- 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.
Latest Updates
- Emergence of virtual technologies in monitoring and scheduling weight loss management
- Updated with 2020 CMA Practice Guidelines
- In the United States, prevalence of overweight and obese adults has been increasing over the past several decades. Most recently published US data (2013-2014), the overall age-adjusted prevalence of obesity was 37.7%; among men, it was 35.0% and among women, it was 40.4%.
- Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity and for class 3 obesity (BMI>40) but not among men.
- Emergence of virtual technologies in monitoring and scheduling weight loss management
- Updated with 2020 CMA Practice Guidelines
- In the United States, prevalence of overweight and obese adults has been increasing over the past several decades. Most recently published US data (2013-2014), the overall age-adjusted prevalence of obesity was 37.7%; among men, it was 35.0% and among women, it was 40.4%.
- Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity and for class 3 obesity (BMI>40) but not among men.
Surgical Treatment of Obesity and the Metabolic Syndrome
- Emergence of virtual technologies in monitoring and scheduling weight loss management
- Updated with 2020 CMA Practice Guidelines
- Metabolic surgery
- Robotic surgery
- Endoscopic therapies
Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxisperiop
- 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.
Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis
- 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.
Injuries to the Spleen and Diaphragm
- Although controversial, multiple institutions have increasingly used angiography routinely in higher-grade spleen injuries undergoing nonoperative management (NOM).
- A meta-analysis published in 2011 and a subsequent prospective study in 2014 highlighted the higher splenic salvage rate during NOM when angioembolization is employed in all grade IV and V injuries. This is echoed in a Level 2 recommendation in the Eastern Association for the Surgery of Trauma practice management guidelines from 2016
- Subcapsular hematomas also may be at higher risk for delayed rupture, and special consideration should be given to patients with this injury pattern. Also currently controversial is the superiority of proximal embolization versus distal embolization.
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.
