What's New | Decker

Sternal wound complications have dramatically decreased due to improvements in perioperative care of cardiac surgical patients
Innovation in flap design has made treatment of sternal wound infections more reliable
New sternal plating systems hold potential to further reduce sternotomy complications in high risk patients

Walter P Maksymowych, MB, ChB, FRCP (UK), FRCPC, FACP

The combined use of T₁-weighted MRI with a water-sensitive MRI sequence significantly enhances early detection of spondyloarthritis, identifies patients responsive to therapeutic intervention with tumor necrosis factor inhibitors (TNFIs), and constitutes a key prognostic factor for structural progression.
Treatment of patients with TNFI early in the disease course when radiographic sacroiliitis is not yet evident is highly effective, especially in patients with an elevated C-reactive protein and/or features of inflammation on MRI.
Treatment targeting interleukin-17 is an effective new treatment option for patients with spondyloarthritis, especially in the setting of concomitant psoriasis.
Imaging recommendations that allow for precision in diagnosis.

Bryan Hierlmeier, MD, Vanetta Levesque, MD, Henrique Vale, MD

Newer lung isolation devices may increase the success of placement with decreased difficulty.
Bronchial blockers can be used for lung isolation in a suspected difficult airway.
Stepwise ways to predict and manage hypoxia during one-lung ventilation.

Surgery for neurogenic bladder aims to protect the upper urinary tract and optimize continence.
Major factors to consider are the injury level, gender, habitus, dexterity, and cognitive functions.
Surgical options for storage and emptying failure are discussed, including indication, technique, and complications.
New surgical technology and regenerative medicine are mentioned together.

Antihistamines to block the binding of histamine at target sites, aspirin and NSAIDs to block the synthesis of prostaglandin D2, and leukotriene antagonists blocking it’s downstream effects
Allergen immunotherapy to induce long-lasting clinical tolerance in sensitized patients in an antigen-specific approach
Monoclonal antibodies against IL-5 (mepolizumab, reslizumab), and IL-5 receptor (benralizumab) for treatment of hypereosinphilia and proposed for allergy diseases

Use of molecular testing of non-diagnostic thyroid nodule FNAs to increase the ability to obtain a diagnosis, decrease the need for repeated biopsies, and improve patient care
Refining the indications for total or complete thyroidectomy
Decreasing the use of radioactive iodine ablation based on risk stratification
Indications for lymphadenectomy approach in selected patients
Improving molecular targeted agents for iodine-refractory metastatic disease with improvements shown in progression free survival
Targeted therapy for recurrent, unresectable, iodine-refractory lesions

Sylvia Botros-Brey, MD, MSCI, K. Christopher McMains, MD, PhD, MS, Jo Shapiro, MD, FACS

The central feature of medical ethics is the primacy of the patient’s interests.
The ethical obligations of a for-profit corporation include maximizing profit and growth.
The rise of entrepreneurialism and the growing corporatization of medicine also challenge the traditions of virtue-based medical care. When these processes are allowed to dominate medicine, health care becomes a commodity.
The different obligations of business and medical ethics call the appropriateness of applying industrial models to provision of health care into question. It is no less than each of our professional duties to address these tensions where they exist.

Orchiopexy without transparenchymal suturing is a new surgical approach for the treatment of acute testicular torsion.
There is a recent focus on the role of ischemia-reperfusion injury in acute testicular torsion and medications that may help prevent damage caused by ischemia-reperfusion injury.
Fasciotomy with tunica vaginalis flap is a new surgical technique aimed at preventing damage from ischemia reperfusion injury.
There is a new focus on immediate reconstruction with testicular prosthetic at the time of orchiectomy for testicular torsion.

Trunk And Perineal Reconstruction