bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Risk Breast Lesions
Authors: Bleicher Richard J 
Published: January 2021

Clinicians who treat breast disease deal with a variety of pathologic findings. Although there is often a focus on paradigms and data regarding malignant breast disease, benign breast disease ranges from that which requires no imaging, evaluation, or treatment to that which requires further testing to rule out concomitant cancer and ameliorate subsequent risk. This review discusses the most frequent types of high-risk lesions facing the breast practitioner, including atypical ductal hyperplasia, lobular neoplasia, radial scar, and papillary lesions. It is critical that the clinician understand the implications of each finding to advise about the risks associated with each of these entities, fully assess the need for further therapy, and mitigate the patient’s future risk.
This review contains 2 tables, and 69 references.
Key words: atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, papillary lesions, pleomorphic, pseudoangiomatous stromal hyperplasia, radial scar, usual ductal hyperplasia
Benign Breast Disease
Authors: Valente Stephanie A , Grobmyer Stephen R 
Published: January 2021

Benign breast disease constitutes any abnormality that upon further workup is found to be noncancerous and does not establish premalignant potential. Benign breast diseases can present in various ways, such as breast pain, a palpable breast lump, nipple discharge, or an imaging abnormality. Appropriate workup is essential to ensure that the new change is benign. This may entail additional imaging, biopsy, or surgery if necessary. Surgeons need to be able to recognize the presentation, appropriate workup, and treatment recommendations for the various benign breast diseases. This review addresses the broad range of benign breast lesions and their management recommendations.
This review contains 7 figures, 5 tables and 54 references
Key words: benign breast disease, breast cyst, breast mass, breast pain, idiopathic granulomatous mastitis, nipple discharge, papilloma, periductal mastitis, sclerosing adenosis
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.

Key words: computed tomography, diffusion-weighted imaging, imaging, magnetic resonance imaging, positron emission tomography, soft tissue, technique, tumor, ultrasonography
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.

Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection
Atrial Fibrillation
Authors: Al-Salamah Tareq , Bontempo Laura J. 
Published: January 2021

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by chaotic atrial electrical activity. It is associated with heart failure, stroke, and reduced quality of life. AF is frequently recurrent and refractory to treatment. These facts underscore the importance of recognizing this arrhythmia even in its asymptomatic form. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of AF. Figures show AF, atrial flutter, and AF with preexcitation on a 12-lead electrocardiogram, rate control agent selection recommendations, and a decision-making algorithm for oral anticoagulation therapy. Tables list etiologies and risk factors for AF, American Heart Association/American College of Cardiology/Heart Rhythm Society classification of AF, some of the clinical consequences of AF, diagnostic evaluation for AF, antiarrhythmic drugs for conversion of AF, drugs used for acute rate control of AF, CHA2DS2-VASc score calculation, CHA2DS2-VASc adjusted stroke rate and treatment guidelines, scoring system to assess the risk of bleeding with oral anticoagulation: HAS-BLED (hypertension, abnormal renal/liver function, history of stroke, bleeding history or predisposition, labile international normalized ratio, elderly [65 years], drugs/alcohol concomitant), and HAS-BLED scores with proportion of patients from the Euro Heart Survey in each category and associated major bleeding risk.

This review contains 5 highly rendered figures, 10 tables, and 69 references
Key words: Atrial fibrillation; Supraventricular tachycardia; Irregular heart beat; Cardioversion; Nonvalvular atrial fibrillation; Paroxysmal atrial fibrillation; Rate control; CHA2DS2-VASc scoring system; Rhythm control
Supraventricular Tachycardia
Authors: Baker Annalee M 
Published: January 2021

Supraventricular tachycardia (SVT) is a category of arrhythmias that originate at or above the atrioventricular node. These are typically narrow complex QRS arrhythmias, without discernible P waves, with a regular rhythm and rapid rate. SVT is relatively common, occurring in 2.25 cases per 1,000 persons. Therefore, understanding the pathophysiology and method of treatment of SVT is an important skill for the emergency medicine physician to master. Therapeutic interventions include vagal maneuvers or pharmacologic agents, such as adenosine or calcium channel blockers, for the stable patient and synchronized cardioversion for the unstable patient. Stable patients with minimal comorbidities whose sinus rhythm is converted back in the emergency department can be safely discharged with a close follow-up by a cardiologist. However, admission is often required for the patient who presents with unstable SVT or has multiple comorbidities and requires further work-up.

