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Essential Surgical Knowledge

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2065 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/29321547/polycythemia-vera-treatment-algorithm-2018
#1
REVIEW
Ayalew Tefferi, Alessandro M Vannucchi, Tiziano Barbui
Recently reported mature survival data have confirmed the favorable prognosis in polycythemia vera (PV), with an estimated median survival of 24 years, in patients younger than age 60 years old. Currently available drugs for PV have not been shown to prolong survival or alter the natural history of the disease and are instead indicated primarily for prevention of thrombosis. Unfortunately, study endpoints that are being utilized in currently ongoing clinical trials in PV do not necessarily target clinically or biologically relevant outcomes, such as thrombosis, survival, or morphologic remission, and are instead focused on components of disease palliation...
January 10, 2018: Blood Cancer Journal
https://www.readbyqxmd.com/read/29297387/personalised-fluid-resuscitation-in-the-icu-still-a-fluid-concept
#2
REVIEW
Frank van Haren
The administration of intravenous fluid to critically ill patients is one of the most common, but also one of the most fiercely debated, interventions in intensive care medicine. Even though many thousands of patients have been enrolled in large trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Critically ill patients are significantly heterogeneous, making a one size fits all approach unlikely to be successful.New data from basic, animal, and clinical research suggest that fluid resuscitation could be associated with significant harm...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29331260/multifaceted-behavior-of-meckel-s-diverticulum-in-children
#3
Qingjiang Chen, Zhigang Gao, Lifeng Zhang, Yuebin Zhang, Tao Pan, Duote Cai, Qixing Xiong, Qiang Shu, Yunzhong Qian
PURPOSE/BACKGROUND: Meckel's diverticulum (MD) is one of the most common congenital malformations of gastrointestinal tract in children. However, the nonspecific clinical manifestations of MD often cause a diagnostic as well as therapeutic challenge to pediatric surgeon. This study aimed to review our experience in managing this disease while evaluating the management strategies. METHODS: We retrospectively analyzed the clinical data of all patients diagnosed with MD admitted to our center between January 2010 and December 2015...
December 5, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29291601/diagnostic-endoscopic-ultrasound-technique-current-status-and-future-directions
#4
REVIEW
Tiing Leong Ang, Andrew Boon Eu Kwek, Lai Mun Wang
Endoscopic ultrasound (EUS) is now well established as an important tool in clinical practice. From purely diagnostic imaging, it has progressed to include tissue acquisition, which provided the basis for therapeutic procedures. Even as interventional EUS developed, there has been ongoing progress in EUS diagnostic capabilities due to improved imaging systems, better needles for tissue acquisition and development of enhanced imaging functions such as contrast harmonic EUS (CHEUS) and EUS elastography. EUS is well established for differentiation of subepithelial lesions, for T-staging of luminal gastrointestinal and pancreaticobiliary malignancies, for differentiation of benign pancreaticobiliary disorders and for diagnostic tissue acquisition, which can be achieved by EUS-guided fine needle aspiration or by EUS-guided fine needle biopsy using dedicated biopsy needles...
January 3, 2018: Gut and Liver
https://www.readbyqxmd.com/read/29315649/current-principles-of-surgery-for-retroperitoneal-sarcomas
#5
REVIEW
Mark Fairweather, Ricardo J Gonzalez, Dirk Strauss, Chandrajit P Raut
Surgery for primary retroperitoneal sarcomas (RPS) often requires a technically challenging, en bloc multivisceral resection to optimize outcomes. Surgery may also be appropriate for patients with localized recurrent RPS. Anatomic considerations and tumor biology driven by histologic subtype may guide the extent of resection in patients with RPS. This review provides an overview of the current surgical principles for primary and recurrent RPS.
January 8, 2018: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29316119/solid-pseudopapillary-tumour-of-the-pancreas-clinicopathological-analysis
#6
Simon McCluney, Nilukshi Wijesuriya, Vinayata Sheshappanavar, Joanne Chin-Aleong, Roger Feakins, Robert Hutchins, Ajit Abraham, Satyajit Bhattacharya, Roberto Valente, Hemant Kocher
BACKGROUND: We report on our experience of the surgical management and outcomes of 11 patients with solid pseudopapillary tumour of the pancreas (SPT). We sought to correlate the immunohistochemical staining of these tumours with that previously reported in the literature. METHODS: A retrospective analysis of the clinical presentation, radiological findings, surgical treatment, histopathological characteristics and outcomes for patients surgically managed with SPT at The Royal London Hospital...
