{"title":"Anatomy of the brachial plexus and upper limb peripheral neuropathies","authors":"Alastair Stephens, Clare Langley","doi":"10.1016/j.mpsur.2024.11.007","DOIUrl":"10.1016/j.mpsur.2024.11.007","url":null,"abstract":"<div><div>The brachial plexus is a complex network of nerves supplying the upper limb. Anatomical knowledge allows correlation between clinical findings diagnosing a neuropathy. We will discuss the brachial plexus anatomy and how clinical assessment permits diagnosis and management of injuries.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 69-73"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chronic pancreatitis","authors":"James Lucocq, Michael Hughes","doi":"10.1016/j.mpsur.2024.10.007","DOIUrl":"10.1016/j.mpsur.2024.10.007","url":null,"abstract":"<div><div>Chronic pancreatitis (CP) is a chronic inflammatory condition that results in irreversible morphological changes of the pancreas, including fibrosis and loss of both exocrine and endocrine functions. The aetiology of CP is multifaceted, including genetic, environmental, and autoimmune factors. Chronic alcohol consumption, smoking, and genetic mutations are significant contributors, with mechanisms involving oxidative stress, ductal obstruction, and immune-mediated inflammation. The clinical presentation is variable, with abdominal pain, malnutrition due to exocrine insufficiency, and diabetes mellitus being common presentations. Diagnosis of CP involves clinical evaluation, laboratory tests, and imaging studies, such as CT, MRCP, and endoscopic ultrasound, to assess pancreatic damage and complications. Management is complex and includes pain control, nutritional support, pancreatic enzyme replacement and, in severe cases, surgical interventions. Endoscopic treatment, such as stenting, and surgical procedures, like pancreaticojejunostomy, are used for ductal abnormalities and intractable pain. Emerging therapies, including antifibrotic treatments and stem cell therapy, are being explored. Long-term management requires a multidisciplinary approach, addressing not only medical and surgical needs but also psychological support and patient education. Advances in imaging and molecular biology are enhancing the understanding and treatment of CP, promising improved patient outcomes and quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 57-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Human metabolism: metabolic pathways and clinical aspects","authors":"Marcos Castro-Guarda, Rhys D Evans","doi":"10.1016/j.mpsur.2024.10.009","DOIUrl":"10.1016/j.mpsur.2024.10.009","url":null,"abstract":"<div><div>All mammalian energy is derived from food, in three chemical forms: carbohydrate, lipid, and protein, each providing a unique advantage in energy provision. Metabolism describes the series of chemical reactions that are concerned with the provision of energy to biological systems. They may be divided into reactions involved in energy mobilization/yield (catabolism: demand exceeds supply), and energy storage (anabolism: supply exceeds demand). Regulation of these pathways is critical for homeostasis, and derangements in metabolism are seen in a wide variety of pathological processes. Many common diseases have a metabolic aetiology, whilst others affect patient metabolism with significant clinical consequences. Understanding metabolism is key to the treatment of many common diseases, notably diabetes, as well as providing a rational basis for managing critically ill patients with sepsis and trauma, and underpinning clinical nutritional support.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 6-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself: MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2024.11.003","DOIUrl":"10.1016/j.mpsur.2024.11.003","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 67-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute pancreatitis","authors":"James Lucocq, Sanjay Pandanaboyana","doi":"10.1016/j.mpsur.2024.10.005","DOIUrl":"10.1016/j.mpsur.2024.10.005","url":null,"abstract":"<div><div>Acute pancreatitis (AP) is a significant cause of morbidity worldwide, with a steadily rising incidence, particularly in Western nations. This article provides a comprehensive overview of the epidemiology, aetiology, pathophysiology, and management of AP. The various aspects of the Revised Atlanta classification system are emphasized for its utility in defining AP severity, stratifying risk and guiding treatment. Both the role of imaging and the ‘step-up’ approach to guide procedural and endoscopic management are discussed, demonstrating the shift towards minimally invasive techniques. Early recognition of organ dysfunction and supportive care, including judicious fluid management, nutritional support, and appropriate use of antibiotics, are critical to improving outcomes. Specific considerations and recommendations for the management of local and systemic complications are outlined, with recommendations for early referral to specialized centres for optimal care.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 47-56"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgery of the spleen","authors":"Claire Jones","doi":"10.1016/j.mpsur.2024.11.001","DOIUrl":"10.1016/j.mpsur.2024.11.001","url":null,"abstract":"<div><div>The spleen is a solid organ located beneath the left hemidiaphragm. Indications for surgical resection include trauma (blunt or penetrating), haematological diseases, abscesses, hydatid disease, oncological resection or immunosuppression. Surgical approaches include open, laparoscopic and, more recently, robotic; the complications of operative intervention will also be discussed. In patients with an absent spleen there is a significant increased risk of developing overwhelming post-splenectomy infection (OPSI). It is therefore essential to protect patients from infection due to encapsulated organisms through vaccination. This requires a combination of vaccinations, antibiotic prophylaxis and good education.