bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locally Advanced Rectal Cancer
Authors: Kleiman David A , Weiser Martin R. 
Published: January 2021

Locally advanced rectal cancer is a complex disease that requires a multidisciplinary treatment team to carefully evaluate each patient before prescribing a treatment plan. The current standard of care in the United States is multimodal therapy, consisting of chemotherapy, radiation, and surgery. Commonly, this involves neoadjuvant long-course chemoradiation, followed by total mesorectal excision and then adjuvant systemic chemotherapy. However, alternative regimens using chemotherapy first, followed by chemoradiation and then surgery (total neoadjuvant therapy), may allow for better tolerance of therapy. Short-course radiation is also acceptable but is rarely used in the United States. Minimally invasive surgical techniques such as laparoscopy, robotic surgery, and transanal total mesorectal excision offer several potential advantages over conventional open surgery, but their oncologic equivalence has not been determined. The role of nonoperative management for locally advanced rectal cancer is still evolving, and additional studies are needed to improve patient selection and evaluate long-term outcomes of a watch-and-wait approach.

This review contains 1 figure, 2 table and 58 references
Key words: colorectal cancer, locally advanced rectal cancer, minimally invasive surgery, nonoperative management, radical proctectomy, robotic surgery, total mesorectal excision, total neoadjuvant therapy, transanal total mesorectal excision, watch and wait
Small Intestine: Adenocarcinoma
Authors: Baumgartner Joel M , Banerjee Sudeep , Sicklick Jason K 
Published: January 2021

Adenocarcinoma is the second most common nonduodenal small bowel tumor. Small bowel adenocarcinoma has risk factors similar to those of colorectal adenocarcinoma but is rarer and less well understood. Diagnosis relies on advanced imaging techniques as well as endoscopy or enteroscopy for tissue diagnosis. Aggressive biology and vague symptoms in early disease cause a majority of patients to present with late-stage disease. Adenocarcinomas with lymph node involvement should be treated with resection and systemic chemotherapy. In contrast, systemic chemotherapy alone should be employed in cases with distant metastases unless the primary tumor is bleeding, perforated, or causing a bowel obstruction.

This review contains 4 figures, 5 tables and 17 references
Key words: adenocarcinoma, chemotherapy, enteroscopy, hereditary syndrome, inflammatory bowel disease, lymph node, mesentery, small bowel
Principles in Reconstruction after Resection of Extremity and Truncal Sarcomas
Authors: Nelson Jonas A. , Matros Evan 
Published: January 2021

Reconstruction of sarcoma defects of the trunk or extremity requires detailed understanding of a variety of techniques for wound closure. Advances in reconstruction and oncologic treatment have led to higher rates of limb salvage in patients who would have previously undergone amputation. Such defects often require consideration of the reconstructive ladder, moving from the most simplistic closure to free flaps. As previous surgeries or radiation therapy can create a challenging wound environment with scar and fibrosed tissues, at times the more complex up-front option will be a better long-term solution for a patient following sarcoma resection. A multidisciplinary approach to the initial management, resection, and reconstruction is certainly warranted to attain the best overall outcome for the patient from the oncologic and aesthetic standpoint. This review provides an overview of the reconstructive techniques employed in addressing defects of the trunk and extremities following sarcoma resection.
This review contains 20 Figures and 30 References.
Key words: abdominal wall reconstruction, chest wall reconstruction, free flap, lower extremity reconstruction, pedicled flap, propeller flap, reconstructive elevator, reconstructive ladder, upper extremity reconstruction
Adjuvant Radiation for Tissue Extremity and Truncal Sarcomas
Authors: Wasif Nabil , Qu Melody 
Published: January 2021

In this review, we cover the clinical use of radiation therapy in the treatment of soft tissue extremity and truncal sarcomas. After a brief overview of the seminal trials establishing the efficacy of radiation therapy as a component of limb-preserving therapy, we cover current indications for use and discuss when radiation therapy can be withheld without compromising oncologic outcomes. Controversies in treatment sequencing with surgery are fleshed out with pros and cons for both pre- and postoperative treatment. Finally, different modalities of radiation therapy are discussed and common toxicities are covered.

