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Essential Surgical Knowledge

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1891 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28324284/nonoperative-management-or-watch-and-wait-for-rectal-cancer-with-complete-clinical-response-after-neoadjuvant-chemoradiotherapy-a-critical-appraisal
#1
Tarik Sammour, Brandee A Price, Kate J Krause, George J Chang
BACKGROUND: There is increasing interest in nonoperative management (NOM) for rectal cancer with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT). OBJECTIVE: The aim of this systematic review was to summarize the available data on NOM, with the intention of formulating standardized protocols on which to base future investigations. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted...
March 21, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#2
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28318008/meta-analysis-of-prophylactic-abdominal-drainage-in-pancreatic-surgery
#3
REVIEW
F J Hüttner, P Probst, P Knebel, O Strobel, T Hackert, A Ulrich, M W Büchler, M K Diener
BACKGROUND: Intra-abdominal drains are frequently used after pancreatic surgery whereas their benefit in other gastrointestinal operations has been questioned. The objective of this meta-analysis was to compare abdominal drainage with no drainage after pancreatic surgery. METHODS: PubMed, the Cochrane Library and Web of Science electronic databases were searched systematically to identify RCTs comparing abdominal drainage with no drainage after pancreatic surgery...
March 20, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28240562/guidelines-for-management-of-incidental-pulmonary-nodules-detected-on-ct-images-from-the-fleischner-society-2017
#4
Heber MacMahon, David P Naidich, Jin Mo Goo, Kyung Soo Lee, Ann N C Leung, John R Mayo, Atul C Mehta, Yoshiharu Ohno, Charles A Powell, Mathias Prokop, Geoffrey D Rubin, Cornelia M Schaefer-Prokop, William D Travis, Paul E Van Schil, Alexander A Bankier
The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences...
February 23, 2017: Radiology
https://www.readbyqxmd.com/read/28288059/effects-of-intraoperative-fluid-management-on-postoperative-outcomes-a-hospital-registry-study
#5
Christina H Shin, Dustin R Long, Duncan McLean, Stephanie D Grabitz, Karim Ladha, Fanny P Timm, Tharusan Thevathasan, Alberto Pieretti, Cristina Ferrone, Andreas Hoeft, Thomas W L Scheeren, Boyd Taylor Thompson, Tobias Kurth, Matthias Eikermann
OBJECTIVE: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. BACKGROUND: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery. METHODS: This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28282000/the-fundamentals-of-resident-dismissal
#6
Paul J Schenarts, Sean Langenfeld
Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28282010/complications-and-mortality-associated-with-temporary-abdominal-closure-techniques-a-systematic-review-and-meta-analysis
#7
Adam Cristaudo, Scott Jennings, Ronny Gunnarsson, Alan DeCosta
Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and <ext-link ext-link-type="uri" xlink:href="http://Clinicaltrials...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28213607/efficacy-and-safety-of-nonoperative-treatment-for-acute-appendicitis-a-meta-analysis
#8
REVIEW
Roxani Georgiou, Simon Eaton, Michael P Stanton, Agostino Pierro, Nigel J Hall
CONTEXT: Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy. OBJECTIVE: To determine safety and efficacy of NOT based on current literature. DATA SOURCES: Three electronic databases. STUDY SELECTION: All articles reporting NOT for AUA in children. DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data...
March 2017: Pediatrics
https://www.readbyqxmd.com/read/28267992/clostridium-difficile-disease-diagnosis-pathogenesis-and-treatment-update
#9
REVIEW
Lena M Napolitano, Charles E Edmiston
Clostridium difficile infections are the leading cause of health care-associated infectious diarrhea, posing a significant risk for both medical and surgical patients. Because of the significant morbidity and mortality associated with C difficile infections, knowledge of the epidemiology of C difficile in combination with a high index of suspicion and susceptible patient populations (including surgical, postcolectomy, and inflammatory bowel disease patients) is warranted. C difficile infections present with a wide spectrum of disease, ranging from mild diarrhea to fulminant colitis or small bowel enteritis and recurrent C difficile infections...
March 3, 2017: Surgery
https://www.readbyqxmd.com/read/28259285/serum-and-tissue-markers-in-colorectal-cancer-state-of-art
#10
REVIEW
Massimiliano Berretta, Lara Alessandrini, Chiara De Divitiis, Guglielmo Nasti, Arben Lleshi, Raffaele Di Francia, Gaetano Facchini, Carla Cavaliere, Carlo Buonerba, Vincenzo Canzonieri
Colorectal cancer (CRC) represents one of the most commonly diagnosed cancers worldwide. It is the second leading cause of cancer death in Western Countries. In the last decade, the survival of patients with metastatic CRC has improved dramatically. Due to the advent of new drugs (irinotecan and oxaliplatin) and target therapies (i.e. bevacizumab, cetuximab, panitumab, aflibercept and regorafenib), the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently. Molecular studies have recently widened the opportunity for testing new possible markers, but actually, only few markers can be recommended for practical use in clinic...
March 2017: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/28267689/an-educational-intervention-decreases-opioid-prescribing-after-general-surgical-operations
#11
Maureen V Hill, Ryland S Stucke, Michelle L McMahon, Julia L Beeman, Richard J Barth
OBJECTIVE: The aim of this study was to determine whether an educational intervention was sufficient to decrease opioid prescribing after general surgical operations. SUMMARY OF BACKGROUND DATA: We recently analyzed opioid prescription and use for 5 common outpatient operations at our institution: partial mastectomy (PM), PM with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH)...
