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Essential Surgical Knowledge

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2028 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/29099149/closure-methods-for-laparotomy-incisions-for-preventing-incisional-hernias-and-other-wound-complications
#1
REVIEW
Sunil V Patel, David D Paskar, Richard L Nelson, Satyanarayana S Vedula, Scott R Steele
BACKGROUND: Surgeons who perform laparotomy have a number of decisions to make regarding abdominal closure. Material and size of potential suture types varies widely. In addition, surgeons can choose to close the incision in anatomic layers or mass ('en masse'), as well as using either a continuous or interrupted suturing technique, of which there are different styles of each. There is ongoing debate as to which suturing techniques and suture materials are best for achieving definitive wound closure while minimising the risk of short- and long-term complications...
November 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29141086/use-of-entrustable-professional-activities-in-the-assessment-of-surgical-resident-competency
#2
Justin P Wagner, Catherine E Lewis, Areti Tillou, Vatche G Agopian, Chi Quach, Timothy R Donahue, O Joe Hines
Importance: Competency-based assessments of surgical resident performance require metrics of entrustable autonomy. Objectives: To designate entrustable professional activities (EPAs) in global performance and in specific operations, and to identify differences in perceived capability, autonomy, and expectations between surgical faculty and residents. Design, Setting, and Participants: This survey study was conducted from August 9, 2016, through August 24, 2016, in the Department of Surgery at the UCLA David Geffen School of Medicine...
November 15, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29138183/endovascular-or-open-repair-for-ruptured-abdominal-aortic-aneurysm
#3
EDITORIAL
Martin Björck
No abstract text is available yet for this article.
November 14, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29132517/surgical-critical-care-gastrointestinal-complications
#4
REVIEW
Rowan Sheldon, Matthew Eckert
Critical illness and injury affect the gastrointestinal tract almost uniformly. Complications include the sequelae of direct intestinal injury and repair, impaired motility, intra-abdominal hypertension, and ulceration, among others. Contemporary clinical practice has incorporated many advances in the prevention and treatment of gastrointestinal complications during critical illness. This article discusses the epidemiology, risk factors, means of diagnosis, treatment, and prevention of some of these compilations...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29133258/when-should-patients-undergo-genetic-testing-for-hereditary-colon-cancer-syndromes
#5
Gregory Idos, Samir Gupta
No abstract text is available yet for this article.
November 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29126671/treatment-challenges-in-and-outside-a-specialist-network-setting-pancreatic-neuroendocrine-tumours
#6
Panagis M Lykoudis, Stefano Partelli, Francesca Muffatti, Martyn Caplin, Massimo Falconi, Giuseppe K Fusai
Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network...
October 16, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29069302/mechanistic-overview-of-immune-checkpoints-to-support-the-rational-design-of-their-combinations-in-cancer-immunotherapy
#7
A Rotte, J Y Jin, V Lemaire
Checkpoint receptor blockers, known to act by blocking the pathways that inhibit immune cell activation and stimulate immune responses against tumor cells, have been immensely successful in the treatment of cancer. Among several checkpoint receptors of immune cells, cytotoxic T-lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), T-cell immunoglobulin and ITIM domain (TIGIT), T-cell immunoglobulin-3 (TIM-3) and lymphocyte activation gene 3 (LAG-3) are the most commonly targeted checkpoints for cancer immunotherapy...
October 24, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29116644/management-outcomes-and-prognostic-factors-of-ruptured-hepatocellular-carcinoma-a-systematic-review
#8
REVIEW
Demetrios Moris, Jeffery Chakedis, Steven H Sun, Gaya Spolverato, Diamantis I Tsilimigras, Ioannis Ntanasis-Stathopoulos, Eleftherios Spartalis, Timothy M Pawlik
Ruptured hepatocellular (rHCC) is a rare but life-threatening presentation that often requires acute intervention. In this systematic review we identified 67 eligible studies reporting on 4941 patients with rHCC. Here we present the treatment approaches for the management of rHCC both in the acute setting with regards to management of hemorrhage, as well long-term with regards to oncological treatment.
November 8, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29112564/a-surgical-clostridium-associated-risk-of-death-score-predicts-mortality-after-colectomy-for-clostridium-difficile
#9
Audrey S Kulaylat, Zain Kassam, Christopher S Hollenbeak, David B Stewart
BACKGROUND: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. OBJECTIVE: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy...
December 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29116488/the-relationship-between-clavien-dindo-morbidity-classification-and-oncologic-outcomes-after-colorectal-cancer-resection
#10
Leonardo C Duraes, Luca Stocchi, Scott R Steele, Matthew F Kalady, James M Church, Emre Gorgun, David Liska, Hermann Kessler, Olga A Lavryk, Conor P Delaney
BACKGROUND: Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. METHODS: Patients with pathological stages I-III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database...
November 7, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29103784/expanding-the-inclusion-criteria-for-nonoperative-management-of-uncomplicated-appendicitis-outcomes-and-cost
#11
Steven L Lee, Lara Spence, Kyle Mock, James X Wu, Huan Yan, Daniel A DeUgarte
BACKGROUND: Carefully selected children with early appendicitis may be managed nonoperatively. However, it is unknown whether nonoperative management (NOM) is applicable to all patients with uncomplicated appendicitis. The purpose of this study was to evaluate the outcomes of NOM of uncomplicated appendicitis with expanded inclusion criteria. METHODS: A prospective, nonrandomized patient-preference study comparing NOM versus laparoscopic appendectomy (LA) was performed in children with radiographic/clinical evidence of uncomplicated appendicitis...
