DeckerMed CGSO Case-Based Reviews最新文献

{"title":"Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19","authors":"M. Ison","doi":"10.2310/cgso.1422","DOIUrl":"https://doi.org/10.2310/cgso.1422","url":null,"abstract":"Coronaviruses (CoVs) are a group of viral pathogens that infect mammals and birds. The presentation in humans is typically that of a mild upper respiratory tract infection, similar to the common cold. However, in recent years, dramatic attention has arisen for more lethal members of this viral family (e.g., severe acute respiratory syndrome [SARS-CoV], Middle East respiratory syndrome [MERS-CoV], and coronavirus disease 2019 [COVID-19]). The epidemiology, clinical presentation, diagnosis, and management of these viruses are discussed in this review. Importantly, new guideline tables from the Centers for Disease Control and Prevention, as well as the World Health Organization are provided at the conclusion of the review.\u0000This review contains 12 tables, 3 figure and 48 references.\u0000Keywords: Coronavirus, severe acute respiratory distress syndrome (SARS), Middle East respiratory syndrome (MERS), COVID-19, respiratory infection, antiviral, real-time polymerase chain reaction","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125093217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroesophageal Junction Cancer","authors":"D. Joyce, R. Schwarz","doi":"10.2310/7800.16054","DOIUrl":"https://doi.org/10.2310/7800.16054","url":null,"abstract":"Cancers of the gastroesophageal junction (GEJ) remain challenging malignancies to treat effectively. The GEJ represents the transition between esophagus and stomach, and approaching GEJ cancers as “esophageal” or as “gastric” cancers, a priori will run risk for excluding some more appropriate therapeutic options based on actual location. Gastroesophageal junction cancers are increasing in incidence, in particular at the distal esophageal and gastric cardia locations. They may be discovered in an early stage on upper GI endoscopy, but when presenting with dysphagia symptoms they are often of more advanced stage. Endoscopic resection options are limited to non-ulcerated T1 lesions, and surgical resection as only therapy is accepted for nodal-negative T1 or T2 disease. All other mid-stage GEJ cancers should be considered for multimodality therapy and should undergo a formal and complete multidisciplinary evaluation process before any therapy is started. While the proper approach remains debated, most often trimodality therapy with preoperative chemoradiation followed by resection is being offered, as it offers the greatest likelihood for complete pathologic response and survival benefit but requires a shorter preoperative treatment duration. Perioperative chemotherapy remains acceptable as well, based on the patient’s tolerance for related toxicity. The Siewert classification with 3 subtypes of GEJ cancers, based on the relationship of the tumor’s epicenter to the gastric cardia, remains useful for planning resection approach and extent as well as reconstruction technique. Type I (proximal GEJ) tumors require esophageal resection with mediastinal and retrogastric lymphadenectomy; reconstruction most often involves a gastric tube pull-up. Type III (distal GEJ) lesions are gastric cancers that require total or proximal gastrectomy with D2 dissection; reconstruction often utilizes Roux-Y esophagojejunostomy, but may include small bowel interposition for proximal gastrectomy too. Best approaches to type II lesions (of the cardia) remain debated; complete resection through esophagectomy (as type I) or transhiatal esophagogastrectomy (as in type III with appropriate proximal extension) remain acceptable, as long as complete resection and proper extent lymphadenectomy are performed. Minimally invasive approaches (versus open), patient comorbidity, individual tumor extent and surgeon’s experience should determine the best individual choice for operative approach. Surgeons engaging in GEJ cancer care should be familiar with all aspects of multidisciplinary and operative treatment planning, and should be able to offer the most appropriate resection choice for the patient’s best benefit.\u0000This review contains 2 figures, 3 tables, and 100 references.\u0000Key words: adenocarcinoma, gastrectomy, gastroesophageal junction, laproscopy, lymphadenectomy, metastasis, minimally invasive esophagectomy","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131461051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Right Hepatectomy","authors":"O. Salehi, E. Vega, C. Conrad","doi":"10.2310/7800.16174","DOIUrl":"https://doi.org/10.2310/7800.16174","url":null,"abstract":"Laparoscopic right hepatectomy (LRH) is an important technique in a modern hepatobiliary surgeon’s arsenal. It’s application extends to many different disease processes including both malignant and benign tumors as well as infections and in trauma. The procedure involves using minimally invasive methods to remove Couinaud segments 5-8 delineated by the portion of the liver right and lateral to Cantlie’s line. In this chapter, we explain the approach to performing this operation by delving into preoperative considerations with a focus on high quality imaging, 3D reconstruction, and virtual hepatectomy, optimizing the future liver remnant (FLR) with PVE and use of parenchymal sparing methods, and detailed intraoperative steps emphasizing caudal view, Glissonian approach, MHV roadmap, and communication with anesthesia. We also give context to LRH by discussing the two most common diseases addressed by it, namely colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC), as well as historical perspectives and how LRH use has evolved. We also address complication management such as post-operative liver failure and intra-operative bleeding accidents, variants on exposure with hand assist and transthoracic view, and comparing the advantages and disadvantages between open and laparoscopic right hepatectomy.