Latest Updates

Evaluation and Treatment of Monogenic Forms of Inflammatory Bowel Diseases 

    • Advanced genetic platforms have identified more than 50 different monogenic disorders causing inflammatory bowel disease.
    • A monogenic cause of inflammatory bowel disease should be suspected in patients with atypical or severe IBD phenotypes.
    • The diagnosis of monogenic defects is made through a combination of functional immunologic studies and DNA sequencing (whole exome sequencing).
    • Monogenic IBDs usually present in the first years of life, but several diseases manifest adolescence or adulthood.
    • Identifying a monogenic form of inflammatory bowel disease can lead to tailored specific therapy (eg, stem cell transplantation) and have major impact on patient’s care.

Airway Procedures

    • The anesthesiologist is challenged to keep pace with the evolving field of interventional bronchoscopy with its expanding applications. Bronchial thermoplasty and placement of endobronchial valves or coils are some of the newer therapeutic procedures.
    • Drugs like propofol, dexmedetomidine, remifentanil, and sugammadex have changed the practice of sedation and total intravenous anesthesia for these procedures. Phase III trials of remimazolam for bronchoscopy have been completed.
    • Familiarity with newer airway and ventilation devices including high-frequency jet ventilator, jet ventilation catheters, and endobronchial tubes are essential for managing obstructed airways.

Systemic Lupus Erythematosus

    • A 2018 Rheumatology guideline for the management of adult systemic lupus erythematosus
    • A 2015 Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care and Research

Systemic Lupus Erythematosus

    • A 2018 Rheumatology guideline for the management of adult systemic lupus erythematosus
    • A 2015 Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care and Research

Hemorrhoids

    • Rubber band ligation remains the most effective nonexcisional technique available.
    • Advanced energy devices such as the LigaSure technique and Harmonic scalpel have demonstrated a modest decrease in immediate postoperative pain with equal efficacy when compared to the traditional excisional hemorrhoidectomy, however at a greater cost.
    • At this time, stapled hemorrhoidopexy and Doppler-guided hemorrhoidal dearterialization have not been shown to have a clear advantage over the traditional excisional hemorrhoidectomy.

Pathophysiology and Treatment of Cystinuria

    • Identifying cystinuria as an associated risk factor for chronic kidney disease
    • Demonstration of cystine obstruction in the nephron initiating a renal inflammatory process
    • Identification of new potential therapeutic agents including a-lipoic acid, L-cystine dimethyl ester, 1-cystine bismorpholide, and 1-cystine bis (N-methylpiperazide)

Parotidectomy

    • Although facial nerve injury is the most feared complication of parotidectomy, consent should include reference to the common sequelae of cosmetic deformity, earlobe numbness, salivary fistula, and gustatory sweating.
    • The facial nerve dissection may be performed in antegrade fashion from the main trunk of the facial nerve distally or, if the main trunk cannot be exposed, from a peripheral branch proximally.
    • Complete superficial parotidectomy with exposure of all branches of the facial nerve is seldom necessary, although it may be mandated by tumor size.
    • Nerve branches sacrificed due to tumor involvement or inadvertently injured should be repaired primarily or with a cable graft at the time of injury rather than in a staged procedure.

Biomaterials

    • The paradigm of biocompatibility
    • How biomaterials integrate into tissues
    • Main biomaterials used in plastic surgery
    • Current limitations of clinically used biomaterials
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