- Therapy for cutaneous vasculitis is first directed at recognizing and eliminating any underlying precipitant. Infectious etiologies should be sought and treated. Potential offending drugs should be withdrawn. Association with myelodysplasia and myeloproliferative disease should be considered, especially if cytopenias or abnormal cell forms are evident on peripheral blood smear.
- Early reports of PAN and MPA did not adequately distinguish the two entities. It is now generally accepted that PAN is a rare disorder that is linked to arteritis of medium-sized muscular arteries; small vessels are unaffected, so purpura should not be present in patients with classic PAN.
- The standard approach to the treatment of patients with potentially life-threatening systemic vasculitic syndromes has been to introduce therapy with a course of high-dose corticosteroids along with a second immunosuppressive agent to induce remission and then, depending on the disease, to gradually taper the corticosteroids and continue immunosuppressive therapy with the safest effective immunosuppressant to maintain remission. The noncorticosteroid second agent may initially be cyclophosphamide, which is felt to be one of the most potent agents.
Latest Updates
- Therapy for cutaneous vasculitis is first directed at recognizing and eliminating any underlying precipitant. Infectious etiologies should be sought and treated. Potential offending drugs should be withdrawn. Association with myelodysplasia and myeloproliferative disease should be considered, especially if cytopenias or abnormal cell forms are evident on peripheral blood smear.
- Early reports of PAN and MPA did not adequately distinguish the two entities. It is now generally accepted that PAN is a rare disorder that is linked to arteritis of medium-sized muscular arteries; small vessels are unaffected, so purpura should not be present in patients with classic PAN.
- The standard approach to the treatment of patients with potentially life-threatening systemic vasculitic syndromes has been to introduce therapy with a course of high-dose corticosteroids along with a second immunosuppressive agent to induce remission and then, depending on the disease, to gradually taper the corticosteroids and continue immunosuppressive therapy with the safest effective immunosuppressant to maintain remission. The noncorticosteroid second agent may initially be cyclophosphamide, which is felt to be one of the most potent agents.
- Modern eyelid surgery demands a tailored approach that recognizes anatomical, functional, and aesthetic characteristics that are particular to a patient’s age, gender, ethnicity, and medical history.
- Fat conservation should guide any surgical treatment plan in order to achieve optimal revolumization of aged periorbital structures.
- The transconjunctival approach to lower eyelid blepharoplasty can be augmented with fat transposition to recontour the lid-cheek junction and minimize or remove periorbital grooves and hollows.
- Use of steroids in the medical and surgical management of caustic injuries
- Button batteries as a source of caustic injury
- Management of strictures secondary to caustic injury, including stent placement
- Initial medical management of caustic injury
- Surgical management of caustic injury
Important Infections Due To Molds
- Diagnostic technology is evolving for mold infections, advancing to include β-d-glucan, nucleic acid, or antigen testing, although this may not be available at all centers.
- There are three general classes of antifungal agents, and the specific class used for an individual infection differs depending on whether the need to treat is superficial or invasive infection and on the preference for an oral or an intravenous agent in a specific situation.
- Therapeutic drug monitoring is becoming more common with advanced azole treatment courses.
- The epidemiology of a mold species responsible for an individual infection may depend on previous exposure to and treatment with various antifungal agents.
- Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
- High-volume plasma exchange improves overall survival in patients with ALF
- Improved understanding of the abnormalities of global hemostasis in patients with ALF
- Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses
Tumors of the Stomach and Small Bowel
- The overall incidence of gastric carcinoma has decreased in the past few decades, but it remains the second leading cause of cancer death worldwide. In high-risk areas (e.g., Japan), mass screening programs have been successful in identifying early gastric cancer, which is generally amenable to surgical cure. Screening is not used in Western countries because the incidence of gastric cancer is low enough that screening is not cost-effective.
- AJCC 8th edition staging manual for gastrointestinal tumors is included in this review.
- One new method for the identification of small bowel tumors is wireless capsule endoscopy. This minimally invasive technique may be particularly useful in identifying small lesions in the distal jejunum and ileum that cannot be identified radiographically.
Tumors of the Stomach and Small Bowel
- The overall incidence of gastric carcinoma has decreased in the past few decades, but it remains the second leading cause of cancer death worldwide. In high-risk areas (e.g., Japan), mass screening programs have been successful in identifying early gastric cancer, which is generally amenable to surgical cure. Screening is not used in Western countries because the incidence of gastric cancer is low enough that screening is not cost-effective.
- AJCC 8th edition staging manual for gastrointestinal tumors is included in this review.
- One new method for the identification of small bowel tumors is wireless capsule endoscopy. This minimally invasive technique may be particularly useful in identifying small lesions in the distal jejunum and ileum that cannot be identified radiographically.
