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E/M Medical Decision Making


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8701. Craniopharyngiomas (Follow-up)

Disorders and Stroke, National Institutes of Health (NIH); Fishbein Fellow, JAMA Ryszard M Pluta, MD, PhD is a member of the following medical societies: , Disclosure: Nothing to disclose. Chief Editor Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Brian H Kopell, MD is a member of the following medical societies: , , , , , Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation (...) of endoscopic techniques has placed greater emphasis on minimally invasive approaches, but this should not rule out the use of the surgical techniques that the surgeon feels most comfortable with. [ , ] Next: Medical Therapy No primary medical therapy exists for craniopharyngioma. Hormonal replacements are administered as needed if endocrine abnormalities exist. Previous Next: Surgical Therapy Choice of surgical approach The initial surgical decision concerns the approach to the craniopharyngioma

2014 eMedicine Surgery

8702. Epilepsy Surgery (Follow-up)

completely new AEDs since 1993, an estimated 300 years would be required to try all medications in all combinations. Far more important, subsequent studies of patients with new-onset seizures have shown that only 64% have seizure freedom by the time they try their third AED. [ ] Thus, after 3 different AEDs have failed to control seizures, more than 35% of patients continue to have seizures. Therefore, the decision to proceed with surgery must take into consideration both the chance of seizure freedom (...) –rapid eye movement sleep in some epilepsies. On fewer occasions than in the past, sphenoidal and additional extracranial electrodes are used to help reveal epileptiform (interictal) and ictal discharges. [ ] Although the standard scalp EEG is helpful in making a diagnosis of epilepsy, it is not usually used when the physician makes major surgical decisions. This is because the distribution of interictal EEG discharges may not correctly localize epileptic foci. This error occurs for several reasons

2014 eMedicine Surgery

8703. Forearm Fractures (Follow-up)

when a rigidly plated fracture of the forearm has healed on the basis of radiographic findings is difficult, partly because very little external callus results when fractures are stabilized in a rigid manner as is the case for plate-and-screw fixation of radius and ulnar fractures. Strenuous activity must be prohibited until bone trabeculae cross the fracture. Previous References Singh S, Bhatia M, Housden P. Cast and padding indices used for clinical decision making in forearm fractures (...) is a member of the following medical societies: , , , , , , , Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor. Chief Editor Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical

2014 eMedicine Surgery

8704. Foot Drop (Follow-up)

JP, Fuller R. March gangrene; ischaemic myositis of the leg muscle from exercise. J Bone Joint Surg Br . 1957 Nov. 39-B (4):679-93. . . Weyns FJ, Beckers F, Vanormelingen L, Vandersteen M, Niville E. Foot drop as a complication of weight loss after bariatric surgery: is it preventable?. Obes Surg . 2007 Sep. 17(9):1209-12. . Koffman BM, Greenfield LJ, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve . 2006 Feb. 33(2):166-76. . Kuntz C 4th, Blake L, Britz G (...) to disclose. Chief Editor Vinod K Panchbhavi, MD, FACS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedics, University of Texas Medical Branch School of Medicine Vinod K Panchbhavi, MD, FACS is a member of the following medical societies: , , , , , Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker. Acknowledgements John S Early, MD Foot/Ankle Specialist, Texas Orthopaedic Associates

2014 eMedicine Surgery

8705. Cervical Spine Injuries in Sports (Follow-up)

, are imperative for diagnosing cervical injuries. [ , ] The team physician plays a crucial role in the coordination of medical assessment on the playing field, immobilization and transportation to a qualified facility for evaluation and treatment, and decision-making regarding return to play following an injury. These decisions should be discussed with the athlete and the athlete's parents, coaches, trainers, and agents. The ultimate decision should be made in the best interest of the patient. [ ] See (...) . Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World Neurosurg . 2018 Feb. 110:e427-e437. . de Jonge MC, Kramer J. Spine and sport. Semin Musculoskelet Radiol . 2014 Jul. 18(3):246-64. . Hannon M, Mannix R, Dorney K, Mooney D, Hennelly K. Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis. Ann Emerg Med . 2015 Mar. 65 (3):239-47. . Presciutti SM

