Latest Updates

The Morbidly Obese Surgical Patient

Gregory Grimberg, MD, Michael A. Schweitzer, M.D., FACS, FASMBS
    • Morbidly obese patients are at increased risk for venous thromboembolism (VTE) events following surgery, specifically deep vein thrombosis (DVT) and pulmonary embolism (PE); they maybe also be less likely to survive PE due to higher than average pulmonary artery pressures in patients with obesity hypoventilation syndrome. IVC filters are rarely needed for most operations on the morbidly obese population.
    • Research has consistently shown resolution of many obesity related co-morbidities that occur on a long-term basis after a patient undergoes bariatric surgery.
    • Multiple studies have shown that weight loss surgery leads to improved glycemic control with marked reduction in the use of daily insulin.

Genetics of Psychosis

Matcheri Keshavan, MD, William Stone, PhD, Ming Tsuang, MD, PhD, DSc
    • Schizophrenia is currently viewed as a disorder of disrupted connectivity across diverse neural circuitries, effecting cognition, affect, and behavior.
    • Several neurochemical mechanisms may underlie psychotic disorders (e.g. dopamine functions).
    • Excessive synaptic pruning has been implicated in the development of schizophrenia among some people who develop schizophrenia.
    • Multiple common genes with small effects and some rarer genes with larger effects have been identified in schizophrenia. 

The Morbidly Obese Surgical Patient

Gregory Grimberg, MD, Michael A. Schweitzer, M.D., FACS, FASMBS
    • Morbidly obese patients are at increased risk for venous thromboembolism (VTE) events following surgery, specifically deep vein thrombosis (DVT) and pulmonary embolism (PE); they maybe also be less likely to survive PE due to higher than average pulmonary artery pressures in patients with obesity hypoventilation syndrome. IVC filters are rarely needed for most operations on the morbidly obese population.
    • Research has consistently shown resolution of many obesity related co-morbidities that occur on a long-term basis after a patient undergoes bariatric surgery.
    • Multiple studies have shown that weight loss surgery leads to improved glycemic control with marked reduction in the use of daily insulin.

Cognitive-Behavioural Therapy

Hassan Majeed, MD, Charles Stanfa, MD , Donna Sudak, MD
    • There is an extensive evidence base supporting the use of cognitive-behavioral therapy (CBT) in a wide variety of psychiatric disorders.
    • CBT is characterized by an active and collaborative therapeutic relationship, and treatment is informed by individual case conceptualization.
    • Exposure, behavioral activation, and cognitive restructuring are key therapeutic interventions in CBT.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

Herbert Chen, MD, FACS, Irene Lou, MD
    • A recent meta-analysis comparing the safety and efficacy of new oral anticoagulants with those of warfarin revealed comparable safety with a reduction in stroke and systemic embolic events in patients on the new agents… The risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) complications in thyroidectomy and parathyroidectomy patients is very low at 0.16%, with a risk of bleeding requiring a return to the operating room that is 10-fold higher. Venous thromboembolism (VTE) prophylaxis should be reserved for only the highest risk patients undergoing these procedures
    • Recent results from the EINSTEIN-DVT and -PE studies that compared the efficacy and safety of single-drug oral rivaroxaban versus standard therapy of low-molecular-weight heparin and a vitamin K antagonist for the treatment of DVT/PE revealed similar efficacy of rivaroxaban with lower rates of major bleeding.

Repair of Femoral and Popliteal Artery Aneurysms

Patrick J. O'Hara, MD, FACS
    • Reported 5-year patency rate for saphenous vein and Dacron interposition grafts used for repair of isolated femoral artery aneurysms is 80 to 83%. Limitations on endovascular techniques are attributable to flexion and extension stresses at the femoral artery crossing the joint crease.
    • Popliteal artery aneurysm repair is often preferred with autogenous vein, but synthetic grafts may be required if autogenous vein is unavailable/inadequate. An innovative option is popliteal reconstruction using superficial femoral artery autograft and replacing superficial femoral artery segment with synthetic interposition when suitable autogenous vein is absent.
    • Intraoperative completion angiography is recommended to allow detection and correction of technical problems with reconstruction before closure in cases of popliteal artery aneurysm repair.

Repair of Femoral and Popliteal Artery Aneurysms

Patrick J. O'Hara, MD, FACS
    • Reported 5-year patency rate for saphenous vein and Dacron interposition grafts used for repair of isolated femoral artery aneurysms is 80 to 83%. Limitations on endovascular techniques are attributable to flexion and extension stresses at the femoral artery crossing the joint crease.
    • Popliteal artery aneurysm repair is often preferred with autogenous vein, but synthetic grafts may be required if autogenous vein is unavailable/inadequate. An innovative option is popliteal reconstruction using superficial femoral artery autograft and replacing superficial femoral artery segment with synthetic interposition when suitable autogenous vein is absent.
    • Intraoperative completion angiography is recommended to allow detection and correction of technical problems with reconstruction before closure in cases of popliteal artery aneurysm repair.

Trauma Imaging

Kathleen R. Fink, MD, Joel A. Gross, MD, Martin L. Gunn, MBChB, FRANZCR
    • Imaging studies have revolutionized the assessment of the trauma patient in the past three decades. Computed tomography (CT) provides excellent spatial and contrast resolution, especially when intravenous contrast is administered. Magnetic resonance imaging (MRI) provides soft tissue detail unavailable from other modalities.
    • An advantage of MRI over CT is its lack of ionizing radiation. However, MRI takes considerably longer to complete than CT imaging, the patient is immobilized in a confined space, and the tremendously strong magnetic field presents safety concerns. The use of ultrasonography for evaluation of trauma has been increasing.
    • A major role of ultrasonography in trauma evaluation is focused assessment with sonography for trauma (FAST), which is a noninvasive and repeatable test that takes less than 5 minutes to perform and can be done concurrently with trauma resuscitation. In recent years, the extended FAST examination has been introduced. This extended bedside ultrasound examination evaluates for pneumothorax and hemothorax.
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