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E/M Medical Decision Making

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8801. Abdominal Angina (Follow-up)

surgeries Patient comorbidities Local operative conditions Possible incision for trapdoor aortotomy. Plaque at orifices of visceral vessels is removed after trapdoor incision is lifted. When satisfactory endarterectomy has been achieved, trapdoor is sutured shut. Because patency rates, morbidity, and mortality are comparable for the two surgical approaches, the authors prefer to make the decision on a case-by-case basis, applying the technique best suited to the individual patient's specific (...) Author Faisal Aziz, MD Assistant Professor of Surgery, Divsion of Vascular and Endovascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine Faisal Aziz, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Anthony J Comerota, MD, FACS, FACC, FRACS Director of Jobst Vascular Institute, Program Director of General Vascular Surgery Residency, Toledo Hospital; Director of Jobst (ProMedica) Vascular Laboratories; Adjunct

2014 eMedicine Surgery

8802. Abdominal Aortic Aneurysm (Follow-up)

medical societies: and Disclosure: lippincott Royalty textbook royalty; wiley Royalty textbook royalty Jeffrey Lawrence Kaufman, MD Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: , , , , , , , and Disclosure: Nothing to disclose. Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Robert E O'Connor (...) , expansion, or leak. Next: Treatment of Unruptured Aneurysms Even patients who do not have symptoms from their AAAs may eventually require surgical intervention because the result of medical management in this population is a mortality of 100% over time as a consequence of rupture. In addition, these patients have a potential for limb loss from peripheral embolization. The decision to treat an unruptured AAA is based on operative risk, the risk of rupture, and the patient’s estimated life expectancy

2014 eMedicine Surgery

8803. Transfusion and Autotransfusion (Follow-up)

Medical News. Available at . Accessed: January 27, 2015. Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med . 2008 May 29. 358(22):2319-31. . Allison G, Feeney C. Successful use of a polymerized hemoglobin blood substitute in a critically anemic Jehovah's Witness. South Med J . 2004 Dec. 97:1257-1258. . Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal (...) allogeneic blood transfusion. Cochrane Database of Systematic Reviews . 2006 Oct 18. 4:CD001888: . Codner P, Cinat M. Massive transfusion for trauma is appropriate. TraumaCare . 2005. 15(3):148-152. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT Study: Anemia and blood transfusion in the critically ill--Current clinical practice in the United States. Crit Care Med . 2004. 32(1):39-52. . Curtis BR, McFarland JG. Mechanisms of transfusion-related acute lung injury (TRALI

2014 eMedicine Surgery

8804. Tibia Fractures, Open (Follow-up)

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; The Foundry, Cotera; ABMT; Conmed;
Received research grant from: Histogenics; Cotera; Arthrex. Additional Contributors Dennis P Grogan, MD Clinical Professor (Retired), Department of Orthopedic Surgery, University of South Florida College of Medicine; Orthopedic Surgeon

2014 eMedicine Surgery

8805. Tibial Shaft Fractures (Follow-up)

, Department of Orthopedic Surgery, University of Minnesota College of Medicine Brian K Konowalchuk, MD is a member of the following medical societies: 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

2014 eMedicine Surgery

8806. Thoracic Spine Fractures and Dislocations (Follow-up)

to disclose. Coauthor(s) Zachary T Hubert, MD Resident Physician, Department of Orthopedic Surgery, Baylor Scott & White Healthcare, Texas A&M University College of Medicine Zachary T Hubert, MD is a member of the following medical societies: , Disclosure: Received income in an amount equal to or greater than $250 from: Pylant Medical, Medical Device Business Services
Monetary Support for Conference Attendance for: Stryker. Mark Rahm, MD Chair and Associate Professor, Department of Orthopedic Surgery (...) , Baylor Scott and White/Texas A&M Health Science Center College of Medicine, Scott and White Memorial Hospital Mark Rahm, MD is a member of the following medical societies: , , , Disclosure: Received research grant from: institutional funds from K2M
Received income in an amount equal to or greater than $250 from: Received royalty from SpineSmith. Michael J Leahy, MD Staff Surgeon, Department of Orthopedic Surgery, Baylor Scott and White All Saints Medical Center, Harris Methodist Hospital of Fort

