Latest Updates

Surgical Management of Benign and Malignant Colorectal Disease in the Immunocompromised Patient

Cindy Kin, MD, Amy Lightner, MD, Mark Welton, MD, MHCM
    • Immunosuppression alters colorectal disease
    • Immunosuppressive therapy for inflammatory bowel disease may worsen postoperative outcomes
    • Diverticulitis, even if uncomplicated, should be treated with a surgical resection in patients who have had a solid-organ transplantation
    • Typhlitis may mimic appendicitis in immunocompromised patients but should not be managed with surgery
    • Certain neoplasms are increased in the setting of immunosuppression

Surgical Management of Benign and Malignant Colorectal Disease in the Immunocompromised Patient

Cindy Kin, MD, Amy Lightner, MD, Mark Welton, MD, MHCM
    • Immunosuppression alters colorectal disease
    • Immunosuppressive therapy for inflammatory bowel disease may worsen postoperative outcomes
    • Diverticulitis, even if uncomplicated, should be treated with a surgical resection in patients who have had a solid-organ transplantation
    • Typhlitis may mimic appendicitis in immunocompromised patients but should not be managed with surgery
    • Certain neoplasms are increased in the setting of immunosuppression

Metabolic Response to Critical Illness - Part 2

Palmer Q. Bessey, MD
    • Use of growth hormone for manipulation of metabolic response and muscle characteristics. This in combination with early physical therapy/exercise aids in preservation.
    • Anti-cytokine antibodies for partial attenuation of metabolic response. These approaches have elucidated the complexity of mechanisms leading to the metabolic response of critically ill patients.
    • Relatively recent adoption of the important role of the gut in metabolic response. This includes production of mediators and functioning as a barrier to bacteria which dramatically affect severity of metabolic response.

Medications and Botulinum Toxin for Overactive Bladder

    • Emerging role of beta agonist therapy for treatment of OAB
    • The pharmacologic use of onabotulinumtoxinA (Botox®) upgraded to strongest rating of “standard" (strength of evidence grade B) by the amended 2014 AUA/SUFU guidelines.
    • Studies reporting trigonal injections of Botox may be associated with superior continence rates

Urogenital Fistulas and Female Urethral Diverticula

    •  For iatrogenic vesicovaginal fistula, delaying repair until healing has occurred is no longer mandatory, and outcomes for immediate repair are comparable to delayed repairs. 
    •  Concomitant stress incontinence surgery with autologous fascial pubovaginal sling at the same time as repair of complex urethral diverticula appears to be safe and effective.
    • MRI is a valuable tool for surgical planning and is recommended prior to urethral diverticulectomy.

Pneumonia and other Pulmonary Infections

Scott A. Fruhan, MD, MBA, Karen D. Serrano, MD
    • Pneumonia is caused by a variety of infectious agents, including bacteria, viruses, and fungi. The diagnosis of pneumonia is determined based on a combination of clinical features and radiographic studies.
    • Providers should identify patients at risk for health care–associated pneumonia or infection with resistant organisms. 
    • Tuberculosis has both active and latent forms, which are treated with different antibiotic regimens. Definitive diagnosis requires either acid-fast bacilli smear and culture or nucleic acid amplification testing of sputum.

Viral Upper Respiratory Infection

James Creswell Simpson, MD, Kristin H. Dwyer, MD, MPH
    • Adult epiglottitis has reported mortality between 7 and 20%. A high index of suspicion is recommended in patients who are stridorous, are drooling, or have odynophagia. Airway control is critical; the airway should be secured early and under controlled conditions, with personnel and equipment for surgical airway readily available. Orotracheal intubation or tracheostomy can both trigger a sudden loss of airway, and bag-mask ventilation may worsen airway obstruction. These patients require emergent otolaryngology consultation, and the emergency physician must be prepared to establish a definitive airway. Patients should never be left unmonitored and should be kept sitting up to maximize airway patency. 

Kidney Biopsy

Gearoid McMahon, MD, Adina Voiculescu, MD
    • Summarizes different indications
    • Helps select most appropriate technique of biopsy
    • Summarizes type and frequency of complications
    • Gives guidance for treatment of complications
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