What's New | Decker

There has been increased interest in using statins to slow the progression of carotid artery disease. In the Asymptomatic Carotid Artery Plaque Study, lovastatin was compared in a double-blinded study to evaluate the effect on intima-media thickness and cardiovascular events. In both men and women with moderately elevated low-density lipoprotein levels, the progression of intima-media thickness in the carotid arteries was reduced compared with placebo, and lovastatin was also associated with reduced cardiovascular events and mortality.
The initial imaging study for patients with carotid bruit or cerebrovascular symptoms is duplex imaging of the extracranial carotid arteries. Duplex ultrasonography is an accurate and reliable noninvasive tool to determine the degree of carotid stenosis and plaque morphology in most patients.
Conventional angiography, once considered the gold standard for carotid imaging, is now reserved for patients with conflicting studies or patients being considered for carotid stenting. Conventional contrast selective carotid angiography poses a stroke risk of approximately 1% and therefore has a limited role in place of modern MRA and CTA, except in cases of planned carotid stenting.

Nasogastric tube feedings are often employed for the early stages of postoperative feeding in infants to ensure adequate nutrition. In general, feeding is begun after the resolution of postoperative ileus. Initially, small volumes of rehydration fluid are given orally or via a gastrostomy tube. If these are tolerated, the feedings are increased gradually until the nutritional goals are reached.
The laparoscopic approach for abdominal testes is safe and cost-effective; it allows for both localization and surgical treatment, minimizing the use of preoperative imaging for localization of the testicle. Orchiopexy is performed in one or two stages depending on the anatomic localization of the testicle and feasibility of mobilization of the spermatic vessels. Orchiectomy is indicated when an atrophic or hypoplastic testicle is encountered.
Babies with CDH require immediate resuscitation, correction of acidosis, and, in most cases, endotracheal intubation. Placement of an orogastric tube can help decompress the GI tract. Once the patient is relatively stable, surgical intervention should be delayed to allow time for the pulmonary hypertension to improve.

Operative techniques employed to treat esophageal disease have advanced considerably as a result of the successful introduction of minimally invasive approaches to the esophagus. For a number of diseases (e.g., achalasia and routine antireflux surgery), minimally invasive procedures have proved to be as effective as their open counterparts while causing less postoperative morbidity.
If esophageal obstruction prevents oral intake, endoscopic dilation of the stricture, accompanied by either nasogastric intubation or percutaneous endoscopic gastrostomy (PEG), is often indicated; the patient should then be able to resume at least a liquid diet.
Transhiatal esophagectomy is commonly performed to treat end-stage benign esophageal disease and carcinomas of the cardia and the lower esophagus. Esophageal resection through a combined laparotomy–right thoracotomy approach (Ivor Lewis esophagectomy) is ideal for cancers of the middle esophagus but is also used by many for lower third cancers. A three-hole esophagectomy (also known as a McKeown esophagectomy) is sometimes preferred for its excellent exposure of all lymph node stations.

Guideline for the diagnosis of drug hypersensitivity reactions 2015 S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG)
Some immunologic and clinical studies suggest that type-IV (T cell-mediated) and type-I (IgE-mediated) pathogenic mechanisms help in nonmediated and mediated reactions.

Guideline for the diagnosis of drug hypersensitivity reactions 2015 S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG)
Some immunologic and clinical studies suggest that type-IV (T cell-mediated) and type-I (IgE-mediated) pathogenic mechanisms help in nonmediated and mediated reactions.

James L Baldwin, MD, Aimee L. Speck, MD

Guideline for the diagnosis of drug hypersensitivity reactions 2015 S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG)
Some immunologic and clinical studies suggest that type-IV (T cell-mediated) and type-I (IgE-mediated) pathogenic mechanisms help in nonmediated and mediated reactions.

Guideline for the diagnosis of drug hypersensitivity reactions 2015 S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG)
Some immunologic and clinical studies suggest that type-IV (T cell-mediated) and type-I (IgE-mediated) pathogenic mechanisms help in nonmediated and mediated reactions.

Heather R. Faulkner, MD, MPH, FACS

Evidence-based guidelines for pre-operative/pre-procedure patient assessment.
Comprehensive review of non-operative and operative techniques for truncal body contouring.
Review of complications from body contouring of the trunk.

Vascular System