What's New

Medical Management of Premature Ejaculation

    • The International Society for Sexual Medicine agreed on a definition of premature ejaculation in 2014.
    • Premature ejaculation (PE) classification has been expanded to include natural variable (variable PE) and premature-like ejaculatory dysfunction (subjective PE).
    • There is now well-established pharmacotherapy mainly with SSRIs with differing levels of efficacy as well as potential adjunctive therapy with topical or local anesthetics.

Intrahepatic Cholangiocarcinoma

    • The majority of patients with iCCA present with locally advanced or metastatic disease.
    • Surgery for patients iCCA involves margin-negative resection with porta hepatis lymphadenectomy including at least six lymph nodes.
    • Formal volumetry should be considered for patients requiring extended hepatectomy to ensure adequatefuture liver remnant size
    • Adjuvant chemotherapy should be considered after resection, particularly for high-risk features such as lymph node involvement or positive margins.

Intrahepatic Cholangiocarcinoma

    • The majority of patients with iCCA present with locally advanced or metastatic disease.
    • Surgery for patients iCCA involves margin-negative resection with porta hepatis lymphadenectomy including at least six lymph nodes.
    • Formal volumetry should be considered for patients requiring extended hepatectomy to ensure adequatefuture liver remnant size
    • Adjuvant chemotherapy should be considered after resection, particularly for high-risk features such as lymph node involvement or positive margins.

Opioids for Anesthesia and Postoperative Pain Control

    • Clinical gestalt can also accurately assess the pretest probability of PE.
    • For patients with a low pretest probability of PE, the Pulmonary Embolism Rule-out Criteria can be used to rule out PE without further testing including no need to order a D-dimer.
    • The YEARS protocol may be used to exclude a subset of patients from having a workup to rule out PE when their D-dimer is less than 1000 as opposed to 500.
    • Intravenous alteplase, catheter-directed thrombolysis, surgical embolectomy, and catheter-directed embolectomy are treatment modalities for patients with PE who are hemodynamically unstable.
    • For patients in imminent or actual PE-related cardiac arrest, current guidelines recommend a bolus regimen consisting of 50 mg IV t-PA given over two minutes and repeated after 15 minutes in the absence of return of spontaneous circulation.
    • A subset of patients with PE can be treated as outpatients if their Simplified Pulmonary Severity Index is 0.

Late Stage Prostate Cancer

    • Emphasis on landmark clinical trials in metastatic prostate cancer (especially since 2010)
    • Critical analysis and summary of PSA-based prostate cancer screening
    • Advances and integration of genomic sciences in early and advanced stages of prostate cancer

Late Stage Prostate Cancer

    • Emphasis on landmark clinical trials in metastatic prostate cancer (especially since 2010)
    • Critical analysis and summary of PSA-based prostate cancer screening
    • Advances and integration of genomic sciences in early and advanced stages of prostate cancer

Introduction to the Patient with Rheumatic Disease

    • ACR/SAA/SRTN 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.
    • American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee

Introduction to the Patient with Rheumatic Disease

    • ACR/SAA/SRTN 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.
    • American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee
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