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Essential Surgical Knowledge

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1925 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28506408/genetics-of-medullary-thyroid-cancer-an-overview
#1
REVIEW
Giacomo Accardo, Giovanni Conzo, Daniela Esposito, Claudio Gambardella, Marco Mazzella, Filomena Castaldo, Carlo Di Donna, Andrea Polistena, Nicola Avenia, Vittorio Colantuoni, Dario Giugliano, Daniela Pasquali
Medullary thyroid carcinoma (MTC) represents 3-5% of thyroid cancers. 75% is sporadic and 25% is the dominant component of the hereditary multiple endocrine neoplasia (MEN) type 2 syndromes. Three different subtypes of MEN2, such as MEN2A, MEN2B, and Familial MTC (FMTC) have been defined, based on presence or absence of hyperparathyroidism, pheocromocytoma and characteristic clinical features. Mutations of the RET proto-oncogene are implicated in the pathogenesis of MTC, but there are many other mutational patterns involved...
May 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28476201/resident-training-in-a-teaching-hospital-how-do-attendings-teach-in-the-real-operative-environment
#2
Carly E Glarner, Katherine E Law, Amy B Zelenski, Robert J McDonald, Jacob A Greenberg, Eugene F Foley, Douglas A Wiegmann, Caprice C Greenberg
BACKGROUND: The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs. METHODS: Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression...
March 23, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#3
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28487044/regional-variation-in-the-treatment-of-pancreatic-adenocarcinoma-decreasing-disparities-with-multimodality-therapy
#4
Gyulnara G Kasumova, Mariam F Eskander, Susanna W L de Geus, Mario Matiotti Neto, Omidreza Tabatabaie, Sing Chau Ng, Rebecca A Miksad, Anand Mahadevan, James R Rodrigue, Jennifer F Tseng
BACKGROUND: Survival in pancreatic cancer remains poor with curative potential dependent on operative resection. We reviewed national adherence to practice guidelines to evaluate regional variation in the treatment and survival of patients with pancreatic cancer. METHODS: Retrospective cohort review of adults with pancreatic adenocarcinoma using the National Cancer Data Base from 2006 to 2013. Overall survival was compared by the Kaplan-Meier method and Cox proportional hazards models...
May 6, 2017: Surgery
https://www.readbyqxmd.com/read/28480072/operative-microwave-ablation-for-hepatocellular-carcinoma-a-single-center-retrospective-review-of-219-patients
#5
Erin H Baker, Kyle Thompson, Iain H McKillop, Allyson Cochran, Russell Kirks, Dionisios Vrochides, John B Martinie, Ryan Z Swan, David A Iannitti
BACKGROUND: Microwave ablation (MWA) of hepatocellular carcinoma (HCC) offers local regional treatment that can be safely and effectively performed, even in patients with advanced liver disease. We update results from our group's previous analysis of operative MWA for HCC. METHODS: Retrospective review was performed of all patients who underwent operative MWA for HCC from 2007-2014. Patient demographics, operative characteristics and complications were recorded...
April 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28489620/adult-desmoid-tumors-biology-management-and-ongoing-trials
#6
Nicolas Penel, Frédéric Chibon, Sébastien Salas
PURPOSE OF REVIEW: To summarize the current knowledge about the biology and clinical management of adult desmoid tumors. RECENT FINDINGS: In the past decade, we have learned that desmoid tumors are driven by alterations of the Wnt/APC/β-catenin pathway, sporadic desmoid tumors are associated with somatic mutations of CTNNB1, and germline mutations of APC and somatic mutations of CTNNB1 are probably mutually exclusive. One-third of desmoid tumors are misdiagnosed; a second pathological opinion is therefore of major importance for desmoid tumor...