January 8, 2018: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29310137/diagnosis-of-venous-thromboembolism-20-years-of-progress
#7
Philip S Wells, Ryma Ihaddadene, Aiofe Reilly, Melissa Anne Forgie
Many guidelines suggest incorporating clinical assessment, imaging, and D-dimer testing into diagnostic algorithms in patients with suspected deep venous thrombosis (DVT) and pulmonary embolism (PE). This special article reviews the evidence supporting the use of algorithms and their individual components for diagnosis of upper- and lower-extremity DVT and PE in adults, including pregnant women. The authors identified evidence through several electronic database searches to April 2017, evaluated the robustness of selected evidence, assessed whether diagnostic approaches that do not use algorithms are acceptable, and identified knowledge gaps that require further research...
January 9, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29301740/urgent-reversal-of-vitamin-k-antagonists
#8
Beverley J Hunt, Marcel Levi
No abstract text is available yet for this article.
January 4, 2018: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29303803/postoperative-eras-interventions-have-the-greatest-impact-on-optimal-recovery-experience-with-implementation-of-eras-across-multiple-hospitals
#9
Mary-Anne Aarts, Ori D Rotstein, Emily A Pearsall, J Charles Victor, Allan Okrainec, Marg McKenzie, Stuart A McCluskey, Lesley Gotlib Conn, Robin S McLeod
BACKGROUND: Enhanced recovery after surgery (ERAS) programs incorporate evidence-based practices to minimize perioperative stress, gut dysfunction, and promote early recovery. However, it is unknown which components have the greatest impact. OBJECTIVE: This study aims to determine which components of ERAS programs have the largest impact on recovery for patients undergoing colorectal surgery. METHODS: An iERAS program was implemented in 15 academic hospitals...
January 4, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29293183/american-society-for-enhanced-recovery-and-perioperative-quality-initiative-joint-consensus-statement-on-postoperative-gastrointestinal-dysfunction-within-an-enhanced-recovery-pathway-for-elective-colorectal-surgery
#10
Traci L Hedrick, Matthew D McEvoy, Michael Monty G Mythen, Roberto Bergamaschi, Ruchir Gupta, Stefan D Holubar, Anthony J Senagore, Tong Joo Gan, Andrew D Shaw, Julie K M Thacker, Timothy E Miller, Paul E Wischmeyer, Franco Carli, David C Evans, Sarah Guilbert, Rosemary Kozar, Aurora Pryor, Robert H Thiele, Sotiria Everett, Mike Grocott, Ramon E Abola, Elliott Bennett-Guerrero, Michael L Kent, Liane S Feldman, Julio F Fiore
The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus...
December 29, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29268916/the-society-for-vascular-surgery-practice-guidelines-on-the-care-of-patients-with-an-abdominal-aortic-aneurysm
#11
Elliot L Chaikof, Ronald L Dalman, Mark K Eskandari, Benjamin M Jackson, W Anthony Lee, M Ashraf Mansour, Tara M Mastracci, Matthew Mell, M Hassan Murad, Louis L Nguyen, Gustavo S Oderich, Madhukar S Patel, Marc L Schermerhorn, Benjamin W Starnes
BACKGROUND: Decision-making related to the care of patients with an abdominal aortic aneurysm (AAA) is complex. Aneurysms present with varying risks of rupture, and patient-specific factors influence anticipated life expectancy, operative risk, and need to intervene. Careful attention to the choice of operative strategy along with optimal treatment of medical comorbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative surveillance is necessary to minimize subsequent aneurysm-related death or morbidity...
January 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29247356/current-and-future-pharmacological-therapies-for-nafld-nash
#12
REVIEW
Yoshio Sumida, Masashi Yoneda
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease worldwide, and there is no approved pharmacotherapy. The efficacy of vitamin E and pioglitazone has been established in nonalcoholic steatohepatitis (NASH), a progressive form of NAFLD. GLP-1RA and SGLT2 inhibitors, which are currently approved for use in diabetes, have shown early efficacy in NASH, and also have beneficial cardiovascular or renal effects. Innovative NASH therapies include four main pathways. The first approach is targeting hepatic fat accumulation...
December 16, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/29282510/changes-in-clinical-practice-reduce-the-rate-of-anastomotic-leakage-after-colorectal-resections
#13
Henrik Iversen, Madelene Ahlberg, Marja Lindqvist, Christian Buchli
BACKGROUND: Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections. METHODS: Retrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed...
