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Dissociative Disorders and Their Clinical Management Part One: Dissociative Amnesia (Including Its Variant Dissociative Fugue)

    • Antecedents of dissociative amnesia range from massive psychological trauma to seemingly minor stressful life events.
    • The memory impairment in dissociative amnesia is most frequently of a retrograde type and preponderantly circumscribed to the episodic-autobiographical memory domain.
    • An abrupt loss of both memory for past experiences and personal identity is highly suggestive of the diagnosis of dissociative amnesia.
    • Functional neuroimaging in dissociative amnesia often shows changes in brain areas involved in memory processing.
    • Neuropsychological testing plays a key role in distinguishing between true and feigned amnesia.

Nerve Sheath Tumors: Malignant peripheral nerve sheath tumors, Schwannomas, and Neurofibromas

    • Oncogenic signatures responsible for the transformation MPNST include activation of the STAT3/HIF, catenin/Wnt and RHO/ROCK pathways.
    • MPNSTs often harbor recurrent inactivation of polycomb repressive complex 2 from somatic mutation of EED and/or SUZ12.
    • Genetic analysis revealed germline mutations in SMARCB1 in approximately 50% of individuals affected by familial schwannomatosis.
    • Germline mutations in LZTR1 were identified in about 80% of schwannomatosis cases lacking mutations in SMARCB1.

Pulmonary Diseases: Preoperative Assessment

    • After emergence from general anesthesia, vital capacity may remain decreased from baseline in 50% of healthy patients for up to 1 week postoperatively.
    • A change from the upright to supine position alone reduces FRC by approximately 0.8 to 1.0 L. This underscores the importance of perioperative optimization to prevent postoperative atelectasis.
    • There is no prohibitive level of obstruction on spirometry that precludes surgery. Routine perioperative spirometry testing has not been associated with decreased rates of PPCs or mortality, and PFTs should not be the primary or sole determinant for denying surgery.
    • Patients with well-controlled asthma that require general anesthesia with endotracheal intubation are not considered at higher risk for PPCs than the general surgical population.
    • Obesity by itself has not been consistently demonstrated to be an independent risk factor for PPCs across several meta-analyses. Conversely, underweight patients were found to have a fivefold increased risk of 30-day mortality, underscoring the importance of optimizing nutrition status.

Trauma to the Thoracic Aorta

    • BTAI is now the gold standard n treating patients with these problems
    • The grade of injury with these lesions has been defined and there is controversy on which lesion should be treated and how emergently
    • Recently in the US a device changed its IFU because of complications after TEVAR for BTAI. It was being used outside its IFU.
    • Recent advancement on sizing and device differences between BTAI and other pathologies treated with TEVAR

Biliary Tumors

    Trauma to the Thoracic Aorta

      • BTAI is now the gold standard n treating patients with these problems
      • The grade of injury with these lesions has been defined and there is controversy on which lesion should be treated and how emergently
      • Recently in the US a device changed its IFU because of complications after TEVAR for BTAI. It was being used outside its IFU.
      • Recent advancement on sizing and device differences between BTAI and other pathologies treated with TEVAR

    Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

      • We provide a review of the physiologic changes during pregnancy and how they might affect non-obstetric surgery in parturients.
      • We discuss pharmacology as is pertinent in parturients undergoing non-obstetric surgery.
      • Specific considerations for parturients undergoing laparoscopy, trauma or non-obstetric gynecologic surgery are made. 

    Non-melanoma Skin

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