Latest Updates

Nondiabetic Endocrine Emergencies 1: Adrenal Crisis, Pheochromocytoma, And Hypopituitarism

Jason J Lewis, MD, Richard E Wolfe, MD
    • The hydrocortisone emergency injection kit can be used by patients with adrenal insufficiency in acute illness to help prevent acute adrenal crises.
    • Stabilization with alpha-adrenergic blockade first followed by beta-adrenergic blockade in catecholamine surge is essential.
    • Hypopituitarism can present with one or more hormonal deficiencies, and one should preemptively treat for adrenal crises with steroids prior to treatment of hypothyroidism as levothyroxine administration can precipitate adrenal crisis by increasing the metabolism of cortisol.

Hypopharyngeal, Esophageal, and Neck Reconstruction

Steven B Chinn, MD MPH, Peirong Yu, MD
    • The anterolateral thigh flap is the optimal flap for pharyngoesophageal reconstruction.
    • Salvage pharyngolaryngectomy reconstruction requires attention to detail to avoid catastrophic complications.
    • Transverse cervical vessels are the optimal recipients in a salvage, vessel-poor neck. 

Flexor Tendon Injuries

James Chang, MD, Paige M Fox, MD, PhD, Chao Long, AB, Lisa C Moody, MD
    • Tissue engineering of tendons, although not yet applied clinically, has the potential to address many of the challenges posed by flexor tendon injuries by developing off-the-shelf, ready-to-use tendon constructs available for tendon reconstruction.
    • Research on tissue engineering tendon-bone interface (TBI) constructs is also under way as a way to improve the inadequate healing between this interface when tendon is directly secured to bone.
    • Advances in recent years that manipulate mechanical and biologic factors involved in adhesion formation show potential as preventive strategies.

Fenestrated and Branched Endografts

Mirza Shadman Baig, MD, Carlos H. Timaran, MD
    • Fenestrated and branched endografts versus standard EVAR
    • “Off-the-shelf” versus custom-made endografts for paravisceral aneurysms
    • Evidence indicates that the Z-FEN graft may be used in patients with less than the recommended infrarenal neck length of 4 mm

Epigenetics In Autoimmune Disease

Matlock A Jeffries, MD
    • Epigenetics is strongly linked with multiple autoimmune diseases.
    • Epigenetic modifications include DNA methylation, histone side-chain modifications, and noncoding RNA.
    • Epigenetic changes occur early in autoimmune disease; for example, in systemic lupus erythematosus, DNA methylation changes are present in naive T cells even before activation.
    • Technological advances have led to our ability to simultaneously map the epigenome of multiple tissue types across multiple autoimmune diseases, shedding light on common shared pathways.

Reconstructive Approaches to Nasal Defects

Michael L. Bentz, MD, FAAP, FACS, Ravi K Garg, MD

    • Non-melanoma skin cancers are the most common cause of nasal defects necessitating reconstruction.

    • Nasal reconstructive strategies should ensure that there is adequate structural support of the nasal airway while also optimizing aesthetic outcomes.

    • While reconstruction of nasal aesthetic subunits may be a guiding principle for some patients, consideration of nasal texture, color, and contour may be more important for deciding which parts of the nose to resurface in other patients.
    • A comprehensive operative plan addresses restoration of nasal lining, support, and cover, based on the extent of the nasal defect.
    • Reconstruction of nasal cover may be as simple as allowing a small defect to heal by secondary intent or as complicated as a two or three stage forehead flap procedure. Prosthetic reconstruction may be a better option for patients who have failed previous autologous reconstruction or patients who are poor surgical candidates.

Tenosynovitis Disorders of the Hand and Wrist

Michael Aversano, MD, Nader Paksima, DO, MPH
    • The introduction of office-based, ultrasonography-guided injections has become an important part of the treatment algorithm for tenosynovitis disorders.

    • Surgical techniques using wide-awake local anesthesia and no tourniquet are becoming increasingly popular.

    • Use of corticosteroid injections in treatment has been shown to have higher rates of symptom-free resolution, decreased pain, and improved function.

Pediatric Minimally Invasive Pyeloplasty

Pasquale Casale, MD, Julia Beth Finkelstein, MD
    • Pediatric robotic pyeloplasty is safe and effective, with comparative studies showing similar success and complication rates between minimally invasive and open pyeloplasty.
    • Anderson-Hynes dismembered pyeloplasty is the standard approach for repair, but robotic approaches can be tailored to the specific case when complex patient anatomy is encountered.
    • Several benefits of robotic pyeloplasty are intimated; previously unrecognized advantages include human capital gain, indirect benefits from shortened hospitalizations, and parental satisfaction. 
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