This review contains 10 figures, 3 tables, and 48 references.
Keywords: ablation, adenosine, cardioversion, supraventricular tachycardia, valsalva maneuver, Wolff-Parkinson-White syndrome
Approach to the Patient Presenting with Chest Pain
Authors: Temin Elizabeth 
Published: January 2021

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain.
This review contains 1 figure, 25 tables, and 36 references.
Key words: acute coronary syndrome, acute myocardial infarction, angina pectoris, chest pain, coronary artery disease, pulmonary embolism, high sensitivity troponin, HEART Score, EDAC score, cardiac CT Angiogram
Acute Pancreatitis
Authors: Ahn Jason , Huang Calvin K. 
Published: January 2021

Pancreatitis is a leading differential diagnosis in patients presenting with abdominal pain. Although there are multiple initial inciting factors, the end result is the inappropriate activation of pancreatic enzymes leading to localized, and sometimes systemic, inflammation. The severity of pancreatitis as a disease can range from mild pain to shock and hypotension. This review covers the initial treatment and stabilization of patients with this disease as well as the mainstay of diagnosis including lab testing and imaging. Disease severity scoring systems including the revised Atlanta Criteria, APACHE II score, SIRS criteria, BISAP score, and Ranson criteria, followed by treatment and disposition stratified by disease severity, are discussed. Figures display pertinent findings of the imaging modalities including fluoroscopy, ultrasound, and computed tomography. Tables list the major causes of pancreatitis, differential diagnosis, and non-pancreatic causes of amylase and lipase elevation.
This review contains 6 figures, 5 tables, and 53 references.
Key words: pancreatitis, abdominal pain, shock, gallstones, ultrasound, lipase, amylase
Hypersensitivity Reactions and Anaphylaxis
Authors: Ford Kristopher K. , Loftus Timothy M. , Moellman Joseph J. 
Published: January 2021

Allergic reactions vary in intensity from mild rash or allergic rhinitis to devastating anaphylactic shock. Anaphylaxis, often underrecognized and undertreated, can be a life-threatening syndrome leading to multiorgan dysfunction. This review covers the etiology, pathophysiology, and treatment of severe allergic reactions and anaphylaxis. It is precipitated by exposure to particular allergens—commonly food, medications, insect stings, and environmental exposures—in a previously sensitized individual. Symptoms develop from an IgE-mediated immune response leading to degranulation of mast cells and basophils and the release of preformed mediators, lipid-derived metabolites, and inflammatory cytokines. First-line treatment for anaphylaxis involves epinephrine. Secondary treatments are antihistamines and corticosteroids. Further treatments for patients refractory to standard therapies involve vasopressor agents, nebulized albuterol, and glucagon. Frequency and duration of biphasic reactions are variable, limiting the development of consensus guidelines for monitoring of anaphylactic reactions.
Figures show the immune activity and inflammatory pathways in allergic responses, mast cell degranulation, and a depiction of common organs involved and corresponding clinical manifestations. Tables list the criteria for diagnosis of anaphylaxis, classification of hypersensitivity reactions, common clinical manifestations, and etiology and mediators of anaphylaxis.
This review contains 4 highly rendered figures, 11 tables, and 43 references.
Key words: allergy, anaphylaxis, antihistamine, corticosteroid, epinephrine, mast cells
Radiation Injury
Authors: Mazer-Amirshahi Maryann 
Published: January 2021

Since the development of x-rays in the late 19th century, radiation has increasingly been used for diagnostic imaging and various industrial purposes. The human health consequences of radiation exposure can range from minor asymptomatic exposures to the development of potentially fatal acute radiation sickness depending on the characteristics of the exposure. This review provides an overview of radiation injury, including historical perspective and principles of toxicity; assessment and stabilization (bedside evaluation, supportive care, and empirical therapy); diagnosis (estimation of radiation dose, laboratory assessment, biodosimetry and bioassays, smoke inhalation, and psychiatric sequelae); treatment and disposition (hematologic acute radiation illness, countermeasures and antidotes, gastrointestinal symptoms, fluid and electrolyte management, surgical intervention, local radiation injury, psychiatric treatment, radiation exposure during pregnancy, palliative care, and disposition); and outcomes (carcinogenesis, noncancer effects). Tables include the characteristic of common radioactive isotopes, common radiation dose equations and conversions, prescribing information for colony-stimulating factors, recommended antimicrobial prophylaxis and treatment regimens, and radioisotope decorporation or blocking agents. Figures show types of ionizing radiation, comparison of radiation contamination and exposure, patterns of early lymphocyte response based on radiation dose, the relationship between time to onset of vomiting and radiation dose, and a sample body chart for documentation of radiation contamination.
This review contains 5 figures, 5 tables, and 82 references.
Key Words: radiation, radiation exposure, radiation sickness, diagnostic imaging, pregnancy, carcinogenesis, toxicity, acute radiation syndrome (ARS)
Lightning and Electrical Injury
Authors: Davis Christopher , Cushing Tracey A. 
Published: January 2021

