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The interchange between physicians discussing a patient’s
case has been mentioned in written history since ancient
Greece. From the time of Hippocrates, physicians have been
encouraged to seek consultation on difficult cases when they
were in doubt. They were urged not to be jealous of one
another but to realize their own limitations and to use the
knowledge of their colleagues to help. “Nor, among physicians,
do those who treat by diet envy those who employ
surgery, but they even call each other into consultation and
commend one another.” It is clear, however, that there were
disagreements in those days: “Physicians who meet in consultation
must never quarrel or jeer at one another.” There
were also “wretched quarrelsome consultations at the bedside
of the patient, with no consultant agreeing with another,
fearing he might acknowledge a superior.”
Over the next 25 centuries, consultation has had its ups and
downs. Much of what was written had to do with the etiquette
and ethics of the interaction. In medieval Europe, little
changed from ancient times. Physicians were encouraged to
ask colleagues for help if needed and to refrain from criticizing
each other in front of non-physicians.
The incidence of first-time venous thromboembolic (VTE) events is approximately 70–113 cases per 100,000 people per year. Approximately one-third of these cases are due to pulmonary embolism (PE). Venous thromboembolism will recur in approximately 7% of patients at 6 months, with patients presenting with PE more likely to have recurrent PE. Thirty-day mortality following PE is approximately 12%. While anti-coagulation remains the gold-standard therapy for VTE, patients who have recurrent PE despite adequate anticoagulation, high-risk patients with contraindications to anticoagulation, or patients who have bleeding complications while on anticoagulation therapy meet criteria for inferior vena cava (IVC) filter placement. Inferior vena cava filter placement is contraindicated in patients with complete thrombosis of the IVC, or with an IVC that is otherwise inaccessible by percutaneous means.
Inferior vena cava filters are inserted percutaneously under local anesthesia via the femoral or jugular vein, with fluoroscopic or ultrasound guidance. The procedure usually takes less than 30 minutes, and consists of obtaining central venous access under ultrasound guidance. Venography is performed; fluoroscopic guidance may be used to measure the IVC, locate the renal veins, and identify any possible aberrant anatomy. Procedural morbidity is extremely rare and consists primarily of complications at the insertion site. Long-term complications are more significant and need to be considered when placing filters in young patients. Such complications include device migration, device fracture, caval thrombosis, IVC perforation, and post-thrombotic syndrome.
Now in its fifth edition, Medical Management of the Surgical Patient: A Textbook of Perioperative Medicine has been fully revised and updated and continues to provide an authoritative account of all aspects of perioperative care for surgical patients. Including recommended plans which aid accurate treatment of patients, it provides an evidence-based approach for consulting physicians to care for patients with underlying medical conditions that will affect their surgical management. The latest minimally invasive surgical techniques are included, with new chapters on thoracic aortic disease, reconstruction after cancer ablation, lung transplantation, esophagomyotomy, vasectomy and thyroid malignancies, amongst others. With detailed descriptions of nearly one-hundred operations, highlighting their usual course as well as their common complications, the book encourages learning from experience. This definitive account includes numerous contributions from leading experts at national centers of excellence. It will continue to serve as a significant reference work for internists, hospitalists, anesthesiologists and surgeons.