May 9, 2017: Current Opinion in Oncology
https://www.readbyqxmd.com/read/28487435/risk-of-acute-myocardial-infarction-with-nsaids-in-real-world-use-bayesian-meta-analysis-of-individual-patient-data
#7
Michèle Bally, Nandini Dendukuri, Benjamin Rich, Lyne Nadeau, Arja Helin-Salmivaara, Edeltraut Garbe, James M Brophy
Objective To characterise the determinants, time course, and risks of acute myocardial infarction associated with use of oral non-steroidal anti-inflammatory drugs (NSAIDs).Design Systematic review followed by a one stage bayesian individual patient data meta-analysis.Data sources Studies from Canadian and European healthcare databases.Review methods Eligible studies were sourced from computerised drug prescription or medical databases, conducted in the general or an elderly population, documented acute myocardial infarction as specific outcome, studied selective cyclo-oxygenase-2 inhibitors (including rofecoxib) and traditional NSAIDs, compared risk of acute myocardial infarction in NSAID users with non-users, allowed for time dependent analyses, and minimised effects of confounding and misclassification bias...
May 9, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28473039/approach-to-the-patient-with-hematochezia
#8
REVIEW
Thomas G Cotter, Niamh S Buckley, Conor G Loftus
The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner.
May 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28471761/american-exceptionalism-and-the-american-surgical-association-the-rise-of-surgery-in-the-united-states
#9
Ira Rutkow, Keith D Lillemoe
OBJECTIVE: To explore use of the notion of American exceptionalism by fellows of the American Surgical Association (ASA) (1880 through World War I) and how this proved instrumental in the rise of surgery in the United States. BACKGROUND: American exceptionalism is the belief that the United States is innately different from other nations because of its economic, geographic, political, religious, and social foundations. Although, currently, the concept of American exceptionalism implies superiority, in its original 19th century connotation, the idea referred to the distinctive character of America as a free nation...
May 2, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28467526/centers-for-disease-control-and-prevention-guideline-for-the-prevention-of-surgical-site-infection-2017
#10
Sandra I Berríos-Torres, Craig A Umscheid, Dale W Bratzler, Brian Leas, Erin C Stone, Rachel R Kelz, Caroline E Reinke, Sherry Morgan, Joseph S Solomkin, John E Mazuski, E Patchen Dellinger, Kamal M F Itani, Elie F Berbari, John Segreti, Javad Parvizi, Joan Blanchard, George Allen, Jan A J W Kluytmans, Rodney Donlan, William P Schecter
Importance: The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. Objective: To provide new and updated evidence-based recommendations for the prevention of SSI...
May 3, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28433613/association-between-early-ercp-and-mortality-in-patients-with-acute-cholangitis
#11
Ming Tan, Ove B Schaffalitzky de Muckadell, Stig B Laursen
BACKGROUND AND AIMS: Acute cholangitis (AC) is associated with high mortality of up to 10%. The association between timing of ERCP and mortality in AC patients remains unclear. The aim of this study was to investigate if early ERCP within 24 hours was associated with improved survival. METHODS: All AC patients that underwent ERCP at Odense University Hospital, Denmark, between March 2009 and September 2016 were identified using a prospective ERCP database. Clinical data were collected from medical records...
April 19, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28439797/desmoid-type-fibromatosis-who-when-and-how-to-treat
#12
REVIEW
Javier Martínez Trufero, Isabel Pajares Bernad, Irene Torres Ramón, Jorge Hernando Cubero, Roberto Pazo Cid
Desmoid-type fibromatosis is a sarcoma subtype that gathers some singular characteristics, making it a difficult challenge to face in clinical practice. Despite its excellent survival prognosis, these tumors may be unpredictable, ranging from an asymptomatic indolent course to persistent, local, and extended recurrences that significantly impair quality of life. Although surgery was initially considered the first elective treatment, collected published data during the past few years are now pointing to the "wait and see" approach as a reasonable initial strategy because many patients can live a long life with the disease without having symptoms...