2014 eMedicine Surgery

8706. Carcinoid Lung Tumors (Follow-up)

have been quite small, and long-term results have yet to be determined. This area has been controversial. [ , ] Preparation for surgery The surgeon must have a clear preoperative understanding of the location of the tumor (particularly if it is intrabronchial) and, to the degree possible, its extent. Many surgeons revisualize the tumor with the bronchoscope in the operating room immediately prior to the resection. This may facilitate decision-making regarding the choice of surgical procedure (...) (3):e183-9. . Hindié E. The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors. Theranostics . 2017. 7 (5):1159-1163. . . Esfahani AF, Chavoshi M, Noorani MH, Saghari M, Eftekhari M, Beiki D, et al. Successful application of technetium-99m-labeled octreotide acetate scintigraphy in the detection of ectopic adrenocorticotropin-producing bronchial carcinoid lung tumor: a case report. J Med Case

2014 eMedicine Surgery

8707. Cerebral Aneurysm (Follow-up)

decision-making is needed to determine which aneurysm or aneurysms require treatment in the acute setting. In approximately 15% of patients with nontraumatic SAH, no aneurysm is found despite a complete, high-quality, six-vessel cerebral angiogram. Two distinct subsets of these patients have been recognized. The first group consists of those with so-called benign perimesencephalic nonaneurysmal SAH (BPNSAH), in which bleeding on CT or MRI is localized immediately anterior to the brainstem and adjacent (...) and have a slight male predilection. Aneurysms found in children are also larger than those found in adults, averaging 17 mm in diameter. Aneurysms commonly arise at the bifurcations of major arteries (see the first image below). Most saccular aneurysms arise on the circle of Willis (see the second image below) or the middle cerebral artery (MCA) bifurcation. Common locations of cerebral saccular aneurysms, with relative incidences. Copyright 2006 Massachusetts Medical Society. All rights reserved

2014 eMedicine Surgery

8708. Dupuytren Contracture (Follow-up)

to disclose. Chief Editor Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine Harris Gellman, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Acknowledgements Michael S Clarke, MD Clinical Associate Professor (...) , PLLC Steve Lee, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Michael Baytion, MD Ohio State University College of Medicine Disclosure: Nothing to disclose. Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY) Yelena Bogdan is a member of the following medical societies: Disclosure: Nothing to disclose. Derek L Reinke, MD Consulting Staff, Cary Orthopedic and Sports Medicine Specialists Disclosure: Nothing

2014 eMedicine Surgery

8709. Deep Venous Thrombosis (Follow-up)

decision-making, because recanalization may be achieved faster than before and with a decreased dose of lytic; therefore, the bleeding risk may be decreased. Inpatient Versus Outpatient Treatment Acute DVT may be treated in an outpatient setting with LMWH. Patients with low-risk PE may be safely discharged early from hospital or receive only outpatient treatment with LMWH, followed by vitamin K antagonists, although nonvitamin K-dependent oral anticoagulants may be as effective but safer than the LMWH (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTkxMTMwMy10cmVhdG1lbnQ= processing > Deep Venous Thrombosis (DVT) Treatment & Management Updated: Jul 05, 2017 Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP Share Email Print Feedback Close Sections Sections Deep Venous Thrombosis (DVT) Treatment Approach Considerations The primary objectives for the treatment of deep venous thrombosis (DVT) are to prevent pulmonary embolism (PE), reduce morbidity, and prevent or minimize the risk of developing the postthrombotic syndrome (PTS

2014 eMedicine Surgery

8710. Charcot-Marie-Tooth Disease (Follow-up)

helps parents to understand the risk of having children with this disorder and gives them a chance to make informed decisions regarding pregnancy. [ , ] A study of mitochondrial data from 442 patients suggested that MT-ATP6 mutations are an important cause of CMT disease and can be evaluated with a simple blood test. [ ] Previous Next: Long-Term Monitoring Patients should have regular follow-up visits to check for deterioration in function and the development of contractures. This follow-up allows (...) . 883:42-6. . Lassuthova P, Rebelo AP, Ravenscroft G, Lamont PJ, Davis MR, Manganelli F, et al. Mutations in ATP1A1 Cause Dominant Charcot-Marie-Tooth Type 2. Am J Hum Genet . 2018 Mar 1. 102 (3):505-514. . . Ben Othmane K, Hentati F, Lennon F, Ben Hamida C, Blel S, Roses AD, et al. Linkage of a locus (CMT4A) for autosomal recessive Charcot-Marie-Tooth disease to chromosome 8q. Hum Mol Genet . 1993 Oct. 2 (10):1625-8. . Bolino A, Muglia M, Conforti FL, LeGuern E, Salih MA, Georgiou DM, et al

