Traumatic Duodenal Injury: Current Management Update
AbstractPurpose of ReviewAlthough duodenal injuries are a rare entity of all trauma, they carry high risk of morbidity and mortality. The management of duodenal injuries should encompass a multidisciplinary approach. Optimal operative management of duodenal injuries has evolved in the last few decades.Recent FindingsIsolated duodenal injuries are rare due to its proximity to major vascular and organ structures. Immediate mortality from duodenal injuries is due to hemorrhage from major vascular injuries. Non-operative management of isolated low-grade classification of duodenal injuries is accepted with close clinical and la...
Source: Current Surgery Reports - April 3, 2020 Category: Surgery Source Type: research
Mobile Spaced Education in Surgical Education Settings and Specialties: A Scoping Review
This report discusses the application of mobile spaced education in surgical specialties and highlights key findings to date across the surgical education continuum.Recent FindingsScoping review methods were used to identify all mobile spaced surgical education evaluation studies published through mid-February 2020. Among 31 eligible studies reviewed, mobile spaced education has been applied and evaluated in many general and subspecialty surgical settings covering a variety of topics. Most of the studies have been done in graduate medical education settings, whereas far fewer were identified in medical school or continuing...
Source: Current Surgery Reports - March 26, 2020 Category: Surgery Source Type: research
Palliative Considerations Regarding Enteral Access in Surgical Patients
AbstractPurpose of ReviewWith a focus on advanced-stage cancer patients, this review will highlight applications of nutrition support both as an adjunct therapy for a subset of conditions and as a key standard of practice in palliative care.Recent FindingsRecent studies indicate the importance of early integration of palliative care into the treatment of patients with advanced cancer. Advances in the field of cancer-directed therapies have led to historically incurable cancers being treated more like chronic diseases. The type, method, and role of nutrition in the management of these patients are critical components of the...
Source: Current Surgery Reports - March 25, 2020 Category: Surgery Source Type: research
Disparities in End-Organ Care for Hispanic Patients with Kidney and Liver Disease: Implications for Access to Transplantation
AbstractPurpose of ReviewHispanics experience kidney and liver disease with a higher incidence and greater severity than their non-Hispanic White counterparts. Higher baseline rates of hypertension, obesity, diabetes, and alcoholism, combined with a variety of ill-defined socioeconomic and cultural factors create significant disparities in access to abdominal organ transplantation. Moreover, a consistently lower rate of organ donation among Hispanics suggests a lack of awareness, education, and/or acceptance of transplant-related practices.Recent FindingsRecent work has demonstrated that culturally competent interventions ...
Source: Current Surgery Reports - March 21, 2020 Category: Surgery Source Type: research
A Surgeon ’s Review for Difficult Conversations
We describe a strategy for difficult conversations that is tailored for use by surgeons and modeled on surgical principles. (Source: Current Surgery Reports)
Source: Current Surgery Reports - March 2, 2020 Category: Surgery Source Type: research
Burns as the Outlier in Early Enteral Nutrition in Critical Illness
This article aims to review the current literature regarding early enteral nutrition in burn patients.Recent FindingsEarly enteral feeding is thought to be an important component of modulating the hypermetabolic and inflammatory response seen in critical illness. This dogma has been questioned by studies indicating that permissive underfeeding in the first phase of critical illness might be of benefit. However, these studies lack stratification to evaluate outcomes in the burn population, specifically. Studies that do evaluate early enteral nutrition in the burn population have revealed reduced morbidity and mortality with...
Source: Current Surgery Reports - January 16, 2020 Category: Surgery Source Type: research
Gene Signatures in Cutaneous Malignancies
AbstractPurpose of ReviewIn this review, we will discuss the recent advances in the identification of landmark gene signatures in cutaneous melanoma and in the discovery of those relevant to cutaneous squamous cell carcinoma (cSCC).Recent FindingsMelanoma and cSCC are the most important cutaneous malignancies when considering morbidity and mortality. They are responsible for the greatest number of skin cancer related deaths. Over the past several years, a number of gene signatures have been identified showing great promise in terms of tumor molecular classification and risk stratification of patients to anticipate best the...
Source: Current Surgery Reports - November 19, 2019 Category: Surgery Source Type: research
Stromal Markers of Breast Cancer Progression: A Review of Recent Findings
AbstractPurpose of the ReviewBreast cancer research has long focused on breast epithelium in cancer development. This traditional view is being challenged by more recent work which suggests that stromal components such as fibroblasts, immune cells, endothelial cells, and others may play a central role in cancer development. The purpose of this review is to investigate the elements of the breast stroma and their interaction with the epithelium in creating the necessary pro-tu morigenic environment.Recent FindingsSeveral studies have revealed that breast cancer stroma differs significantly from normal breast stroma, with a...
