Latest Updates

Imaging Of Lung Disease, Part II: ­Cavities, Cysts, Nodules, And Masses

Eugene A Berkowitz, MD, PhD, Adam Bernheim, MD, Gerald W. Staton Jr, MD, FACP
    • Granulomatosis with polyangiitis, formerly called Wegener’s granulomatosis, is the most common pulmonary vasculitis and can present with (often cavitary) pulmonary nodules and/or consolidation
    • Tracheobronchial papillomatosis is now known to be caused by human papillomavirus (HPV) and has an association with squamous cell carcinoma
    • Algorithms for management of incidental solid and sub-solid pulmonary nodules are available to provide recommendations for optimal follow-up decisions
    • Data from the National Lung Screening Trial (NLST) demonstrated a 20% reduction in mortality with lung cancer screening CT and forms the rationale for lung cancer screening in high-risk patients
    • Lung cancer screening should utilize the American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS)

Fluid and Electrolyte Considerations for the Pediatric Surgical Patient

Denise B Klinkner, MD, MEd, TK Pandian, MD, Stephanie Polites, MD
    • Hyponatremia should be avoided by using isotonic fluids Glucose infusion rates apply to pediatric and adult patients.
    • Recognition and early management of sodium and electrolyte losses are critical to normal development.

Imaging of Lung Disease, Part i: Focal and Diffuse Parenchymal Lung Diseases

Eugene A Berkowitz, MD, PhD, Adam Bernheim, MD, Gerald W. Staton Jr, MD, FACP
    • Lung adenocarcinoma, now the most common primary lung cancer, has recently been reclassified pathologically (as in situ, minimally invasive, and invasive)
    • Rates of pulmonary tuberculosis are increasing in some locations and may present on chest imaging with (often cavitary) opacities with an upper lung predilection
    • While decreasing in incidence due to improving treatment for patients with human immunodeficiency virus (HIV) infection, Kaposi sarcoma remains an important acquired immunodeficiency syndrome (AIDS) defining neoplastic lesion that presents with bronchocentric opacities
    • A patient’s medication profile should always be considered because drug reactions are not uncommon, and utilization of some new medications does have an association with some drug reactions that must be recognized promptly
    • Rates of some pneumoconioses are decreasing in some locations due to increasing awareness and safety precautions, but silicosis, coal worker’s pneumoconiosis, asbestosis, and berylliosis still occur and often present with characteristic imaging patterns

Wrist Fractures and Dislocations

Jerry I Huang, MD, Rahul K Kasukurthi, MD, Angelo B Lipira, MD
    • Treatment of scapholunate and lunotriquetral injuries
    • Treatment of scaphoid fractures
    • Patient-tailored decision making for distal radius fractures
    • Volar- and fragment-specific fixation of distal radius fractures
    • Dorsal spanning plates for distal radius fractures

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

Isabelle E. Bauer, PhD, Marsal Sanches, MD, PhD, Jair C. Soares, MD, Antonio L Teixeira, MD, PhD
    • The DSM-5 includes new specifiers, such as mixed features, anxious distress, and peripartum onset. This addition will be helpful in making treatment-planning decisions related to suicide risk and treatment.
    • Neuroimaging findings showed that individuals with depressive disorders display alterations in the activity and connectivity of brain regions underlying reward and memory. This could explain symptoms such as reduced happiness, pleasure, and negative memories.
    • Neuroimaging techniques are gaining in importance in predicting treatment response and risk of relapse. For instance, patients with higher amygdalar activity are more likely to respond to psychotherapy.
    • There is no “one” way of treating depression, and treatment should be personalized. There are a number of effective treatments, including pharmacotherapy and psychotherapy (separately or combined) and neurostimulation. It is important that health professionals help patients find the right treatment for their needs.
    • Neuromodulation techniques such as vagal nerve stimulation and transcranial magnetic stimulation have been shown to have beneficial therapeutic effects. They are, however, long-term therapies, and medications are needed to manage some residual symptoms. 

Nondiabetic Endocrine Emergencies 1: Adrenal Crisis, Pheochromocytoma, And Hypopituitarism

Jason J Lewis, MD, Richard E Wolfe, MD
    • The hydrocortisone emergency injection kit can be used by patients with adrenal insufficiency in acute illness to help prevent acute adrenal crises.
    • Stabilization with alpha-adrenergic blockade first followed by beta-adrenergic blockade in catecholamine surge is essential.
    • Hypopituitarism can present with one or more hormonal deficiencies, and one should preemptively treat for adrenal crises with steroids prior to treatment of hypothyroidism as levothyroxine administration can precipitate adrenal crisis by increasing the metabolism of cortisol.

Hypopharyngeal, Esophageal, and Neck Reconstruction

Steven B Chinn, MD MPH, Peirong Yu, MD
    • The anterolateral thigh flap is the optimal flap for pharyngoesophageal reconstruction.
    • Salvage pharyngolaryngectomy reconstruction requires attention to detail to avoid catastrophic complications.
    • Transverse cervical vessels are the optimal recipients in a salvage, vessel-poor neck. 

Flexor Tendon Injuries

James Chang, MD, Paige M Fox, MD, PhD, Chao Long, AB, Lisa C Moody, MD
    • Tissue engineering of tendons, although not yet applied clinically, has the potential to address many of the challenges posed by flexor tendon injuries by developing off-the-shelf, ready-to-use tendon constructs available for tendon reconstruction.
    • Research on tissue engineering tendon-bone interface (TBI) constructs is also under way as a way to improve the inadequate healing between this interface when tendon is directly secured to bone.
    • Advances in recent years that manipulate mechanical and biologic factors involved in adhesion formation show potential as preventive strategies.
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