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Essential Surgical Knowledge

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2314 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
Sandhya R Panch, Celina Montemayor-Garcia, Harvey G Klein
New England Journal of Medicine, Volume 381, Issue 2, Page 150-162, July 2019.
July 11, 2019: New England Journal of Medicine
Jesse A Columbo, Pablo Martinez-Camblor, Alistair James O'Malley, Bjoern D Suckow, Andrew W Hoel, David H Stone, Andres Schanzer, Marc L Schermerhorn, Art Sedrakyan, Philip P Goodney
OBJECTIVE: To describe the long-term reintervention rate after endovascular abdominal aortic aneurysm repair (EVR), and identify factors predicting reintervention. SUMMARY OF BACKGROUND DATA: EVR is the most common method of aneurysm repair in America, and reintervention after EVR is common. Clinical factors predicting reintervention have not been described in large datasets with long-term follow-up. METHODS: We studied patients who underwent EVR using the Vascular Quality Initiative registry linked to Medicare claims...
July 8, 2019: Annals of Surgery
A Pulvirenti, A Pea, N Rezaee, C Gasparini, G Malleo, M J Weiss, J L Cameron, C L Wolfgang, J He, R Salvia
BACKGROUND: Total pancreatectomy is required to treat diseases involving the entire pancreas, and is characterized by high morbidity rates and impaired long-term quality of life (QoL). To date, risk factors associated with perioperative and long-term outcomes have not been determined fully. METHODS: Data from patients undergoing total pancreatectomy between 2000 and 2014 at two high-volume centres were analysed retrospectively to assess risk factors for major surgical complications...
July 8, 2019: British Journal of Surgery
Laurent Castera, Mireen Friedrich-Rust, Rohit Loomba
Nonalcoholic fatty liver disease (NAFLD) is estimated to afflict approximately 1 billion individuals worldwide. In a subset of NAFLD patients, who have the progressive form of NAFLD termed as nonalcoholic steatohepatitis (NASH), it can progress to advanced fibrosis, cirrhosis, hepatocellular carcinoma and liver-related morbidity and mortality. NASH is typically characterized by a specific pattern on liver histology, including steatosis, lobular inflammation, ballooning with or without peri-sinusoidal fibrosis...
January 17, 2019: Gastroenterology
Joseph D Feuerstein, Alan C Moss, Francis A Farraye
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that can involve any aspect of the colon starting with mucosal inflammation in the rectum and extending proximally in a continuous fashion. Typical symptoms on presentation are bloody diarrhea, abdominal pain, fecal urgency, and tenesmus. In some patients, extraintestinal manifestations may predate the onset of gastrointestinal symptoms. A diagnosis of UC is made on the basis of presenting symptoms consistent with UC as well as endoscopic evidence showing continuous and diffuse colonic inflammation that starts in the rectum...
July 2019: Mayo Clinic Proceedings
Hiroshi Sogawa, Guilherme Costa, Sherif Armanyous, Geoffrey J Bond, Ruy J Cruz, Abhinav Humar, George Mazariegos, Kareem M Abu-Elmagd
OBJECTIVE: To define long-term outcome, predictors of survival, and risk of disease recurrence after gut transplantation (GT) in patients with chronic intestinal pseudo-obstruction (CIPO). BACKGROUND: GT has been increasingly used to rescue patients with CIPO with end-stage disease and home parenteral nutrition (HPN)-associated complications. However, long-term outcome including quality of life and risk of disease recurrence has yet to be fully defined. METHODS: Fifty-five patients with CIPO, 23 (42%) children and 32 (58%) adults, underwent GT and were prospectively studied...
June 26, 2019: Annals of Surgery
Mark Jayanathan, Ryan P Erwin, Nicholas Molacek, Marcus Fluck, Marie Hunsinger, Jeffrey Wild, Tania K Arora, Mohsen M Shabahang, Jan Franko, Joseph A Blansfield
BACKGROUND: Multimodal therapy is beneficial in gastric cancer, however this practice is not universal. This study examines trends, identifies associative factors, and examines overall survival (OS) benefit from multimodal therapy in gastric cancer. METHODS: Gastric cancer patients staged IB-III from 2005 to 2014, identified using the National Cancer Database, were categorized by treatment: surgery alone, perioperative chemotherapy, and adjuvant chemoradiation. Groups were analyzed to identify associative factors of perioperative therapy...