\u0000This review contains 12 figures, 4 tables, and 111 references.\u0000Keywords: augmented reality, laparoscopic right hepatectomy, laparoscopic PVE and ALPPS, low CVP anesthesia, MHV roadmap, minimally invasive liver resection, parenchymal sparing right hepatectomy, Takasaki caudal approach, virtual hepatectomy,","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125118438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Stage I Rectal Cancer","authors":"J. García-Aguilar","doi":"10.2310/7800.16029","DOIUrl":"https://doi.org/10.2310/7800.16029","url":null,"abstract":"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.\u0000 \u0000This review contains 5 figures, 5 tables and 37 references\u0000Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery\u0000 ","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127661671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locally Advanced Rectal Cancer","authors":"D. Kleiman, M. Weiser","doi":"10.2310/7800.16030","DOIUrl":"https://doi.org/10.2310/7800.16030","url":null,"abstract":"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. \u0000\u0000This review contains 1 figure, 2 table and 58 references\u0000Key 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","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"132 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116624310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated Thyroid Cancer","authors":"R. Michael Tuttle, William Cance, James R. Howe","doi":"10.2310/cgso.16001","DOIUrl":"https://doi.org/10.2310/cgso.16001","url":null,"abstract":"<jats:p />","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123777216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated Thyroid Cancer","authors":"R. Tuttle, William Cance, James R. Howe","doi":"10.1007/1-84628-006-0_6","DOIUrl":"https://doi.org/10.1007/1-84628-006-0_6","url":null,"abstract":"","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141222201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendiceal Neoplasm","authors":"T. Samdani, G. Nash","doi":"10.2310/cgso.16032","DOIUrl":"https://doi.org/10.2310/cgso.16032","url":null,"abstract":"Appendiceal neoplasms are rare and are typically found in the setting of metastatic disease or, less commonly, as an incidental finding in an appendectomy specimen in cases of appendicitis or an unrelated condition. The World Health Organization classifies appendiceal neoplasms as benign or malignant. The management of the mucinous variety of appendiceal neoplasms is influenced by the presence of peritoneal involvement. Selected patients with metastatic appendiceal neoplasms are treated with surgical cytoreduction and intraperitoneal chemotherapy and/or systemic chemotherapy. Nonmetastatic appendiceal adenocarcinoma is typically managed with staging right colectomy and adjuvant fluorouracil-based chemotherapy based on colon cancer guidelines. Neuroendocrine tumors (NETs) constitute 50 to 77% of all appendiceal neoplasms and 19% of all gastrointestinal NETs. Right hemicolectomy is indicated if the size of the NET is more than 2 cm, the base of the appendix is involved, it is a high-grade tumor, or the depth of invasion of the mesoappendix is more than 3 mm.\u0000This review contains 7 figures, 9 tables and 37 references\u0000Key Words: appendiceal adenocarcinoma, appendiceal adenoma, appendiceal neoplasm, diffuse peritoneal adenomucinosis, Goblet cell carcinoid of appendix, low-grade appendiceal mucinous neoplasm, mucocele of appendix, neuroendocrine tumor of appendix, peritoneal mucinous carcinomatosis (PMCA), pseudomyxoma peritonei  ","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116400928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Standardized Clinical Pathway Approach to Esophageal Cancer","authors":"A. Wirsching, D. Low","doi":"10.2310/cgso.16055","DOIUrl":"https://doi.org/10.2310/cgso.16055","url":null,"abstract":"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.  \u0000This review contains 3 figures, 8 tables, and 33 tables.\u0000Key words: clinical pathway, costs, enhanced recovery, esophageal cancer, esophagectomy, hospital stay, implementation, length of stay, outcome, standardized pathway","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"606 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132818797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synovial Sarcoma","authors":"M. Tan","doi":"10.2310/cgso.16114","DOIUrl":"https://doi.org/10.2310/cgso.16114","url":null,"abstract":"Synovial sarcomas are a common extremity soft tissue sarcoma, typically arising in the para-articular regions of young adults. All synovial sarcomas are considered high grade. Distinctive clinical features are the two common histologic variants (monophasic and biphasic) and more frequent incidence of nodal metastasis. In addition to the sheets of spindle cells seen in monophasic tumors, biphasic tumors have interspersed areas of glandular differentiation. Synovial sarcomas are characterized by the SS18-SSX translocation. Most biphasic tumors contain the SS18-SSX1 translocation, whereas almost all SS18-SSX2 tumors are monophasic. Radical resection is the mainstay of therapy. Synovial sarcomas are chemosensitive, and ifosfamide-doxorubicin is often used neoadjuvantly. Adjuvant radiation should be considered for tumors greater than 5 cm.\u0000This review contains 7 figures, 2 tables, and 35 references.\u0000Key Words: E-cadherin, extremity sarcoma, ifosfamide, neoadjuvant chemotherapy, nomogram, SS18-SSX fusion, synovial sarcoma, translocation-associated sarcoma","PeriodicalId":381094,"journal":{"name":"DeckerMed CGSO Case-Based Reviews","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115786567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}