- CT of the chest has taken a greater role in determining injury severity in inhalation injury.
- Airway control and ventilator management remain the mainstays of treatment in those with severe injury.
- Volumetric diffusive respiration is a mode specifically developed for inhalation injury that has been shown to decrease use of other rescue modes of ventilation.
Latest Updates
Injuries to the Upper Urogenital Tract
- Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
- Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
- A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy
- Visceral artery aneurysms are increasingly identified with the widespread use of advanced imaging techniques.
- Increasing incidence is thought to be linked with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma.
- Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies.
- Members of the European Organisation for Research and Treatment of Cancer–Invasive Fungal Infection Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for invasive fungal infections for clinical research.
- The development of standardized methodology for antifungal susceptibility testing is another recent advance in the laboratory evaluation of Aspergillus species. Although azole resistance by Aspergillus species is unusual, patients exposed chronically to antifungal triazoles have been reported to have refractory infection caused by isolates with elevated minimum inhibitory concentrations.
- Fusarium and Scedosporium species are increasingly common causes of infections in surgical patients, especially in recipients of stem cell or organ transplants.
- Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
- Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
- Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.
- Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
- Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
- Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.
Management of Depression, Part 1: Identification and Diagnosis
- The two leading classification systems for diagnosing mental illness are the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association and the ICD-10, the most recent edition of the International Classification of Diseases published by the World Health Organization.
- There is no standard medical workup for a patient presenting with depression. Health care providers use their clinical judgment in conjunction with a good history, review of medical systems, and physical examination. Indiscriminate ordering of laboratory tests in depressed patients rarely yields useful results. A pooled analysis of psychiatric inpatients showed the rates of clinically significant laboratory findings to be remarkably low.
- Single-photon emission CT (SPECT) has been promoted by some as a reliable tool in diagnosing and treating a number of psychiatric disorders, including depression. SPECT measures regional cerebral blood flow using a gamma-emitting tracer in the blood.
- Ultrasonography criteria for the diagnosis of early pregnancy loss have recently been redefined.
- Medical and surgical management are safe and effective, and should be influenced largely by patient preference.
- Recommendations regarding interval to next conception have recently shifted away from the traditional 3 months.
