Pathologic Evaluation of Soft Tissue Sarcoma
- Concepts of pathologic examination and grading
- Important diagnostic criteria for each soft tissue sarcoma
- Latest molecular diagnostic methods used in the diagnosis of sarcomas
Latest Updates
Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma
- The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
- A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
- Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.
Nutritional Management of Celiac Disease
- Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
- Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
- IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.
Child Abuse and Nonaccidental Trauma
- Abusive injuries account for over 1% of pediatric emergency department visits.
- Skeletal survey should now be obtained in any child under age 3 with concern for abusive injury.
- Cardiopulmonary resuscitation does not lead to significant rib fractures or retinal hemorrhages, and these conditions should be considered highly concerning for abusive injury.
ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS
- DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
- Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
- In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.
Nephrology: Drug Dosing in Acute Kidney Injury
- Full review of all available literature on the impact of acute kidney injury (AKI) on drug pharmacokinetic parameters
- Recommendations for drug dosing strategies in patients with AKI, including loading doses, maintenance therapy, and therapeutic drug monitoring
- Evaluation of specific medications that require special attention in patients with AKI
Nephrology: Hypertensive Disorders in Pregnancy
- New diagnostic criteria for preeclampsia
- Pathophysiology of preeclampsia
- Role of serologic biomarkers for diagnosis of preeclampsia
- Guidelines for target blood pressure in pregnancy
Nephrology: Management of Cardiovascular Disease in Dialysis Patients
- Left ventricular hypertrophy is associated with cardiovascular outcomes, including sudden cardiac death. Efforts to mitigate left ventricular hypertrophy (blood pressure control, aggressive fluid management, and frequent hemodialysis) may improve outcomes.
- Low potassium dialysate (< 2 mEq/L), low calcium dialysate (< 2.5 mEq/L), and high ultrafiltration rates (> 13 mL/kg/hr) have been associated with worse cardiovascular outcomes in hemodialysis patients.
- End-stage renal disease (ESRD) patients with atrial fibrillation are at increased risk for both stroke and bleeding events. Routine anticoagulation is not recommended for stroke prophylaxis.
- In two small randomized trials, use of spironolactone reduced cardiovascular events and left ventricular mass index compared with placebo in patients with ESRD.
