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A major advance has occurred over recent decades in the treatment strategies for infective endocarditis (IE). A significant part of this progress is due to a clearer knowledge of IE insult patterns; especially those concerning valvular damage and resultant heart failure. Furthermore, the existence of IE unique vegetations ensuring a suitable platform for organism growth and partial antibiotic resistance, has led to an understanding of the limited capacity of antibiotics to treat IE. Accordingly, an increased emphasis on surgical intervention has emerged. Indeed, the last decades were characterized by increased attempts to explore the feasibility and efficacy of surgical approach in IE. The present review is a result of these attempts, summarizing the major indications for surgical intervention in IE, as was recently published by the American Heart Association. Generally, such intervention is warranted in IE complications including: hemodynamically significant valvular damage, paravalvular abscess, continuous infection despite optimal treatment, recurrent emboli and antibiotic-resistant organisms. Recognition of the prognostic influence of pre-treatment heart failure degree has led to the development of early surgical intervention, namely, surgical intervention during the active period of IE. Application of such early intervention has led to survival rates which are significantly higher than achieved by antibiotic treatment per se.

Budd-Chiari Syndrome (BCS) refers to hepatic venous outflow obstruction, resulting in simultaneous occurrence of hepatic congestion and portal hypertension, leading to a typical clinical triad consisting of right upper quadrant pain, hepatomegaly and ascites. Contrary to Asia and Africa, where BCS is caused primarily by an obstructing membranous web, BCS in the western world is considered a thrombotic complication of an underlying hypercoagulable state. Recognition of the contribution of hypercoagulability as a causative factor in BCS, has led to acknowledgement of the importance of anti-coagulant therapy in BCS. Indeed, a conservative approach consisting of diuretics and anti-coagulant therapy is considered an appropriate treatment strategy for the BCS patient, in the absence of significant hepatic insult. However, once disease progression is noted, based on clinical symptoms, hepatic laboratory disturbance or histological evidence of irreversible hepatic damage, a definite invasive treatment should be applied. The specific procedure to be used is dependent upon the extent of hepatic insult and the anatomical characteristics of the venous obstruction in any individual patient. In the absence of significant hepatic damage, one may employ surgical shunting or invasive roentgenic measures, such as TransJugular Intrahepatic Porto-Systemic Shunt procedure, for the decompression of the portal system. Alternatively, in cases of a single localized obstruction, one may use balloon angioplasty with stent insertion. In contrast, upon evidence of significant hepatic damage, liver transplantation becomes necessary. To date, numerous studies report excellent results regarding the success of liver transplantation for patients with advanced BCS disease accompanied by significant hepatic damage.

Various methods exist for rewarming hypothermia casualties. Most of these methods necessitate sophisticated medical equipment or vigorous hemodynamic and electrolytic monitoring. Therefore, only a few methods remain suitable for pre-hospital scenarios. The current work reviews the literature regarding these pre-hospital rewarming methods, focusing on their efficacy and compatibility to the cold pre-hospital environment with its limited resources. By relying on endogenous heat producing mechanisms and by isolating the victim, one can achieve fairly efficient rewarming for mild hypothermia (rectal temperature of 32 degrees C-35 degrees C) casualties. Many consider this as an independent rewarming method (passive or endogeneous rewarming method), advisable for mild hypothermia cases. There are also many active rewarming methods, suitable for pre-hospital treatment. These methods, however, suppress the endogenous heat producing mechanisms, and therefore are not more efficient than passive rewarming for mild hypothermia cases. In moderate or severe hypothermia casualties, hypothermia (rectal temperature below 32 degrees C) however, is characterized by suppressed or deficient endogenous heat producing mechanisms. Passive rewarming is not enough in these cases, necessitating the addition of active, central or peripheral rewarming methods. Studies regarding the use of various active rewarming methods in severe hypothermia casualties revealed low rewarming efficacy for the low heat capacity methods, such as warm air inhalation, and a high rewarming efficacy for the high heat capacity methods, such as forced air methods.

Exposure to extreme weather or physical work conditions can lead to dangerous core temperature changes, and to the clinical syndromes accompanying them. Core temperature measurement is the main tool for diagnosing these syndromes. Recent technological advances particularly NASA's telemetry and miniaturizing technologies, have led to the development of a CorTemp Ingestible Temperature Sensor, or "pill". The pill is a small electronic device, which senses the body's temperature and transmits it through a radio wave signal to an external receiver. The advantage of the pill over other temperature measurement devices is that it is a simple device that enables core temperature measurement for many hours without the need of any wire connections or other cumbersome instruments. For this reason, the pill is an ideal tool for core temperature measurements in field locales or for continuous long duration temperature monitoring of ambulatory patients. The following study reviews available literature concerning the use of the pill and the validity of its measurements. A high correlation has been revealed between pill temperature measurements and rectal or esophageal measurements. Pill temperature values usually fall between the high rectal and the low esophageal measurements, considered the gold standard for core temperature measurement. A number of studies emphasizing the advantage of the pill are presented in this review.