Latest Updates

Endovascular Techniques in Mesenteric Ischemia

M Ashraf Mansour, MD, MBA, FACS, Sarah E Strot, DO
    • Endovascular therapy (EVT) has become the first-line treatment of choice for revascularization in chronic mesenteric ischemia. It offers better short-term morbidity over open repair but does have a decreased long-term primary patency, requiring higher rates of reintervention. Reintervention is associated with low mortality and excellent symptom improvement. Secondary patency is similar between open repair and EVT.
    • EVT has become the first-line treatment of choice for acute mesenteric ischemia in some centers with skilled interventionalists. This has reduced the need for laparotomy in patients presenting without peritoneal signs and suspicion of bowel necrosis. A high index of suspicion should remain in these patients, and hesitation should not be made for laparotomy should the patient decline clinically.
    • Retrograde open superior mesenteric stenting during laparotomy has provided an alternative to surgical bypass in the critically ill patient with AMI. This technique allows inspection and resection of the nonviable bowel.
    • Currently accepted surveillance duplex ultrasonography (DUS) criteria for native mesenteric arteries have a poor correlation with in-stent restenosis after mesenteric angioplasty and stenting. Given the high rate of recurrence, lack of accepted DUS criteria can make clinical decision making difficult regarding reintervention. New velocity criteria have been proposed but require validation in individual laboratories.

Dermatologic Wounds

Luis J Borda, MD, Jose A Jaller, MD, Penelope J Kallis, BS, Robert S Kirsner, MD, PhD
    • Compression should be considered in patients with leg ulcers and  ankle brachial index greater  than 0.8.
    • Pyoderma gangrenosum lesions ≤2 cm2 may benefit from topical/intralesional corticosteroids
    • Chronic hydroxyurea therapy may lead to leg ulcers. Lesions typically occur near the malleolar area.
    • Proper diagnosis/therapy of the underlying condition are key when clinicians are face atypical wounds.  

Diagnostic and Therapeutic Principles In Allergy

Mitchell H. Grayson, MD, Peter Mustillo, MD
    • Development of biologic therapies (primarily anti-cytokine) for the treatment of allergic diseases including asthma.
    • Use of sIgE component testing for diagnosis and treatment of food allergy
    • Early peanut introduction to prevent peanut allergy
    • Novel treatment options for food allergy

Medical Management of Transplant Patients

Nelson B Goes, MD, Nidyanandh Vadivel, MB, BCh
    • Alternatives therapies calcineurin inhibitors to prevent kidney allograft fibrosis.
    • Maintenance immunosuppression with belatacept preserves glomerular filtration and increases kidney allograft survival.
    • Better understanding and management of post transplant diabetes mellitus.

Upper Blepharoplasty

Tiffany N Ballard, MD, Robert H Gilman, MD, DMD
    • The crush and snip technique is a quick and relatively bloodless method for skin removal in blepharoplasty.
    • Care should be taken not to overresect fat and leave a sunken appearance to the upper eyelid.
    • A simple Q-stick swab is one of the most useful instruments for the procedure of blepharoplasty.

Postresuscitation Management And Outcomes

Shamai A. Grossman, MD, MS, Patrick Hughes, MD, Oren Mechanic, MD, MPH
    • Therapeutic hypothermia is recommended for comatose survivors of cardiac arrest. The most recent evidence suggests that avoiding pyrexia may be the most important factor.
    • The AHA recommends against prehospital cooling with cold intravenous fluid.
    • Percutaneous coronary intervention is an independent predictor of survival.
    • Prognostication is not recommended until 72 hours after return to normothermia in patients undergoing therapeutic hypothermia.
    • Debriefing has been shown to improve several metrics of subsequent resuscitations.

Evaluation Of Elevated Transaminases In Children

Udeme D Ekong, MD, MPH, Pamela L Valentino, MD, MSc, FRCPC
    • The threshold for the upper limit of normal for ALT is lower in children than previously reported based on studies of healthy, nonobese children.
    • NAFLD needs to be identified and addressed in childhood as obese adolescents have a higher rate of complications in adulthood.
    • NAFLD is a common indication for liver transplantation in adults.

Viral Hepatitis C: Treatment

Raymond T. Chung, MD, Jacinta A Holmes, MBBS, PhD, Anna Lidofsky, BS, Jay Luther, MD, Stephanie M Rutledge, MBBCh BAO MRCPI
    • Recent advances in treatment of chronic HCV to include interferon-free direct-acting antiviral agent regimens
    • Latest treatment recommendations, including special populations
    • Issues surrounding treatment-emergent resistance-associated variants 
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