The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

This paper is the second in a series of three publications relating to the European evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the management of active disease, maintenance of medically induced remission and surgery. The aims and methods of the ECCO Consensus, as well as sections on diagnosis and classification are covered in the first paper [van Assche et al. JCC 2009a]. The final paper covers post-operative recurrence, fistulating disease, the management of paediatric and adolescent IBD, pregnancy, psychosomatics, extraintestinal manifestations and complementary or alternative therapy for Crohn's disease [Van Assche et al JCC 2009b]. #### Principal changes with respect to the 2006 ECCO guidelines

The early use of azathioprine/mercaptopurine or methotrexate in combination with steroids is an appropriate option in moderately active localised ileocaecal CD. Anti-TNF therapy should be considered as an alternative for patients with objective evidence of active disease who have previously been steroid-refractory, steroid-dependent, or steroid-intolerant (based on Statement 5B).

For those patients with severely active localised ileocaecal Crohn's disease and objective evidence of active disease who have relapsed, anti-TNF therapy with or without an immunomodulator is an appropriate option [EL1a, RG B for infliximab]. For some patients who have infrequently relapsing disease, restarting steroids with an immunomodulator may be appropriate (based on Statement 5C).

All currently available anti-TNF therapies appear to have generally similar efficacy and adverse-event profiles for inflammatory (‘luminal’) Crohn's disease, so the choice depends on availability, route of delivery, patient preference, cost and national guidelines \[EL5, RG D\] (Statement 5I).

Patients receiving azathioprine or mercaptopurine who relapse should be evaluated for adherence to therapy and have their dose optimised. Changing their maintenance therapy to methotrexate [EL1b RG B] or anti-TNF therapy [EL1a RGB] should be considered. Surgery should always be considered as an option in localised disease [EL4, …

/pdf/the-second-european-evidence-based-consensus-on-the-2blhqp1c4c.pdf

The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

TFOS DEWS II Epidemiology Report.

American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update

PURPOSE: To perform a meta-analysis to compare endoluminal ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging in rectal cancer staging. MATERIALS AND METHODS: Relevant articles published between 1985 and 2002 were included if more than 20 patients were studied, histopathologic findings were the reference standard, and data were presented for 2 × 2 tables; articles were excluded if data were reported elsewhere in more detail. Two reviewers independently extracted data on study characteristics and results. Bivariate random-effects approach was used to obtain summary estimates of sensitivity and specificity for invasion of muscularis propria, perirectal tissue, and adjacent organs and for lymph node involvement. Summary receiver operating characteristic (ROC) curves were fitted for perirectal tissue invasion and lymph node involvement. RESULTS: Ninety articles fulfilled all inclusion criteria. For muscularis propria invasion, US and MR imaging had similar sensitivities; speci...

Rectal Cancer: Local Staging and Assessment of Lymph Node Involvement with Endoluminal US, CT, and MR Imaging—A Meta-Analysis

Objectives To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. Methods A review was made of 137 SICU patients who had serial lactate and blood gas measurements. Patients were stratified by absolute lactate and base deficit values as well as time to lactate clearance. Results Initial and 24-hour lactate level was significantly elevated in nonsurvivors versus survivors ( P = 0.002). Initial base deficit was not significantly different; 24-hour base deficit did achieve statistical significance ( P = 0.02). Subgroup analysis among trauma patients (n = 36) and major abdominal surgery (n = 101) confirmed the significant correlation between lactate levels and survival. There was poor correlation between initial and 24-hour lactate and base deficit among all patients ( r = −0.3 and −0.5). Mortality if lactate normalized within 24 hours was 10%, compared with 24% for >48 hours and 67% if lactate failed to normalize. Physical status at discharge was related to initial lactate ( P = 0.05), as well as to lactate clearance time ( P = 0.01). Conclusions Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.

Serum lactate and base deficit as predictors of mortality and morbidity.

Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank.

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis.

Acute and chronic mesenteric ischemia.

https://www.surgical.theclinics.com/article/S0039-6109(09)00157-1/pdf

Scott R. Steele

Papers

Serum lactate and base deficit as predictors of mortality and morbidity.

Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis.

Acute and chronic mesenteric ischemia.

Rectal foreign bodies.