Latest Updates

Thyroiditis, Goiter, Thyroid Nodules, and Thyroid Cancer

Paul W. Ladenson, MD
    • 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
    • 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

Psychiatric Diseases in Pregnancy

    • In March 2019, the U.S. Food and Drug Administration approved Zulresso (Brexanolone) injection for intravenous (IV) use for the treatment of postpartum depression (PPD) in adult women. This is the first drug approved by the FDA specifically for treatment of PPD and is currently available only under a restricted distribution program due to concerns about serious risks including excessive sedation or sudden loss of consciousness during administration. Specific restrictions and requirements are planned to be detailed on the medication’s associated black box warning label. 
    • All women should be screened multiple times during pregnancy and in the postpartum period for depression, regardless of their risk factors or medical history. Many tools such as the Edinburgh Postnatal Depression Scale form are available to assist in screening.
    • When considering intrapartum pain management in women with opioid use disorder, it is important to avoid drugs with an opioid antagonist component, such as nalbuphine, as this can precipitate withdrawal symptoms. Use of other medications such as NSAIDs can reduce the amount of opioids required.
    • The effect of marijuana use in pregnancy is unclear, as studies are confounded due to co-existing mental health disorders, socioeconomic status, parental education, and cigarette smoking. Despite these limitations, several studies have demonstrated an association with preterm labor, low birth weight, NICU admission, and stillbirth. As with any drug of abuse, abstinence during pregnancy should be encouraged.

Minimally Invasive Esophageal Procedures

Jon O. Wee, MD, FACS

    Approach to the Patient with Abdominal Pain

      • Point-of-care ultrasonography should be used in the patient presenting with abdominal pain 
      • Computed tomography is often used in diagnostic care of the patient with abdominal pain
      • Analgesia should be liberally used when appropriate in the patient with abdominal pain

    Thoracic Trauma

      Traumatic Brain Injury

      Pierre Borczuk, MD, FACEP
        • Subdural hematoma and traumatic subarachnoid blood are the most common hemorrhagic computed tomographic (CT) findings in patients with head injury.
        • In the patient with signs of brain herniation and borderline or shock vital signs, the ideal hyperosmotic agent is hypertonic saline.
        • Although the incidence of traumatic findings on a cranial CT scan in patients with head injury, loss of consciousness, and a Glasgow Coma Scale score of 15 is about 6%, the need for neurosurgical intervention in this cohort is 0.4%.
        • Guidelines for ordering CT scans in adults after head trauma are the Canadian CT head rule and the New Orleans criteria. The guideline for pediatric patients is the PECARN set of rules.
        • Four-factor prothrombin complex concentrate can rapidly reverse the effects of warfarin in patients with intracranial hemorrhage.
        • For the athlete with head injury, immediate removal from play and a graded increase in activity as long as the patient is asymptomatic are the basis of concussion management.

      Traumatic Brain Injury

      Pierre Borczuk, MD, FACEP
        • Subdural hematoma and traumatic subarachnoid blood are the most common hemorrhagic computed tomographic (CT) findings in patients with head injury.
        • In the patient with signs of brain herniation and borderline or shock vital signs, the ideal hyperosmotic agent is hypertonic saline.
        • Although the incidence of traumatic findings on a cranial CT scan in patients with head injury, loss of consciousness, and a Glasgow Coma Scale score of 15 is about 6%, the need for neurosurgical intervention in this cohort is 0.4%.
        • Guidelines for ordering CT scans in adults after head trauma are the Canadian CT head rule and the New Orleans criteria. The guideline for pediatric patients is the PECARN set of rules.
        • Four-factor prothrombin complex concentrate can rapidly reverse the effects of warfarin in patients with intracranial hemorrhage.
        • For the athlete with head injury, immediate removal from play and a graded increase in activity as long as the patient is asymptomatic are the basis of concussion management.

      Hypersensitivity Reactions and Anaphylaxis

        • Novel therapies with the potential for management of anaphylaxis are currently being investigated. Omalizumab, a monoclonal antibody, has several proposed mechanisms of action, among which includes the rapid reduction of the level of free immunoglobulin E (IgE) in serum. Omalizumab has been approved and used in the treatment of patients with moderate to severe asthma as well as other IgE-mediated allergic disorders. Although there have been case reports regarding its use in anaphylaxis, ongoing research is needs to be performed.
        • Another potential therapy for anaphylaxis is methylene blue. It has been show to inhibit the relaxation of smooth muscle in vessels that lead to vasodilation and shock. Animal studies have demonstrated the potential of methylene blue in the prevention of cerebral ischemia associated with anaphylactic shock; however, more research is needed.
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