Latest Updates

Management of Small Renal Masses

Antonio Finelli , MD, MSc, FRCSC, Keith A Lawson , MD, MSc
    • An improved understanding of the natural history of SRMs underscores their overall slow growth rate and low propensity to metastasize.
    • Up to 30% of SRMs are benign, highlighting a role for upfront renal tumor biopsy to stratify those patients requiring therapy. Contemporary experience has demonstrated the safety in performing renal tumor biopsy and the excellent diagnostic rates (> 90%) that can be achieved at centers of excellence. 
    • There is an increasing role for active surveillance for SRMs, with appropriately selected patients achieving excellent clinical outcomes.
    • Partial nephrectomy remains the gold standard treatment for SRMs requiring intervention when technically feasible.
    • The management of SRMs is evolving towards a personalized medicine approach with integration of clinical nomograms and genomics to better predict which patients require treatment and when.

Diagnostic and Therapeutic Principles In Allergy

Mitchell H. Grayson, MD, Peter Mustillo, MD
    • Development of biologic therapies (primarily anti-cytokine) for the treatment of allergic diseases including asthma.
    • Use of sIgE component testing for diagnosis and treatment of food allergy
    • Early peanut introduction to prevent peanut allergy
    • Novel treatment options for food allergy

Dermatologic Wounds

Luis J Borda, MD, Jose A Jaller, MD, Penelope J Kallis, BS, Robert S Kirsner, MD, PhD
    • Compression should be considered in patients with leg ulcers and  ankle brachial index greater  than 0.8.
    • Pyoderma gangrenosum lesions ≤2 cm2 may benefit from topical/intralesional corticosteroids
    • Chronic hydroxyurea therapy may lead to leg ulcers. Lesions typically occur near the malleolar area.
    • Proper diagnosis/therapy of the underlying condition are key when clinicians are face atypical wounds.  

Medical Management of Transplant Patients

Nelson B Goes, MD, Nidyanandh Vadivel, MB, BCh
    • Alternatives therapies calcineurin inhibitors to prevent kidney allograft fibrosis.
    • Maintenance immunosuppression with belatacept preserves glomerular filtration and increases kidney allograft survival.
    • Better understanding and management of post transplant diabetes mellitus.

Upper Blepharoplasty

Tiffany N Ballard, MD, Robert H Gilman, MD, DMD
    • The crush and snip technique is a quick and relatively bloodless method for skin removal in blepharoplasty.
    • Care should be taken not to overresect fat and leave a sunken appearance to the upper eyelid.
    • A simple Q-stick swab is one of the most useful instruments for the procedure of blepharoplasty.

Postresuscitation Management And Outcomes

Shamai A. Grossman, MD, MS, Patrick Hughes, MD, Oren Mechanic, MD, MPH
    • Therapeutic hypothermia is recommended for comatose survivors of cardiac arrest. The most recent evidence suggests that avoiding pyrexia may be the most important factor.
    • The AHA recommends against prehospital cooling with cold intravenous fluid.
    • Percutaneous coronary intervention is an independent predictor of survival.
    • Prognostication is not recommended until 72 hours after return to normothermia in patients undergoing therapeutic hypothermia.
    • Debriefing has been shown to improve several metrics of subsequent resuscitations.

Viral Hepatitis C: Treatment

Raymond T. Chung, MD, Jacinta A Holmes, MBBS, PhD, Anna Lidofsky, BS, Jay Luther, MD, Stephanie M Rutledge, MBBCh BAO MRCPI
    • Recent advances in treatment of chronic HCV to include interferon-free direct-acting antiviral agent regimens
    • Latest treatment recommendations, including special populations
    • Issues surrounding treatment-emergent resistance-associated variants 

Evaluation Of Elevated Transaminases In Children

Udeme D Ekong, MD, MPH, Pamela L Valentino, MD, MSc, FRCPC
    • The threshold for the upper limit of normal for ALT is lower in children than previously reported based on studies of healthy, nonobese children.
    • NAFLD needs to be identified and addressed in childhood as obese adolescents have a higher rate of complications in adulthood.
    • NAFLD is a common indication for liver transplantation in adults.
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