December 28, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29253554/heparin-induced-thrombocytopenia-in-the-critically-ill-patient
#14
REVIEW
James M East, Christine Cserti- Gazdewich, John T Granton
Heparin induced thrombocytopenia (HIT) is associated with significant morbidity and mortality. Critically ill patients are commonly thrombocytopenic and exposed to heparin. Although HIT should be considered, it is not usually the cause of thrombocytopenia in the medical-surgical ICU population. A systematic approach to the critically ill patient with thrombocytopenia using clinical features, complemented by appropriate laboratory confirmation should lead to a reduction in inappropriate laboratory testing and reduce the use of more expensive and less reliable anticoagulants...
December 15, 2017: Chest
https://www.readbyqxmd.com/read/29255070/how-i-treat-disseminated-intravascular-coagulation
#15
Marcel Levi, Marie Scully
Disseminated intravascular coagulation (DIC) is a condition characterised by systemic activation of coagulation, potentially leading to thrombotic obstruction of small and midsize vessels, thereby contributing to organ dysfunction. At the same time, ongoing consumption of platelets and coagulation proteins results in thrombocytopenia and low concentrations of clotting factors, which may cause profuse hemorrhagic complications. DIC is always secondary to an underlying condition, such as severe infections, solid or hematologic malignancies, trauma, or obstetric calamities...
December 18, 2017: Blood
https://www.readbyqxmd.com/read/29259657/the-10th-anniversary-of-patient-safety-in-surgery
#16
EDITORIAL
Philip F Stahel, Wade R Smith, Ernest E Moore, Philip S Mehler, Sebastian Weckbach, Fernando J Kim, Nathan Butler, Hans-Christoph Pape, Ted J Clarke, Martin A Makary, Pierre-Alain Clavien
No abstract text is available yet for this article.
2017: Patient Safety in Surgery
https://www.readbyqxmd.com/read/29251646/use-of-uncrossmatched-erythrocytes-in-emergency-bleeding-situations
#17
Mark H Yazer, Jonathan H Waters, Philip C Spinella, Col Andrew Cap, Capt Roland L Fahie, Emmett Gourdine, Donald H Jenkins, Steven Kleinman, Ernest E Moore, Paul Ness, Eilat Shinar, Steve R Sloan, James R Stubbs, Kevin R Ward
No abstract text is available yet for this article.
December 15, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29199388/efficacy-and-safety-of-stress-ulcer-prophylaxis-in-critically-ill-patients-a-network-meta-analysis-of-randomized-trials
#18
REVIEW
Waleed Alhazzani, Fayez Alshamsi, Emilie Belley-Cote, Diane Heels-Ansdell, Romina Brignardello-Petersen, Mustafa Alquraini, Anders Perner, Morten Hylander Møller, Mette Krag, Saleh Almenawer, Bram Rochwerg, Joanna Dionne, Roman Jaeschke, Mohammed Alshahrani, Adam Deane, Dan Perri, Lehana Thebane, Awad Al-Omari, Simon Finfer, Deborah Cook, Gordon Guyatt
PURPOSE: Stress ulcer prophylaxis (SUP) is commonly prescribed in the intensive care unit. However, data from systematic reviews and conventional meta-analyses are limited by imprecision and restricted to direct comparisons. We conducted a network meta-analysis of randomized clinical trials (RCTs) to examine the safety and efficacy of drugs available for SUP in critically ill patients. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2017 for randomized controlled trials that examined the efficacy and safety of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), and sucralfate for SUP in critically ill patients...
December 4, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/29153290/locally-advanced-pancreatic-cancer-an-emerging-entity
#19
REVIEW
Grainne M O Kane, Jennifer J Knox
Pancreatic adenocarcinoma (PDAC) remains a highly fatal disease that is increasing in incidence. PDAC can be classified according to resectability status with 3 nonmetastatic groups defined: resectable, borderline resectable, and locally advanced PDAC (LAPC). Delineating these subtypes is important with the optimal treatment approach dictated by high-quality CT imaging and multidisciplinary team discussion. Patients with LAPC are thought unresectable and are therefore rarely cured. In these patients, chemotherapy remains the mainstay of treatment...
November 16, 2017: Current Problems in Cancer
https://www.readbyqxmd.com/read/29203195/2017-acc-expert-consensus-decision-pathway-on-management-of-bleeding-in-patients-on-oral-anticoagulants-a-report-of-the-american-college-of-cardiology-task-force-on-expert-consensus-decision-pathways
#20
Gordon F Tomaselli, Kenneth W Mahaffey, Adam Cuker, Paul P Dobesh, John U Doherty, John W Eikelboom, Roberta Florido, William Hucker, Roxana Mehran, Steven R Messé, Charles V Pollack, Fatima Rodriguez, Ravindra Sarode, Deborah Siegal, Barbara S Wiggins
No abstract text is available yet for this article.
December 19, 2017: Journal of the American College of Cardiology
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