Latest Updates

Psychopharmacology for Eating Disorder

    • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are recommended as initial pharmacotherapy by most guidelines for the treatment of Bulimia Nervosa (BN) and Binge Eating Disorder (BED)
    • Topiramate has positive outcome and efficacy data in the treatment of BN and BED, and lisdexamfetamine is FDA approved in the treatment of BED
    • Olanzapine is recommended as adjunctive treatment for patients with anorexia nervosa (AN) who do not restore healthy body weight with nutritional rehabilitation plus psychotherapy.
    • SSRIs may be used to treat co-morbid depression and anxiety in patients with AN once a healthy body weight is restored.

Craniosynostosis Part I: Pathophysiology and Patient Evaluation

    • Although craniosynostosis pathophysiology has controversy, the primary suture fusion model best accounts for the cranial variables (calvarial thickness at the affected suture, cranial base length, brain volume, CSF volume, ICP) observed in early and late craniosynostosis.
    • Muenke syndrome was described in the late 1990’s as another FGFR3 syndromic craniosynostosis with sexual dimorphism and variable expression.
    • In addition to fundoscopic exam, non-invasive assessment of intracranial pressure can be performed with visual evoked potentials or transcranial ultrasound.  CT and MRI can also be used for further assessment but are at higher costs and often require sedation.

Locally Advanced Rectal Cancer

    • Total neoadjuvant therapy (neoadjuvant chemotherapy and chemoradiation prior to total mesorectal excision)
    • Minimally invasive techniques for surgery of rectal cancer (laparoscopy, robotic surgery, and transanal total mesorectal excision)
    • Nonoperative management of rectal cancer (watch and wait)

     

Surgical Treatment of Stage I Rectal Cancer

    • Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques.
    • The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors.
    • Outcomes for immediate salvage surgery are generally better than for delayed salvage surgery.

Wounds in Patients with Cancer

    • Chemotherapy is traditionally regarded as negatively impacting wound healing; however, recent data has not supported that credo
    • Radiation therapy is deleterious to wound healing; brachytherapy minimizes the typical adverse effects of radiation on surrounding tissues
    • New evidence supports limb salvage surgery as the treatment of choice for most patients with soft tissue sarcoma

Polyposis Syndromes

    • Classic familial adenomatous polyposis (FAP) syndromes have been expanded to include attenuated FAP (aFAP) and new syndromes, such as MUTYH-associated polyposis (MAP).
    • Additional studies support chemoprevention of extracolonic manifestations of FAP, including sulindac with high-dose selective estrogen receptor modulators for FAP-associated desmoid tumors and sulindac with erlotinib for suppression of duodenal polyps.
    • The diagnostic criteria for attenuated polyposis syndromes including aFAP and MAP are a cumulative 10 to 100 lifetime polyps, with an APC gene mutation or biallelic MUTYH mutations.

Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19

    • Specific features on high resolution imaging (CT) for the more severe coronavirus syndromes are now accepted for clinical diagnosis in the appropriate context, followed by RT-PCR confirmation. This includes ground-glass opacity, with lower-lobe and bilateral involvement, and septal thickening. Other characteristics either make diagnosis more or less likely.
    • Molecular studies of the evolution of the S protein affinity COVID-19 for has allowed more complete understanding the mechanism of transmission and predisposing factors. These attachment proteins have highest affinity for ACE2 receptors on type II pneumocytes. What remains to be explained is the present of virus in saliva, blood, urine and gastrointestinal tract; are these potential modes of transmission?
    • Investigation of specific antiviral agents (e.g., JAK inhibitors) to control the consequences of elevated cytokines during SARS-CoV, MERS-CoV, and COVID-19 infection.

Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19

    • Specific features on high resolution imaging (CT) for the more severe coronavirus syndromes are now accepted for clinical diagnosis in the appropriate context, followed by RT-PCR confirmation. This includes ground-glass opacity, with lower-lobe and bilateral involvement, and septal thickening. Other characteristics either make diagnosis more or less likely.
    • Molecular studies of the evolution of the S protein affinity COVID-19 for has allowed more complete understanding the mechanism of transmission and predisposing factors. These attachment proteins have highest affinity for ACE2 receptors on type II pneumocytes. What remains to be explained is the present of virus in saliva, blood, urine and gastrointestinal tract; are these potential modes of transmission?
    • Investigation of specific antiviral agents (e.g., JAK inhibitors) to control the consequences of elevated cytokines during SARS-CoV, MERS-CoV, and COVID-19 infection.
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