Latest Updates

Lower Blepharoplasty

Branko Bojovic, MD, FACS, Martin Buta, MD, MBA
    • 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.

Caustic and Toxic Ingestions

CDR Thomas Q Gallagher, DO, CDR Robert L Ricca, MD
    • 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

Jaime S Green, MD, Jo-Anne H. Young, MD, FACP
    • 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.

Tumors of the Stomach and Small Bowel

David J. Bentrem, MD, FACS, L. Mark Knab, MD, Jeffrey D. Wayne, MD, FACS
    • 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

David J. Bentrem, MD, FACS, L. Mark Knab, MD, Jeffrey D. Wayne, MD, FACS
    • 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.

Anorectal Disorders

Megan Fix, MD, Steven Glerum, MD
    • Abdominal radiographs to diagnose functional constipation in pediatric patients not indicated.
    • In unreliable pediatric patients, plain abdominal radiography may be useful.
    • PEG is recommended as first-line maintenance treatment for functional constipation.

Blunt Cerebrovascular Injuries

Clay Cothren Burlew, MD, FACS
    • Multislice (> 64 slice) computed tomographic angiography is the routine imaging test performed to identify blunt cerebrovascular injury (BCVI).
    • With noninvasive imaging used for BCVI identification, screening criteria have recently been expanded.
    • Antithrombotic treatment almost universally prevents BCVI-related stroke.
    • Endovascular therapy for BCVI should be reserved for those patients who are markedly symptomatic from their injury or have an enlarging pseudoaneurysm on repeat imaging.

Overview Of Schizophrenia And Other Psychotic Disorders

Donald W. Black, MD, James A Wilcox, DO, PhD
    • Psychotic disorders have been reclassified by grouping together those considered to fall within a schizophrenia spectrum.
    • Delusional disorder no longer requires the presence of nonbizarre delusions.
    • Schizophrenic subtypes (paranoid, disorganized, catatonic) were discontinued in the DSM-5. 2020 APA practice guidelines to be published.
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