Characterization and Localization of Focal Atrial Tachycardia in Patients With Adult Congenital Heart Disease.

Background: In patients with structurally normal hearts, algorithms using surface electrocardiographic P-wave morphology are helpful to predict focal atrial tachycardia (FAT) location. However, these algorithms have not been formally assessed in patients with adult congenital heart disease (ACHD).

Objectives: This study sought to assess the efficacy of FAT-location prediction algorithms in an adult population of patients with ACHD.

Updates in Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

Although endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be a safe and effective approach in treating these diseases while carrying lower morbidity than traditional surgical treatments, ERCP has associated risks, with post-ERCP pancreatitis (PEP) being the most common serious adverse event and carries significant morbidity and health care cost. PEP results from multifactorial factors involving trauma to the pancreatic duct and papilla, leading to subsequent obstruction and impairment of pancreatic drainage. Important risk factors for PEP include history of prior PEP, suspected sphincter of Oddi dysfunction, difficult cannulation, pancreatic duct contrast injections, and pancreatic sphincterotomy.

Surgical Step-Up Approach in Management of Necrotizing Pancreatitis.

Necrotizing pancreatitis often demands intervention; contemporary management is directed by the step-up approach. Timing of intervention and specific approach is best directed by a multi-disciplinary team including advanced endosocpists, interventional radiologists, and surgeons with interest and experience managing this complex problem. The intervention is often a combination of percutaneous drainage, transluminal endoscopic approaches, and surgical debridement (minimally invasive or open).

What Is the Latest in Autoimmune Pancreatitis.

Autoimmune pancreatitis (AIP) is a steroid-responsive fibroinflammatory disorder with 2 clinically distinct subtypes known as type 1 autoimmune and type 2 autoimmune pancreatitis. Type 1 AIP is considered the pancreatic manifestation of immunoglobulin G4-related disease, a systemic disease often presenting with other organ involvement. Advances in understanding the unique clinical presentation, imaging findings, histopathology, and clinical course of this relatively uncommon disease have led to international consensus regarding diagnosis and treatment.

Updates in the Surgical Management of Pancreatic Ductal Adenocarcinoma.

Surgical management of pancreas cancer is complex, including the timing of surgery, surgical approach, intraoperative techniques, and postoperative management, which are reviewed in detail in this manuscript. Ultimately, referral to a high-volume pancreatic surgeon or pancreatic surgery center is critical to ensuring appropriate short-term and long-term outcomes.

Pancreatic Cancer: Screening and Early Detection.

Pancreatic cancer, often diagnosed at advanced stages, has poor survival rates. Effective screening aims to detect the disease early, improving outcomes. Current guidelines recommend screening high-risk groups, including those with a family history or genetic predispositions, using methods like endoscopic ultrasound and MRI.

What Is the Latest in Pancreatic Cysts?

Pancreatic cysts are common incidental findings. The understanding of pancreatic cysts has evolved tremendously over the past few decades. Molecular diagnostic and endoscopic techniques have led to more precise characterization of cyst types and interventions to improve patient outcomes.

Risk Factors and Mechanisms for Diabetes in Pancreatitis.

Diabetes (DM) can occur as a complication of acute, acute recurrent, or chronic pancreatitis, affecting more than 30% of adults with chronic pancreatitis. Data on the pathophysiology and management are limited, especially in pediatric population. Proposed mechanisms include insulin deficiency, insulin resistance, decreased pancreatic polypeptide, and possible beta-cell autoimmunity (in a small subset).

Updates in the Management of Chronic Pancreatitis: Navigating Through Recent Advances.

This article provides an up-to-date review of the management of chronic pancreatitis, highlighting advancements in medical therapy, nutritional support, endoscopic and surgical approaches, and emerging treatments. Nutritional management accentuates addressing malabsorption and nutrient deficiencies. Advances in endoscopy and parenchyma-sparing surgical techniques have opened new avenues for improved patient outcomes, with total pancreatectomy and islet autotransplantation offering the only definitive solution for selected patients.

Updates in the Diagnosis of Chronic Pancreatitis: Current Approaches and New Possibilities.

This review provides a comprehensive update on the diagnostic approaches to chronic pancreatitis (CP), emphasizing recent advancements in imaging techniques, biomarker research, and multivariable scoring systems. Despite substantial progress in these areas, current diagnostic algorithms have limitations, particularly for early and non-calcific CP. Traditional criteria have focused on classic diagnostic signs, but "minimal change" CP is increasingly recognized through advanced imaging and function tests.

Clinical and Investigative Approach to Recurrent Acute Pancreatitis.

