Latest Updates

Infrainguinal Arterial Procedures

Amy B. Reed, MD, FACS
    • varying imaging modalities for planning
    • variety of options for lower extremity bypass
    • incorporation of endovascular techniques with bypass

Conservative Management of Acute Kidney Injury

Rolando Claure-Del Granado, MD, FASN, Etienne Macedo, MD, PhD, Ravindra L. Mehta, MD, FASN
    • Approaches to breast augmentation in the male-to-female transgender patient require special attention outside of conventional breast augmentations.
    • Understanding the differences in the nipple-areola complex (NAC) between females and males when undertaking gender-confirming breast augmentations
    • Special consideration is needed for the clitoral and urethral anatomy in gender-confirming vaginoplasty.
    • Postoperative care and complications in gender-confirming vaginoplasty require close follow-up and consideration. 

Vascular Anomalies

Javier A Couto, MD, Arin K Greene, MD, MMSc
    • Sirolimus is an effective systemic medication for lymphatic malformations
    • Infantile hemangiomas do not improve significantly after 3 years of age; thus, intervention for a residual deformity should not be prolonged after this time
    • The somatic mutation for most vascular anomalies has recently been discovered, providing the potential for the development of pharmacotherapy for these lesions

Surgical Management of the Breast

Anees B Chagpar, MD, MSc, MPH, MA, MBA
    • Diagnosis of breast cancer: from open biopsy of palpable lesions to minimally invasive image-guided core-needle biopsy
    • Extirpation of primary breast cancer: from mastectomy to breast conservation and oncoplastics
    • Lymph node evaluation: from axillary dissection to sentinel node biopsy
    • Integration with multidisciplinary management of breast cancer

Nondiabetic Endocrine Emergencies 2: ­Hypoparathyroidism, Hyperparathyroidism, Myxedema Coma, And Thyroid Storm

Jason J Lewis, MD, Richard E Wolfe, MD
    • Surgical management via parathyroidectomy is the only definitive therapy for hyperparathyroidism and more cost-effective than long-term observation or medical management.
    • Treatment with IV T4 is the mainstay therapy for myxedema coma, and addition of T3 may be beneficial.
    • Treatment of thyroid storm involves controlling hyperpyrexia. Ice packs, or cooling blankets, should be used with high fever. Aspirin and other NSAIDs should be avoided because they displace T4 from thyroid-binding globulin, resulting in increased free T4. Acetaminophen does not affect free thyroid hormone.

Chemotherapy for Gynecologic Malignancies

Lauren E Dockery, MD, MS, Laura L Holman, MD, MS
    • Targeted therapies such as antiangiogenesis agents improve outcomes in ovarian and metastatic cervical cancer. 
    • Poly(ADP)ribose polymerase (PARP) inhibitors improve outcomes as treatment and maintenance therapies in recurrent epithelial ovarian cancer. 
    • Intraperitoneal administration of chemotherapy can be considered for a select group of patients with ovarian cancer in the front-line setting. 

Musculoskeletal Problems In The ­Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Operative treatment is not as successful for atraumatic shoulder instability as it is for traumatic instability. Treatment should start with a supervised exercise regimen.
    • Prevention programs, including neuromuscular and proprioceptive interventions, reduce ACL injuries by 50.7%.
    • There is a lack of evidence to show that knee orthoses reduce knee pain or improve function in individuals undergoing exercise programs for patellofemoral pain.

Thoracic Injuries and Management Options

Michal Radomski, MD, Babak Sarani, MD, FACS, FCCM
    • Treatment of rib fractures is centered on pain control. Multimodality treatment utilizing non-narcotic medications is optimal.
    • Operative fixation of flail chest is associated with decreased respiratory failure, pneumonia, pain.
    • Patients with type III or IV blunt aortic injury require repair, preferably using an endovascular approach.
    • Most esophageal injuries require open repair. Time to repair is directly associated with mortality. Stenting has little role in repair.
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