June 12, 2019: American Journal of Surgery
A Sokal, A Sauvanet, B Fantin, V de Lastours
Acute cholangitis is an infection of the bile and biliary tract which in most cases is the consequence of biliary tract obstruction. The two main causes are choledocholithiasis and neoplasia. Clinical diagnosis relies on Charcot's triad (pain, fever, jaundice) but the insufficient sensitivity of the latter led to the introduction in 2007 of a new score validated by the Tokyo Guidelines, which includes biological and radiological data. In case of clinical suspicion, abdominal ultrasound quickly explores the biliary tract, but its diagnostic capacities are poor, especially in case of non-gallstone obstruction, as opposed to magnetic resonance cholangiopancreatography and endoscopic ultrasound, of which the diagnostic capacities are excellent...
June 24, 2019: Journal of Visceral Surgery
Colin R Lindsay, Fiona H Blackhall
Despite its status as the most commonly mutated oncogene in cancer, Ras has long been considered 'undruggable'. In 2019, we will see the first clinical trial results for direct mutant Ras inhibitors, a result of persistent cross-disciplinary research that has been informed by a number of previous clinical and biological failures.
June 26, 2019: British Journal of Cancer
Francis Hall, Victor Villalobos, Breelyn Wilky
Sarcoma is a broad term for mesenchymal malignancies that arise from soft tissue or bone. Despite classification by histologic subtype, clinical behavior and response to therapy have great variability. Modern genetic sequencing techniques have been able to identify additional genetic variability and subsequently new targeted therapies. In this review, we discuss the current state of STS diagnostics and treatment and explore some of the more promising areas in which progress is being made. We discuss therapies targeting PDGFRα/KIT, β-Catenin/APC/NOTCH, IDH-1/2 mutations, MDM2 amplifications, EZH2/INI1 expression loss, ALK fusion, and ASPSCR1-TFE3 fusion...
June 19, 2019: Current Problems in Cancer
Alok A Khorana, Shannon E McKernin, Jordan Berlin, Theodore S Hong, Anirban Maitra, Cassadie Moravek, Matthew Mumber, Richard Schulick, Herbert J Zeh, Matthew H G Katz
PURPOSE: The purpose of this guideline update is to incorporate recently reported practice-changing evidence into ASCO's recommendations on potentially curable pancreatic adenocarcinoma. METHODS: ASCO convened an Expert Panel to evaluate data from PRODIGE 24/CCTG PA.6, a phase III, multicenter, randomized clinical trial of postoperative leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX) versus gemcitabine alone, presented at the 2018 ASCO Annual Meeting...
June 10, 2019: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Alexander S Chiu, Raymond A Jean, Benjamin Resio, Kevin Y Pei
BACKGROUND: Surgical futility is poorly defined. However, there are patients with extremely high preoperative risk who still undergo surgery and ultimately die, suggesting futile care. To further explore surgical futility, we examined the incidence and factors associated with extreme-risk patients undergoing major emergency general surgery with early death. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all adults undergoing colectomy, small bowel resection, control of bleeding ulcer, lysis of adhesion, and exploratory laparotomy between 2007 and 2015...
June 14, 2019: Surgery
Douglas E Wright, Steven J Knuesel, Amulya Nagarur, Lisa L Philpotts, Jeffrey L Greenwald
OBJECTIVE: To conduct a systematic review of published cardiac risk indices relevant to patients undergoing noncardiac surgery and to provide clinically meaningful recommendations to physicians regarding the use of these indices. METHODS: A literature search of articles published from January 1, 1999, through December 28, 2018, was conducted in Ovid (MEDLINE), PubMed, Embase, CINAHL, and Web of Science. Publications describing models predicting risk of cardiac complications after noncardiac surgery were included and citation chaining was used to identify additional studies for inclusion...
June 12, 2019: Mayo Clinic Proceedings
Tessa Mulder, Jan A J W Kluytmans
To reduce the of risk infection after colorectal surgery, oral antibiotic preparation (OAP) and mechanical bowel preparation (MBP) can be applied. Whether OAP can be used without MBP is unclear. A meta-analysis of observational studies demonstrated comparable effectiveness of OAP with and without MBP regarding SSI risk.
