Latest Updates

Overview of Enteral Nutrition 

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.

The Immunocompromised Surgical Patient and Opportunistic Infections

Kiran Gajurel, MD, Aruna K Subramanian, MD
    • Solid-organ transplant recipients may not present with classic signs and symptoms of infections due to their immunosuppressive state
    • Due to overlapping radiologic and clinical features of various opportunistic infections, a tissue biopsy should be obtained, if feasible, to establish diagnosis.
    • Mycobacterium chimaera,associated with heater cooler devices used during cardiac surgery, has recently emerged as an important pathogen in post cardiac surgery patients.
    • Rapamycins cause delayed wound healing and should be avoided in the immediate postoperative period.
    • Isavuconazole is  as efficacious as voriconazole in the treatment of invasive aspergillosis.

Management of Pancreatic Adenocarcinoma

David A Kooby, MD, FACS, Alexandra G Lopez-Aguiar, MD, Shishir K Maithel, MD, FACS
    • New AJCC staging model for pancreatic adenocarcinoma
    • Use of neoadjuvant FOLFIRINOX in resectable pancreatic cancer
    • Laparoscopic and robotic pancreaticoduodenectomy
    • Laparoscopic and robotic distal pancreatectomy

Chronic Allograft Dysfunction 

Lakshman Gunaratnam, MD, MSc, Juliya Hemmett, MD, FRCPC, Anthony M Jevnikar, MD, FRCPC, MSc
    • Redefining chronic allograft nephropathy, which is an overly broad and somewhat imprecise pathologic diagnosis, to chronic allograft dysfunction to describe a clinical diagnosis of late graft failure from various causes
    • Development of donor-specific antibodies and chronic antibody rejection emerging as the major pathophysiologic mechanisms responsible for this entity
    • Use of donor-specific antibody in the diagnosis and prognostication of chronic allograft dysfunction

Management of Pancreatic Adenocarcinoma

David A Kooby, MD, FACS, Alexandra G Lopez-Aguiar, MD, Shishir K Maithel, MD, FACS
    • New AJCC staging model for pancreatic adenocarcinoma
    • Use of neoadjuvant FOLFIRINOX in resectable pancreatic cancer
    • Laparoscopic and robotic pancreaticoduodenectomy
    • Laparoscopic and robotic distal pancreatectomy

Metabolic Alkalosis

Fouad T Chebib, MD
    • Metabolic alkalosis, one of the most common electrolytes disorders, is characterized by an increase in pH, a decrease in [H+], and an increase in [HCO3–].
    • The pathogenesis of metabolic alkalosis involves a generative and a maintenance phase. The generative phase involves either loss of acid, gain of bicarbonate, or cellular shift. The maintenance phase involves impairment of the renal handling of bicarbonate.
    • The etiologies of metabolic alkalosis can be divided into categories of chloride depletion, potassium depletion, and hypercalcemic states.
    • A diagnostic approach using volume status and urine chloride can be useful.
    • Management of metabolic alkalosis is best achieved by correcting the factor responsible for maintenance. Treatment options differ if the metabolic alkalosis was chloride responsive or chloride resistant. 

Dermatofibrosarcoma Protuberans

Benjamin Deschner, MD, Jeffrey Wayne, MD, FACS
    • Recognition of the characteristic tentaclelike projections resulting in an acentric growth pattern requiring horizontal sectioning with meticulous margin analysis
    • Appreciation of fibrosarcomatous change as a poor prognostic indicator carrying an increased risk of metastasis and death
    • Use of the targeted tyrosine kinase receptor inhibitor imatinib as an adjuvant treatment strategy

Dermatofibrosarcoma Protuberans

Benjamin Deschner, MD, Jeffrey Wayne, MD, FACS
    • Recognition of the characteristic tentaclelike projections resulting in an acentric growth pattern requiring horizontal sectioning with meticulous margin analysis
    • Appreciation of fibrosarcomatous change as a poor prognostic indicator carrying an increased risk of metastasis and death
    • Use of the targeted tyrosine kinase receptor inhibitor imatinib as an adjuvant treatment strategy
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