bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Soft Tissue Mass in the Extremity or Trunk
Authors: Thomas Daniel C , Han Dale
Published: January 2021

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation.  Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease.
This review contains 6 figures, 6 tables and 50 references
Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade
Basics of Imaging Techniques in Evaluation of Soft Tissue Tumors
Authors: Aherne Emily Alanna , Hwang Sinchun
Published: January 2021

Medical imaging plays a pivotal role in the detection, diagnosis, and clinical management of primary soft tissue tumors. Various imaging modalities have been used, and each modality offers unique advantages in the workup of soft tissue tumors by localizing the lesions in different compartments of the body and characterizing macroscopic tissue composition of the lesions in a noninvasive and safe manner. We review the clinical role and technical aspects of the frequently used imaging modalities, including magnetic resonance imaging (MRI), computed tomography, ultrasonography, positron emission tomography, and plain radiography with an emphasis on MRI as a mainstay imaging modality and a brief discussion of advanced techniques. We also review imaging features of common soft tissue tumors that can be detected and characterized using current imaging techniques.

This review contains 54 figures, 1 table and 37 references.  
Key words: computed tomography, diffusion-weighted imaging, imaging, magnetic resonance imaging, positron emission tomography, soft tissue, technique, tumor, ultrasonography
Evaluation of Intra-abdominal and Retroperitoneal Soft Tissue Masses
Authors: Farma Jeffrey M , Goel Neha
Published: January 2021

Proper workup of intra-abdominal and retroperitoneal sarcomas cannot be overstated in the management of these rare tumors. In particular, evaluation should begin with a thorough history and physical examination, including careful consideration of genetic syndromes. Next, computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast should be performed to determine whether a tumor is completely resectable as complete resection is the mainstay of sarcoma management. Completion staging studies with CT of the chest should also be performed. Following imaging, a core-needle biopsy, usually an interventional radiology–guided biopsy, is performed to obtain a tissue diagnosis. In certain large, intermediate- to high-grade tumors involving other vital organs, neoadjuvant chemotherapy or neoadjuvant radiation is considered to try to decrease the tumor in the hope of improving the chance of obtaining an R0 resection and to limit the extent of surgery. Overall, it is important to remember that prior to the initiation of any therapy, all patients should be evaluated and managed by a multidisciplinary team with expertise and experience in sarcoma.

This review contains 3 figures, 3 tables and 39 references
Key words: biopsy, genetic testing, intra-abdominal and retroperitoneal sarcoma, neoadjuvant chemotherapy, neoadjuvant radiotherapy
Management of Recurrent Retroperitoneal Sarcoma
Authors: Parsyan Armen , Gupta Abha , Catton Charles , Gladdy Rebecca
Published: January 2021

Retroperitoneal sarcomas (RPSs) are a heterogeneous group of mesenchymal tumors. The mainstay of treatment of RPS is curative surgical resection, which often involves a multivisceral resection. The predominant pattern of failure in RPS is local recurrence, which poses significant management challenges and limits survival. There is a paucity of high-level evidence to guide the management of primary and recurrent RPS, mainly due to the rarity of the disease. This review highlights the challenges and decision making in the diagnosis and management of recurrent RPS. 

This review contains 6 figures, 5 tables and 50 references
Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection
Leiomyosarcoma
Authors: Fiore Marco , Pasquali Sandro , Colombo Chiara
Published: January 2021

Leiomyosarcoma of soft tissue is a rare tumor affecting one new patient in every 100,000 people yearly. The most frequent sites of origin are the retroperitoneum and abdomen, followed by the limbs and trunk, skin, major vessels, and, rarely, organs. Increasing evidence suggests that all of these tumors originate from the smooth cell muscles of blood vessels. Surgery is the main treatment for localized disease. The risk of disease progression at distant sites outweighs that of local recurrence, suggesting that extensive resections are not recommended, particularly for retroperitoneal tumors. Moreover, leiomyosarcomas are sensitive to various chemotherapy regimens. The eighth edition of the AJCC TNM staging system introduced new accurate nomograms for predicting patient survival that are improving prognostic stratification for identifying those patients at higher risk for disease progression who are likely to benefit from perioperative treatments. More research for this rare tumor is needed to identify innovative predicting and prognostic biomarkers and new effective treatment strategies.

