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Essential Surgical Knowledge

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2200 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
David J Feller-Kopman, Chakravarthy B Reddy, Malcolm M DeCamp, Rebecca L Diekemper, Michael K Gould, Travis Henry, Narayan P Iyer, Y C Gary Lee, Sandra Z Lewis, Nick A Maskell, Najib M Rahman, Daniel H Sterman, Momen M Wahidi, Alex A Balekian
BACKGROUND: This Guideline, a collaborative effort from the American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology, aims to provide evidence-based recommendations to guide contemporary management of patients with a malignant pleural effusion (MPE). METHODS: A multidisciplinary panel developed seven questions using the PICO (Population, Intervention, Comparator, and Outcomes) format. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the Evidence to Decision framework was applied to each question...
October 1, 2018: American Journal of Respiratory and Critical Care Medicine
Srijan Tandukar, Paul M Palevsky
Continuous renal replacement therapy (CRRT) is commonly employed to provide renal support for critically ill patients with acute kidney injury (AKI); particularly patients who are hemodynamically unstable. A variety of techniques that vary in their mode of solute clearance may be used, including continuous venovenous hemofiltration (CVVH) with predominantly convective solute clearance, continuous venovenous hemodialysis (CVVHD) with predominantly diffusive solute clearance and continuous venovenous hemodiafiltration (CVVHDF), which combines both dialysis and hemofiltration...
September 25, 2018: Chest
Emery N Brown, Kara J Pavone, Marusa Naranjo
Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids...
September 24, 2018: Anesthesia and Analgesia
Ralph R Weichselbaum
Metastasis from most adult solid tumors generally has been considered to be widespread and incurable. Here, I present clinical and molecular data to support the hypothesis that some metastases are limited in number and pace and are curable with ablative therapies. I advance the hypothesis that immunotherapy combined with radiotherapy may be a general strategy to increase the number of patients with metastatic cancer amenable to cure. I further suggest that, in the context of ablative radiotherapy, the potential synergies between immunotherapy and radiotherapy are principally within the local tumor microenvironment and require treatment of all or most sites of metastatic disease...
September 27, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
John L Falcone
BACKGROUND: American Board of Surgery examination performance represents an important residency metric. The hypothesis is that demographic differences exist between the most and least successful programs. METHODS: This was a retrospective fifteen-year study. Data focused on program Examination Index (EI). The first and tenth decile programs were compared across demographics, using an α = 0.05. RESULTS: The first decile had a higher EI than the tenth decile (91...
September 7, 2018: American Journal of Surgery
Jeremy H Kaplan, Tamas A Gonda
Cyst fluid biomarkers may be used to identify pancreatic cyst subtypes. Biomarkers are selected based on their ability to accurately distinguish mucinous from nonmucinous cysts and to risk stratify cysts based on malignant potential. Biomarkers of interest include but are not limited to amylase, oncogenes, DNA analysis, and epigenetic markers. The introduction of next-generation sequencing and molecular panels has aided in improved diagnostic accuracy and risk stratification. This review presents the diagnostic performance of currently available biomarkers and proposes an algorithm to incorporate their use in the diagnosis of pancreatic cysts...
October 2018: Gastrointestinal Endoscopy Clinics of North America
Seung Mok Ryoo, Ryeok Ahn, JungBok Lee, Chang Hwan Sohn, Dong Woo Seo, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Won Young Kim
BACKGROUND: The objective of this study was to evaluate the prognostic value of lactate levels during the first 12 hours after shock development and to identify the optimal timing for repeated lactate measurements in patients with septic shock. METHODS: We conducted a retrospective cohort study using a prospective data registry, and enrolled 2,226 consecutive adult patients with septic shock between January 2010 and December 2015. Blood lactate was measured at shock development, and after 2, 4, 6 and 12 hours (T0 , T2 , T4 , T6 and T12 ) during protocol-driven resuscitation bundle therapy...
August 2018: American Journal of the Medical Sciences
Stavros A Antoniou, Sofia Tsokani, Dimitrios Mavridis, Manuel López-Cano, George A Antoniou, Dimitrios Stefanidis, Nader K Francis, Neil Smart, Filip E Muysoms, Salvador Morales-Conde, Hendrik Jaap Bonjer, Melissa C Brouwers
OBJECTIVE: The aim of the study was to identify clinical practice guidelines published by surgical scientific organizations, assess their quality, and investigate the association between defined factors and quality. The ultimate objective was to develop a framework to improve the quality of surgical guidelines. SUMMARY BACKGROUND DATA: Evidence on the quality of surgical guidelines is lacking. METHODS: We searched MEDLINE for clinical practice guidelines published by surgical scientific organizations with an international scope between 2008 and 2017...
September 4, 2018: Annals of Surgery
Francisco Schlottmann, Charles Gaber, Paula D Strassle, Marco G Patti, Anthony G Charles
BACKGROUND: Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis. METHODS: We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000-2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included...
September 17, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ben Goldacre, Nicholas J DeVito, Carl Heneghan, Francis Irving, Seb Bacon, Jessica Fleminger, Helen Curtis
OBJECTIVES: To ascertain compliance rates with the European Commission's requirement that all trials on the EU Clinical Trials Register (EUCTR) post results to the registry within 12 months of completion (final compliance date 21 December 2016); to identify features associated with non-compliance; to rank sponsors by compliance; and to build a tool for live ongoing audit of compliance. DESIGN: Retrospective cohort study. SETTING: EUCTR. PARTICIPANTS: 7274 of 11 531 trials listed as completed on EUCTR and where results could be established as due...