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 64-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cystic neoplasms of the pancreas","authors":"Alistair Rowcroft, Andrew Healey","doi":"10.1016/j.mpsur.2024.10.006","DOIUrl":"10.1016/j.mpsur.2024.10.006","url":null,"abstract":"<div><div>As the use of cross-sectional imaging has become more frequent, there has been an increase in the diagnosis of cystic neoplasms and small non-functioning neuroendocrine neoplasms within the pancreas. Investigation and follow-up of cystic lesions of the pancreas requires a multi-modal approach, of which endoscopic ultrasound with biopsy is becoming an increasingly important component. The main premalignant cystic neoplasms of the pancreas are mucinous-type tumours, intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). Main-duct IPMN should be resected due to the high incidence of underlying malignancy; however, a selective approach to intervention for side-branch IPMN should be taken (dependent on the presence of symptoms, tumour markers and tumour characteristics). Pancreatic neuroendocrine neoplasms (PanNENs) can also present as cystic lesions. Biochemically confirmed functional PanNEN and non-secreting PanNENs larger than 2 cm in size should be evaluated for surgery.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 38-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pancreatic pathology for the surgeon","authors":"Huaibin Mabel Ko, Runjan Chetty","doi":"10.1016/j.mpsur.2024.10.008","DOIUrl":"10.1016/j.mpsur.2024.10.008","url":null,"abstract":"<div><div>The pancreas can show a wide range of pathologies that span non- neoplastic (congenital abnormalities, inflammatory and infective) to neoplastic both primary and secondary. The purpose of this article is to provide an overview of pancreatic pathology for the non-pathologist reader, particularly highlighting the commoner entities. The article also shows the importance of sampling of certain lesions in total to exclude evidence of invasion in pre-cancerous pancreatic lesions. The reader is thus provided with some insight into the detailed gross and microscopic examination involved in the assessment of many pancreatic lesions.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 16-25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy of the pancreas and spleen","authors":"Meghan Coyle, Myutan Kulendran","doi":"10.1016/j.mpsur.2024.10.011","DOIUrl":"10.1016/j.mpsur.2024.10.011","url":null,"abstract":"<div><div>The pancreas is a retroperitoneal organ located at the level of the transpyloric plane. Descriptively it can be divided into the head, neck, body, and tail. It has several important anatomical relations, including the formation of the portal vein posteriorly. The main pancreatic duct drains secretions by combining with the common bile duct at the ampulla of Vater before opening into the duodenum via the major duodenal papilla. The pancreatic arterial supply is via the superior and inferior pancreaticoduodenal and splenic arteries. Acute pancreatitis is most commonly caused by gallstones and ethanol and can range in severity. Management focuses on symptom control, although interventions may be required for subsequent complications. Ductal adenocarcinoma accounts for over 85% of pancreatic neoplasms. The only curative treatment is surgical resection. The spleen lies within the left upper quadrant of the abdomen and is the largest lymphoid organ. Anatomically it can be divided into a superior and inferior pole, visceral and diaphragmatic surface, and superior, inferior, and intermediate borders. At the hilum, peritoneal reflections create two ligaments; the gastrosplenic and splenorenal. The blood supply is via the splenic artery and vein. Splenectomies can be considered in a variety of pathologies, including trauma, haematological conditions, and neoplasia.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pancreatic cancer","authors":"Mari-Claire McGuigan, Nigel B Jamieson","doi":"10.1016/j.mpsur.2024.10.004","DOIUrl":"10.1016/j.mpsur.2024.10.004","url":null,"abstract":"<div><div>Improving the survival of patients with pancreatic ductal adenocarcinoma (PDAC) remains an oncological and surgical challenge. The non-specific nature of presenting symptoms which results in approximately 50% of patients having advanced disease at diagnosis, coupled with its relative chemoresistance have led to persistently poor survival rates. Unfortunately, even long-term outcomes following surgical resection for PDAC remain poor, with only 20% of patients surviving 5 years after pancreatectomy. Patient selection for surgery remains sub-optimal largely due to the absence of consideration of aggressive tumour biology. The benefits of FOLFIRINOX for patients with metastatic disease are now being realized in the adjuvant setting and potentially in the neoadjuvant space coupled with improved understanding of the impact of treatment sensitive molecular subgroups. For all patients with PDAC, management should incorporate multidisciplinary management, and integrated supportive care with comprehensive germline testing becoming increasingly applied. The future will likely see gradual progression to more patient-centred treatment algorithms based on tumour molecular profiling with the aim of improving not only survival outcomes but also quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 26-37"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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