2014 eMedicine Surgery

8807. Thromboembolism (Follow-up)

) Abdallah E Kharnaf, MD Resident Physician, Department of Medicine, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University Abdallah E Kharnaf, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Chief Editor Thomas C Dowd, MD Associate Director of Orthopedic Surgery Residency Program, Department of Orthopedic Surgery, San Antonio Military Medical Center; Assistant Professor of Surgery, The Norman M Rich Department of Surgery, Uniformed (...) Patients: An APEX Trial Substudy (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban). Circulation . 2017 Feb 14. 135 (7):648-655. . Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet . 1993 Feb 27. 341 (8844):507-11. . DeYoung E, Minocha J. Inferior Vena Cava Filters: Guidelines, Best Practice

2014 eMedicine Surgery

8808. Temporary Abdominal Closure Techniques (Follow-up)

of patients are challenging both from a pathophysiologic and from a surgical technical standpoint. Optimal care is best achieved through a multidisciplinary approach that is led by the surgeon in close collaboration with the anesthesia and intensive care unit (ICU) teams and conducted in a staged manner. Two published algorithms, by Fernandez [ ] and by Coccolini et al, [ ] outline the step-by-step surgical decision-making more commonly involved in the care of the patient with an open abdomen. (See (...) . The fascial closure rate (71.08%) reported by Miller et al [ ] compared favorably with the results previously published by Barker et al in their large review of fascial closure rates using the standard vacuum pack technique; the fascial closure rate in the earlier study was 70%. [ ] Bruhin et al published evidence-based recommendations for the use of negative-pressure wound therapy (NPWT) in the open abdomen. [ ] Case study In the following case study, Dennis E Weiland, MD, and John M Stein, MD

2014 eMedicine Surgery

8809. Tendon Transfers (Follow-up)

in the hand. Medicine of Japan in 1959. Vol 5, pp 958-69. Paper presented at: Proceedings of the 15th General Assembly of the Japan Medical Congress; April 1-5, 1959; Tokyo, Japan. Morelli M, Nagamori J, Gilbart M, Miniaci A. Latissimus dorsi tendon transfer for massive irreparable cuff tears: an anatomic study. J Shoulder Elbow Surg . 2008 Jan-Feb. 17 (1):139-43. . Ogunro O. Dynamic stabilization of chronic scapholunate dissociation with palmaris longus transfer: a new technique. Tech Hand Up Extrem Surg (...) , 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. Additional Contributors Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University

2014 eMedicine Surgery

8810. Tension Pneumothorax (Follow-up)

signs, and perform pulse oximetry. A tension pneumothorax is almost always associated with hypotension. Administer oxygen to the patient, ventilate the patient, and establish an intravenous (IV) line. Tension pneumothorax Failure of the emergency medical service personnel (EMS) and medical control physician to make a correct diagnosis of tension pneumothorax and to promptly perform needle decompression in the prehospital setting can result in rapid clinical deterioration and cardiac arrest. Most (...) , Heffner JE. Spontaneous pneumothorax. N Engl J Med . 2000 Mar 23. 342(12):868-74. . Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med . 2006 Jul 1. 174(1):26-30. . Tabakoglu E, Ciftci S, Hatipoglu ON, Altiay G, Caglar T. Levels of superoxide dismutase and malondialdehyde in primary spontaneous pneumothorax. Mediators Inflamm . 2004 Jun