This review contains 14 figures, 3  tables and 56 references
Key words: inferior vena cava leiomyosarcoma, leiomyosarcoma, retroperitoneal sarcoma
Sarcoma: Vascular Tumors (EHE and Angiosarcoma)
Authors: Grand'Maison Anne , Salerno Kilian , Kane III John M
Published: January 2021

Angiosarcoma (AS) and epithelioid hemangioendothelioma (EHE) are rare but clinically disparate vascular sarcomas. Common AS scenarios include the head and neck/scalp region in older patients or in association with chronic lymphedema or radiation therapy (often in the setting of breast cancer treatment). AS behaves like a high-grade tumor with a propensity for multifocality and hematogenous metastases. The potentially curative treatment is negative margin wide resection. Adjuvant radiation may be considered to does not reduce the risk of local recurrence. Unresectable localized tumor can be treated with definitive radiation therapy. Although data are limited, neoadjuvant and adjuvant chemotherapy are occasionally used. Extensive primary tumor or metastatic disease is treated with systemic therapy. EHE can arise in the liver, bone, lung, pleura, or skin/soft tissue and can also metastasize hematogenously. The tumor is frequently asymptomatic and can be clinically indolent. Therefore, specific therapy is reserved for documented progression. Limited primary tumor is treated with surgical resection and occasionally adjuvant radiation. There is no proven benefit to adjuvant chemotherapy. Liver-directed therapy and occasionally transplantation are used for unresectable hepatic disease. Metastatic disease is treated with systemic therapy, but only in the setting of clinical progression.
Key words: angiosarcoma, breast, cutaneous, epithelioid hemangioendothelioma, lymphedema, neoadjuvant chemotherapy, radiation associated, visceral
Atrial Fibrillation
Authors: Michaud Gregory F. , John Roy M.
Published: January 2021

Atrial fibrillation (AF) is an abnormal rhythm characterized by chaotic atrial electrical activity resulting in loss of atrial contraction, an irregular and unpredictable heart rate, and a tendency for thrombus formation. The prevalence of AF is estimated at 1 to 2%, but it’s likely higher than that because one-third of patients may have no symptoms and might never seek medical attention. Data suggest that 1 in 4 people over the age of 40 will develop AF in their lifetime. About 10% of patients over age 80 have experienced the arrhythmia, and some estimates predict the prevalence will double in the next 50 years. This chapter discusses the pathophysiology, genetics, diagnosis, classification, and treatment of AF. Figures show atrial fibrillation and coarse atrial fibrillation plus common right atrial flutter. One algorithm is for oral anticoagulation therapy, and a second shows a recommended hierarchical choice of antiarrhythmic therapies versus catheter ablation for recurrent symptomatic atrial fibrillation. Tables list classification, diagnostic evaluation of, clinical consequences of, and conditions often associated with atrial fibrillation. Three scoring systems are included: 1) for congestive heart failure, hypertension, diabetes, stroke, and transient ischemic attack; 2) to assess the risk of bleeding with oral anticoagulation, and 3) data and proportion of patients from the Euro Heart Survey. Other tables include long-term anticoagulation guidelines for atrial fibrillation, intravenous drugs used for acute rate control, oral drugs used for chronic rate control, and antiarrhythmic drugs for conversion of atrial fibrillation and/or maintenance of sinus rhythm. In addition, there’s a summary of randomized trials weighing rate control and rhythm control strategies, plus schemes for categorizing thromboembolism risk.
This review contains 4 highly rendered figures, 13 tables, and 129 references.
Unstable Angina and Other Acute Coronary Syndromes
Authors: Wright R Scott , Murphy Joseph G
Published: January 2021

