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Essential Surgical Knowledge

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2285 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
Davide Ciardiello, Pietro Paolo Vitiello, Claudia Cardone, Giulia Martini, Teresa Troiani, Erika Martinelli, Fortunato Ciardiello
A better knowledge of the complex interactions between cancer cells and the immune system has led to novel immunotherapy approaches. Treatment with selective anti-PD1, anti-PD-L1 and/or anti-CTLA-4 monoclonal antibodies (mAbs) has been a revolution in the therapeutic scenario of several cancer types, with the highest clinical efficacy in melanoma and in lung cancer. Colorectal cancer is one of the tumours in which immunotherapy has been shown less effective. Whereas in deficient mismatch repair (MMR) or in highly microsatellite instable (MSI-H) metastatic colorectal cancer there is clear clinical evidence for a therapeutic role of immune checkpoint inhibitors, the vast majority of patients with proficient MMR or with microsatellite stable (MSS) tumours do not benefit from immunotherapy...
May 4, 2019: Cancer Treatment Reviews
Cornelius A Thiels, Elizabeth B Habermann, W Michael Hooten, Molly M Jeffery
OBJECTIVE: To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids. DESIGN: Observational study of administrative claims data. SETTING: United States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018. PARTICIPANTS: Opioid-naive patients undergoing elective surgery. MAIN OUTCOME MEASURE: Risk of persistent opioid use after discharge for patients treated with tramadol alone compared with other short acting opioids, using three commonly used definitions of prolonged opioid use from the literature: additional opioid use (defined as at least one opioid fill 90-180 days after surgery); persistent opioid use (any span of opioid use starting in the 180 days after surgery and lasting ≥90 days); and CONSORT definition (an opioid use episode starting in the 180 days after surgery that spans ≥90 days and includes either ≥10 opioid fills or ≥120 days' supply of opioids)...
May 14, 2019: BMJ: British Medical Journal
M Barraqué, A Filippello, A Brek, S Baccot, J Porcheron, G Barabino
Retrorectal tumors (RRT), whether benign or malignant in nature, are rare in adults and often asymptomatic. While diagnosis is based on clinical findings, differential diagnosis depends mainly on magnetic resonance imaging (MRI). MRI provides guidance for surgical management, the first-line treatment of choice. Four surgical approaches are described: abdominal, perineal, posterior and abdomino-sacral.. This review of major reported series has made it possible to specify the indications for each surgical approach, as well as the advantages, disadvantages and complications of each one...
May 9, 2019: Journal of Visceral Surgery
Joshua D Wallach, Harlan M Krumholz
No abstract text is available yet for this article.
May 7, 2019: Annals of Internal Medicine
Laura M Mazer, George A Poultsides
Cancer of the gastroesophageal junction (GEJ) is increasing in incidence, likely as a result of rising obesity and gastroesophageal reflux disease rates. The tumors that arise here share features of esophageal and gastric cancer, and are classified based on their location in relationship to the GEJ. The definition of the GEJ itself, as well as optimal resection strategy, extent of lymph node dissection, resection margin length, and reconstruction methods are still very much a subject of debate. This article summarizes the available evidence on this topic, and highlights specific areas for further research...
June 2019: Surgical Clinics of North America
Venkata S Akshintala, Vikesh K Singh
The current article provides a brief summary of current evidence-based practices in the treatment of autoimmune pancreatitis.
April 28, 2019: Clinical Gastroenterology and Hepatology
Kyle H Sheetz, Justin B Dimick
No abstract text is available yet for this article.
April 30, 2019: JAMA: the Journal of the American Medical Association
Tammy Ju, Lisbi Rivas, Kyle Kurland, Sheena Chen, Andrew Sparks, Paul P Lin, Khashayar Vaziri
BACKGROUND: To identify trends in total and subtotal gastrectomy for middle and distal third gastric adenocarcinoma in the U.S. METHODS: NCDB was queried for patients with stage 0-III middle or distal gastric adenocarcinoma treated with total or subtotal gastrectomy. Statistical analysis including cox proportional hazards model was performed to examine overall survival by stage. RESULTS: 1,628 (85%) underwent subtotal gastrectomy and 283 (15%) underwent total...
April 19, 2019: American Journal of Surgery
Westyn Branch-Elliman, William O'Brien, Judith Strymish, Kamal Itani, Christina Wyatt, Kalpana Gupta
Importance: The benefits of antimicrobial prophylaxis are limited to the first 24 hours postoperatively. Little is known about the harms associated with continuing antimicrobial prophylaxis after skin closure. Objective: To characterize the association of type and duration of prophylaxis with surgical site infection (SSI), acute kidney injury (AKI), and Clostridium difficile infection. Design, Setting, and Participants: In this multicenter, national retrospective cohort study, all patients within the national Veterans Affairs health care system who underwent cardiac, orthopedic total joint replacement, colorectal, and vascular procedures and who received planned manual review by a trained nurse reviewer for type and duration of surgical prophylaxis and for SSI from October 1, 2008, to September 30, 2013, were included...
April 24, 2019: JAMA Surgery
F Sköldberg, J Granlund, A Discacciati, F Hjern, P T Schmidt, O Olén
BACKGROUND: Studies on incidence rates of first-time colonic diverticular disease are few, and population-based estimates of lifetime risk are lacking. In this observational study, the incidence, admission rates and lifetime risks of hospitalization and surgery for diverticular disease were investigated. METHODS: Considering the entire Swedish population as an open cohort, incidence and admission rates, and lifetime risk estimates (considering death as a competing risk) of hospitalization and surgery for diverticular disease were calculated using data from cross-linked national registers and population statistics from 1987 to 2010...