October 9, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29086150/72%C3%A2-h-is-the-time-critical-point-to-operate-in-acute-appendicitis
#12
Mohammed Elniel, Jennie Grainger, Edward J Nevins, Nikhil Misra, Paul Skaife
BACKGROUND AND AIMS: Delay of operative management of acute appendicitis may adversely affect post-operative outcomes and increase the likelihood of post-operative complications occurring. We aim to correlate the duration of symptoms with intra-operative findings to create a timeline of the pathological change in appendicitis. METHODS: Appendicectomies performed at a large teaching hospital between June 2015 and July 2016 were prospectively analysed. Time of onset of pain, operative findings, pre-operative C-reactive protein (CRP) and white cell count (WCC) were recorded...
October 30, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28811703/barrett-s-oesophagus-current-controversies
#13
REVIEW
Chidi Amadi, Piers Gatenby
Oesophageal adenocarcinoma is rapidly increasing in Western countries. This tumour frequently presents late in its course with metastatic disease and has a very poor prognosis. Barrett's oesophagus is an acquired condition whereby the native squamous mucosa of the lower oesophagus is replaced by columnar epithelium following prolonged gastro-oesophageal reflux and is the recognised precursor lesion for oesophageal adenocarcinoma. There are multiple national and society guidelines regarding screening, surveillance and management of Barrett's oesophagus, however all are limited regarding a clear evidence base for a well-demonstrated benefit and cost-effectiveness of surveillance, and robust risk stratification for patients to best use resources...
July 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29043578/duodenal-crohn-s-disease-a-diagnostic-conundrum
#14
Amy L Lightner, Joel G Fletcher
Gastroduodenal Crohn's disease is rare as most often the disease is found in the terminal ileum and colon rather than the upper gastrointestinal tract. The most common phenotype is stricturing disease which can lead to obstructive-like symptoms. Medical treatment options include proton pump inhibitors and biologic therapy. Endoscopic and surgical intervention may be needed to relieve the obstructive-like symptoms from the stricturing phenotype.
October 17, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29070507/prescribing-antibiotics-to-hospitalised-patients-increases-the-risk-of-clostridium-difficile-infection-for-the-next-bed-occupant
#15
Nick Daneman
No abstract text is available yet for this article.
October 25, 2017: Evidence-based Medicine
https://www.readbyqxmd.com/read/29028110/melanoma-staging-evidence-based-changes-in-the-american-joint-committee-on-cancer-eighth-edition-cancer-staging-manual
#16
Jeffrey E Gershenwald, Richard A Scolyer, Kenneth R Hess, Vernon K Sondak, Georgina V Long, Merrick I Ross, Alexander J Lazar, Mark B Faries, John M Kirkwood, Grant A McArthur, Lauren E Haydu, Alexander M M Eggermont, Keith T Flaherty, Charles M Balch, John F Thompson
Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria...
November 2017: CA: a Cancer Journal for Clinicians
https://www.readbyqxmd.com/read/29064902/the-role-of-bowel-preparation-in-colorectal-surgery-results-of-the-2012-2015-acs-nsqip-data
#17
Aaron L Klinger, Heather Green, Dominique J Monlezun, David Beck, Brian Kann, Herschel D Vargas, Charles Whitlow, David Margolin
OBJECTIVE: To analyze potential benefits with regards to infectious complications with combined use of mechanical bowel preparation (MBP) and ABP in elective colorectal resections. BACKGROUND: Despite recent literature suggesting that MBP does not reduce infection rate, it still is commonly used. The use of oral antibiotic bowel preparation (ABP) has been practiced for decades but its use is also controversial. METHODS: Patients undergoing elective colorectal resection in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program cohorts were selected...
October 23, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28971908/comparison-of-up-front-treatments-for-newly-diagnosed-immune-thrombocytopenia-a-systematic-review-and-network-meta-analysis
#18
Yasuyuki Arai, Tomoyasu Jo, Hiroyuki Matsui, Tadakazu Kondo, Akifumi Takaori-Kondo
Corticosteroids such as prednisolone and dexamethasone have been established as up-front therapy for the treatment of newly diagnosed immune thrombocytopenia. Recent studies have indicated that other treatments such rituximab or thrombopoietin receptor agonist can also be effective choices. We performed a systematic review and network meta-analysis to establish a clinically meaningful hierarchy of the efficacy and safety of treatment for newly diagnosed primary immune thrombocytopenia in adults. Randomized controlled trials evaluating medical treatments for newly diagnosed immune thrombocytopenia were included...
September 29, 2017: Haematologica
https://www.readbyqxmd.com/read/28947668/pneumothorax-management-time-to-improve-the-evidence-base
#19
EDITORIAL
Nick A Maskell
No abstract text is available yet for this article.
December 2017: Thorax
https://www.readbyqxmd.com/read/28943323/hartmann-s-procedure-or-primary-anastomosis-for-generalized-peritonitis-due-to-perforated-diverticulitis-a-prospective-multicenter-randomized-trial-diverti
#20
Valerie Bridoux, Jean Marc Regimbeau, Mehdi Ouaissi, Muriel Mathonnet, Francois Mauvais, Estelle Houivet, Lilian Schwarz, Diane Mege, Igor Sielezneff, Charles Sabbagh, Jean-Jacques Tuech
BACKGROUND: About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma results in lower mortality rates than Hartmann's procedure (HP) in patients with diverticular peritonitis. STUDY DESIGN: We conducted a multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI (Primary vs Secondary Anastomosis for Hinchey Stage III-IV Diverticulitis) trial...
September 22, 2017: Journal of the American College of Surgeons
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