Latest Updates

Important Infections Due To Molds

Jaime S Green, MD, Jo-Anne H. Young, MD, FACP
    • Diagnostic technology is evolving for mold infections, advancing to include β-d-glucan, nucleic acid, or antigen testing, although this may not be available at all centers.
    • There are three general classes of antifungal agents, and the specific class used for an individual infection differs depending on whether the need to treat is superficial or invasive infection and on the preference for an oral or an intravenous agent in a specific situation.
    • Therapeutic drug monitoring is becoming more common with advanced azole treatment courses.
    • The epidemiology of a mold species responsible for an individual infection may depend on previous exposure to and treatment with various antifungal agents.

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Tumors of the Stomach and Small Bowel

David J. Bentrem, MD, FACS, L. Mark Knab, MD, Jeffrey D. Wayne, MD, FACS
    • The overall incidence of gastric carcinoma has decreased in the past few decades, but it remains the second leading cause of cancer death worldwide. In high-risk areas (e.g., Japan), mass screening programs have been successful in identifying early gastric cancer, which is generally amenable to surgical cure. Screening is not used in Western countries because the incidence of gastric cancer is low enough that screening is not cost-effective.
    • AJCC 8th edition staging manual for gastrointestinal tumors is included in this review.
    • One new method for the identification of small bowel tumors is wireless capsule endoscopy. This minimally invasive technique may be particularly useful in identifying small lesions in the distal jejunum and ileum that cannot be identified radiographically.

Tumors of the Stomach and Small Bowel

David J. Bentrem, MD, FACS, L. Mark Knab, MD, Jeffrey D. Wayne, MD, FACS
    • The overall incidence of gastric carcinoma has decreased in the past few decades, but it remains the second leading cause of cancer death worldwide. In high-risk areas (e.g., Japan), mass screening programs have been successful in identifying early gastric cancer, which is generally amenable to surgical cure. Screening is not used in Western countries because the incidence of gastric cancer is low enough that screening is not cost-effective.
    • AJCC 8th edition staging manual for gastrointestinal tumors is included in this review.
    • One new method for the identification of small bowel tumors is wireless capsule endoscopy. This minimally invasive technique may be particularly useful in identifying small lesions in the distal jejunum and ileum that cannot be identified radiographically.

Anorectal Disorders

Megan Fix, MD, Steven Glerum, MD
    • Abdominal radiographs to diagnose functional constipation in pediatric patients not indicated.
    • In unreliable pediatric patients, plain abdominal radiography may be useful.
    • PEG is recommended as first-line maintenance treatment for functional constipation.

Blunt Cerebrovascular Injuries

Clay Cothren Burlew, MD, FACS
    • Multislice (> 64 slice) computed tomographic angiography is the routine imaging test performed to identify blunt cerebrovascular injury (BCVI).
    • With noninvasive imaging used for BCVI identification, screening criteria have recently been expanded.
    • Antithrombotic treatment almost universally prevents BCVI-related stroke.
    • Endovascular therapy for BCVI should be reserved for those patients who are markedly symptomatic from their injury or have an enlarging pseudoaneurysm on repeat imaging.

Overview Of Schizophrenia And Other Psychotic Disorders

Donald W. Black, MD, James A Wilcox, DO, PhD
    • Psychotic disorders have been reclassified by grouping together those considered to fall within a schizophrenia spectrum.
    • Delusional disorder no longer requires the presence of nonbizarre delusions.
    • Schizophrenic subtypes (paranoid, disorganized, catatonic) were discontinued in the DSM-5. 2020 APA practice guidelines to be published.

Mechanical Ventilation: Advanced Ventilation and Adjuncts

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Adrian A. Maung, MD, FACS, FCCM
    • The use of prone positioning to improve the outcome in patients with acute respiratory distress syndrome
    • The use of neuromuscular blockade in patients with severe acute respiratory distress syndrome
    • High-flow nasal cannula therapy as a possible alternative to noninvasive positive-pressure ventilation
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