Clinical surgery alfred cuschieri pdf free download: The ultimate reference for surgical diagnosis a

The second edition of Clinical Surgery is perfect for undergraduate and junior doctors alike as well as other health professionals who need a comprehensive account of surgery in all the major medical specialities. With a strong emphasis on clinical practice and the necessary knowledge and skills, this is a must-buy for anyone going on a surgical rotation. Clinical Surgery is intended to teach you everything you need to know about surgery at the start of your career.

In agreement with other studies [3, 4, 21, 22, 32], the diagnosis of perforated PUD in this study was made from history and identification of free air under the diaphragm in plain abdominal and chest radiographs, and the diagnosis was confirmed at laparotomy. The value of the radiological investigation has been compared with other writers and with current radiological techniques; 80-90% of cases are correctly diagnosed [4, 33]. In case of perforated PUD ulcer, free intraperitoneal gas is less likely to be seen if the time interval between the perforation and radiological examination in short [4]. Recently, Computerized tomography (CT) scans with oral contrast are now considered the reliable method of detecting small pneumoperitonium before surgery and the gold standard for the diagnosis of a perforation [34, 35]. Abdominal ultrasonography has also been found to be superior to plan radiographs in the diagnosis of free intra-peritoneal air [35]. None of these imaging studies were used in the diagnosis of free intra-peritoneal air in our study. We relied on plain radiographs of the abdominal/chest to establish the diagnosis of free intra-peritoneal air which was demonstrated in 65.8% of cases. We could not establish, in our study, the reason for the low detection rate of free air under the diaphragm.

Clinical surgery alfred cuschieri pdf free download

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In this study, Graham's omental patch of the perforations with either a pedicled omental patch or a free graft of omentum was the operation of choice in our centre. Similar surgical treatment pattern was reported in other studies [3, 4, 21, 22]. This is a rapid, easy and life-serving surgical procedure that has been shown to be effective with acceptable mortality and morbidity [22, 39]. Although this procedure has been associated with ulcer recurrence rates of up to 40% in some series, Graham's omental patch of PUD perforations remains a surgical procedure of choice in most centres and to avoid recurrence the procedure should be followed by eradication of H. pylori[22, 40]. Simple closure of perforation with omental patch and the use of proton pump inhibitors have changed the traditional definitive peptic ulcer surgery of truncal vagotomy and drainage procedures [41]. Definitive surgery is indicated only for those who are reasonably fit and presented early to the hospital for surgery [22]. Definitive peptic ulcer surgery increases operative time, exposes the patient to prolonged anaesthesia and also increases the risk of postoperative complications. This is especially true in developing countries including Africa where patients often present late with severe generalized peritonitis [23]. In the present study, only one patient who presented early with stable haemodynamic state underwent definitive peptic ulcer surgery of truncal vagotomy and drainage. Recently, laparoscopic repair of perforated peptic ulcer has also been reported, [42] and this is believed to help reduce postoperative morbidity and mortality [43].

The second edition of Clinical Surgery is perfect for undergraduate and junior doctors alike as well as other health professionals who need a comprehensive account of surgery in all the major medical specialities. With a strong emphasis on clinical practice and the necessary knowledge and skills, this is a must-buy for anyone going on a surgical rotation. Clinical Surgery is intended to teach you everything you need to know about surgery at the start of your career.

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