a genetic change leading to the development of tumors in endocrine organs and tissues. Alterations in the menin gene, a tumor suppressor gene, results in MEN type 1 (MEN1), while MEN type 2 (MEN2) occurs as a result of changes in the RET proto-oncogene. This results in both benign and malignant endocrine tumors, and the…

The Adrenal Glands

History The adrenal glands were first described by the Italian anatomist Bartolomeo Eustachi in 1563. The German comparative anatomist Albert von Kölliker (1817–1905), who noted the presence of the adrenals in a number of vertebrate species, is credited with first identifying two distinct portions of the adrenal gland, the cortex and the medulla. Although Thomas Addison described the clinical features of primary adrenal failure in 1855,…

Endocrine Pancreas

First identified over 400 years ago by Greek anatomists, the pancreas is located in the retroperitoneum with the head of the pancreas lying in the C loop of the duodenum ( Fig. 39.1A and B ). The pancreas has distinct hormonal (endocrine) and digestive (exocrine) functions. Endocrine cells are organized in discrete clusters throughout the pancreas. First described in 1869 by then medical student Paul Langerhans,…

The Parathyroid Glands

History of the Parathyroid Glands The parathyroid glands were the last endocrine glands to be discovered. The earliest reference to the parathyroid glands is Sir Richard Owen’s description of a small compact yellow glandular body that was attached to the thyroid gland in the Indian rhinoceros. Ivar Victor Sandstrom, a 25-year-old Swedish medical student at the University of Uppsala, has been credited with first identifying the…

Thyroid

Disclosures IS is a consultant for Medtronic and Prescient Surgical. JAS is a member of the Data Monitoring Committee of the Medullary Thyroid Cancer Consortium Registry supported by GlaxoSmithKline, Novo Nordisk, Astra Zeneca, and Eli Lilly. History of Thyroid Surgery The history of thyroid surgery began more than 1000 years ago. Most records agree that the first thyroidectomy was performed for endemic goiter by the legendary…

Breast Reconstruction

In women in the United States, breast cancer is the most common cancer and the second most common cause of death from cancer. From the 1980s to 2015, breast cancer mortality rates have declined, and 5-year survival has increased to almost 90%. The American Cancer Society (ACS) adjusted its breast cancer screening guidelines in 2015 and now strongly recommends annual mammograms from age 45 and older.…

Diseases of the Breast

Anatomy The breast lies between the subdermal layer of adipose tissue and the superficial pectoral fascia ( Fig. 35.1 ). The breast parenchyma is composed of lobes that comprise multiple lobules. Multiple fibrous bands termed the suspensory ligaments of Cooper provide structural support and run from the chest wall to the dermis. The retromammary fat pad is a relatively avascular space that lies between the breast…

Head and Neck

Normal Histology The normal histology of the upper aerodigestive tract varies based on the cells, tissues, and function required of each site. A complete review of the thyroid and parathyroid glands is beyond the scope of this chapter. The upper aerodigestive tract can be conceptualized to start with the openings to the nose and mouth. The shape of the nasal vestibule is maintained by underlying septal,…

Bone Tumors

Overview Orthopedic oncology is a complex surgical discipline that involves the diagnosis, management, and surveillance of primary mesenchymal malignancies (sarcomas), benign bone and soft tissue masses, and secondary neoplasms of bone and soft tissue. The unique structural qualities of bone, along with its complex microenvironment, must be considered when formulating strategies for management of bone tumors. This chapter reviews the complex biology of the bone microenvironment…

Soft Tissue Sarcoma

Epidemiology Soft tissue sarcoma (STS) is a diverse group of more than 60 neoplasms that can arise from virtually any anatomic site and can affect the very young as well as the elderly. The tissue types of STS origin include skeletal muscle, adipose cells, blood and lymphatic vessels, and connective tissue or those cells with a common mesoderm origin ( Fig. 32.1 and Table 32.1 ).…

Melanoma and Cutaneous Malignancies

Skin cancer is the most common form of cancer, accounting for at least half of all malignant neoplasms. Almost one in five Americans will be diagnosed with skin cancer in their lifetime. The high incidence of skin cancer is largely attributable to environmental exposures, particularly sunlight. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) comprise the majority of all skin cancer diagnoses, while melanoma represents…

Tumor Immunology and Immunotherapy

Cancer immunotherapy has had a long and generally disappointing clinical history, until recently. There were clues from early landmark clinical trials using high-dose interleukin-2 (IL-2), which effected dramatic and durable complete responses in small subsets of patients with metastatic melanoma and renal cell cancer; these regressions that were mediated by the infiltration of these tumors with cytotoxic lymphocytes. Another major advance was the demonstration that T…

Tumor Biology and Tumor Markers

Neoplasia (literally meaning “new growth”) is the uncontrolled proliferation of cells. The term tumor , which was originally used to describe the swelling caused by inflammation, is now used interchangeably with neoplasm. Transformation is the multistep process in which normal cells acquire malignant characteristics, such as the ability to invade tissues and to spread to distant sites (metastasize). Each step-in transformation reflects one or more genetic…

Small Bowel Transplantation

History Intestine transplantation has become a lifesaving treatment option for patients with intestinal failure. The term intestinal failure encompasses multiple disorders of inadequate intestinal length or function that prevent adequate nutrient absorption. In contrast, enteral autonomy is a term describing the ability of an individual to absorb all nutrient needs from the gastrointestinal tract. For the subset of patients who have intestinal failure because of loss…

Kidney and Pancreas Transplantation

Historical Perspective The field of organ transplant has contributed to the development of surgical technique as well as to the advancement of immunology. Attempts at transplant to cure organ failure date back several centuries. Alexis Carrel developed techniques of triangulation of vascular anastomoses by performing various organ transplants in animals and received the Nobel Prize in 1912. Organ function was minimal, and further attempts at organ…

Liver Transplantation

History More than 90% of patients receiving a liver transplant in the United States will be alive 1 year after the surgery, and almost 85% will be alive after 3 years. This extraordinary achievement arose as the result of the syntheses of a myriad of discoveries in disparate fields. Liver transplantation represents a triumph of scientific achievement, collaboration, and teamwork. Seminal discoveries instrumental in developing transplantation…

Transplantation Immunobiology and Immunosuppression

Video 25.1 Results of the World’s First Successful Hand Transplant. Only a few short decades ago, there were no options for patients dying of end-stage organ failure. The concept of transplanting an organ from one individual to another was thought to be impossible. The evolution of clinical transplantation and transplant immunology is one of the bright success stories of modern medicine. It was through understanding of…