Category: Medicine

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Latest Recommendations On Endoscopic Removal Of Colorectal Lesions (USMSTF, 2020)

The recommendations on endoscopic removal of colorectal lesions were published in March 2020 by the US Multi-Society Task Force on Colorectal Cancer (USMSTF).

Lesion Assessment and Description

Documentation of endoscopic descriptors of the lesion (eg, location, size, and morphology) in the colonoscopy procedure report is suggested. Use of the Paris classification to describe surface morphology is suggested. For nonpedunculated adenomatous (Paris 0-II and 0-Is) lesions ≥10 mm, surface morphology should also be described as granular or nongranular lateral spreading lesions.

Photo documentation of all lesions ≥10 mm before removal is recommended, and photo documentation of the postresection defect is suggested.

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Oral Antibiotics Without Mechanical Bowel Preperation Preoperatively Reduce Infections After Colon Surgery

Oral antibiotics given the day before colon surgery can help prevent surgical-site infections without mechanical bowel preparation, according to a new randomized controlled trial.

“In patients scheduled to undergo elective colon resection, preoperative oral antibiotics should be used to reduce the incidence of surgical-site infections,” Dr. Eloy Espin Basany of the Hospital Valle de Hebron at the Universitat Autonoma de Barcelona, in Spain, and colleagues conclude in The Lancet Gastroenterology and Hepatology.

Mechanical bowel preparation and oral non-absorbable antibiotics have been used as prophylaxis for surgical-site infections after colorectal surgery for decades, but there remains no consensus about whether the approach is beneficial, Dr. Basany and his colleagues note.

“To date, no large, multicentre, randomised controlled trial has been done to assess the effectiveness of oral antibiotics alone versus no treatment before colon surgery,” they add.

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The Revised Clinical Practice Guidelines For The Management Of Thyroid Tumors

The Japan Associations of Endocrine Surgeons (JAES) have developed and published updated clinical practice guidelines on the management of thyroid tumors.

Papillary Thyroid Carcinoma

The management of papillary thyroid carcinoma (PTC) should be based on risk classification: very low-risk, low-risk, intermediate-risk, and high-risk.

Total thyroidectomy is recommended for high-risk PTC but not for very low- and low-risk PTC (T1N0M0). As for intermediate-risk PTC, the extent of thyroidectomy chosen should be based on prognosis and patient background characteristics.

Prophylactic central lymph node dissection is recommended in the surgical treatment of PTC. For low-risk PTC, prophylactic lateral lymph node dissection is not recommended. As for intermediate and high-risk PTC, the decision to perform prophylactic lateral node dissection should be based on the patient’s prognostic factors, background, and decision.

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COVID-19 : The Medical Specialists Who Are At Increased Risk For Acquiring Disease

The doctor in China who risked his job to warn the world about COVID-19 was not a frontline emergency medicine or ICU doctor. Li Wenliang, MD, was an ophthalmologist, a glaucoma specialist who died after contracting the virus from an asymptomatic patient.

Now a new preprint suggests that that may not have been a coincidence: The survey data show that of all resident physicians who worked within the greater New York City area between March and April, anesthesiology, emergency medicine, and ophthalmology residents were at greatest risk of contracting COVID-19.

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