May 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28448386/barriers-to-goal-concordant-care-for-older-patients-with-acute-surgical-illness-communication-patterns-extrinsic-to-decision-aids
#13
Lauren J Taylor, Sara K Johnson, Michael J Nabozny, Jennifer L Tucholka, Nicole M Steffens, Kristine L Kwekkeboom, Karen J Brasel, Toby C Campbell, Margaret L Schwarze
OBJECTIVE: We sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care. BACKGROUND: Decision aids are designed to facilitate difficult clinical decisions by providing better treatment information. However, these interventions may not be sufficient to effectively reveal patient values and promote preference-aligned decisions for seriously ill, older adults. METHODS: We conducted a secondary analysis of 31 decision-making conversations between surgeons and frail, older inpatients with acute surgical problems at a single tertiary care hospital...
April 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28437313/enhanced-recovery-after-surgery-for-noncolorectal-surgery-a-systematic-review-and-meta-analysis-of-major-abdominal-surgery
#14
Anthony Visioni, Rupen Shah, Emmanuel Gabriel, Kristopher Attwood, Moshim Kukar, Steven Nurkin
OBJECTIVE: To evaluate the impact of enhanced recovery after surgery (ERAS) protocols across noncolorectal abdominal surgical procedures. BACKGROUND: ERAS programs have been studied extensively in colorectal surgery and adopted at many centers. Several studies testing such protocols have shown promising results in improving postoperative outcomes across various surgical procedures. However, surgeons performing major abdominal procedures have been slower to adopt these ERAS protocols...
April 21, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28431186/unfractionated-heparin-versus-low-molecular-weight-heparins-for-avoiding-heparin-induced-thrombocytopenia-in-postoperative-patients
#15
REVIEW
Daniela R Junqueira, Liliane M Zorzela, Edson Perini
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction presenting as a prothrombotic disorder related to antibody-mediated platelet activation. It is a paradoxical immune reaction resulting in thrombin generation in vivo, which leads to a hypercoagulable state and the potential to initiate venous or arterial thrombosis. A number of factors are thought to influence the incidence of HIT including the type and preparation of heparin (unfractionated heparin (UFH) or low molecular weight heparin (LMWH)) and the heparin-exposed patient population, with the postoperative patient population at higher risk...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28431202/pharmacological-interventions-for-acute-pancreatitis
#16
REVIEW
Elisabetta Moggia, Rahul Koti, Ajay P Belgaumkar, Federico Fazio, Stephen P Pereira, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES: To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs)...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28420040/semi-end-to-end-esophagojejunostomy-after-laparoscopy-assisted-total-gastrectomy-better-reduces-stricture-and-leakage-than-the-conventional-end-to-side-procedure-a-retrospective-study
#17
Wei Duan, Kaijun Liu, Xiaolong Fu, Xuqi Shen, Jun Chen, Chongyu Su, Peiwu Yu, Yongliang Zhao
BACKGROUND AND OBJECTIVE: Laparoscopy-assisted total gastrectomy (LATG) has not gained popularity due to the technical difficulty of esophagojejunostomy (EJ) and the high incidence of EJ-related complications. Herein, we compared two types of EJ for Roux-en-Y reconstruction to determine whether semi-end-to-end (SETE) EJ is more convenient than the end-to-side (ETS) procedure and is capable of reducing stricture and leakage. METHODS: A total of 268 patients who underwent LATG with Roux-en-Y reconstruction were included in this study...
April 18, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28395784/acute-mesenteric-ischemia-part-i-incidence-etiologies-and-how-to-improve-early-diagnosis
#18
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28385477/espen-guideline-clinical-nutrition-in-surgery
#19
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28407088/borderline-resectable-pancreatic-cancer-conceptual-evolution-and-current-approach-to-image-based-classification
#20
J W Gilbert, B Wolpin, T Clancy, J Wang, H Mamon, A B Shinagare, J Jagannathan, M Rosenthal
BACKGROUND: Diagnostic imaging plays a critical role in the initial diagnosis and therapeutic monitoring of pancreatic adenocarcinoma. Over the past decade, the concept of "borderline resectable" pancreatic cancer has emerged to describe a distinct subset of patients existing along the spectrum from resectable to locally advanced disease for whom a microscopically margin-positive (R1) resection is considered relatively more likely, primarily due to the relationship of the primary tumor with surrounding vasculature...
April 12, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
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