Recurrent acute pancreatitis (RAP) is a complex syndrome that presents variably, with many cases remaining idiopathic after thorough diagnostics. For evaluating structural etiologies, endoscopic ultrasound and MR cholangiopancreatography are preferred over endoscopic retrograde cholangiopancreatography (ERCP) given their more favorable risk profile and sensitivity. The diagnostic work-up remains paramount since treatment should focus on addressing underlying causes such as early cholecystectomy for gallstone pancreatitis.

Pharmacotherapy for Tourette Syndrome.

Tourette syndrome (TS) is associated with dysregulated cortico-striatal-thalamo-cortical neural circuitry, of which the primary implicated neurotransmitters include dopamine, glutamate, and gamma-aminobutyric acid. Pharmacologic intervention for tics should be considered when tics are causing psychological, functional, or physical impairment, and behavioral treatment is either inaccessible or ineffective. Only 3 medications have Food and Drug Administration approval for TS, including 2 typical antipsychotics (pimozide and haloperidol) and 1 atypical antipsychotic (aripiprazole).

Evidence-Based Behavior Therapy for Tourette Syndrome.

This article provides an overview of evidence-based behavior therapy for Tourette syndrome (TS) in children, adolescents, and adults. First, this article describes evidence-based behavioral therapies for TS, examines their efficacy in randomized controlled trials, and identifies extant limitations. Second, based on the identified limitations, this article presents future directions for further research on behavioral therapies for TS.

Evidence-Based Assessment of Tourette Syndrome.

Tourette syndrome and persistent tic disorders (collectively, TS) are impairing childhood-onset neuropsychiatric conditions. Utilizing evidence-based assessments (EBA) is standard for effective and accurate screening, diagnosis, and monitoring of TS. EBAs consist of brief screening instruments, structured/semi-structured clinician-administered interviews, self-report, and parent-report and child-report.

Functional Neuroanatomy of Tics: A Brain Network Perspective.

Tourette syndrome is defined by motor and vocal tics, yet our understanding of the pathophysiology of tics remains limited. Functional MRI (fMRI) can localize brain function related to the clinical phenomenology of tics. Here, we review extant fMRI studies examining brain activity during the premonitory urge, tic release, and tic suppression.

The Role of CBGTC Synaptic Neurotransmission in the Pathophysiology of Tics.

The pathophysiology of tic disorders involves an alteration in the transmission of messages through the cortico-basal ganglia-thalamo-cortical circuit. A major requirement for the passage of a message through this circuit is an intact chemically mediated synaptic neurotransmitter system (ie, neurotransmitters and second messengers). This article reviews the scientific evidence supporting the involvement of a variety of neurotransmitters (ie, dopamine, glutamate, gamma-aminobutyric acid, serotonin, acetylcholine, and the opioid system).

Systematic Literature Review on Public Health Impacts of Persistent Tic Disorders: Health Care Needs and Health Care Use.

This study describes our systematic literature review documenting outcomes associated with persistent tic disorders (PTDs) and summarizes 15 articles comparing health care use between individuals with PTDs and a comparison group without PTDs. Only 2 studies included adults and only one study stratified findings by sociodemographic characteristics, precluding conclusions on health care disparities. Most children with PTDs had access to routine care, similar to children without PTDs, but needed and used more specialty health care, including mental health services, compared to children without PTDs.

Repetitive but Not Interchangeable: Similarities and Differences in the Repetitive Behaviors of Tourette Syndrome, Obsessive-Compulsive Disorder, Tourettic Obsessive-Compulsive Disorder, and Autism Spectrum Disorder.

Repetitive behaviors are the hallmark of many neuropsychiatric disorders, including Tourette syndrome (TS), obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD). Tics, compulsions, and stereotypies may appear similar and can be difficult to disentangle. This review addresses similarities and differences between these behaviors including clinical presentations, neuroimaging, genetics, and treatment paradigms in order to clarify the relationship between these disorders.

When It's Not Tics: Functional Tic-Like Behaviors.

Functional tic-like behaviors (FTLBs) are a manifestation of functional neurologic disorder that can be mistaken for neurodevelopmental tic disorders like Tourette syndrome. Much information was gained about FTLBs because of an outbreak of FTLBs spreading among adolescents and young adults via social media during the coronavirus disease 2019 pandemic. In comparison to neurodevelopmental tic disorders, FTLBs have an older age of onset, more abrupt symptom onset, and more complex tics as well as other features that would be atypical of Tourette syndrome.

The Pathophysiology of Tics: An Anatomic Review.

The underlying pathophysiology of tics in Tourette syndrome is a topic of major scientific interest. To date, there is an absence of consensus among researchers regarding the precise anatomic location responsible for tics. The goal of this article is to review the current understanding of these brain circuits and data supporting specific anatomic regions.