Nov 052013
 
Related Articles

Patients with chronic pulmonary disease.

Med Clin North Am. 2013 Nov;97(6):1095-107

Authors: Hong CM, Galvagno SM

Abstract
Chronic pulmonary disease is common among the surgical population and the importance of a thorough and detailed preoperative assessment is monumental for minimizing morbidity and mortality and reducing the risk of perioperative pulmonary complications. These comorbidities contribute to pulmonary postoperative complications, including atelectasis, pneumonia, and respiratory failure, and can predict long-term mortality. The important aspects of the preoperative assessment for patients with chronic pulmonary disease, and the value of preoperative testing and smoking cessation, are discussed. Specifically discussed are preoperative pulmonary assessment and management of patients with chronic obstructive pulmonary disease, asthma, restrictive lung disease, obstructive sleep apnea, and obesity.

PMID: 24182721 [PubMed - in process]

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Nov 052013
 
Related Articles

Patients with immunodeficiency.

Med Clin North Am. 2013 Nov;97(6):1139-59

Authors: Hannaman MJ, Ertl MJ

Abstract
Patients presenting in an immunocompromised state merit special consideration when being evaluated for fitness to undergo surgery. A variety of immunodeficient conditions and their respective therapies, including human immunodeficiency virus, cancer, and transplantation, exert numerous systemic effects that may lead to multiorgan dysfunction. Understanding the potential impact of these disease manifestations, and their proper evaluation, is essential in achieving optimal perioperative outcomes for these patients.

PMID: 24182724 [PubMed - in process]

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Nov 052013
 
Related Articles

Patients with chronic endocrine disease.

Med Clin North Am. 2013 Nov;97(6):1123-37

Authors: Njoku MJ

Abstract
This article summarizes the key features and clinical considerations related to preoperative management and planning for the care of patients of common endocrine disorders (diabetes mellitus, adrenal insufficiency, thyroid disease), a less common disorder but one that has significant perioperative implications (acromegaly), and 2 disorders for which preoperative management is essential to good postoperative outcomes (pheochromocytoma and carcinoid syndrome). There are few evidence-based guidelines for preoperative management of chronic endocrine disease; hence, this review is based on recent subspecialty society consensus guidelines and professional society clinical practice recommendations.

PMID: 24182723 [PubMed - in process]

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Nov 052013
 
Related Articles

Patients with chronic kidney disease.

Med Clin North Am. 2013 Nov;97(6):1109-22

Authors: Kalamas AG, Niemann CU

Abstract
Chronic kidney disease (CKD) is a major public health problem worldwide. Roughly 1 in 10 adult Americans has CKD. These patients are at significant risk for excessive morbidity and mortality during the perioperative period. Given the health and cost burden of end-stage renal disease (ESRD), preventing or avoiding progression of CKD to ESRD is critical. Therefore, identifying risk factors and implementing risk mitigation strategies to prevent further deterioration of renal function during the perioperative period is of paramount importance. This article reviews patient risk stratification, preoperative evaluation and management, and perioperative interventions for renal protection.

PMID: 24182722 [PubMed - in process]

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Sep 032013
 

Osteomyelitis in the diabetic foot: diagnosis and management.

Med Clin North Am. 2013 Sep;97(5):947-56

Authors: Game FL

Abstract
Osteomyelitis of the foot in diabetes is common and frequently undiagnosed. Diagnosis should be clinical and based on signs of infection, the size of the lesion, and the visibility of bone in the first instance but supported by the results of radiologic examination. The gold standard for diagnosis is histologic and microbiological examination of bone, which is not possible or necessary in all patients. There is no consensus as to whether management should be primarily medical or surgical; the pros and cons of each approach must be taken into account on an individual basis and after discussion with patients.

PMID: 23992902 [PubMed - in process]

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Sep 032013
 

Diagnosis and management of infection in the diabetic foot.

Med Clin North Am. 2013 Sep;97(5):911-46

Authors: Peters EJ, Lipsky BA

Abstract
Foot infections are common in persons with diabetes mellitus. Most diabetic foot infections occur in a foot ulcer, which serves as a point of entry for pathogens. Unchecked, infection can spread contiguously to involve underlying tissues, including bone. A diabetic foot infection is often the pivotal event leading to lower extremity amputation, which account for about 60% of all amputations in developed countries. Given the crucial role infections play in the cascade toward amputation, all clinicians who see diabetic patients should have at least a basic understanding of how to diagnose and treat this problem.

PMID: 23992901 [PubMed - in process]

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