Patients with coronary artery disease (CAD) present clinically when their disease enters an unstable phase known as an acute coronary syndrome (ACS), in which the cap of a previously stable atheromatous coronary plaque ruptures or erodes, which in turn activates a thrombotic cascade that may lead to coronary artery occlusion, myocardial infarction (MI), cardiogenic shock, and patient death. There are nearly 2 million episodes of ACS in the United States annually; it is the most common reason for hospitalization with CAD and is the leading cause of death in the developed world. ACS patients include those with unstable angina (UA), non–ST segment elevation myocardial infarction (non-STEMI), and ST segment elevation myocardial infarction (STEMI) and patients who die suddenly of an arrhythmia precipitated by coronary occlusion. The distinction among various ACS subgroups reflects varying characteristics of clinical presentation (presence or absence of elevated cardiac biomarkers) and the type of electrocardiographic (ECG) changes manifested on the initial ECG at the time of hospitalization. This chapter focuses on UA and non-STEMI. A graph outlines mortality risks faced by patients with varying degrees of renal insufficiency. An algorithm describes the suggested management of patients admitted with UA or non-STEMI. Tables describe the risk stratification of the patient with chest pain, categories of Killip class, examination findings of a patient with high-risk ACS, diagnosis of MI, causes of troponin elevation other than ischemic heart disease, initial risk stratification of ACS patients, and long-term medical therapies and goals in ACS patients.
This review contains 2 highly rendered figures, 11 tables, and 76 references.
Ventricular Arrhythmias
Authors: John Roy M. , Stevenson William G
Published: January 2021

Ventricular arrhythmias are common in all forms of heart disease and are an important cause of cardiac arrest and sudden death. Many ventricular arrhythmias are benign but may serve as a marker for underlying disease or its severity. Others are life threatening. The significance of an arrhythmia is determined by the specific characteristics of the arrhythmia and the associated heart disease, and these features guide evaluation and therapy. This review discusses various mechanisms and types of ventricular arrhythmias and management based on clinical presentation (including patients with symptomatic arrhythmia and increased risk of sudden death without arrhythmia symptoms). Genetic arrhythmia syndromes, such as abnormalities of repolarization and the QT interval, catecholaminergic polymorphic ventricular tachycardia (VT), and inherited cardiomyopathies, are discussed in depth. Under the rubric of management of ventricular arrhythmias, drug therapy for ventricular arrhythmias, implantable cardioverter-defibrillators (ICDs), and catheter ablation for VT are also covered. Tables chart out guideline recommendations for ICD therapy, drugs for the management of ventricular arrhythmias, and indications and contraindications for catheter ablation of ventricular arrhythmias. Electrocardiograms are provided, as well as management algorithms for ventricular arrhythmias based on patient presentation, and an algorithm for identifying patients with systolic heart failure and left ventricular ejection less than or equal to 35% who are candidates for consideration of an ICD for primary prevention of sudden cardiac death.
This review contains 5 highly rendered figures, 3 tables, and 60 references.
Chronic Stable Angina
Authors: Scirica Benjamin J , Gutierrez J. Antonio T.
Published: January 2021

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits.
This review contains 7 highly rendered figures, 12 tables, and 109 references.
Heart Transplantation
Authors: Givertz Michael M.
Published: January 2021

Heart failure is a major public health problem with significant associated morbidity and mortality. Heart transplantation remains the standard of care for highly selected patients with end-stage heart failure and absence of contraindications to transplantation. This chapter discusses indications and contraindications for transplantation; recipient evaluation, selection, and management; donor selection; timing of the procedure and surgical technique; medical management, including immunosuppression, prevention and treatment of infections, and other standard or preventive therapy; late complications; and functional status and long-term survival. Tables describe patient referral to a specialized center for heart transplantations; guidelines of indications for cardiac transplantation; organ dysfunction; pretransplantation evaluation; waiting lists; therapeutic options for patients with advanced or refractory heart failure; treating highly sensitized patients; suggested vaccinations; guidelines for donor hearts with severe infection; high-risk donor behavior; hemodynamic effect of commonly used parenteral agents; frequency of follow-up evaluations; revised International Society for Heart and Lung Transplantation (ISHLT) formulation for diagnosis of cardiac allograft rejection and suggested treatment; function of immunosuppressive agents; administration, dosing, monitoring, and adverse effects of commonly used immunosuppressants; common agents that interfere with tacrolimus and cyclosporine; cytomegalovirus prophylaxis and valganciclovir based on estimated renal function; cumulative morbidity rates in adult heart transplant survivors; and therapies to prevent and treat osteoporosis posttransplantation. Figures depict the progression of heart failure; change in functional status over time in patients with chronic heart failure; US heart transplantations in 2012; percentage of US adult wait-listed patients who received a donor heart transplant within a year and donation rates by state; bicaval surgical technique; endomyocardial biopsies; timeline of infection following solid-organ transplantation; cardiac allograft vasculopathy; and squamous cell carcinomas in a heart transplant patient. Graphs show adult worldwide heart transplantation volume from 1982 to 2010; changing characteristics of US adult heart transplant recipients; relative risk of death and development of cardiac allograft vasculopathy; posttransplantation immunosuppression at 1 and 5 years in the ISHLT Registry; older donor age and risk of developing cardiac allograft vasculopathy; freedom from malignancy in the ISHLT Registry; employment status of adult heart transplant recipients; adult heart transplant survival; and patient survival among US heart transplant recipients by gender and race.
This review contains 18 highly rendered figures, 20 tables, and 109 references.
Postoperative and Ventilator-Associated Pneumonia
Authors: Coopersmith Craig M. , Fitzgerald Caitlin A.
Published: January 2021