2014 eMedicine Surgery

8811. Synovial Cell Sarcoma (Follow-up)

is external-beam radiation that is directed at the tumor site and that includes a margin of surrounding normal tissue. The decision about the timing of radiation therapy (ie, before or after surgery) is controversial. The local radiation dose is usually 40-60 Gy. Vital neurologic structures, open physes, or an extreme peripheral location (hand or foot) can make external-beam radiation therapy potentially hazardous. Brachytherapy (radiation administered by a local implant) is an alternative consideration (...) . The synovial sarcoma-associated SYT-SSX2 oncogene antagonizes the polycomb complex protein Bmi1. PLoS One . 2009. 4(4):e5060. . . Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res . 2004 Feb. 155-61. . Ladenstein R, Treuner J, Koscielniak E, d'Oleire F, Keim M, Gadner H, et al. Synovial sarcoma of childhood and adolescence. Report of the German CWS-81 study. Cancer . 1993 Jun 1. 71(11):3647-55. . Stefanovski PD, Bidoli E, De Paoli

2014 eMedicine Surgery

8812. Supracondylar Humerus Fractures (Follow-up)

fractures: treatment by type of orthopedic surgeon. J Child Orthop . 2008 Mar. 2(2):91-5. . . Pescatori E, Memeo A, Brivio A, Trapletti A, Camurri S, Pedretti L, et al. Supracondylar humerus fractures in children: a comparison of experiences. J Pediatr Orthop B . 2011 Dec 26. . Mehne DK, Matta J. Bicolumn fractures of the adult humerus. Presented at: The 53rd Annual Meeting of the American Academy of Orthopaedic Surgeons. 1986. New Orleans, La. Silva M, Pandarinath R, Farng E, Park S, Caneda C, Fong YJ (...) Disclosure: Received salary from Medscape for employment. for: Medscape. Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center Samuel Agnew, MD, FACS is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Chief Editor Jeffrey D Thomson, MD Professor of Orthopedic

2014 eMedicine Surgery

8813. Subdural Hematoma (Follow-up)

–like in appearance. of 8 Tables Contributor Information and Disclosures Author Herbert H Engelhard, III, MD, PhD, FACS, FAANS Professor of Clinical Neurosurgery and Bioengineering, Chief, Division of Neuro-Oncology, Medical Director, UIC Neurosurgery Clinic, Department of Neurosurgery, University of Illinois at Chicago College of Medicine Herbert H Engelhard, III, MD, PhD, FACS, FAANS is a member of the following medical societies: , , , , , , , Chicago Neurological Society, , , , , Disclosure (...) : Nothing to disclose. Coauthor(s) Grant P Sinson, MD, MD Grant P Sinson, MD, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. George Timothy Reiter, MD Associate Professor, Department of Neurosurgery, Pennsylvania State University College of Medicine; Director of Spinal Neurosurgery, Associate Director, Penn State Spine Center, Milton S Hershey Medical Center; Active Staff, Hershey Outpatient Surgery Center; Active Staff, Wilkes-Barre General Hospital; Hospital

2014 eMedicine Surgery

8814. Rheumatoid Spondylitis (Overview)

. Spine . 1989 Oct. 14(10):1057-64. . Kawaida H, Sakou T, Morizono Y, Yoshkuni N. Magnetic resonance imaging of upper cervical disorders in rheumatoid arthritis. Spine . 1989 Nov. 14(11):1144-8. . Boden SD. Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery. Spine (Phila Pa 1976) . 1994 Oct 15. 19(20):2275-80. . Kauppi M, Anttila P. A stiff collar can restrict atlantoaxial instability in rheumatoid cervical spine in selected cases. Ann (...) . . Heyde CE, Fakler JK, Hasenboehler E, et al. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis. Patient Saf Surg . 2008 Jun 6. 2:15. . Pahys JM, Pahys JR, Cho SK, et al. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am . 2013 Mar 20. 95(6):549-54. . Wattenmaker I, Concepcion M, Hibberd P, Lipson S. Upper-airway obstruction and perioperative management of the airway in patients

