Latest Updates

Thoracic Injuries and Management Options

Michal Radomski, MD, Babak Sarani, MD, FACS, FCCM
    • Treatment of rib fractures is centered on pain control. Multimodality treatment utilizing non-narcotic medications is optimal.
    • Operative fixation of flail chest is associated with decreased respiratory failure, pneumonia, pain.
    • Patients with type III or IV blunt aortic injury require repair, preferably using an endovascular approach.
    • Most esophageal injuries require open repair. Time to repair is directly associated with mortality. Stenting has little role in repair.

Neurobiology of Mood Disorders

Eric Hollander, MD, Vera Nezgovorova, MD, Danya Schlussel, MS, Genoveva Uzunova, MD, PhD
    • Clinical characteristics determine differences in the neuroanatomy and neurobiology of mood disorders.
    • Mood disorders have neurobiological circuitry in the prefrontal cortical, limbic, and brain reward systems.  
    • Synaptic plasticity changes are important in the neurobiology of mood disorders.
    • Neurochemical substrates of mood disorders are glutamate, GABA, dopamine, serotonin, endocannabinoids, cortisol, and immune system molecules.
    • Mood disorders have a significant genetic basis, which is more pronounced for bipolar disorder.
    • Transcranial magnetic stimulation represents a paradigm shift in the understanding and treatment of mood disorders.

Neurobiology of Mood Disorders

Eric Hollander, MD, Vera Nezgovorova, MD, Danya Schlussel, MS, Genoveva Uzunova, MD, PhD
    • Clinical characteristics determine differences in the neuroanatomy and neurobiology of mood disorders.
    • Mood disorders have neurobiological circuitry in the prefrontal cortical, limbic, and brain reward systems.  
    • Synaptic plasticity changes are important in the neurobiology of mood disorders.
    • Neurochemical substrates of mood disorders are glutamate, GABA, dopamine, serotonin, endocannabinoids, cortisol, and immune system molecules.
    • Mood disorders have a significant genetic basis, which is more pronounced for bipolar disorder.
    • Transcranial magnetic stimulation represents a paradigm shift in the understanding and treatment of mood disorders.

Imaging Of Lung Disease, Part II: ­Cavities, Cysts, Nodules, And Masses

Eugene A Berkowitz, MD, PhD, Adam Bernheim, MD, Gerald W. Staton Jr, MD, FACP
    • Granulomatosis with polyangiitis, formerly called Wegener’s granulomatosis, is the most common pulmonary vasculitis and can present with (often cavitary) pulmonary nodules and/or consolidation
    • Tracheobronchial papillomatosis is now known to be caused by human papillomavirus (HPV) and has an association with squamous cell carcinoma
    • Algorithms for management of incidental solid and sub-solid pulmonary nodules are available to provide recommendations for optimal follow-up decisions
    • Data from the National Lung Screening Trial (NLST) demonstrated a 20% reduction in mortality with lung cancer screening CT and forms the rationale for lung cancer screening in high-risk patients
    • Lung cancer screening should utilize the American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS)

Imaging of Lung Disease, Part i: Focal and Diffuse Parenchymal Lung Diseases

Eugene A Berkowitz, MD, PhD, Adam Bernheim, MD, Gerald W. Staton Jr, MD, FACP
    • Lung adenocarcinoma, now the most common primary lung cancer, has recently been reclassified pathologically (as in situ, minimally invasive, and invasive)
    • Rates of pulmonary tuberculosis are increasing in some locations and may present on chest imaging with (often cavitary) opacities with an upper lung predilection
    • While decreasing in incidence due to improving treatment for patients with human immunodeficiency virus (HIV) infection, Kaposi sarcoma remains an important acquired immunodeficiency syndrome (AIDS) defining neoplastic lesion that presents with bronchocentric opacities
    • A patient’s medication profile should always be considered because drug reactions are not uncommon, and utilization of some new medications does have an association with some drug reactions that must be recognized promptly
    • Rates of some pneumoconioses are decreasing in some locations due to increasing awareness and safety precautions, but silicosis, coal worker’s pneumoconiosis, asbestosis, and berylliosis still occur and often present with characteristic imaging patterns

Fluid and Electrolyte Considerations for the Pediatric Surgical Patient

Denise B Klinkner, MD, MEd, TK Pandian, MD, Stephanie Polites, MD
    • Hyponatremia should be avoided by using isotonic fluids Glucose infusion rates apply to pediatric and adult patients.
    • Recognition and early management of sodium and electrolyte losses are critical to normal development.

Wrist Fractures and Dislocations

Jerry I Huang, MD, Rahul K Kasukurthi, MD, Angelo B Lipira, MD
    • Treatment of scapholunate and lunotriquetral injuries
    • Treatment of scaphoid fractures
    • Patient-tailored decision making for distal radius fractures
    • Volar- and fragment-specific fixation of distal radius fractures
    • Dorsal spanning plates for distal radius fractures

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

Isabelle E. Bauer, PhD, Marsal Sanches, MD, PhD, Jair C. Soares, MD, Antonio L Teixeira, MD, PhD
    • The DSM-5 includes new specifiers, such as mixed features, anxious distress, and peripartum onset. This addition will be helpful in making treatment-planning decisions related to suicide risk and treatment.
    • Neuroimaging findings showed that individuals with depressive disorders display alterations in the activity and connectivity of brain regions underlying reward and memory. This could explain symptoms such as reduced happiness, pleasure, and negative memories.
    • Neuroimaging techniques are gaining in importance in predicting treatment response and risk of relapse. For instance, patients with higher amygdalar activity are more likely to respond to psychotherapy.
    • There is no “one” way of treating depression, and treatment should be personalized. There are a number of effective treatments, including pharmacotherapy and psychotherapy (separately or combined) and neurostimulation. It is important that health professionals help patients find the right treatment for their needs.
    • Neuromodulation techniques such as vagal nerve stimulation and transcranial magnetic stimulation have been shown to have beneficial therapeutic effects. They are, however, long-term therapies, and medications are needed to manage some residual symptoms. 
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