Preoperative Evaluation for Noncardiac Surgery.

The previous In the Clinic that addressed preoperative evaluation for noncardiac surgery was published in December 2016. This update reaffirms much of the information in the previous version and provides new information that has accumulated since then. The goal of preoperative assessment is to identify the risk for postoperative complications so health care teams can more fully understand how to implement strategies to mitigate risks before and after the operation.

Perioperative cardiovascular medicine: 5 questions for 2018.

A MEDLINE search was performed from January 2017 to February 2018, and articles were selected for this update based on their significant influence on the practice of perioperative cardiovascular medicine.

Symptomatic Heart Failure After Transjugular Intrahepatic Portosystemic Shunt Placement: Incidence, Outcomes, and Predictors.

Purpose: To assess the incidence of symptomatic heart failure (SHF) occurring after transjugular intrahepatic portosystemic shunt (TIPS) placement, identify potential predictors of SHF, and evaluate clinical presentation and outcomes in cases of post-TIPS SHF.

Materials And Methods: A prospectively maintained TIPS database was used to identify patients who underwent new TIPS placements at a large urban tertiary care center between 1995 and 2014. SHF was defined as otherwise unexplained new-onset dyspnea, hypoxemia, radiologic pulmonary edema, an increased need for diuretics, or need for intubation within 7 days after TIPS placement.

Association of Statins With Decreased Acute Pancreatitis Severity: A Propensity Score Analysis.

Background: Statins possess anti-inflammatory properties and have a protective effect in certain inflammatory conditions; however, their effect on the natural history of pancreatitis is unknown.

Aim: The aim of this study is to assess the effect of statin exposure on the severity of pancreatitis and incidence of organ failure using a propensity-matched approach.

Methods: A historical cohort study was conducted of adult patients with acute pancreatitis (AP) admitted in the Cleveland Clinic Health System between 2007 and 2014.

Clinical Approach to Patients With Obstructive Jaundice.

Obstructive jaundice is a clinical symptom that results from cholestasis. Cholestasis can be extrahepatic or intrahepatic and is typically associated with biochemical abnormalities in the liver function tests. Once these abnormalities are identified, more extensive imaging tests can be performed to determine the nature, etiology, and level of obstruction.

Diagnosis and management of primary sclerosing cholangitis-perspectives from a therapeutic endoscopist.

Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a cholestatic profile, endoscopic retrograde cholangiopancreatography (ERCP) is warranted for a definite diagnosis of PSC.

Advanced therapeutic endoscopist and inflammatory bowel disease: dawn of a new role.

Endoscopy plays a key role in the diagnosis and treatment of patients with inflammatory bowel disease (IBD). Colonoscopy has been traditionally used in the diagnosis of IBD and helps in determination of an important end point in patient management, "mucosal healing". However, the involvement of an advanced endoscopist has expanded with innovations in therapeutic and newer imaging techniques.