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E/M Medical Decision Making


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8821. Septic Arthritis, Pediatrics (Follow-up)

by aspiration. Decision-making in these situations should be analogous to that used in the management of an acute abdomen. The risks of an unnecessary arthrotomy are minimal compared with the certainty of permanent joint damage that accompanies a neglected septic arthritis. The chief concern with septic arthritis in childhood and infancy is the potential for severe complications. The condition must be expeditiously diagnosed and appropriate treatment begun without delay. The diagnosis must be considered (...) A, Manoura A, Hatzidaki E, Saitakis E, Anatoliotaki M, et al. Methicillin-resistant Staphylococcus aureus osteomyelitis and septic arthritis in neonates: diagnosis and management. Jpn J Infect Dis . 2007 May. 60(2-3):129-31. . Morrison MJ, Herman MJ. Hip septic arthritis and other pediatric musculoskeletal infections in the era of methicillin-resistant Staphylococcus aureus. Instr Course Lect . 2013. 62:405-14. . Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, et al. Changing patterns

2014 eMedicine Surgery

8822. Spinal Instability and Spinal Fusion Surgery (Follow-up)

Spinal Instability and Spinal Fusion Surgery (Follow-up) Spinal Instability and Spinal Fusion Surgery Treatment & Management: Approach Considerations, Medical Therapy, General Surgical Considerations 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. (...) then be treated with reoperation. Next: Medical Therapy In acute overt instability, stabilization of the spine is required in all cases. In this context, medical treatment refers to the use of external bracing for spine stabilization. If instability is due to an osseous fracture, if the fracture fragments can be reduced to near-anatomic alignment, and if there is no significant neural compression after reduction, the patient may be treated nonsurgically with a brace until the fracture heals. In anticipated

2014 eMedicine Surgery

8823. Subarachnoid Hemorrhage (Follow-up)

of SAH is an intracranial aneurysm; therefore, the procedures discussed will focus primarily on treating aneurysms. An estimated 15-30% of patients with aneurysmal SAH (aSAH) die before reaching the hospital, and approximately 25% of patients die within 24 hours, with or without medical attention. Mortality at the end of 1 week approaches 40%. Half of all patients die in the first 6 months, and only half of the patients who make it to the hospital return to their previous level of functioning. SAH (...) . . Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery . 2001 Dec. 49(6):1341-8; discussion 1348-50. . Krayenbühl N, Erdem E, Oinas M, Krisht AF. Symptomatic and silent ischemia associated with microsurgical clipping of intracranial aneurysms: evaluation with diffusion-weighted MRI. Stroke . 2009 Jan. 40(1):129-33. . Hohlrieder M, Spiegel M

2014 eMedicine Surgery

8824. Spinal Muscle Atrophy (Follow-up)

are not obligate carriers: carrier testing is important for reproductive decision-making. Am J Med Genet . 2002 Jan 22. 107 (3):247-9. . Piepers S, van den Berg LH, Brugman F, Scheffer H, Ruiterkamp-Versteeg M, van Engelen BG, et al. A natural history study of late onset spinal muscular atrophy types 3b and 4. J Neurol . 2008 Sep. 255 (9):1400-4. . Bouwsma G, Van Wijngaarden GK. Spinal muscular atrophy and hypertrophy of the calves. J Neurol Sci . 1980 Jan. 44(2-3):275-9. . Rudnik-Schöneborn S, Heller R, Berg (...) Dystrophiae musculorum mit positivenen Ruckenmakefunde. Wien Med Wochenschr . 1890. 40:1798. Kugelberg E, Welander L. Heredo-familial juvenile muscular atrophy simulating muscular dystrophy. AMA Arch Neurol Psychiatry . 1956. 75:500. Hoffman J. Ueber chronische spinale Muskelatophie im Kindersalter. Deutsch Ztschv f Nerrenh . 1891. 1:95. Soler-Botija C, Ferrer I, Gich I, Baiget M, Tizzano EF. Neuronal death is enhanced and begins during foetal development in type I spinal muscular atrophy spinal cord

2014 eMedicine Surgery

8825. Spinal Tumors (Follow-up)

. Percutaneous radiofrequency ablation of osteoid osteoma. Clin Orthop Relat Res . 2000 Apr. (373):115-24. . Nakatsuka A, Yamakado K, Takaki H, Uraki J, Makita M, Oshima F, et al. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Intervent Radiol . 2009 Jan. 32 (1):70-5. . Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E. Osteoblastomas of the spine: a comprehensive (...) -Sep. 3 (3):245-251. . . Goodwin CR, Abu-Bonsrah N, Bilsky MH, Reynolds JJ, Rhines LD, Laufer I, et al. Clinical Decision Making: Integrating Advances in the Molecular Understanding of Spine Tumors. Spine (Phila Pa 1976) . 2016 Oct 15. 41 Suppl 20:S171-S177. . Goodwin CR, Abu-Bonsrah N, Rhines LD, Verlaan JJ, Bilsky MH, Laufer I, et al. Molecular Markers and Targeted Therapeutics in Metastatic Tumors of the Spine: Changing the Treatment Paradigms. Spine (Phila Pa 1976) . 2016 Oct 15. 41 Suppl 20

