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Principles of Surgery, Companion Handbook

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This handbook has resulted from the need of students and house officers to be able to carry a book with them for easy reference when there is limited access to the companion textbook. This portable handbook is not meant to supersede the textbook and should be used in conjunction with the seventh edition of Principles of Surgery. The material prepared by the contributors to the handbook is based solely on the chapters from the seventh edition and is meant to be a concise synopsis of the work of those original authors.

The host response to injury—surgical, traumatic, or infectious—is characterized by various endocrine, metabolic, and immunologic alterations. If the inciting injury is minor and of limited duration, wound healing and restoration of metabolic and immune homeostasis occur readily. More significant insults lead to further deterioration of the host regulatory processes, which, without appropriate intervention, often precludes full restoration of cellular and organ function or results in death. The spectrum of cellular metabolic and immunologic dysfunction resulting from injury suggests a complex mechanism for identifying and initially quantifying the injurious event. This initial response is inherently inflammatory, inciting the activation of cellular processes designed to restore or maintain function in tissues while also promoting the eradication or repair of dysfunctional cells. These dynamic processes imply the existence of anti-inflammatory or counterregulatory processes that promote the restoration of homeostasis. A discussion of the response to injury must account for the collective dynamics of neuroendocrine, immunologic, and metabolic alterations characteristic of the injured patient.

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