Postoperative pneumonia is currently the third most common complication seen in surgical patients and is associated with an increase in both patient morbidity and hospital costs. The incidence of postoperative pneumonia varies among the different surgical subspecialties. A number of evidence-based strategies exist regarding the prevention and management of pneumonia. However, the majority of studies on ventilator-associated pneumonia (VAP) do not specifically focus on surgical patients but rather are based on mixed medical-surgical ICU patients. The aim of this review is to define the incidence, pathogenesis, and risk factors of both postoperative and VAP; determine what pathogens are commonly encountered; discuss treatment methods; and introduce measures that can be implemented in both the surgical wards and the ICU aimed at preventing this complication.
This review contains 5 figures, 7 tables, and 64 references. 
Key Words: antimicrobial therapy, disease prevention, postoperative pneumonia, surgical critical care; ventilator associated pneumonia, culture, prevention, management, bundles, diagnosis
Critical Care Implications of Adrenal Disease States
Authors: Thompson Shaun , Etoll Erin
Published: January 2021

Adrenal disease in the critically ill patient can present many challenges for the intensivist. Besides primary, secondary, and tertiary adrenal insufficiency, a state known as critical care–related corticosteroid insufficiency (CIRCI) has been described. Adrenal insufficiency can pose many issues to the critically ill patient as it can decrease the patient’s ability to respond to the stress that critical illness presents to the human body. Proper recognition and diagnosis of adrenal insufficiency in the critically ill patient can be extremely important in the treatment of these patients and could be a lifesaving intervention if CIRCI is discovered. A less commonly encountered issue of adrenal disease lies in the area of adrenal hormone excess caused by a pheochromocytoma or extra-adrenal paragangliomas. These tumors can release large amounts of endogenous catecholamines that cause significant patient morbidity and mortality if not recognized early and treated appropriately. Although adrenal insufficiency and adrenal excess are less commonly encountered problems in critically ill patients, the recognition and treatment of these disease states can prevent the morbidity and mortality of critically ill patients that suffer from these disease states.
This review contains 5 figures, 5 tables, and 89 references.
Key words: adrenal insufficiency, hypothalamic-pituitary axis, critical illness–related corticosteroid insufficiency, pheochromocytoma, steroid replacement therapy
Medical Futility
Authors: Blythe Jacob A , Harman Stephanie
Published: January 2021

Since its infancy in the 1980s, the concept of medical futility has represented the challenge between increasing technological advancements in medicine and how to approach their limits. Given the nature of the debate, this is likely to continue to be the case; however, in recent years, the concept of medical futility has softened as many have realized that determinations of futile care do not fall solely under the purview of medical experts. Although some jurisdictions continue to enshrine the concept of futility, many professional societies and states have begun to transition away from strong invocations of medical futility toward more robust methods of shared decision making and more equitable procedures for resolving intractable disputes. This review attempts to trace the history of medical futility from its rise in the 1980s to its fall over the past few years, to grasp medical futility as a conceptual model, and, finally, to provide a template for invoking futility in an age when most admit that patient desires are integral to understanding both the goals of care and potentially inappropriate treatments.

