Latest Updates

Approach to Metastatic Melanoma

    • Intralesional therapy
    • Limb infusion
    • Percutaneous hepatic perfusion

Surgical Treatment of Female Stress Urinary Incontinence: Pubovaginal Slings

    • • ARF PVS has similar outcomes to MUS procedures in index patients.
      • ARF PVS is the procedure of choice for women undergoing concomitant repair of urethrovaginal fistula, urethral diverticulum, or urethral mesh erosion.
      • Outcomes after ARF PVS in women with recurrent SUI may be similar to those in women undergoing primary repair.

Upper Extremity Compartment Syndrome

    • Acute compartment syndrome (ACS) of the upper extremity is commonly associated with trauma; however, over 20% of cases occur in the absence of a fracture.
    • A high index of suspicion is required for ACS, particularly in the obtunded or insensate patient.
    • Clinical examination findings can be highly variable and have a low sensitivity. Always perform serial examinations and monitor for any change over time.
    • Pain out of proportion to passive stretch of the involved compartment is often the most reliable clinical sign.
    • Compartment pressure measurements can be used to aid diagnosis but should not be used independently to diagnose ACS.
    • Surgical management consists of an emergent thorough fasciotomy of all involved compartments.
    • Functional outcomes following fasciotomy are generally good if addressed acutely. Higher complication rates may occur following delayed diagnosis and management.

Hypertension

    • Increasing recognition of the importance of home-based and ambulatory blood pressure monitoring reflected in expanded indications for use
    • Specific guidance from professional societies with regard to patients with chronic kidney disease
    • Recent clinical outcomes trials adding important data about optimal treatment targets
    • Recent clinical outcomes trials adding important data regarding treatment in the elderly

Rare Fibroblastic and Myofibroblastic Tumors

    • Advances in cytogenetic analysis allowing more accurate diagnosis of these rare tumors, some of which have specific gene rearrangements
    • Advances in targeted therapies such as crizotinib for tumors with ALK gene rearrangements
    • Advanced in radiation therapy allowing dose escalation to the target with sparing of normal tissue (as in intensity modulated radiotherapy)

Rare Fibroblastic and Myofibroblastic Tumors

    • Advances in cytogenetic analysis allowing more accurate diagnosis of these rare tumors, some of which have specific gene rearrangements
    • Advances in targeted therapies such as crizotinib for tumors with ALK gene rearrangements
    • Advanced in radiation therapy allowing dose escalation to the target with sparing of normal tissue (as in intensity modulated radiotherapy)

Mistreatment of Elders

    Elder mistreatment affects a considerable proportion of individuals older than 60 to 65 years of age and may include intentional abuse (physical, sexual, emotional, or financial) and neglect. As the proportion of the population that is older than 65 years of age increases, elder mistreatment will become an increasingly common issue. Only a minority of cases of elder abuse are reported; thus, an interview with the patient should be conducted in private if elder mistreatment is suspected. Patient risk factors for elder mistreatment include cognitive or behavioral impairment, poor physical health, and poor social supports.

Adjustment Disorder and Its Clinical Management

    • Adjustment disorder is an often-applied diagnosis in clinical settings.
    • Despite its prevalence, few hints are available about its treatments.
    • In people who died by suicide, a past diagnosis of adjustment disorder is often found.
    • A past diagnosis of adjustment disorder is related to high all-cause mortality.
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