April 23, 2019: British Journal of Surgery
Yader Sandoval, Allan S Jaffe
Acute myocardial infarction (MI) can occur from increased myocardial oxygen demand and/or reduced supply in the absence of acute atherothrombotic plaque disruption; a condition called type 2 myocardial infarction (T2MI). As with any MI subtype, there must be clinical evidence of myocardial ischemia to make the diagnosis. This condition is increasingly diagnosed due to the increasing sensitivity of cardiac troponin assays and is associated with adverse short-term and long-term prognoses. Limited data exist defining optimal management strategies because T2MI is a heterogeneous entity with varying etiologies and triggers...
April 16, 2019: Journal of the American College of Cardiology
Yoav Golan
Acute bacterial skin and skin-structure infections (ABSSSIs) are a common reason for seeking care at acute healthcare facilities, including emergency departments. Staphylococcus aureus is the most common organism associated with these infections, and the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) has represented a considerable challenge in their treatment. To address this need, a number of new antibiotics have been developed for the treatment of ABSSSIs in the past several years...
April 8, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Adam Cuker, Allison Burnett, Darren Triller, Mark Crowther, Jack Ansell, Elizabeth M Van Cott, Diane Wirth, Scott Kaatz
Two specific reversal agents for direct oral anticoagulants (DOACs) have been approved in the United States: idarucizumab for dabigatran reversal and andexanet alfa for apixaban and rivaroxaban reversal. Non-specific prohemostatic agents such as prothrombin complex concentrate (PCC) and activated PCC have also been used for DOAC reversal. The goal of this document is to provide comprehensive guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of DOAC reversal agents...
March 27, 2019: American Journal of Hematology
Rachel A Freedman, Kathryn J Ruddy
No abstract text is available yet for this article.
April 17, 2019: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Julia Bohlius, Kari Bohlke, Roberto Castelli, Benjamin Djulbegovic, Maryam B Lustberg, Massimo Martino, Giannis Mountzios, Namrata Peswani, Laura Porter, Tiffany N Tanaka, Gianluca Trifirò, Hushan Yang, Alejandro Lazo-Langner
PURPOSE: To update the American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. METHODS: PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs in patients with cancer published from January 31, 2010, through May 14, 2018. For biosimilar ESAs, the literature search was expanded to include meta-analyses and RCTs in patients with cancer or chronic kidney disease and cohort studies in patients with cancer due to limited RCT evidence in the cancer setting...
April 10, 2019: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Jillian Simard, Suneel Kamath, Sheetal Kircher
Effective therapy for treatment of colorectal cancer includes comprehensive and evidence-based therapies that may include a combination of surgery, chemotherapy, targeted therapy, and/or radiation. However, in order to provide patients with the highest quality of care, providers must consider all aspects of survivorship care including: surveillance for recurrence/second primaries, genetic counseling, psychosocial/physical late effects of cancer and its therapies, and preventative lifestyle strategies. Health systems, providers, and researchers need to identify systematic methods of addressing the unique needs of the survivorship population that include multidisciplinary teams including supportive oncology (i...
April 1, 2019: Current Treatment Options in Oncology
Edward Wolfgang Lee, Puja Shahrouki, Lourdes Alanis, Pengxu Ding, Stephen T Kee
Importance: Varices are one of the main clinical manifestations of cirrhosis and portal hypertension. Gastric varices are less common than esophageal varices but are often associated with poorer prognosis, mainly because of their higher propensity to bleed. Observations: Currently, treatments used to control and manage gastric variceal bleeding include β-blockers, endoscopic injection sclerotherapy, endoscopic variceal ligation, endoscopic variceal obturation, shunt surgery, transjugular intrahepatic portosystemic shunts, balloon-occluded retrograde transvenous obliteration (BRTO), and modified BRTO...
April 3, 2019: JAMA Surgery
Thomas F Seykora, Jason B Liu, Laura Maggino, Henry A Pitt, Charles M Vollmer
MINI: Early drain removal has yet to be explored following distal pancreatectomy. Following analysis of ACS-NSQIP data, early removal demonstrated significantly better outcomes when compared to late removal and drain omission. Multivariable analysis revealed early removal had reduced odds for pancreatic fistula and death or serious morbidity compared to drain omission, while late drain removal conversely displayed increased odds. OBJECTIVE: To explore contemporary drain management practices and examine the impact of early removal following distal pancreatectomy (DP)...
January 30, 2019: Annals of Surgery
Mark J Truty, Michael L Kendrick, David M Nagorney, Rory L Smoot, Sean P Cleary, Rondell P Graham, Ajit H Goenka, Christopher L Hallemeier, Michel G Haddock, William S Harmsen, Amit Mahipal, Robert R McWilliams, Thorvardur R Halfdanarson, Axel F Grothey
MINI: Total neoadjuvant therapy, or systemic induction chemotherapy followed by chemoradiation, is an optimal preoperative sequencing strategy for patients with borderline resectable or locally advanced pancreatic adenocarcinoma. This strategy allows high rate of negative margins despite low frequency of radiologic downstaging with survival dependent on chemotherapy duration and response factors that are potentially modifiable by alteration in initial systemic therapy decisions.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4...
April 5, 2019: Annals of Surgery
Ismail Jatoi, William F Anderson, Anthony B Miller, Otis W Brawley
No abstract text is available yet for this article.
April 2019: Current Problems in Surgery
2019-04-03 12:34:19
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