This review contains 3 figures and 30 references
Key words: end-of-life care, futile care, ineffective care, medical futility, potentially inappropriate care
Thoracic Injuries and Management Options
Authors: Radomski Michal , Sarani Babak
Published: January 2021

Thoracic trauma accounts for nearly 25% of deaths secondary to blunt trauma. The most common chest injury is a rib fracture, which can be associated with a mortality risk as high as 35%. Other injuries include pneumothorax, hemothorax, esophageal injury, aortic transection, blunt cardiac injury, tracheobronchial disruption, and pulmonary contusion. The majority of thoracic injuries can be treated successfully with either observation or tube thoracostomy and general supportive care alone. Independent contributors to mortality include inadequate pain control, poor pulmonary hygiene, failure to intubate appropriately, and excessive crystalloid-based resuscitation.
 
This review contains 3 figures, 5 tables and 64 references
Key words: aorta, bronchus, esophagus, hemothorax, pneumothorax, pulmonary contusion, rib fracture, thoracic, trachea, tracheobronchial
Basic Management of Pelvic Fractures
Authors: Simpson Amelia , Coimbra Raul , Costantini Todd W
Published: January 2021

The management and treatment of complex pelvic fractures require knowledge of the initial evaluation of a trauma patient, pertinent anatomy, and techniques available for hemorrhage control. Trauma patients with complex pelvic fractures are at high risk for hemorrhage and require thoughtful and expeditious management. A multidisciplinary team including a trauma surgeon, an orthopedic surgeon, and an interventional radiologist is required for optimal treatment of these complex injuries. The team must be managed by the trauma surgeon to guide ongoing resuscitation as the patient may travel throughout the hospital to undergo several interventions to control hemorrhage. A number of techniques can be emergently implemented for fracture stabilization and hemorrhage control, including temporary application of a pelvic binder, preperitoneal pelvic packing, external fixation, and angioembolization. The patient’s clinical status, fracture pattern, and bleeding source must be considered when deciding which hemorrhage control techniques should be performed. New temporary hemorrhage control interventions, such as resuscitative endovascular balloon occlusion of the aorta, have shown early success in control of pelvic fracture–related hemorrhage and require further investigation. Pelvic fractures are associated with a number of neurovascular and genitourinary injuries, which can carry long-term morbidity. This review discusses the diagnosis, management, and treatment of complex pelvic fracture and associated hemorrhage.
This review contains 5 figures, and 55 references. 
Key words: angioembolization, pelvic fixation, pelvic fracture, preperitoneal packing, resuscitative endovascular balloon occlusion of the aorta
Surgical Treatment of Stage I Rectal Cancer
Authors: Garcia-Aguilar Julio
Published: January 2021

For treatment of early-stage rectal cancer, local (transanal) excision offers the advantages of lower rates of morbidity, mortality, and functional impairment in comparison with radical surgery such as total mesorectal excision (TME). Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques. The main drawback of local excision is the higher risk of local recurrence compared with TME. The risk of local recurrence is higher in patients with close resection margins, tumors penetrating beyond the submucosa, or tumors with unfavorable histologic features. In these patients, outcomes for immediate proactive TME are generally better than observation followed by reactive salvage TME in case of local recurrence. The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors. As chemoradiation and local excision are being increasingly used for later-stage tumors, advances in imaging technologies will play a crucial role in facilitating careful patient selection.
 
This review contains 5 figures, 5 tables and 37 references
Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery
A Standardized Clinical Pathway Approach to Esophageal Cancer
Authors: Wirsching Andrea , Low Donald E
Published: January 2021

Clinical pathways associated with the surgical treatment of esophageal cancer patients represent an important development to maximize the opportunity for clinical and cost efficiency in patient care. The main goals implemented in standardized clinical pathways are a comprehensive preoperative workup and tumor board presentation; anesthesia management dedicated to enable enhanced recovery and standardized steps of postoperative recovery, including early mobilization; efficient removal of tubes, catheters, and lines; and early enteral feedings. Recent studies report a decreased length of hospital and intensive care unit stay and decreased costs associated with the routine application of these pathways. Some reports have also shown a decrease in postoperative morbidity and mortality related to the implementation and refinement of standardized clinical pathways. The present review is dedicated to all aspects of standardized clinical pathways for esophagectomy and aims to give an insight into key components of the clinical pathway, which have evolved over the last 20 years at our institution.  
This review contains 3 figures, 8 tables, and 33 tables.
Key words: clinical pathway, costs, enhanced recovery, esophageal cancer, esophagectomy, hospital stay, implementation, length of stay, outcome, standardized pathway
Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma
Authors: Yoon Sam S. , Chang Kevin K.
Published: January 2021