This review contains 3 figures, 1 table and 41 references
Key words: brachytherapy, limb preservation, neoadjuvant therapy, radiation therapy, soft tissue sarcoma
General Approach to the Poisoned Patient
Authors: Gordon Emily , Bird Steven B 
Published: January 2021

Poisoning and ingestions constitute an increasing amount of morbidity and mortality nationwide. According to the American Association of Poison Control Centers (AAPCC), 2.2 million exposures were reported in 2013, and ingestions are currently the leading cause of injury-related death in the United States. Exposures include intentional overdose or suicide attempts, accidental overdose in drug abusers or children, and work-related injuries or acts of terrorism. According to the AAPCC, 50% of exposures are in children less than 5 years old and 80% of exposures are unintentional. When it comes to the unstable undifferentiated and possibly poisoned patient, one must take a stepwise approach similar to that for any critically ill patient, This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of poisoning. Figures show The Full Outline of Unresponsiveness (FOUR) scale, a patient with methemoglobinemia, a hand with scaling due to mercury poisoning, an electrocardiogram with examples of QT prolongation and QRS widening, and an electrocardiogram of bidirectional ventricular tachycardia, pathognomonic of digitalis glycoside poisoning. Tables list a stepwise approach to a potentially poisoned patient, a general approach to the poisoned patient, heart rate, toxidromes, anticholinergic toxidrome, cholinergic toxidrome, Glasgow Coma Scale, toxins and associated odors, electrocardiogram findings, causes of anion-gap metabolic acidosis, and antidotes.

This review contains 5 highly rendered figures, 13 tables, and 23 references

Key words: Poison ingestion, Accidental poisoning, Toxidrome, Accidental overdose
Gallstones and Biliary Tract Emergencies
Authors: Lobon Luis F. , Billington Michael 
Published: January 2021

Patients with diseases of the biliary tract (which includes the hepatic bili canaliculi, hepatic bile ducts, common bile duct, and gallbladder) typically present with symptoms that include abdominal pain, nausea, vomiting, and jaundice. This review covers the pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for common biliary tract emergencies (cholelithiasis, acute cholecystitis, choledocholithiasis, and ascending cholangitis).
This review contains 5 figures, 11 tables, and 34 references.
Keywords: Cholelithiasis, gallbladder disease, acute cholecystitis, gallstones, choledocholithiasis, ascending cholangitis
Integrating Principles and Practice of Palliative Medicine in Emergency Care
Authors: O’Malley Patricia J. 
Published: January 2021

Trajectories of serious illness and dying have changed in the last century; people now live longer, often with prolonged debility in advanced stages of illness. With more options for aggressive interventions at the end of life, patients and families face increasingly complex medical decisions. Many of these patients will present repeatedly to the emergency department (ED) before their death, and emerging evidence suggests that integrating palliative care into the treatment of advanced illness, including in the emergency setting, can improve outcomes. This review covers changing trajectories of illness and death, palliative care as a medical specialty, emerging models of integration, essential palliative care competencies for the ED clinician, and managing the actively dying patient in the ED. Figures show palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, and patient-centered communication. Tables list philosophy of palliative care, domains of suffering addressed by palliative care, palliative performance scale, NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit: effect on clinical outcomes and family satisfaction, and SPIKES mnemonic for breaking bad news.

This review contains 4 highly rendered figures, 6 tables, and 113 references
Unstable Angina and Non-ST Segment Elevation Acute Coronary Syndrome
Authors: Blomkalns Andra L. 
Published: January 2021

Unstable angina and non-ST-segment acute coronary syndrome represent a frequent and serious presentation to the emergency department. While most patients present with chest discomfort, atypical presentations warrant that clinicians maintain a high index of suspicion. This review summarizes the present nomenclature, definitions, and pathophysiology for this high morbidity disease process. The rapid acquisition of an electrocardiogram and serial cardiac troponins are mainstays of diagnosis. Also outlined is an approach for initial assessment, high-risk ECG findings, risk stratification, biomarker strategies, and subsequent stabilization. Once diagnosed, treatment options for these patients aim to halt continued ischemia and resultant necrosis. These therapies may include agents such as supplemental oxygen, nitrates, anti-platelet agents, beta blockers, anti-coagulation, anti-thrombin and statin therapies in appropriate settings. Caution should be exercised when dosing high-risk patients for bleeding such as those who are elderly or who weigh less than 60kg. Emergent angiography is reserved for patients who develop hemodynamic instability, cardiogenic shock, pulmonary edema, persistent angina refractory to medical therapy, and sustained arrhythmia.
This review contains 2 figures, 12 tables, and 64 references.
Keywords: acute coronary syndrome, unstable angina, myocardial infarction, troponin, electrocardiogram
Panic Attacks and Anxiety Disorders
Authors: Wittmann Curtis 
Published: January 2021

This review discusses the acute diagnosis and management of panic and anxiety disorders. Anxiety disorders are among the most common psychiatric disorders in the country and are a relatively common cause of presentation to the emergency department. Most anxiety disorders can be conceptualized as fear- or phobia-based disorders, including panic disorder, specific phobia, social phobia, acute stress disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Each of these disorders is discussed, including prevalence and common clinical presentations. The initial evaluation of patients with a suspected or diagnosed anxiety disorder will be based on their current symptoms. Some patients may be highly agitated and may require deescalation or sedation to perform a reasonable history and physical examination. To achieve this, providers should ensure their own safety first, with attention to the physical layout of the emergency department, ensuring that they are closer to the room exit than the patient (so that they cannot be trapped). The presence of police or security may be necessary to provide optimal care and an appropriate evaluation. Typical treatment of acute exacerbations of anxiety disorders includes medical management, most often benzodiazepines, which can provide immediate relief. Psychiatric consultation may be necessary in certain cases. For most patients, outpatient management rather than inpatient admission will lead to the most effective management of their anxiety.

