Latest Updates

Reconstruction of the Thumb after Traumatic Tissue Loss

James E Clune, MD, Neil F Jones, MD
    • Microsurgical toe transfer in children after traumatic amputation
    • Single stage thumb reconstruction
    • Cultural considerations in thumb reconstruction

Pathophysiology and Treatment of Infection Stones

Patrick T Gomella, MD, MPH, Patrick W Mufarrij, MD
    • Pathophysiology of infection stone formation
    • Workup of patients suspected of having infection stones, including imaging
    • Surgical management
    • Medical Therapy

Common Congenital Hand Differences

Scott Kozin, MD, Francisco Soldado, MD, PhD
    • The child’s global health and genetic counseling should be addressed before focusing on the upper limb disorder.
    • The main aim when treating these disorders is improving hand function; however, aesthetics must also be considered when planning surgery.
    • Reoperation rates are high for even the most common congenital hand defects treated by experienced surgeons.

Management of Shock in Infants and Children

David H Rothstein, MD, MS, Arianne T Train, DO
    • Sepsis recognition and treatment pathways
    • Noninvasive monitoring tools
    • Automation of shock alerts using an electronic medical record
    • Personalized treatment based on genetic profiling/biomarkers

Invasive Hemodynamic Monitoring in the Intensive Care Unit

Michael C Chang, MD, Mary Garland, MD
    • Employment of invasive methods of hemodynamic monitoring allows the bedside estimation of global cardiovascular function and the independent determinants of cardiac function
    • Global cardiac function and preload can be estimated with a peripheral arterial line.
    • Assessment of adequacy of cardiac function during resuscitation from shock involves measurement of both blood flow and blood pressure.

The Risk Of Surgery In Patients With Liver Disease 2

Adrian Reuben, BSc, MBBS, FRCP, FACG, FAASLD
    • Presents extensive evidence-based appreciation of the risks of operating on patients with some non-cirrhotic liver disease, particularly various forms of acute hepatitis —especially alcoholic—acute liver failure, steatosis, and steatohepatitis, and rare entities such as Wilson disease.
    • Substantiates the relative safety of minimally invasive surgery in patients with mild or moderately advanced cirrhosis, compared to open surgery, for many operations.
    • Amasses numerous clinical results that link the outcomes of a wide spectrum of surgical operations in patients with cirrhosis to indices of severity of liver injury, especially the Child-Turcotte-Pugh (CTP) score and class, and/or the model for end-stage liver disease (MELD) score.
    • Describes a decision tree devised to guide clinicians in determining whether or not to proceed to surgery in any given patient with acute or chronic liver disease, depending on the severity of the liver disease. 

Medical Management of Neurogenic Bladder

Anne P Cameron, MD, FRCSC, FPMRS, John T Stoffel, MD, FPMRS

    • First -line therapy for neurogenic bladder with detrusor overactivity, poor compliance, or related incontinence areis antimuscarinic agents,; however, treatment failures need to be addressed quickly, with dose optimization and progression to botulinum toxin.
    • Endless cycling of different oral medications that are ineffective is of little value to the patient because most are pharmacologically quite similar. The provider must move to a more effective therapy, such as botulinum toxin, in a timely fashion.
    • Desmopressin is an often overlooked therapy for nocturnal polyuria, and if other reversible causes are treated and the patient is properly screened, this can be a very therapeutic intervention.

Ureteroscopic Stone Treatment

Jacob T Ark, MD, Tracy P Marien, MD, Nicole L Miller, MD

    • Variable laser settings
    • Working wires
    • Troubleshooting difficult ureteral access

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