September 12, 2018: BMJ: British Medical Journal
Colleen M Trevino, Tracy VandeWater, Travis P Webb
BACKGROUND: Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems. METHODS: A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review...
August 29, 2018: American Journal of Surgery
Shubham Pant, Joleen Hubbard, Erika Martinelli, Tanios Bekaii-Saab
KRAS mutations are common in pancreatic and colorectal cancers and are associated with lack of response to anti-epidermal growth factor receptor therapy. Ras is an established therapeutic target that has long eluded efforts to develop specific inhibitors, while targeting downstream signaling pathways has proven largely ineffective, highlighting a need for rational combination strategies to overcome resistance. Recently, renewed interest in directly targeting Ras has led to the development of several small-molecule inhibitors that bind directly to K-Ras or its effector proteins, downregulation of K-Ras expression using therapeutic antisense oligonucleotides or siRNAs, and targeting scaffold proteins such as kinase suppressor of Ras...
October 2018: Critical Reviews in Oncology/hematology
Rory Spiegel, Joshua D Farkas, Philippe Rola, Jon-Emile Kenny, Segun Olusanya, Paul E Marik, Scott D Weingart
No abstract text is available yet for this article.
August 30, 2018: Annals of Emergency Medicine
Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow, Harvey D White
No abstract text is available yet for this article.
August 23, 2018: Journal of the American College of Cardiology
S G Parker, S Halligan, S Blackburn, A A O Plumb, L Archer, S Mallett, A C J Windsor
Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty...
September 5, 2018: World Journal of Surgery
Rebecca Saunders, Jayapal Ramesh, Silvia Cicconi, Jonathan Evans, Vincent S Yip, Michael Raraty, Paula Ghaneh, Robert Sutton, John P Neoptolemos, Christopher Halloran
BACKGROUND: The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed. METHOD: We conducted a database search for original comparative studies between plastic and metal stents...
September 6, 2018: Surgical Endoscopy
Justin L Regner, Matthew J Forestiere, Yolanda Munoz-Maldonado, Richard Frazee, Travis S Isbell, Claire L Isbell, Randall W Smith, Stephen W Abernathy
A negative pressure wound therapy (NPWT) protocol using Hydrofera Blue® bacteriostatic foam wicks and silver-impregnated foam overlay to close midline skin incisions after emergency celiotomy was compared to primary skin closure only and traditional open wound vacuum-assisted closure management as part of a quality improvement initiative. This single-institution retrospective cohort study assessed all consecutive emergency celiotomies from July 2013 to June 2014 excluding clean wounds. Included variables were demographics, wound classification, NPWT days, and surgical site occurrences (SSOs)...
January 2018: Proceedings of the Baylor University Medical Center
Isacco Montroni, Giampaolo Ugolini, Nicole M Saur, Antonino Spinelli, Siri Rostoft, Monica Millan, Albert Wolthuis, Ian R Daniels, Roel Hompes, Marta Penna, Alois Fürst, Demetris Papamichael, Avni M Desai, Stefano Cascinu, Jean-Pierre Gèrard, Arthur Sun Myint, Valery E P P Lemmens, Mariana Berho, Mark Lawler, Nicola De Liguori Carino, Fabio Potenti, Oriana Nanni, Mattia Altini, Geerard Beets, Harm Rutten, David Winchester, Steven D Wexner, Riccardo A Audisio
With an expanding elderly population and median rectal cancer detection age of 70 years, the prevalence of rectal cancer in elderly patients is increasing. Management is based on evidence from younger patients, resulting in substandard treatments and poor outcomes. Modern management of rectal cancer in the elderly demands patient-centered treatment, assessing frailty rather than chronological age. The heterogeneity of this group, combined with the limited available data, impedes drafting evidence-based guidelines...
August 15, 2018: European Journal of Surgical Oncology
Britany L Raymond, Jonathan P Wanderer, Alexander T Hawkins, Timothy M Geiger, Jesse M Ehrenfeld, John W Stokes, Matthew D McEvoy
BACKGROUND: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Surgical Risk Calculator (ACS Calculator) provides empirically derived, patient-specific risks for common adverse perioperative outcomes. The ACS Calculator is promoted as a tool to improve shared decision-making and informed consent for patients undergoing elective operations. However, to our knowledge, no data exist regarding the use of this tool in actual preoperative risk discussions with patients...
August 29, 2018: Anesthesia and Analgesia
E Akgun, C Caliskan, O Bozbiyik, T Yoldas, M Sezak, S Ozkok, T Kose, B Karabulut, M Harman, O Ozutemiz
BACKGROUND: The optimal timing of surgery following preoperative chemoradiotherapy (CRT) is controversial. This trial aimed to compare pathological complete response (pCR) rates obtained after an interval of 8 weeks or less versus more than 8 weeks. METHODS: Patients with locally advanced rectal adenocarcinoma situated within 12 cm of the anal verge (T3-4 or N+ disease) were randomized to undergo total mesorectal excision (TME) within 8 weeks (classical interval, CI group) or after 8 weeks (long interval, LI group) following CRT...
August 29, 2018: British Journal of Surgery
2018-09-01 15:16:43
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