Latest Updates

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.

Mechanical Ventilation: Advanced Ventilation and Adjuncts

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Adrian A. Maung, MD, FACS, FCCM
    • The use of prone positioning to improve the outcome in patients with acute respiratory distress syndrome
    • The use of neuromuscular blockade in patients with severe acute respiratory distress syndrome
    • High-flow nasal cannula therapy as a possible alternative to noninvasive positive-pressure ventilation

Systemic Antifungal Agents

Brett A Melnikoff, MD, René P Myers, MD
    • Evidence for efficacy of a recently approved second-generation triazole (isavuconazole)
    • Enhanced understanding of the characteristics of and indications for currently available antifungals
    • Because fluconazole interacts with warfarin, phenytoin, and cyclosporine when given in a daily dose of 200 mg or higher, serum concentrations of these agents should be monitored when they are used in conjunction with fluconazole.

Mechanical Ventilation: Approaches and Special Considerations

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Adrian A. Maung, MD, FACS, FCCM
    • Consideration for specific ventilator modes for those at risk of acute respiratory distress syndrome (ARDS)
    • The use of respiratory therapist–guided spontaneous breathing trials
    • Changes in the pattern of tracheostomy use for acute respiratory failure
    • Expanded penetrance of palliative care in those with prolonged mechanical ventilation
    • The expanded use of extracorporeal techniques for severe ARDS
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