What's New | Decker

Jennifer A Johnson, MD, Daniel R Kuritzkes, MD, FACP

Treatment as prevention reduces the risk of HIV transmission by at least 96%.
Preexposure prophylaxis, either as oral or injectable formulations , may reduce the risk of HIV acquisition by more than 90% when taken with good adherence.
Postexposure prophylaxis reduces the risk of HIV acquisition by at least 80%.
Combination antiretroviral therapy reduces the risk of mother-to-child transmission of HIV to less than 1%.
Risk reduction counseling and barrier protection remain important components of the HIV prevention toolkit.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

An interesting advance in the treatment of advanced basal cell carcinoma is the use of inhibitors of the sonic hedgehog pathway. The vast majority of basal cell carcinomas harbor genetic mutations in the hedgehog signaling pathway, which results in constitutive activation and basal cell proliferation.
SLNB is generally not recommended unless the lesion is between 0.75 and 1.0 mm, high risk based on histologic features (e.g., ulcerated or with > 1 mitoses/mm2), or inadequately staged (e.g., positive deep margin).
An important variable in the prognosis of melanoma is the thickness of the primary tumor as assessed using the Breslow system. Tumor thickness in the Breslow system is measured from the epidermal surface to the deepest point of the tumor with a calibrated ocular micrometer.

Molecular tests for gene point mutations, insertions, deletions, fusions and expression alterations are available that can be used to help risk stratify intermediate risk differentiated thyroid cancers into either surgical management or observation .
Stage IV anaplastic thyroid cancer requires aggressive approach for complete resection and prompt transition to adjuvant definitive-intention therapy to attain long-term survival.
Radiofrequency ablation (RFA) is being studied in clinical trials as alternative to high risk surgical patients and selected benign thyroid nodules.
To avoid neck scar, consider robotic thyroidectomy with approaches including trans axillary (most common), bilateral axilla-breast, retro auricular, and transoral (requires CO2 gas insufflation, not a “clean” procedure) approaches for patients with indeterminate, likely benign lesions if BMI <35.
Transoral endoscopic thyroidectomy can be considered for patients with a thyroid mass without evidence of lymph node metastases as retrospective review of 422 patients did not demonstrate significant difference in complications compared to open thyroidectomy group.

Updating consensus guideline recommendations up to January 2016
Adding a duplex scan image showing a deep vein thrombosis (DVT) in the diagnosis section
Adding a computed tomographic (CT) scan showing a pulmonary embolism (PE)
Showing the various types of approved inferior vena cava filters
Adding five separate flow-chart figures depicting a stepwise management algorithm for the evaluation and treatment of DVT and PE
Adding a section on catheter-associated upper extremity thrombosis
Adding a section on extended prophylaxis, the use of non–vitamin K antagonists, updates on stockings
Writing five new multiple-choice questions based on the review

Infectious Diseases