journal
https://read.qxmd.com/read/36960753/management-of-venous-and-arterial-bullet-emboli
#1
JOURNAL ARTICLE
Miles W Reese, Ricardo E Rendel, Jay N Collins
Gunshot wounds account for significant morbidity and mortality in the United States. A rare and potentially fatal complication of a gunshot wound is bullet embolus. Potential complications include distal limb ischemia, coronary infarct, renal infarction, stroke, pulmonary embolization, cardiac valvular injury, thrombophlebitis, and dysrhythmias. Overall, surgical embolectomy and endovascular retrieval are the preferred treatments for bullet emboli. We report one case of venous bullet embolus and one case of arterial bullet embolus, both of which were successfully treated with endovascular retrieval...
March 24, 2023: American Surgeon
https://read.qxmd.com/read/36959693/cholecystoappendiceal-fistula-from-appendiceal-adenocarcinoma-requiring-a-right-hemicolectomy-with-cytoreduction-and-hyperthermic-intraperitoneal-chemotherapy
#2
JOURNAL ARTICLE
Angel Doño, Jennifer C Schadt, William M Hammond, Clarisse S Muenyi, Jeremiah L Deneve, Jonathan L Altomar, Denis A Foretia
Bilioenteric fistulae are rare and difficult to manage complications of chronic cholecystitis. While cholecystoduodenal and cholecystocolic fistulae are more common, a cholecystoappendiceal fistula is an extremely rare finding. We report the presentation and operative management of a 59-year-old male with cholecystoappendiceal fistula and associated abscess in the gallbladder fossa. The patient was appropriately resuscitated, the abscess drained by interventional radiology, and after a complete workup, underwent a laparoscopic appendectomy and cholecystectomy...
March 23, 2023: American Surgeon
https://read.qxmd.com/read/36951927/open-parenchymal-sparing-posterosuperior-liver-tumor-resection-for-colorectal-liver-metastasis-with-proximity-to-hepatic-veins
#3
JOURNAL ARTICLE
Ahmed Younos, Melissa Touadi, Sharona Ross, Iswanto Sucandy
Liver resection for stage 4 colorectal cancer with liver metastasis is the standard of care, in combination with systemic chemotherapy. R-0 complete resection for colorectal liver metastasis is a curative-intent operation, which is considered the only chance for cure in this disease. The location and proximity of the tumor to major intrahepatic vessels such as hepatic and portal vein determine technical difficulty. Tumors located in the posterosuperior segments of the liver (segments 7 and 8) are technically challenging to resect using a minimally invasive fashion; therefore, conventional open resection is still the technique of choice today...
March 23, 2023: American Surgeon
https://read.qxmd.com/read/36951226/nomenclature-in-palliative-surgery
#4
JOURNAL ARTICLE
Kimberly E Kopecky, Erin A Strong, Katherine F Pellizzeri
Surgical palliative care, palliative care interventions, and palliative surgery all reference a blend of these 2 sub-specialty fields. Despite prior published definitions, use of these phrases both clinically and in the literature is varied and can lead to confusion and misunderstanding. Herein, we proposed the adoption of standardized nomenclature to guide the consistent use of these phrases.
March 23, 2023: American Surgeon
https://read.qxmd.com/read/36951139/gallstone-ileus-a-case-report-in-a-74-year-old-male
#5
JOURNAL ARTICLE
Dylan Smith, Farzad Amiri, David Denning
Gallstone ileus is a rare complication of complicated gallbladder disease. Typically the result of a cholecystocholeduodenal fistula, a gallstone enters the small bowel and impacts in the ileum causing an obstruction. In this case study, a 74-year-old male presented to the emergency department with nausea, vomiting, and constipation for 2 weeks. CT revealed pneumobilia and a 3.1 cm calcified mass in the terminal ileum. The patient was successfully treated with a robotic-assisted enterotomy alone without complications...