2014 eMedicine Surgery

8815. Rehabilitation of Persons With Spinal Cord Injuries (Overview)

the rehabilitation interventions most strongly associated with positive outcomes. The aim of the SCIRehab project was to provide detailed information on treatments delivered by rehabilitation disciplines and to contribute to outcomes-based guidelines for clinical decision-making. The SCIRehab project included 1376 patients with acute SCIs, with outcome data being abstracted from medical records (clinical outcomes data) at six SCI rehabilitation facilities and obtained from patient interviews at 6 and 12 months (...) Rehabilitation of Persons With Spinal Cord Injuries (Overview) Rehabilitation of Persons With Spinal Cord Injuries: Background, Common Medical Problems, Thromboembolic Disease 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. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine Surgery

8816. Posterior Cruciate Ligament Pathology (Overview)

to the femur. Image courtesy of Mervyn J. Cross, MBBS, FRACS. of 20 Tables Contributor Information and Disclosures Author Matthew Lawless, MD Assistant Professor of Orthopedic Surgery, Wright State University School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Miami Valley Hospital and Dayton Veterans Affairs Medical Center Matthew Lawless, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Coauthor(s) Damian M Andrisani, MD Staff Physician, Department (...) of Orthopedic Surgery, Wright State University School of Medicine 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

2014 eMedicine Surgery

8817. Pineal Tumors (Overview)

initially used, significant long-term morbidity remained associated with this strategy, particularly in children. The advent of microsurgical techniques and stereotactic procedures in the later part of the 20th century has obviated the need for empiric radiotherapy without tissue diagnosis. Therapeutic decision-making now is based on tumor histology rather than radiation responsiveness. Currently, initial surgical management for tissue diagnosis, and possible resection, is the standard of care for most (...) . . Parwani AV, Baisden BL, Erozan YS, et al. Pineal gland lesions: a cytopathologic study of 20 specimens. Cancer . 2005 Apr 25. 105(2):80-6. . Posner M, Horrax G. Eye signs in pineal tumors. Journal of Neurosurgery . 1946. 3:15-24. Quest DO, Kleriga E. Microsurgical anatomy of the pineal region. Neurosurgery . 1980 Apr. 6(4):385-90. . Radovanovic I, Dizdarevic K, de Tribolet N, Masic T, Muminagic S. Pineal region tumors--neurosurgical review. Med Arh . 2009. 63(3):171-3. . Sato K, Takeuchi H, Kubota T

2014 eMedicine Surgery

8818. Peroneal Tendon Pathology (Overview)

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 C Dowd, MD Associate Director of Orthopedic Surgery Residency Program, Department of Orthopedic Surgery, San Antonio Military Medical Center; Assistant Professor of Surgery, The Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine Thomas C Dowd, MD (...) is a member of the following medical societies: , , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AOFAS; JBJS; AOA; AAOS. Additional Contributors James K DeOrio, MD Associate Professor of Orthopedic Surgery, Duke University School of Medicine James K DeOrio, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery

2014 eMedicine Surgery

8819. Ulnar Clubhand (Follow-up)

for employment. for: Medscape. Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School Disclosure: Nothing 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. Additional Contributors Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare Joseph E Sheppard, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. What would you like to print? What

2014 eMedicine Surgery

8820. Upper Gastrointestinal Bleeding: Surgical Perspective (Follow-up)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTg3ODU3LXRyZWF0bWVudA== processing > Upper Gastrointestinal Bleeding Treatment & Management Updated: Mar 21, 2016 Author: Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF; Chief Editor: BS Anand, MD Share Email Print Feedback Close Sections Sections Upper Gastrointestinal Bleeding Treatment Approach Considerations The goal of medical therapy in upper gastrointestinal bleeding (UGIB) is to correct shock and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed (...) guideline for the total amount of crystalloid fluid volume needed to correct the hypovolemia is the 3-for-1 rule. Replace each milliliter of blood loss with 3 mL of crystalloid fluid. This restores the lost plasma volume. Patients with severe coexisting medical illnesses, such as cardiovascular and pulmonary diseases, may require pulmonary artery catheter insertion to closely monitor hemodynamic cardiac performance profiles during the early resuscitative phase. Once the ABCs have been addressed, assess

2014 eMedicine Surgery

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