2014 eMedicine Surgery

8711. Growth Plate (Physeal) Fractures (Follow-up)

not be manipulated. In such cases, the risks of the additional force that would have to be exerted on the growth plate must be weighed against the likelihood of spontaneous remodeling of the fracture over time or performing an osteotomy later after growth has ceased. Next: Nonoperative Therapy Closed reduction, casting, and splinting Very commonly, growth plate (physeal) fractures can be treated nonoperatively. Factors that affect treatment decisions include the following: Severity of the injury Anatomic (...) , hardware removal is commonly recommended; continued bone growth can bury hardware, making future removal (if needed) technically challenging. Painful hardware should also be removed. In older patients, hardware that is not causing symptoms can be left in situ. The images below are from a patient with a healed SH III fracture of the distal femur who had pain from a screw head and washer. The pain resolved after removal of the hardware. Growth plate (physeal) fractures. Healed Salter-Harris III fracture

2014 eMedicine Surgery

8712. Glenohumeral Arthritis (Follow-up)

etiology, posttraumatic arthritis is characterized by osseous deformities and asymmetrical soft-tissue contractures. Inflammatory arthritides Inflammatory arthritides make up the second largest category of glenohumeral arthritis. The shoulder commonly is affected in individuals with inflammatory arthritides. The prototypical disease in this category is (RA). In one study, 91% of patients with RA reported shoulder pain and functional limitations. Other inflammatory diseases that may affect the shoulder (...) arthritis, CT scanning and MRI, although not a standard part of the evaluation of RA, may be helpful in preoperative planning. Content. Previous Next: Cell Counts and Culture Septic arthritis The diagnosis of septic arthritis usually is confirmed by for cell count and culture. Positive cultures or a white blood cell count of more than 75,000/µL indicate the presence of septic arthritis. Neuropathic arthritis Joint aspirate is negative in neuropathic arthritis. Previous Next: Medical Therapy

2014 eMedicine Surgery

8713. Gardner Syndrome (Follow-up)

of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow John Geibel, MD, DSc, MSc, AGAF is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Acknowledgements William T Cummins, MD Consulting Staff, Healthstar Physicians Disclosure: Nothing to disclose. Scott M Hovis, MD Staff Physician, Department of General Surgery, Spartanburg Regional Medical Center Scott M Hovis, MD is a member (...) adenomatous polyposis (FAP). The choices are as follows: Proctocolectomy [ ] with ileostomy Proctocolectomy, mucosectomy, and (IPAA) Total colectomy with ileorectal anastomosis (IRA) Contraindications for surgery in patients with polyps blanketing the colon are relative. Because these polyps eventually undergo malignant degeneration in 100% of cases, contraindications for surgery are limited to those general medical conditions that would make survival from and a prolonged operation unlikely. Because

2014 eMedicine Surgery

8714. Bunion (Follow-up)

Bunion (Follow-up) Bunion Treatment & Management: Approach Considerations, Medical Therapy, Surgical Options Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. processing > Bunion Treatment (...) procedure chosen may not address all of its components. Recurrence or suboptimal results also occur when the procedure is used at the upper limits of its indications. When each component of the deformity is addressed, satisfactory results can be achieved. It is worth repeating that it is critical to obtain high-quality standing radiographs in the anteroposterior (AP) and lateral directions prior to surgery. Next: Medical Therapy The first aspect of HV treatment is to have patients wear properly fitting

2014 eMedicine Surgery

8715. Anterior Cruciate Ligament Pathology (Follow-up)

: , , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San (...) Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder Thomas M DeBerardino, MD is a member of the following medical societies: , , , , Herodicus Society, Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap

2014 eMedicine Surgery

8716. Ulnar-Sided Wrist Pain (Diagnosis)

== processing > Ulnar-Sided Wrist Pain Updated: Aug 27, 2018 Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Ulnar-Sided Wrist Pain Background Wrist often proves to be a challenging presenting complaint. Determining the cause of ulnar-sided wrist pain is difficult, largely because of the complexity of the anatomic and biomechanical properties of the ulnar wrist. [ , ] The objectives of this article are to provide an overview of the most (...) to confirm the diagnosis. [ , ] Contrast material may be injected into one of the three noncommunicating spaces of the carpus: the distal radioulnar joint (DRUJ), the radiocarpal joint, and the midcarpal joint. The decision to obtain a single-injection arthrogram versus a triple-injection arthrogram must be based on specific clinical findings. At least one third of cadaver dissections have abnormal communications of the wrist joint. Mikic reported that the incidence of degenerative perforations

2014 eMedicine Surgery

8717. Vertebral Fracture (Diagnosis)

procedure. of 2 Tables Contributor Information and Disclosures Author George M Ghobrial, MD Resident Physician, Department of Neurological Surgery, Thomas Jefferson University Hospital Disclosure: Nothing to disclose. Coauthor(s) Zachary J Senders, MD Resident Physician, Department of General Surgery, Case Western/UH Case Medical Center, Case Western Reserve University School of Medicine Disclosure: Nothing to disclose. James S Harrop, MD Associate Professor, Departments of Neurological and Orthopedic (...) consultation needed for all thoracolumbar fractures? Evaluation of a subspecialist-sparing protocol for screening and management of stable fractures. J Trauma . 2010 Dec. 69(6):1491-5; discussion 1495-6. . Guarnieri G, Izzo R, Muto M. The role of emergency radiology in spinal trauma. Br J Radiol . 2015 Nov 27. 20150833. . Inaba K, Nosanov L, Menaker J, Bosarge P, Williams L, Turay D, et al. Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American

2014 eMedicine Surgery

8718. Acute Abdomen and Pregnancy (Follow-up)

. . Origoni M, Cavoretto P, Conti E, Ferrari A. Isolated tubal torsion in pregnancy. Eur J Obstet Gynecol Reprod Biol . 2009 Oct. 146 (2):116-20. . Chan CM, Chen WL, Chen JH, Wu YL, Huang CC. Pregnancy-induced acute intestinal infarction in a woman with chronic idiopathic mesenteric vein thrombosis under regular anticoagulation treatment. Med Princ Pract . 2009. 18(5):422-4. . [Guideline] Jain V, Chari R, Maslovitz S, Farine D, Maternal Fetal Medicine Committee, Bujold E, et al. Guidelines (...) , and character of the pain, as well as any associated symptoms. [ ] Establishing the gestational age early in the evaluation is essential because the likelihood of different etiologies changes with different gestational ages. Accurate knowledge of gestational age is required to make appropriate decisions regarding fetal viability and the need for fetal evaluation. Remember that nausea, vomiting, constipation, increased frequency of urination, and pelvic or abdominal discomfort are frequently experienced

2014 eMedicine Surgery

8719. Abdominal Trauma, Penetrating (Follow-up)

stabilizing surgical intervention. Obviously, if no surgeon is available, transfer may be the only course of action. Practitioners must be cognizant of Emergency Medical Treatment and Active Labor Act (EMTALA)/Consolidated Omnibus Budget Reconciliation Act (COBRA) violations and document accordingly (see ). This legislation was enacted with the intention of removing economic considerations from important medical decisions in the ED. Previous Next: Initial Emergency Department Care A team leader should (...) ) Katie Jo Stanton-Maxey, MD Assistant Professor, Department of Surgery, Indiana University School of Medicine Katie Jo Stanton-Maxey, MD is a member of the following medical societies: Disclosure: Nothing to disclose. H Scott Bjerke, MD, FACS Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Professor, Department of Surgery, Kansas City University of Medicine

2014 eMedicine Surgery

8720. Acute Mesenteric Ischemia (Follow-up)

, St Francis Hospital Michael A Grosso, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Chandler Long, MD Resident Physician, Department of Surgery, University of Tennessee Medical Center-Knoxville Disclosure: Nothing to disclose. Ashis Mandal, MD Professor, Department of Surgery, Drew University of Medicine and Science and UCLA College of Medicine Disclosure: Nothing to disclose. Robert M McNamara, MD, FAAEM Chair and Professor, Department of Emergency (...) Medicine, Temple University School of Medicine Robert M McNamara, MD, FAAEM is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology Disclosure: RFA Medical None Director; MRC Biotec None Director Yale D Podnos, MD, MPH Consulting

2014 eMedicine Surgery

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