There are multiple types of electrical injuries, which vary according to the type of electricity (alternating current or direct current) and the mechanism of contact. Electrical injuries caused by contact with alternating current are more commonly encountered in the household setting, while direct current is found in industrial accidents. Lightning injuries are rare in the United States but are much more common in developing countries due to a lack of access to infrastructure and more agrarian economies. This review includes an overview, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for each of these types of injury.
This review contains 2 figures, 18 tables, and 68 references.
Keywords: Lightning, electrical injury, burn, voltage, alternating current, direct current, conducted electrical weapon, TASER, arrhythmia, cardiac arrest, myonecrosis, rhabdomyolysis
Septic Arthritis and Osteomyelitis
Authors: Leber Melissa 
Published: January 2021

Septic arthritis is an inflammatory condition within the joint in reaction to bacterial infection in the joint space. Emergent diagnosis and initiation of therapy are necessary to prevent joint destruction and, in some cases, serious systemic illness. This review covers the epidemiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of septic arthritis. Figures show the pathophysiology of bone infection; an algorithm for the initial evaluation and management of a suspected septic joint; a magnetic resonance image of vertebral body osteomyelitis; a cutaneous sinus in a patient with underlying chronic posttraumatic osteomyelitis at the site of a previous tibial fracture; the probe-to-bone test for diagnosing osteomyelitis in the diabetic foot; an algorithm for the initial evaluation and management of suspected vertebral body osteomyelitis; nonsurgical treatment of osteomyelitis of the foot in a patient with diabetes; and algorithms for the evaluation and management of osteomyelitis in diabetic patients with neuropathic ulcers and no or mild foot infection, osteomyelitis in diabetic patients with neuropathic ulcers and moderate or severe foot infection, and chronic posttraumatic osteomyelitis. Tables list supportive findings for diagnosis of chronic osteomyelitis, risk factors for the development of septic arthritis in patients with underlying joint disease, microbiology in septic arthritis, empirical antibiotic therapy for septic arthritis, microbiology in vertebral osteomyelitis, antibiotic therapy for vertebral osteomyelitis awaiting culture results, representative studies with likelihood ratios for diagnostic tests used in the evaluation of native joint septic arthritis, antibiotic therapy for vertebral osteomyelitis with unknown or established microbiology, and antibiotic therapy for diabetic pedal osteomyelitis with unknown or established microbiology.

Key words: osteomyelitis, probe-to-bone test, septic arthritis, septic joint, vertebral osteomyelitis
This review contains 10 highly rendered figures, 9 tables, and 110 references.
HIV Coinfection
Authors: Chan Justin , Yu-Shin Kim Arthur 
Published: January 2021

Improved screening of the blood supply and safer injection practice have led to a decreased prevalence of hepatitis C virus (HCV) worldwide over the past decade. However, those who are coinfected with HIV and HCV experience synergistic interaction between the viruses, leading to accelerated liver fibrosis and possibly increased HIV progression. Left untreated, these coinfected patients experience higher mortality compared with monoinfected individuals. The recent availability of highly efficacious direct-acting antivirals (DAAs) provides opportunity to prioritize coinfected patients for curing HCV, which can improve liver-related and overall mortality. This review summarizes the epidemiology, virology, and natural history of coinfection. Major clinical trials involving coinfected patients are summarized, and drug-drug interactions between HIV antiretroviral therapy and HCV DAA therapy are discussed. Given the numbers of people at risk for primary infection and reinfection after cure, we also discuss important strategies of harm reduction and treatment as prevention. The revolution in DAAs provides the prospect of reducing the burden of liver disease, which remains one of the leading causes of death in people living with HIV.
Key words: HIV-HCV coinfection; Epidemiology; Natural history; Viral interaction; Direct-acting antiviral; Drug-drug interaction
Extraintestinal Manifestations of Inflammatory Bowel Disease
Authors: Silva Punyanganie de , Patel Mital 
Published: January 2021

The extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) can be classified as the following: (a) true EIMs due to reactive IBD affecting organ systems, (b) complications secondary to IBD activity, (c) non–IBD-specific autoimmune disease which occurs in increased frequency in individuals with IBD. Overlap is frequent between EIMs and extraintestinal complications, and it is increasingly evident that multiple organ systems may be involved. This review covers EIMs through their epidemiology, etiology/genetics/pathogenesis, prognosis, complications, and treatment. Also detailed are the organ systems involved with reactive IBD, including musculoskeletal, pulmonary, dermatological, ophthalmic, and hepatobiliary manifestations. Figures show the classification, etiology, and pathogenesis of EIMs of IBD, musculoskeletal and pulmonary manifestations of IBD, metastatic Crohn disease of the intergluteal cleft, pyoderma gangrenosum, oral apthous ulcers, Sweet syndrome, leucocytoclastic vasculitis, anti-tumor necrosis factor–induced psoriasis, uveitis, episcleritis, and primary sclerosing cholangitis. Tables list the modified New York criteria for ankylosing spondylitis, pulmonary manifestations of IBD and IBD-related treatment, diagnostic techniques in lung disorders associated with IBD, dermatologic manifestations of IBD based on classifications, specific cutaneous manifestations or granulomatous cutaneous lesions with the same histological features as the underlying bowel disease, reactive cutaneous manifestation of IBD with immunological mechanisms triggered by common antigens shared by gut bacteria and skin, cutaneous disorders or dermatosis associated with IBD, secondary cutaneous manifestations due to complications of IBD and adverse effects of IBD treatment, treatment of dermatological manifestations of IBD, diagnosis of ophthalmological manifestations of IBD, and other hepatobiliary manifestations of IBD.
This review contains 13 highly rendered figures, 12 tables, and 79 references.
Pathophysiology of Alzheimer Disease
Authors: Knopman David 
Published: January 2021

Genetic discoveries coupled with neuropathologic investigations initially established the central role for β-amyloidosis in Alzheimer disease (AD). Three dominantly inherited genes (APP, PSEN1, and PSEN2) and one common allelic variant with lower penetrance (APOE) account for the majority of the genetic basis for AD. PET biomarkers for AD have been developed in the past decade and are fundamentally altering our view of the disease. The availability of PET tracers, first for amyloid and now for tau, has enabled researchers to develop a model of AD that begins long before people become symptomatic. In persons destined to develop dementia due to AD, brain β-amyloid levels begin to rise 10 to 20 years earlier. Other imaging changes that might precede symptomatic disease include (1) reductions in brain metabolic activity in a group of temporal and parietal cortical association areas that can be demonstrated by [18F]fluorodeoxyglucose-PET scanning; (2) losses of hippocampal volume as measured on structural magnetic resonance imaging; and (3) loss of cortical thickness or cortical volume in temporal and parietal cortical association areas. All of these changes are greatly accentuated once people become symptomatic. Although mild elevations in tau PET abnormalities can also be seen in presymptomatic individuals, it is only when persons become symptomatic that marked elevations in these abnormalities begin to occur in those same temporal and parietal cortical association areas. Cerebrospinal fluid (CSF) biomarkers provide a complementary view, with CSF β-amyloid levels falling (presumably due to aggregation within the cortex) even before amyloid PET abnormalities are visible. CSF total tau and phospho-tau levels begin to rise when persons are much closer to being symptomatic. The sum of these observations has allowed researchers to gain a far more insightful antemortem view of the pathophysiology of AD in humans than had previously been available from neuropathologic investigations.
Keywords: β-amyloid, cerebrospinal fluid β-amyloid, cerebrospinal fluid phospho-tau, cortical thickness, [18F]fluorodeoxyglucose–positron emission tomography, hippocampal atrophy, preclinical Alzheimer disease, tau protein
Appendicitis
Authors: Creswell Simpson James , Sebbag Sarah 
Published: January 2021

Appendicitis is defined as inflammation of the vermiform appendix. It is the most common abdominal surgical emergency and occurs at an annual rate of approximately one in 10,000 in the United States. The lifetime risk of appendicitis is about 9% for males and 7% for females; approximately 80% of cases occur before 45 years of age. Appendicitis rarely occurs in infants; it increases in frequency between 2 and 4 years of age and reaches a peak between the ages of 10 and 19 years. However, clinicians must maintain a high index of suspicion in patients of all age groups. This review covers the pathophysiology, stabilization and assessment, and diagnosis and treatment of complicated and uncomplicated appendicitis. The disposition and outcomes are also reviewed. Figures show an image of appendicitis on a bedside sonogram, and a computed tomographic image of appendicitis. Tables list likelihood ratios of signs and symptoms of appendicitis, the sonographic appearance of appendicitis, the Alvarado scoring system, and the differential diagnosis of appendicitis.

This review contains 2 figures, 7 tables, and 36 references.
Key words: appendicitis, obstructed appendiceal lumen, rebound abdomen, right lower quadrant pain, ruptured appendix