What's New | Decker

Identification of major anxiety disorders observed in adults according to the DSM-5
Description of physiologic, cognitive, and behavioral components of anxiety and their relevance to diagnosis and treatment
Review of cognitive-behavioral treatments and their efficacy for anxiety disorders in adults
Review of pharmacologic treatments and their efficacy for anxiety disorders in adults

Patients with borderline resectable pancreatic adenocarcinoma who are able to undergo successful resection may have survival comparable to patients with resectable disease.
For patients with locally advanced pancreatic adenocarcinoma, neoadjuvant FOLFIRINOX may allow up to 61% of patients to undergo successful resection.
For patients with resectable pancreatic adenocarcinoma and a positive intraoperative frozen section, additional resection to achieve a negative neck margin after a positive frozen section may not be associated with improved overall survival.

Identification of major anxiety disorders observed in adults according to the DSM-5
Description of physiologic, cognitive, and behavioral components of anxiety and their relevance to diagnosis and treatment
Review of cognitive-behavioral treatments and their efficacy for anxiety disorders in adults
Review of pharmacologic treatments and their efficacy for anxiety disorders in adults

The 2003 Rotterdam criteria are more broadly inclusive than the NIH criteria, allowing improved sensitivity for PCOS diagnosis. Diagnosis by the Rotterdam criteria requires the presence of two of the following three conditions: (1) hyperandrogenism, (2) oligo-ovulation, and (3) a classic PCOM described as evidence of any one or both of the following in either ovary: (1) presence of 12 or more follicles measuring 2 to 9 mm in diameter [see Figure 1] and/or (2) an increased ovarian volume (> 10 mL) in the absence of a dominant follicle or corpus luteum in either ovary.
The goals of evaluation are to (1) determine the source of hyperandrogenism (i.e., adrenal or ovarian), (2) assess the severity of androgen excess, (3) rule out an adrenal or ovarian tumor, and (4) screen for metabolic accompaniments of PCOS, including insulin resistance and the MetS.
Spironolactone, an aldosterone antagonist, has demonstrated efficacy against acne and hirsutism associated with PCOS. The antiandrogenic effects of spironolactone are attributed to (1) reduced adrenal androgen production, (2) competitive blockade on androgen receptors in target tissue, and (3) some degree of suppression of 5a-reductase, the enzyme responsible for conversion of testosterone to a more potent androgen dihydrotestosterone.

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.

IM Psychiatry