Source: Current Surgery Reports - September 16, 2019 Category: Surgery Source Type: research
Gut Luminal and Clinical Benefits of Early Enteral Nutrition in Shock
AbstractPurpose of ReviewCirculatory shock and subsequent gut hypoperfusion turn on the ‘gut motor,’ which impairs gut barrier function, promotes dysbiosis, and generates immune dysfunction to perpetuate inflammation. Clinicians may be reluctant to commence enteral nutrition in circulatory shock out of concern for bowel ischemia and splanchnic steal syndrome. Here, we identify cont emporary studies which have evaluated the impact of enteral nutrition during circulatory shock on gut lumen functions and clinical outcomes.Recent FindingsRecent studies show enteral nutrition has luminal benefits and is safe. Observational ...
Source: Current Surgery Reports - August 28, 2019 Category: Surgery Source Type: research
Robotic-Assisted Modified Radical Neck Dissection: Transaxillary, Bilateral Axill-Breast Approach (BABA), Facelift
AbstractPurpose of ReviewN1b thyroid carcinoma has been surgically treated with open-conventional bilateral total thyroidectomy and modified radical neck dissection (mRND). Recently, the use of robotic method has been increasing for the cosmetic demand of patients. Robotic mRND methods can be divided into transaxillary, bilateral axillo-breast approach (BABA), and facelift depending on how the instruments are inserted.Recent FindingsAbout 10 years of experience have been accumulated for transaxillary and BABA, and their oncologic outcomes have also been proven. However, the facelift method requires more experience and on...
Source: Current Surgery Reports - July 14, 2019 Category: Surgery Source Type: research
Robotic Adrenalectomy
AbstractPurposeEven though laparoscopy is still the gold standard technique of adrenal surgery, many of the recent reports noted the safety and efficacy of robotics. However, there are still scant data and debates regarding outcomes of robotics in adrenal surgery. The aim of this review was to discuss recent literature and provide institutional experience on robotic adrenalectomy.Recent FindingsDue to improved maneuverability, robotics have certain advantages especially in patients with large tumors or those needing fine dissection; however, longer operative times and increased costs are still major drawbacks for this tech...
Source: Current Surgery Reports - July 14, 2019 Category: Surgery Source Type: research
Timing of Surgical Stabilization of Rib Fractures
AbstractPurpose of ReviewSurgical stabilization of rib fractures (SSRF) has a proven benefit in patients with flail chest. However, the timing of intervention is currently unclear. We aim to evaluate and summarize current evidence related to the time interval for the surgical stabilization of rib fractures.Recent FindingsRetrospective studies specifically addressing when to perform SSRF in patients with severely displaced rib fractures have reported a benefit for patients who underwent the procedure within 72 h of injury. There are currently no prospective trials specifically addressing timing of rib fixation. Delayed (i...
Source: Current Surgery Reports - June 27, 2019 Category: Surgery Source Type: research
Helicopter Emergency Medical Services for Trauma: An Update
AbstractPurpose of ReviewHelicopter emergency medical services (HEMS) have become a well-established component of most contemporary trauma systems throughout the world. HEMS is associated with significant costs, safety concerns, and potential inappropriate use. In this update, we briefly review the historical context, evidence for clinical effectiveness, and methods for ensuring proper utilization of HEMS.Recent FindingsA recently validated prehospital triage score —the Air Medical Prehospital Triage (AMPT)—is reviewed. Examples of system improvements using evidence-based practices and adherence to both national and lo...
Source: Current Surgery Reports - June 23, 2019 Category: Surgery Source Type: research
Vascular Acute Care Surgery (VACS) Services: A New Model for the Future and a Solution to the Emerging Vascular Surgery Coverage Crisis
AbstractPurpose of ReviewThe following is a comprehensive review of the current practice of Vascular Surgery, highlighting the existing gaps in vascular surgical care and delivery and providing evidence-based suggestions for improvements moving forward.Recent FindingsRecent data demonstrate that a shift of many vascular surgical procedures from extensive, high-risk, inpatient operations toward minimally invasive, endovascular, same-day surgeries has created a gap in the ability of the community-based vascular surgeon to adequately care for acute vascular events.SummaryThe trends towards outpatient vascular surgery, coupled...
Source: Current Surgery Reports - May 15, 2019 Category: Surgery Source Type: research
Resuscitation Strategies for Traumatic Brain Injury
AbstractPurpose of ReviewTraumatic brain injury (TBI) is a leading cause of morbidity and mortality; however, little definitive evidence exists about most clinical management strategies. Here, we highlight important differences between two major guidelines, the 2016 Brain Trauma Foundation guidelines and the Lund Concept, along with recent preclinical and clinical data.Recent FindingsWhile intracranial pressure (ICP) monitoring has been questioned, the majority of literature demonstrates benefit in severe TBI. The optimal cerebral perfusion pressure and ICP are yet unknown, but likely as important is the concept of ICP bur...
Source: Current Surgery Reports - May 14, 2019 Category: Surgery Source Type: research