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This review outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed.
This review contains 4 figures, 7 tables, and 50 references.
Key words: gastrectomy, gastric cancer, lymphadenectomy, lymph node, lymph node staging, stomach
Small Intestine: Neuroendocrine and Miscellaneous Tumors
Authors: Baumgartner Joel M , Banerjee Sudeep , Sicklick Jason K
Published: January 2021

Carcinoid tumors are the most common nonduodenal small bowel tumors. Although the diagnosis of any small bowel tumor is challenging, serum tumor markers and specialized imaging can aid in the diagnosis of carcinoid. Localized carcinoids are treated with surgical resection, whereas metastatic tumors are treated with somatostatin analogues, although liver-directed therapies can improve disease-related symptoms. In contrast, small bowel lymphomas are primarily treated with chemotherapy and sometimes radiation, although surgical intervention may be necessary for diagnosis and resection for palliation of symptoms. Furthermore, there are many benign etiologies of small bowel tumors, including adenoma, leiomyoma, and lipoma. The small bowel can also be a site of distant metastases for which surgical management is reserved for the treatment of complications such as bleeding, obstruction, perforation, or pain.

This review contains 3 figures, 3 tables and 17 references. 
 Key words: carcinoid tumor, desmoid tumor, locoregional therapy, mesentery, neuroendocrine tumor, small bowel, small bowel lymphoma, somatostatin
Management of Locally Recurrent Sarcoma in the Extremity
Authors: Krumeich Lauren , Neuwirth Madalyn G , Karakousis Giorgos
Published: January 2021

Extremity sarcomas are a heterogeneous group of malignant tumors with a varied propensity for local recurrence. This review focuses on factors associated with local recurrence and survival, diagnostic workup, management, outcomes, and surveillance. Local recurrence is more common in patients with previous local recurrence, positive margins, high-grade histology, and deep tumors. In the absence of metastases, the mainstay of treatment is limb-sparing surgery, with radiation to improve local control. Modalities such as brachytherapy or proton therapy may be valuable in the setting of previous irradiation. Systemic chemotherapy is typically limited to the treatment of distant disease, although chemotherapy can be delivered locally via limb perfusion or infusion for locally advanced or recurrent disease. Amputation is used if local control cannot be achieved while preserving adequate limb function or as a palliative option for pain, bleeding, or fungating tumors. Prognostic factors associated with poor survival include tumors that recur with high-grade histology, with a large size (> 5 cm), or within a short interval (< 16 months). Reports of 5-year overall survival in patients with locally recurrent sarcomas vary from 36 to 65%. Surveillance includes physical examination, cross-sectional imaging, and chest x-ray. Genetic profiling and intratumoral injections provide novel therapeutic targets.

This review contains 1 figure, 4 tables and 40 references. 
 Key words: chemotherapy, hyperthermic isolated limb perfusion, intratumoral injection, isolated limb perfusion, local recurrence, margin status, radiation, soft tissue sarcoma, wide local excision
Pediatric Tumors: Rhabdomyosarcoma
Authors: Groundland John , Shaw Sara , Randall R L
Published: January 2021

Rhabdomyosarcoma (RMS) is a group of soft tissue sarcomas that share a common feature of primitive skeletal muscle differentiation. Three main subtypes have been characterized: embryonal, alveolar, and pleomorphic. Presentation and prognosis of RMS are highly variable, depending on anatomic location, subtype, and risk stratification. Currently, treatment centers on systemic control with cytotoxic chemotherapy and local control with surgery and/or therapeutic radiation.

