What’s new in Surgery for May features:
– Injuries to the Peripheral Blood Vessels
– Pulsatile Abdominal Mass
– Pharmacologic Considerations in the Elderly Surgical Patient
– Cancer Epidemiology and Prevention
– Asymptomatic Carotid Bruit/Carotid Artery Stenosis

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Trauma and Thermal Injury

Injuries to the Peripheral Blood Vessels

Charles J. Fox, MD, FACS

University of Colorado School of Medicine, Department of Surgery, Denver Health Medical Center, Denver, CO

 

Currently, multidetector row computed tomographic  angiography (MDCTA) allows for the accurate assessment of arterial runoff despite orthopedic hardware and embedded fragments in the majority of combat-related extremity vascular injuries. MDCTA yields useful high-resolution images in the delayed evaluation of extremity injury and the presence of metallic fragments or orthopedic hardware does not interfere with the interpretation of the findings. MDCTA is a reliable and promising alternative to traditional arteriography for evaluating clinically occult vascular injury.

 


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Vascular System

Pulsatile Abdominal Mass

Robert J.T. Perry, MD, FACS

Division of Vascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA

Gilbert R. Upchurch Jr, MD, FACS

Division of Vascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA

 

Balloon occlusion of the aorta may be used for the management of patients with ruptured abdominal aortic aneurysms (rAAA)  and is standard of practice in centers performing endovascular aneurysm repair (EVAR) for rAAA (rEVAR). Of note, rEVAR can be readily carried out under a local anesthetic without the need for general anesthesia and the attendant  hemodynamic changes that may precipitate cardiovascular collapse in the tenous patient. The IMPROVE trial investigators noted a fourfold reduction in mortality in patients who underwent EVAR under local compared with general anesthesia.

 


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Scientific Foundations

Pharmacologic Considerations in the Elderly Surgical Patient

Tara A. Russell, MD, MPH

Linda Sohn, MD

Joe C. Hong, MD

Michael W. Yeh, MD, FACS

Marcia M. Russell, MD, FACS

Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA

 

In 2015, the Beers Criteria were updated to reflect modern medication use patterns and to describe specific drug-disease combinations that should be avoided in the elderly. Patients are routinely asked to discontinue oral antihyperglycemics on the day of surgery, and are commonly monitored postoperatively with capillary finger-stick blood glucose testing and treated with insulin in the event of hyperglycemia. Caution should be exhibited when prescribing insulin sliding scales for elderly patients. The updated Beers Criteria report that the insulin sliding scale increases risk of hyperglycemia without improvement in glucose management.

 


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Scientific Foundations

Cancer Epidemiology and Prevention

Carlo M. Contreras, MD

Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL

 

Over the last several decades, male circumcision has been demonstrated to have a protective effect against penile cancer. Although penile cancer is a rare malignancy, cases of penile cancer in patients who underwent infant circumcision are vanishingly rare. In addition, male circumcision reduces the frequency of male human papillomavirus colonization and transmission to female partners, which in turn has been associated with a decrease in female cervical cancer. HIV transmission rates are also lower for circumcised males.

 


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© Michel Royon / Wikimedia Commons

 

Vascular System

Asymptomatic Carotid Bruit/Carotid Artery Stenosis

ALI F. ABURAHMA, MD

Division of Vascular and Endovascular Surgery, Vascular Fellowship and Residency Programs, Vascular Laboratory, Vascular Center of Excellence, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV

PATRICK A. STONE, MD

Division of Vascular and Endovascular Surgery, Vascular Fellowship and Residency Programs, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV

 

There has been increased interest in using statins to slow the progression of carotid artery disease. In the Asymptomatic Carotid Artery Plaque Study, lovastatin was compared in a double-blinded study to evaluate the effect on intima-media thickness and cardiovascular events. In both men and women with moderately elevated low-density lipoprotein levels, the progression of intima-media thickness in the carotid arteries was reduced compared with placebo, and lovastatin was also associated with reduced cardiovascular events and mortality.

 


As seen in Scientific AmericanTM Surgery.