Want to learn more about achalasia and its procedural management? Excited about the POEM procedure?  Learn what the current literature says when it comes to recommending POEM or the tried-and-true Heller myotomy from the Swedish Thoracic surgery team. Learning objectives -        Review basics of achalasia -        Discuss the current literature comparing POEM and Heller myotomy with fundoplication -        Understand the major differences in outcomes for these procedures Hosts: Peter White, MD Megan Lenihan, MD Brian Louie, MD Kelly Daus, MD Referenced Material Werner YB, Hakanson B, Martinek J, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. doi: 10.1056/NEJMoa1905380. PMID: 31800987. Gu L, Ouyang Z, Lv L, et al. Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial. Gastrointest Endosc. 2021 Jun;93(6):1304-1312. doi: 10.1016/j.gie.2020.10.006. Epub 2020 Oct 13. PMID: 33058884. Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020 Apr;34(4):1856-1862. doi: 10.1007/s00464-019-06952-2. Epub 2019 Jul 8. PMID: 31286258. Mota RCL, de Moura EGH, de Moura DTH, Bernardo WM, de Moura ETH, Brunaldi VO, Sakai P, Thompson CC. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc. 2021 Jan;35(1):383-397. doi: 10.1007/s00464-020-07412-y. Epub 2020 Mar 23. PMID: 32206921. McKay SC, Dunst CM, Sharata AM, Fletcher R, Reavis KM, Bradley DD, DeMeester SR, Müller D, Parker B, Swanström LL. POEM: clinical outcomes beyond 5 years. Surg Endosc. 2021 Oct;35(10):5709-5716. doi: 10.1007/s00464-020-08031-3. Epub 2021 Jan 4. PMID: 33398572. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this  Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies. Learning Objectives:  In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.  Hosts: Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center. Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768. Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337. Acknowledgements:  We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Jordan Frey, a Plastic Surgeon in Buffalo NY, joins us to talk about how he uses investments in real estate to diversify his portfolio.  We discuss:  -Types of real estate investments and the pros and cons -Books to read on real estate investing -How to get started in real estate -Criteria he uses to choose a property and more Books recommended: The Millionaire Real Estate Investor - Gary Keller https://www.amazon.com/Millionaire-Real-Estate-Investor/dp/0071446370 Doctor's Guide to Real Estate Investing - Cory Fawcett https://www.amazon.com/Dr-Cory-S-Fawcett/e/B01FGK0IC8/ref=aufs_dp_fta_dsk Find Dr. Frey at his website or on social media. Prudentplasticsurgeon.com  or @JordanFreyMD Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Jill Streams, Trauma Surgeon at Vanderbilt, takes us through the ins and outs of understanding your first contract and how and when to negotiate.  In this episode we cover -When/how to apply for your first job -Break down each part of a contract -Why you should negotiate -What and how to negotiate -Salary expectations -Contract landmines and more! You can connect with Dr. Streams on Twitter @JCRStreams Read more at WCI https://www.whitecoatinvestor.com/things-to-ask-for-in-a-physician-contract/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin interviews Dr. Adam Tanious a Vascular Surgeon at MUSC about the ins and outs of managing student debt. Adam is passionate about personal finance and student debt and is happy to discuss further with our listeners, please reach out at tanious@musc.edu . Want to learn more at student debt? Check out White Coat Investor resources on student debt.  https://www.whitecoatinvestor.com/ultimate-guide-to-student-loan-debt-management-for-doctors/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin Kniery and Jason Bingham interview Larry Keller of Physician Financial Services on how and when to choose the right disability policy. You can reach Larry here Lkeller@physicianfinancialservices.com or at his website.  https://www.physicianfinancialservices.com/ White Coat Investor Article breaking down Disability Insurance https://www.whitecoatinvestor.com/what-you-need-to-know-about-disability-insurance/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education. In this episode they discuss how to invest, and what to invest in, also cover topics regarding real estate, and biggest financial regrets.  Links to articles discussed Financial Waterfall for Docs https://www.whitecoatinvestor.com/financial-waterfalls-for-new-residents-and-attendings/ Backdoor Roth IRA Point/Counter Point https://www.physicianonfire.com/the-backdoor-roth/ Simple Path to Wealth https://jlcollinsnh.com/stock-series/ Dr. Mizell can be reached at jsmizell@uams.edu Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education. In this episode they discuss his lecture "How to Resuscitate Your Critically Ill Finances".  Dr. Mizell can be reached at jsmizell@uams.edu Book Recommendation: The Psychology of Money  https://www.amazon.com/Psychology-Money-Timeless-lessons-happiness/dp/0857197681 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join the BTK leadership team for a quick update on what's happening at Behind the Knife! Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule.               Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health. Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., ... & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028. Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., ... & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332. Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.