This review contains 3 figures, 10 tables and 50 references 
Key words: alveolar rhabdomyosarcoma, embryonal rhabdomyosarcoma, pediatric soft tissue sarcoma, pleomorphic rhabdomyosarcoma, rhabdomyosarcona, t(2;13), t(1;13)
Paget Disease of the Breast
Authors: Wheeler Amanda , McLaughlin Sarah
Published: January 2021

Paget disease of the breast is an in situ malignancy located within the epidermal layer of the nipple-areolar complex. It accounts for 0.5% of all breast cancers in women and 1 to 3% of new breast cancers diagnosed annually in the United States. Patients most likely present with erosion at the tip or base of the nipple. These symptoms are often confused with the symptoms of eczema. Persistent itching can occur. As the disease progresses, ulceration of the nipple expands outward over the areola. Full-thickness biopsy of the nipple or involved skin is needed to confirm diagnosis. Further workup includes mammography and, frequently, breast magnetic resonance imaging to rule out an associated breast parenchymal malignancy. Surgical excision requires removal of the nipple and involved areolar complex as well as any underlying malignancy. Mastectomy is also an option and may be required if additional multicentric disease is present.
This review contains 10 figures, 6 tables, and 52 references.
Key words: breast conservation, breast magnetic resonance imaging, eczema, intraepithelial adenocarcinoma, nipple abnormalities, nipple biopsy, occult malignancy, Paget disease
Practicing Evidence-Based Medicine
Authors: Barnett Michael , Choudhry Niteesh
Published: January 2021

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies.
This review contains 6 highly rendered figures, 9 tables, and 28 references.
Syncope
Authors: Baker Annalee M
Published: January 2021

Syncope is a common presenting complaint in the emergency department, accounting for approximately 1 to 3% of presentations and up to 6% of admissions. Syncope is properly defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. Often syncope must be distinguished from other etiologies of transient loss of consciousness, such as seizures and hypoglycemia. Comprehension of the pathogenesis, clinical presentation, and prognosis of the varied causes of syncope is essential if emergency physicians are to succeed in identifying patients at risk for adverse events while also reducing unnecessary syncope admissions. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of syncope. Figures show heart block, prolonged QTc and torsades de pointes, Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, and Brugada syndrome. 
This review contains 6 figures, 18 tables, and 58 references.
Keywords: Syncope, near-syncope, pre-syncope, arrhythmia, dysrhythmia, sudden cardiac death, vasovagal, passing out, neurocardiogenic
Skin and Soft Tissue Infections
Authors: Pallin Daniel J.
Published: January 2021

The skin is the largest organ of the human body, and has diverse functions including protection from infection, temperature regulation, sensation, and immunologic and hormonal functions. Skin infections occur when the skin’s protective mechanisms fail. Some infections may be life-threatening (eg, necrotizing fasciitis) or may require the patient to be placed on contact precautions; thus, the initial goals of assessment of patients with skin and soft tissue infections are to assess the patient’s stability and to determine whether precautions are necessary to protect others. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for a variety of skin and soft tissue infections. Figures show an algorithm for treatment of bacterial infections of the skin, and photographs of  various infections including necrotizing fasciitis, cellulitis, an abscess caused by methicillin-resistant Staphylococcus aureus, a furuncle, a carbuncle, nonbullous and bullous impetigo, echythma, folliculitis, anthrax lesion, tinea corporis, condyloma acuminatum, and plantar warts. Tables list cellulitis treatment with particular exposures, the dermatophytoses, and yeast infections of skin and mucous membranes.
This review contains 16 highly rendered figures, 3 tables, and 32 references.
Diseases of the Stomach
Authors: Sheets Tara C. , Amro Moath
Published: January 2021

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection.
Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery
Acute Kidney Injury
Authors: Grodin Lee , McHugh Joshua , Sinert Richard
Published: January 2021

Acute kidney injury (AKI) is defined as a syndrome in which there is an abrupt (hours to days) absolute increase in serum creatinine (SCr) of 0.5 mg/dL or a 25% increase from baseline. Even a modest rise in SCr of 0.3 mg/dL during hospitalization is associated with increased mortality and morbidity. Because of difficulties using SCr as a determinant of AKI, a variety of serum (neutrophil gelatinase–associated lipocalin, interleukin-18) and urine (kidney injury molecule–1) biomarkers of AKI are currently undergoing intense investigation. AKI may be defined pathophysiologically, as a decrease in renal blood flow (prerenal), or an intrinsic renal parenchymal disease (renal), or obstruction of urine flow (postrenal). Indications for emergent dialysis include hyperkalemia, fluid overload, acidosis, and signs and symptoms of uremia. If AKI is diagnosed in the emergency department, the patient should be admitted for further workup. In the majority of patients who survive AKI, renal function essentially returns to normal. 
Key words: acute kidney injury, dialysis, hyperkalemia, serum creatinine
This review contains 3 highly rendered figures, 11 tables, and 49 references.
Chronic Obstructive Pulmonary Disease
Authors: Marsh Regan H.
Published: January 2021