2014 eMedicine Surgery

8826. Spinal Stenosis (Follow-up)

. . Mullin BB, Rea GL, Irsik R, Catton M, Miner ME. The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord . 1996 Apr. 9(2):107-16. . Naderi S, Benzel EC, Baldwin NG. Cervical spondylotic myelopathy: surgical decision making. Neurosurg Focus . 1996 Dec 15. 1(6):e1. . Nasca RJ. Rationale for spinal fusion in lumbar spinal stenosis. Spine (Phila Pa 1976) . 1989 Apr. 14(4):451-4. . Nasca RJ. Surgical management of lumbar spinal stenosis. Spine (...) stenosis. Eur Spine J . 2007 Jul. 16(7):901-3. . . Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine . 2009 Aug. 11(2):104-11. . Keim HA, Hajdu M, Gonzalez EG, Brand L, Balasubramanian E. Somatosensory evoked potentials as an aid in the diagnosis and intraoperative management of spinal stenosis. Spine (Phila Pa 1976) . 1985 May. 10(4):338-44. . Daffner SD, Wang JC. The pathophysiology and nonsurgical treatment

2014 eMedicine Surgery

8827. Scheuermann Kyphosis (Follow-up)

to the individual, and base treatment not only on the severity of symptoms but also on the correlation between symptoms and the deformity. Additionally, in making decisions regarding treatment options, the physician must understand the natural history of Scheuermann kyphosis. Generally, the degree of clinical problems mirrors the magnitude of the deformity. Therefore, expect patients with mild deformities to have mild clinical symptoms. Murray et al reported the natural history and long-term follow-up (...) by the radiographic deformity and the surgeon's personal expertise. Some degree of controversy remains with respect to bracing care and the surgical decision-making process. Proponents of bracing state that bracing postpones indefinitely the need for surgical intervention. Opponents believe that bracing does not affect the ultimate prognosis of the curve and that, if these patients are monitored long enough, the curve continues to settle and resumes its prebracing course of progression. Surgical care

2014 eMedicine Surgery

8828. Rheumatoid Spondylitis (Follow-up)

. 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

8829. Pes Cavus (Follow-up)

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 Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate (...) with sensation deficits, Plastazote linings in the brace are required, and frequent inspection of the skin for ulceration is warranted. [ , ] Previous Next: Surgical Therapy Surgical decision-making requires a careful and complete examination of the foot and ankle, especially for rigidity, strength, and deformities. [ , , ] The goal of surgery is to provide a plantigrade foot. Surgical procedures can be broadly categorized into soft-tissue and bony procedures. No single procedure is appropriate for all

2014 eMedicine Surgery

8830. Peroneal Tendon Pathology (Follow-up)

, 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, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health Heidi M Stephens, MD, MBA is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. What would you like to print? What would you like

2014 eMedicine Surgery

8831. Distal Humerus Fractures (Follow-up)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzOTUxNS10cmVhdG1lbnQ= processing > Distal Humerus Fractures Treatment & Management Updated: Oct 23, 2017 Author: Edward Yian, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Distal Humerus Fractures Treatment Approach Considerations The decision to offer operative intervention for distal humerus fractures is based on many factors, including fracture type, intra-articular involvement, fragment displacement, bone quality, joint stability, and soft-tissue quality and coverage (...) , the surgeon must be able to make an honest evaluation of his or her ability to successfully perform open reduction and internal fixation (ORIF) of the fracture pattern. Although distal humerus fractures remain a challenging reconstructive problem for orthopedic surgeons, future technology may hold many solutions. With the advent of newer, stronger biocompatible materials, diverse hardware options allow improved reduction and fixation of distal humerus fractures. Lower-profile plates and smaller screws

2014 eMedicine Surgery

8832. Diaphyseal Tibial Fractures (Follow-up)

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

2014 eMedicine Surgery

8833. Decubitus Ulcers (Follow-up)

Decubitus Ulcers (Follow-up) Pressure Injuries (Pressure Ulcers) and Wound Care Treatment & Management: Approach Considerations, General Measures for Optimizing Medical Status, Pressure Reduction 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. (...) pressure injuries, wound care is usually conservative (ie, nonoperative) For stage 3 and 4 lesions, surgical intervention (eg, flap reconstruction) may be required, though some of these lesions must be treated conservatively because of coexisting medical problems [ ] Approximately 70-90% of pressure injuries are superficial and heal by second intention With thorough and comprehensive medical management, many pressure injuries may heal completely without the need for surgical intervention. Successful

2014 eMedicine Surgery

8834. 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

8835. 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

8836. 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

8837. 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

8838. 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

8839. 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

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8840. 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

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