March 6, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28265666/atrial-fibrillation
#12
Peter Zimetbaum
This issue provides a clinical overview of atrial fibrillation, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers...
March 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28239409/iroa-international-register-of-open-abdomen-preliminary-results
#13
Federico Coccolini, Giulia Montori, Marco Ceresoli, Fausto Catena, Rao Ivatury, Michael Sugrue, Massimo Sartelli, Paola Fugazzola, Davide Corbella, Francesco Salvetti, Ionut Negoi, Monica Zese, Savino Occhionorelli, Stefano Maccatrozzo, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Yovcho Yovtchev, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael L Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Luca Ansaloni
BACKGROUND: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). METHODS: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. RESULTS: Four hundred two patients enrolled...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28237644/surgery-for-pancreatic-neoplasms-how-accurate-are-our-surgical-indications
#14
David Jérémie Birnbaum, Sébastien Gaujoux, Julie Berbis, Safi Dokmak, Pascal Hammel, Marie Pierre Vullierme, Philippe Lévy, Alain Sauvanet
BACKGROUND: Accurate preoperative diagnosis is critical for the determination of appropriate surgical indications. The aim of this study was to assess the accuracy of preoperative diagnosis and indications for operative therapy for presumed pancreatic neoplasms. METHODS: From 2005 to 2013, 851 patients underwent pancreatectomies for presumed pancreatic neoplasms. A formal preoperative diagnosis was established during a multidisciplinary tumor board and compared to the final pathologic examination...
February 22, 2017: Surgery
https://www.readbyqxmd.com/read/28241220/management-of-severe-pancreatic-fistula-after-pancreatoduodenectomy
#15
F Jasmijn Smits, Hjalmar C van Santvoort, Marc G Besselink, Marilot C T Batenburg, Robbert A E Slooff, Djamila Boerma, Olivier R Busch, Peter P L O Coene, Ronald M van Dam, David P J van Dijk, Casper H J van Eijck, Sebastiaan Festen, Erwin van der Harst, Ignace H J T de Hingh, Koert P de Jong, Johanna A M G Tol, Inne H M Borel Rinkes, I Quintus Molenaar
Importance: Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking. Objective: To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy. Design, Setting, and Participants: A multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer Group from January 1, 2005, to September 30, 2013...
February 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28232056/prophylactic-corticosteroids-for-prevention-of-post-extubation-stridor-and-reintubation-in-adults-a-systematic-review-and-meta-analysis
#16
Akira Kuriyama, Noriyuki Umakoshi, Rao Sun
BACKGROUND: Corticosteroid administration before elective extubation has been employed to prevent post-extubation stridor and reintubation. We updated a systematic review to identify which patients would benefit from prophylactic corticosteroids before elective extubation. METHODS: We searched PubMed, EMBASE, the Wanfang Database, the China Academic Journal Network Publishing Database, and the Cochrane Central Register of Controlled Trials for eligible trials from inception through February 29, 2016...
February 20, 2017: Chest
https://www.readbyqxmd.com/read/28222250/long-term-treatment-of-cancer-associated-thrombosis-the-choice-of-the-optimal-anticoagulant
#17
REVIEW
I Elalamy, I Mahé, W Ageno, G Meyer
Patients with cancer associated thrombosis (CAT) carry a higher risk of recurrence, bleeding and mortality as compared to non-cancer patients. The specific profile of cancer patients combining frequent co-morbidities, the use of anti-tumoral therapies and the cancer progression itself represent a major therapeutic challenge for choosing a long-term anticoagulant treatment. This review discusses the practical basis of that choice among available drugs for the long-term antithrombotic strategy linked to their pharmacology, mechanism of action, evidence of clinical benefits, advantages and limitations in such a complex clinical context...
February 21, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28230650/acr-appropriateness-criteria%C3%A2-resectable-pancreatic-cancer
#18
William E Jones, W Waren Suh, May Abdel-Wahab, Ross A Abrams, Nilofer Azad, Prajnan Das, Jadranka Dragovic, Karyn A Goodman, Salma K Jabbour, Andre A Konski, Albert C Koong, Rachit Kumar, Percy Lee, Timothy M Pawlik, William Small, Joseph M Herman
Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel...
April 2017: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28160269/infections-in-cancer-patients-with-solid-tumors-a-review
#19
REVIEW
Kenneth V I Rolston
Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses...
March 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/28134673/tolerability-and-long-term-outcomes-of-dose-painted-neoadjuvant-chemoradiation-to-regions-of-vessel-involvement-in-borderline-or-locally-advanced-pancreatic-cancer
#20
Jennifer Y Wo, Andrzej Niemierko, David P Ryan, Lawrence S Blaszkowsky, Jeffrey W Clark, Eunice L Kwak, Keith D Lillemoe, Lorraine N Drapek, Andrew X Zhu, Jill N Allen, Jason E Faris, Janet E Murphy, Ryan Nipp, Carlos Fernandez-Del Castillo, Cristina R Ferrone, Theodore S Hong
PURPOSE: We reviewed our experience involving patients with borderline resectable or locally advanced pancreatic cancer, treated with the dose-painted (DP) boost technique to regions of vessel involvement which preclude upfront surgical resection. We evaluated patient outcomes with respect to tolerability and treatment outcomes. MATERIALS AND METHODS: We retrospectively reviewed 99 patients with borderline resectable (n=25) or locally advanced pancreatic cancer (n=74) treated with DP-neoadjuvant chemoradiation from 2010 to 2015...
January 27, 2017: American Journal of Clinical Oncology
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