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow obstruction that is not fully reversible. The airflow obstruction is usually progressive and associated with an inflammatory response of the lungs to noxious particles and gases, often from smoking. COPD is the third leading cause of death in the United States, with both its prevalence and mortality continuing to increase. It has also become one of the leading causes of death and disability worldwide. COPD is estimated to affect more than 5% of the total population in the United States; approximately 5 million adults have emphysema and another 10 million have chronic bronchitis. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of COPD. Figures show spirometry test results in a normal patient and a patient with severe COPD, stages of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the pathogenesis of emphysema from smoking, pathologic lesions in small airways in a patient with COPD, the acinar structure of normal lungs compared with that of lungs in patients with centriacinar (centrilobular) emphysema or panacinar (panlobular) emphysema, and electrocardiogram demonstrating findings consistent with P pulmonale and right heart strain due to advanced COPD. Tables list pathogenic mechanisms of COPD, pathophysiology of a COPD exacerbation, bacterial pathogens in acute COPD exacerbations, key historical features of COPD, differential diagnosis of patients presenting with possible COPD, criteria for hospitalization as indicated by GOLD guidelines, and indications for ICU admission.
This review contains 6 highly rendered figures, 7 tables, and 124 references
Key words: Chronic obstructive pulmonary disease; COPD; Emphysema; Chronic bronchitis; Acute exacerbation of COPD; AECOPD; Airway disease
Caustics
Authors: Farrugia Lynn A , Babu Kavita
Published: January 2021

A caustic is any substance capable of causing full-thickness damage on contact with healthy, intact tissue. Caustic agents are generally classified by pH as acids or bases. Irritants are those substances that do not produce true breakdown of tissue but cause discomfort and inflammation, such as vomiting, burning eyes, or coughing. This review covers caustic and irritant agents, dermal caustic exposure, caustic inhalation and pulmonary irritants, caustic ingestion, and ocular caustic exposure, along with special consideration of hydrofluoric acid, including hydrofluoric acid and dermal exposure, hydrofluoric acid ingestion, hydrofluoric acid inhalation, ocular hydrofluoric acid exposure, and systematic hydrofluoric acid toxicity. Figures show classification of burns; chemical burns; an autopsy specimen of the tongue, epiglottis, and esophagus after caustic ingestion; and an autopsy specimen of the stomach after caustic ingestion. Tables list common caustic and irritant agents, household products containing caustic and irritant agents, agents for which water or saline irrigation is not recommended, indications for endoscopy after caustic ingestion, ocular chemical burn management, and common chemicals and products containing fluoride.
Key words: caustic eye injury, caustic ingestion, caustic injury, chemical burn, hydrofluoric acid, pulmonary irritants 
This review contains 5 highly rendered figures, 6 tables, and 53 references.
Trauma: Head and Facial Trauma
Authors: Tainter Christopher R. , Seethala Raghu
Published: January 2021

Head and facial trauma includes a wide variety of heterogeneous injuries that vary according to cause, severity, management, and outcomes. These injuries are classified as head injuries (the scalp, skull, and brain) and facial injuries (to the eyes, bony structures, nose, mouth, teeth, tongue, and glands and the accompanying nerves, muscles, and vasculature). This review covers the epidemiology, anatomy, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for traumatic brain injury (TBI), scalp and cranial vault trauma, ocular trauma, and facial trauma. Figures show computed tomographic scans showing a large left frontal lobe intraparenchymal hemorrhage, a traumatic subarachnoid hemorrhage, a subdural hematoma, a right occipital epidural hematoma, and a left orbital floor “blowout” fracture; an illustration of the brain herniation syndromes; the anatomy of the globe; and the Le Fort classification scheme of midface fractures. Tables list the Glasgow Coma Scale, clinical decision aids for computed tomography after mild TBI, the PECARN clinical decision rule for children with mild TBI, the graduated return to play protocol, and anticoagulant and antiplatelet agent reversal.
This review contains 8 highly rendered figures, 5 tables, and 75 references.