August 2019: Infection Control and Hospital Epidemiology
Erika Hutt Centeno, Michael Militello, Marcelo P Gomes
Although some suggest anti-Xa assays should be the preferred method for monitoring intravenous unfractionated heparin therapy, which method is best is unknown owing to the lack of large randomized controlled trials correlating different assays with clinical outcomes. This article provides an overview of heparin monitoring and the pros, cons, and clinical applications of anti-Xa assays.
June 2019: Cleveland Clinic Journal of Medicine
Laurent Papazian, Cécile Aubron, Laurent Brochard, Jean-Daniel Chiche, Alain Combes, Didier Dreyfuss, Jean-Marie Forel, Claude Guérin, Samir Jaber, Armand Mekontso-Dessap, Alain Mercat, Jean-Christophe Richard, Damien Roux, Antoine Vieillard-Baron, Henri Faure
Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. The Grade of Recommendation Assessment, Development and Evaluation (GRADE) methodology has been followed. Four recommendations (low tidal volume, plateau pressure limitation, no oscillatory ventilation, and prone position) had a high level of proof (GRADE 1 + or 1 -); four (high positive end-expiratory pressure [PEEP] in moderate and severe ARDS, muscle relaxants, recruitment maneuvers, and venovenous extracorporeal membrane oxygenation [ECMO]) a low level of proof (GRADE 2 + or 2 -); seven (surveillance, tidal volume for non ARDS mechanically ventilated patients, tidal volume limitation in the presence of low plateau pressure, PEEP > 5 cmH2O, high PEEP in the absence of deleterious effect, pressure mode allowing spontaneous ventilation after the acute phase, and nitric oxide) corresponded to a level of proof that did not allow use of the GRADE classification and were expert opinions...
June 13, 2019: Annals of Intensive Care
Andrew D Newton, Jarrod D Predina, Michael H Shin, Lydia G Frenzel-Sulyok, Charles M Vollmer, Jeffrey A Drebin, Sunil Singhal, Major K Lee
OBJECTIVE: To determine if intraoperative near-infrared (NIR) imaging carries benefit in resection of pancreatic neoplasms. BACKGROUND: Resection of pancreatic malignancies is hindered by high rates of local and distant recurrence from positive margins and unrecognized metastases. Improved tumor visualization could improve outcomes. We hypothesized that intraoperative NIR imaging with a clinically approved optical contrast agent could serve as a useful adjunct in assessing margins and extent of disease during pancreatic resections...
July 2019: Annals of Surgery
N Jewel Samadder, Noemi Baffy, Karthik V Giridhar, Fergus J Couch, Douglas Riegert-Johnson
Hereditary causes due to mutations and defects in certain genes account for roughly 5% to 10% of all colorectal cancers. These inherited syndromes have been associated with a 60% to 100% lifetime risk for development of colorectal cancer, depending on the genetic syndrome, and many also carry an increased risk for multiple extracolonic malignancies. In this second part of a review series on hereditary cancer syndromes, the focus will be to provide guidance on the features and management of the most commonly encountered hereditary colorectal cancers and polyposis conditions including Lynch syndrome, familial adenomatous polyposis, MUTYH-associated polyposis, and hamartomatous polyposis...
June 2019: Mayo Clinic Proceedings
Alfonso J Cruz-Jentoft, Avan A Sayer
Sarcopenia is a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality. It occurs commonly as an age-related process in older people, influenced not only by contemporaneous risk factors, but also by genetic and lifestyle factors operating across the life course. It can also occur in mid-life in association with a range of conditions. Sarcopenia has become the focus of intense research aiming to translate current knowledge about its pathophysiology into improved diagnosis and treatment, with particular interest in the development of biomarkers, nutritional interventions, and drugs to augment the beneficial effects of resistance exercise...
June 3, 2019: Lancet
Anne Loes van den Boom, Elisabeth M L de Wijkerslooth, Bas P L Wijnhoven
Postoperative antibiotics are recommended after appendectomy for complex appendicitis to reduce infectious complications. The duration of this treatment varies considerably between and even within institutions. The aim of this review was to critically appraise studies on duration of antibiotic treatment following appendectomy for complex appendicitis. A systematic literature search according to the PRISMA guidelines was performed. Comparative studies evaluating different durations of postoperative antibiotic therapy...
June 4, 2019: Digestive Surgery
2019-06-10 18:34:55
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