Key words: anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, stress disorder
This review contains 1 highly rendered figure, 17 tables, and 29 references.
Acute Care: Pain Management
Authors: Ranniger Claudia 
Published: January 2021

Pain is a chief complaint in more than 50% of emergency department (ED) visits. Injury accounts for approximately one-third of presentations associated with pain; other common diagnoses include neck and back pain, minor infections, abdominal pain, and headache. In the ED, pain is underdiagnosed and undertreated, and existing pain management practices in the ED are inconsistent. Inadequate pain management is common, and pain remains unchanged or worsens during the ED visit for more than 40% of patients. Patient satisfaction improves when expectations for pain control are met. This review covers the pathophysiology of pain and the practice of pain management. Figures show the approach to pain management in the ED, an example of a numerical and visual analog scale pain rating scale, field block of the pinna, ultrasound probe and hand position for ultrasound-guided regional anesthesia, regional anesthesia of the face, innervation of the hand and fingers, regional anesthesia of the median, radial and ulnar nerves, innervation of the foot, ultrasound-guided regional anesthesia of the posterior tibialis nerve, regional anesthesia of the sural nerve, and method of regional anesthesia of the dorsal foot.
This review contains 13 figures, 16 tables, and 72 references.
Key words: Acute pain, Pain management, Oligoanalgesia, Pain assessment, Inadequate pain management, Acute pain management, Pain management in the emergency department, Pain in the ED, Pain presentation
Gynecologic Emergencies in the Nonpregnant Patient
Authors: Huancahuari Nadia , Genthon Alissa 
Published: January 2021

Nonpregnant patients with gynecologic emergencies often present with pelvic pain that may or may not be unilateral. Many gynecologic emergencies are associated with high morbidity and, occasionally, mortality if left untreated. This review examines the assessment and stabilization, diagnosis, and treatment and disposition of patients with various gynecologic emergencies, including ovarian torsion, cervicitis, pelvic inflammatory disease, uterine fibroids, endometriosis, dysfunctional uterine bleeding, Bartholin cysts, and vulvovaginitis. Figures show an algorithm of gynecologic emergencies, a longitudinal sonogram and a computed tomography (CT) scan showing ovarian torsion, a CT scan and sonogram of a tubo-ovarian abscess, and illustrations of a Bartholin cyst and a Word catheter. Tables list assessment, stabilization, and management guidelines for the subtopics in this review.

This review contains 7 figures, 15 tables, and 68 references.
Keywords: Ovarian torsion, cervicitis, uterine fibroids, endometriosis, Bartholin’s cyst, vulvovaginitis, sexually transmitted infection, bleeding.
Central Nervous System Infections
Authors: Johnson Nicholas J. , Gaieski David F. 
Published: January 2021

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections.

This review contains 8 highly rendered figures, 7 tables, and 94 references
Complications Following Bariatric Surgery
Authors: Harris David A , Sheu Eric G. 
Published: January 2021

Bariatric surgery has proven to be the most effective and durable treatment for obesity and obesity-related diseases. As such, the number of bariatric procedures performed has dramatically increased over the past several decades. Although multiple bariatric procedures have been performed, the sleeve gastrectomy, Roux-en-Y[H1] gastric bypass, and gastric band have been by far the most common operations in the United States in the last decade. Given the prevalence of bariatric surgery and increased push to short-track postoperative hospital stays, emergency department (ED) visits are common in this patient cohort. This review covers the pathophysiology, diagnosis, and treatment of complications that ED providers are likely to see in patients after bariatric surgery. Although many complications are shared between all bariatric procedures, there are unique surgery-specific complications. To address the needs of these patients, providers must understand the surgery that their patients have had and how the postoperative timing and nature of their complaints inform the likely etiology of their presentation.
This review contains 6 figures, 4 tables, and 83 references.
Key words: anastomotic leak, bariatric surgery, cholelithiasis, complications, dehydration, dumping syndrome, gastric banding, gastrogastric fistula, internal hernia, malnutrition, mesenteric vein thrombosis, Roux-en-Y gastric bypass, sleeve gastrectomy, stricture, ulcer, vitamin deficiency
Liver Disease in Pregnancy
Authors: Chang Matthew S , Rutherford Anna E. 
Published: January 2021

