conversations.from: human
conversations.value: Give me a description for a book titled Current Surgical Therapy about John, Cameron, M.D with the genre: New, Used & Rental Textbooks, Medicine & Health Sciences.
conversations.from: assistant
conversations.value: John L. Cameron, M.D., F.A.C.S., The Alfred Blalock Professor and Chairman, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD
conversations.from: human
conversations.value: Reverse the sentences.
conversations.from: assistant
conversations.value: , The Alfred Blalock Professor and Chairman, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD.S.C.A., F.D. Cameron, M.John L
conversations.from: human
conversations.value: Give me the first four paragraphs for the book.
conversations.from: assistant
conversations.value: Current Surgical Therapy
  Endoscopic ultrasound (EUS) may be a useful modality in the assessment of locoregional disease. Its accuracy is better in advanced compared to superficial disease; the latter is better staged with endoscopic mucosal resection (EMR) when possible. Combined with fine-needle aspiration (FNA), EUS provides the most accurate staging modality to prove regional lymph node involvement. T-stage accuracy is approximately 85%. Lymph nodes appear as hypoechoic, well-circumscribed areas greater than 10 mm in the area of the tumor. Lymph node FNA is possible if the needle tract is not obstructed by the tumor itself. For stenotic cancers, it may be difficult to pass the EUS probe distally. Patients with small (<1-1.5 cm) endoscopically visible lesions or identifiable areas should undergo EMR, which allows for accurate histologic distinction between mucosal (T1a) and submucosal (T1b) tumors. The former may be definitively treated with endoscopic methods, while submucosal lesions are best treated via surgical resection. This is due to the fact that esophageal lymphatics are located in the submucosa, leading to a low prevalence of nodal metastases in mucosal lesions. T1b lesions that penetrate the muscularis mucosa carry a potential for metastatic nodes of approximately 30%, rendering them more appropriate for esophagectomy.
  An 18F-fluorodeoxyglucose positron emission tomography (PET) scan in combination with a CT scan is the single best systemic staging modality. This combination of PET-CT allows for optimization of the relationship of anatomic abnormalities to hypermetabolic areas (Figure 1). The magnitude of hypermetabolism, measured as the standard uptake value (SUVmax) has also been reported to have prognostic significance.
  FIGURE 1 PET-CT imaging revealing distal esophageal/gastroesophageal junction (GEJ) hypermetabolic area (increased standardized uptake value [SUV] marked by arrow) in area of confirmed esophageal adenocarcinoma.
  The identification of cancer-related biomarkers is becoming an increasingly important area of esophageal cancer treatment. The immunohistochemical protein expression profile of markers, including Her2, p53, c-myc, Notch, and EGFR, has been analyzed with respect to esophageal carcinogenesis. Current evidence suggests that Her2 overexpression correlates with cancer progression and may be amenable to therapeutic intervention via medications such as trastuzumab. Although preliminary results are promising, extensive work remains to be done to formulate new treatment regimens or interventions based on a patient's genetic profile.
conversations.from: human
conversations.value: Give me four more paragraphs.
conversations.from: assistant
conversations.value: The initial exploration should be under loupe magnification and tourniquet control if possible. If repair of a motor nerve is planned (and it is within 72 hours of the original injury), it is critical to remember that a tourniquet applied longer than 30 minutes can cause ischemia of the distal nerve, and intraoperative nerve stimulation will no longer be possible. Thus, the initial dissection must be well planned, focused, and directed to make sure there is enough time to dissect the putative distal nerve and apply stimulation for 30 minutes afterward.
  Both an organized approach to exposing the injured nerve (Table 4) and a thorough knowledge of the anatomy are essential, especially when significant scarring is expected. To expose the injured segment of the nerve, dissection should be performed between two muscle groups parallel to the long axis of the nerve to identify a normal segment of the nerve, both proximally and distally, before dissecting to expose the injured segment. If it is near a compression site, such as the ulnar nerve near Osborne's band, then the site of compression should be released at this time. The regenerating nerve will become swollen during the regenerative phase, and potential future compression should be prophylactically removed.
  After exposing the injured segment, there are two possibilities: the identification of a lesion-in-continuity versus nerve stumps. Intraoperative inspection of a lesion-in-continuity does not necessarily predict outcomes. A very firm lesion, particularly if a preoperative MRN showed a severe injury, most likely should be resected and reconstructed. However, if a lesion-in-continuity is identified, intraoperative NAP testing can be performed. If NAP (+), conservative management is indicated (observation will render better outcomes than resection, so only neurolysis should be performed). If NAP (−), resection of the lesion followed by nerve reconstruction will improve outcomes.
  If nerve stumps are identified, reconstruction is indicated. NAP, somatosensory-evoked potentials (SSEP), and motor-evoked potentials (MEP) may be used to help determine if the proximal nerve stump can be used for reinnervation.
conversations.from: human
conversations.value: Give me the last three paragraphs.
conversations.from: assistant
conversations.value: The spectrum of therapeutic flexible endoscopy performed by gastroenterologists inside the lumen has widened since the introduction of NOTES. However, it remains unclear who should be trained for performing NOTES and which discipline is primarily involved with NOTES. The fourth Euro-NOTES workshop yielded the consensus statements of NOTES in 2011. According to the consensus, it appears reasonable for a diagnostic approach to be performed by a gastroenterologist; a therapeutic NOTES procedure will probably be performed by a surgeon. The current situation of training surgeons in flexible endoscopy and training gastroenterologists in laparoscopic surgery cannot be regarded as an ideal solution. An ideal goal would be to achieve combined endoscopic/laparoscopic operating room suites with common wards and staff, common conferences, and a substantial volume of "crossover cases" between surgery and endoscopy.
  NOTES is one of the most exciting current developments in minimally invasive endoscopic surgery. Since its theoretical conception in 2000, transluminal procedures without visible scars have been performed via natural orifices by creative endoscopists and surgeons conducting minimally invasive operations worldwide. Some NOTES procedures have become regular minimally invasive therapies at many clinical centers in some areas or countries, such as those in Europe and South America, Japan, and China. NOTES is continuing to evolve and is here to stay.
  ARDS (acute respiratory distress syndrome), incremental approach to management of severe, 1227–1229, 1228f–1229f
conversations.from: human
conversations.value: Delete the first sentence.
conversations.from: assistant
conversations.value: However, it remains unclear who should be trained for performing NOTES and which discipline is primarily involved with NOTES. The fourth Euro-NOTES workshop yielded the consensus statements of NOTES in 2011. According to the consensus, it appears reasonable for a diagnostic approach to be performed by a gastroenterologist; a therapeutic NOTES procedure will probably be performed by a surgeon. The current situation of training surgeons in flexible endoscopy and training gastroenterologists in laparoscopic surgery cannot be regarded as an ideal solution. An ideal goal would be to achieve combined endoscopic/laparoscopic operating room suites with common wards and staff, common conferences, and a substantial volume of "crossover cases" between surgery and endoscopy.
  NOTES is one of the most exciting current developments in minimally invasive endoscopic surgery. Since its theoretical conception in 2000, transluminal procedures without visible scars have been performed via natural orifices by creative endoscopists and surgeons conducting minimally invasive operations worldwide. Some NOTES procedures have become regular minimally invasive therapies at many clinical centers in some areas or countries, such as those in Europe and South America, Japan, and China. NOTES is continuing to evolve and is here to stay.
  ARDS (acute respiratory distress syndrome), incremental approach to management of severe, 1227–1229, 1228f–1229f