What's New | Decker

Amy L Halverson, MD, Massarat Zutshi, MD

Updated illustrations reflect perianal anatomy in greater detail
Detailed illustrations accompany descriptions of mucosal advancement flap, ligation of fistula tract, and episioproctotomy techniques
Additional discussion focuses on management of anovaginal fistulas

Marcia B Goldberg, MD, Molly Paras, MD

In the United States, norovirus is by far the most common cause of acute gastroenteritis. Susceptibility of individuals is determined in part by genetic makeup.
Norovirus is a cause of prolonged and disabling diarrhea among immunocompromised individuals.
Worldwide, Shigella species are the most common cause of diarrhea.
Shiga toxin may be produced by isolates of S. sonnei, as well as by isolates of E coli and S dysenteriae.
The rates of antibiotic resistance to several bacterial gastrointestinal pathogens continue to increase.

Donald W. Black, MD

Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
Research has implicated brain regions that control judgment and impulse control.
Cognitive-behavioral therapy may be helpful in mild cases.

Andrew Quinn, MD, Carolyn D. Runowicz, MD

Evidence that the 9-valent HPV vaccine covers approximately 20% more high-risk infections
Enhanced understanding of the benefits of cervical cancer screening
Interim evidence suggests primary HPV testing is an option for women starting at age 25 years

Thomas H. Cogbill, MD, Basem S Marcos, MD

Prevention of tube thoracostomy complications during insertion relies on three maneuvers: avoiding the neurovascular bundle by entering the pleura above the rib; performing a 360° finger sweep before placing the tube into the pleural space to ensure that there are no adhesions to the lung and to confirm the position of the thoracostomy above the diaphragm; and using a controlled pleural entry.
Pigtail catheter thoracostomy is equivalent to larger chest tube thoracostomy for treating uncomplicated pneumothorax. Insertion-site pain is much reduced with pigtail catheters when compared with larger chest tubes.
Pericardiocentesis for trauma has a very limited role in nontrauma centers where definitive surgical management of cardiac tamponade is not immediately available and transport time to a facility with a higher level of care would support use of temporary pericardial decompression in this manner.
Temporal artery biopsy remains important to confirm the diagnosis of giant cell arteritis because the sensitivity and specificity of diagnosis based on clinical criteria alone are only 68.5% and 58%, respectively.
Skeletal muscle biopsy specimens should be immediately submitted to Pathology fresh and wrapped in dry gauze, and the precise muscle biopsied must be recorded as there is variability in the type of collagen present in different muscle groups that may affect interpretation.

Thomas H. Cogbill, MD, Basem S Marcos, MD

Percutaneous tracheostomy can be performed with perioperative morbidity and mortality rates equal to open tracheostomy. The risk of surgical site infection is considerably less with percutaneous tracheostomy.
Intraosseous access is recommended for patients in extremis for whom a peripheral venous catheter is not readily established; blood, fluids, and medications can be effectively administered via this route until reliable venous access is obtained.
The success rate of central venous catheterization is significantly enhanced with the use of ultrasonography, especially when accessing the internal jugular vein.
The fourth to fifth intercostal space, anterior axillary line, is the preferred site for needle chest decompression of tension pneumothorax. Decompression is more likely to be successful due to less chest wall thickness at this site when compared with the traditional second intercostal space, midclavicular line.

Horacio J Adrogué, MD, Nicolaos E Madias, MD

Horacio J Adrogué, MD, Nicolaos E Madias, MD

Gastroenterology