What's New | Decker

The initial assessment of the patient with suspected AHF should focus on immediate life-threatening conditions. Careful attention should be paid to vital signs. Hypoxia should be treated with supplemental oxygenation and may be a marker for impending respiratory failure. The history should help ascertain possible causes of exacerbation of HF, as well as risk factors or symptoms suggestive of HF mimics.
Nesiritide is a recombinant BNP that, similar to NTG, is a venous, arterial, and coronary dilator. Several early trials demonstrated improved hemodynamics with nesiritide, with a suggestion of some clinical benefit. However, data from these trials failed to demonstrate a mortality benefit and questions arose about the possibility of increased renal insufficiency and worse mortality with its use.
Sodium nitroprusside can be similarly used to decrease both preload and afterload. Observational data have suggested a mortality benefit in AHF patients treated with nitroprusside, but randomized trial data appear to be limited to patients with acute myocardial infarction and have not been able to demonstrate a mortality decrease.

Two new tests are now available: thromboelastography and the thrombin generation test.
Both assays provide much more information than the conventional clotting times
New generations of devices allow both tests to be performed in an automated manner, leading to greater reproducibility and less variation among laboratories.

The initial assessment of the patient with suspected AHF should focus on immediate life-threatening conditions. Careful attention should be paid to vital signs. Hypoxia should be treated with supplemental oxygenation and may be a marker for impending respiratory failure. The history should help ascertain possible causes of exacerbation of HF, as well as risk factors or symptoms suggestive of HF mimics.
Nesiritide is a recombinant BNP that, similar to NTG, is a venous, arterial, and coronary dilator. Several early trials demonstrated improved hemodynamics with nesiritide, with a suggestion of some clinical benefit. However, data from these trials failed to demonstrate a mortality benefit and questions arose about the possibility of increased renal insufficiency and worse mortality with its use.
Sodium nitroprusside can be similarly used to decrease both preload and afterload. Observational data have suggested a mortality benefit in AHF patients treated with nitroprusside, but randomized trial data appear to be limited to patients with acute myocardial infarction and have not been able to demonstrate a mortality decrease.

Two new tests are now available: thromboelastography and the thrombin generation test.
Both assays provide much more information than the conventional clotting times
New generations of devices allow both tests to be performed in an automated manner, leading to greater reproducibility and less variation among laboratories.

The dual-tracer technique of lymphatic mapping has the highest accuracy rates, and most melanoma surgeons prefer this method. Methylene blue is generally avoided due to the high rate of skin necrosis at the site of injection. It should not be considered in melanoma patients in whom the injection site is not going to be excised and should not be considered in breast cancer patients unless a total mastectomy is being performed. Isosulfan blue is most commonly used but is associated with a rare incidence of anaphylaxis. Thus, isosulfan blue should never be used in a setting without direct anesthesia care provided.

The dual-tracer technique of lymphatic mapping has the highest accuracy rates, and most melanoma surgeons prefer this method. Methylene blue is generally avoided due to the high rate of skin necrosis at the site of injection. It should not be considered in melanoma patients in whom the injection site is not going to be excised and should not be considered in breast cancer patients unless a total mastectomy is being performed. Isosulfan blue is most commonly used but is associated with a rare incidence of anaphylaxis. Thus, isosulfan blue should never be used in a setting without direct anesthesia care provided.

Lumbar radiculopathy can cause pain, paresthesia, weakness, reflex changes, and sensory loss and is often isolated to a territory along a specific nerve root. Additionally, symptoms are bilateral in almost 70% of patients. The neurologic examination is often normal in these patients. The straight leg raise (SLR) test has been shown to have a fairly high sensitivity (91%) but low specificity (26%) in detecting lumbar disk herniation.
Computed tomographic angiography (CTA) has increased in popularity for the diagnosis and treatment planning of PAD as the technology has improved. Currently, with 64-slice multidetector imaging, a CTA with runoff can evaluate the chest, abdomen, and legs in a few seconds.
Surgical intervention is reserved for patients who fail conservative management. Laminectomy is most frequently performed, with favorable results in the absence of spondylolithesis. With the addition of spondylolithesis, fusion is frequently required.

Lumbar radiculopathy can cause pain, paresthesia, weakness, reflex changes, and sensory loss and is often isolated to a territory along a specific nerve root. Additionally, symptoms are bilateral in almost 70% of patients. The neurologic examination is often normal in these patients. The straight leg raise (SLR) test has been shown to have a fairly high sensitivity (91%) but low specificity (26%) in detecting lumbar disk herniation.
Computed tomographic angiography (CTA) has increased in popularity for the diagnosis and treatment planning of PAD as the technology has improved. Currently, with 64-slice multidetector imaging, a CTA with runoff can evaluate the chest, abdomen, and legs in a few seconds.
Surgical intervention is reserved for patients who fail conservative management. Laminectomy is most frequently performed, with favorable results in the absence of spondylolithesis. With the addition of spondylolithesis, fusion is frequently required.

Cardiovascular