Liver disease in pregnancy can be unique to pregnancy or coincidental to pregnancy, or pregnancy can occur in women with chronic liver disease, cirrhosis, or portal hypertension. The gestational age of the pregnancy can help determine the diagnosis. Liver disease occurring during pregnancy has the potential to be life threatening to mother and fetus, and any elevation in liver tests should be investigated. Disorders unique to pregnancy include hyperemesis gravidarum; intrahepatic cholestasis of pregnancy; preeclampsia/eclampsia; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; and acute fatty liver of pregnancy. Liver diseases coincidental to pregnancy include acute viral hepatitis, gallstones/biliary disease, and thrombosis such as Budd-Chiari syndrome/hepatic vein thrombosis. Pregnant women may have chronic liver disease or cirrhosis from all of the same etiologies as nonpregnant women, most commonly chronic viral hepatitis. Treatment options may differ during pregnancy because of the potential risks to the fetus. Women who have cirrhosis or portal hypertension or who are post liver transplantation should be managed in conjunction with a hepatologist.
This review contains 4 figures, 6 tables and 40 references
Key words: acute liver failure, delivery, trimester
Primary Sjogren Syndrome: Clinical Features and Management
Authors: Giattino Stephanie L , St. Clair E William 
Published: January 2021

Primary Sjögren syndrome (SS) is a chronic inflammatory disease affecting the lacrimal and salivary glands, resulting in dry eyes and dry mouth. It may also lead to systemic manifestations, including fatigue, arthritis, lung involvement, kidney disease, neuropathy, and vasculitis, and predisposes to B cell lymphoma. The diagnosis of primary SS is based on a composite of clinical, serologic, and pathologic features, namely, objective evidence of dry eyes and dry mouth and either a positive test for anti-SSA (Ro) antibodies or a positive labial salivary gland biopsy. Primary SS may be confused with other conditions affecting the lacrimal and salivary glands, such as chronic hepatitis C virus infection, sarcoidosis, and a new entity, IgG4-related disease. The management of patients with primary SS is largely symptomatic and consists of tear supplementation, regular dental hygiene, and liberal use of moisturizers. Cyclosporine 0.05% ophthalmic emulsion and lifitegrast 5% ophthalmic solution are approved agents for the treatment of dry eyes. Two oral secretagogues, pilocarpine and cevimeline, have been shown in trials to significantly reduce the symptoms of dry eyes and dry mouth. Although hydroxychloroquine may reduce fatigue and joint pain, the results of a randomized controlled trial failed to confirm its efficacy in this clinical setting. More serious organ system involvement may be managed with corticosteroids and other immunomodulatory drugs. Although no disease-modifying drugs are currently approved for the treatment of primary SS, a robust pipeline of promising therapies for this disease is currently in development.
This review contains 3 figures, 5 tables, and 69 references.
Key words: anti-Ro/SSA antibodies, B cell lymphoma, classification criteria, EULAR Sjögren’s syndrome Patient Reported Index (ESSPRI), EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), hydroxychloroquine, keratoconjunctivitis sicca, rituximab, Sjögren syndrome
Infections in Cancer Patients
Authors: Hammond Sarah P. , Satyanarayana Gowri 
Published: January 2021

Infection is a common complication in cancer patients who receive cytotoxic chemotherapy and other targeted therapies. A clear understanding of the underlying host risk factors, the immunologic effects of specific cancer therapies, and the anatomic location of the tumor and its impact on surrounding structures helps predict the types of infection to which the host is most vulnerable. This review covers fever in the setting of neutropenia, infection risk with biological and targeted cancer therapy, and infections in patients with solid tumors. Figures show risk for fever and neutropenia, and empirical antibiotic algorithm for initial management of febrile neutropenia in patients at high risk for complications, radiographic findings associated with invasive fungal disease, a schematic of hepatitis B virus infection and reactivation after anti-CD20 therapy, and management of nonpurulent cellulitis in cancer patients. Tables list the Multinational Association of Supportive Care in Cancer (MASCC) risk index score, the Clinical Index of Stable Febrile Neutropenia (CISNE) scoring system, common bacterial pathogens that cause infection in neutropenic patients, assessment of specific signs and symptoms during febrile neutropenia, empirical antibiotic management of febrile neutropenia, criteria for addition of vancomycin to empirical antibiotic regimen for febrile neutropenia, and biological and targeted agents commonly used to treat hematologic malignancy and associated infections.

This review contains 5 highly rendered figures, 7 tables, and 107 references