March 23, 2023: American Surgeon
https://read.qxmd.com/read/36951056/recanalization-of-inferior-vena-cava-and-bilateral-iliac-veins-15-years-after-may-thurner-syndrome-related-occlusion
#6
JOURNAL ARTICLE
Robert Kelly, Matthew Blecha
May-Thurner syndrome (MTS) is a relatively rare condition involving mechanical compression of a vein between an artery and a bone which may result in venous stenosis, reflux, occlusion, or deep vein thrombosis (DVT). The most common location for MTS to occur is the left iliocaval confluence, specifically where the left common iliac vein crosses under the right common iliac artery and becomes compressed against a vertebral body. Our case represents a unique presentation of MTS where a missed diagnosis of MTS during a presentation of acute LLE DVT over 15 years ago which would later progress to chronic bilateral iliac vein occlusion and IVC obliteration...
March 23, 2023: American Surgeon
https://read.qxmd.com/read/36945792/giant-juvenile-fibroadenoma-in-a-9-year-old-girl-with-marfan-syndrome
#7
JOURNAL ARTICLE
Diana C Fan, Margaret Jayich, Kaitlin Farrell
No abstract text is available yet for this article.
March 21, 2023: American Surgeon
https://read.qxmd.com/read/36943025/robotic-systematic-portal-lymphadenectomy-description-of-surgical-technique
#8
JOURNAL ARTICLE
Ahmed Younos, Melissa Touadi, Sharona Ross, Iswanto Sucandy
Portal lymphadenectomy is an integral part of gallbladder, intrahepatic cholangiocarcinoma, and perihilar cholangiocarcinoma resection to improve staging and prognostication. This is also believed by many oncologists to potentially serve as therapy to remove cancer containing nodes. While the current guideline requires removal of at least 6 portal lymphnodes, many surgeons face technical difficulty in performing the systematic portal lymphadenectomy especially in minimally invasive fashion. The anatomical complexity of biliovascular structures within the porta hepatis contributes to this technical challenge...
March 21, 2023: American Surgeon
https://read.qxmd.com/read/36940369/diagnosis-and-contemporary-management-of-necrotizing-pancreatitis
#9
REVIEW
Shlomi Rayman, Harel Jacoby, Kawtar Guenoun, Uretz Oliphant, Daniel Nelson, Andreas Kaiser, Iswanto Sucandy
BACKGROUND: Acute pancreatitis is a common diagnosis which requires a prompt diagnosis and management by a multidisciplinary team with often general surgeons as the initial provider. Morbidity and mortality from an acute pancreatitis can be very high, especially in patients with a progressive worsening acute pancreatitis developing into pancreatic necrosis in the setting of multiple underlying medical comorbidities. PURPOSE: In this review paper, we discuss all aspects of acute pancreatitis and its potential complications, as well providing updates in the modern management of necrotizing pancreatitis...
March 20, 2023: American Surgeon
https://read.qxmd.com/read/36935586/teaching-small-bite-fascial-closure-technique-improved-accuracy-and-consistency-through-simulation
#10
JOURNAL ARTICLE
Natalie Cuevas, Seth T Beeson, Justin D Faulkner, Colston Edgerton, William W Hope
Despite evidence that small bite closure is beneficial, it is not well documented how accurately and consistently surgeons employ this technique. We created a felt model to simulate fascial closure and educate residents regarding small bites. This study aims to gauge accuracy and consistency of bite size in fascial closure and assess if utilizing a templated model could improve technique. Two 10 cm incisions were made in different pieces of felt. Residents were instructed to suture the incisions to simulate fascial closure by running the incisions closed with 1 cm and 5 mm bites respectively...
March 19, 2023: American Surgeon
https://read.qxmd.com/read/36927107/impact-of-non-automobile-rollover-accidents-on-patient-outcomes-at-an-appalachian-level-i-trauma-center
#11
JOURNAL ARTICLE
Elizabeth A Mannino, Matthew Leonard, Bracken J Burns
The objective of this study was to evaluate outcomes of patients involved in rollover accidents in non-automobile vehicles in a rural level I trauma center. This was a retrospective study including a total of 127 patients over 5 years who were admitted to our level I trauma center following rollover accidents in either of the following: ATV, lawnmower, or tractor. Patients were significantly older in the tractor and lawnmower rollover groups, and patients less than 65 years old were significantly more likely to sustain an injury in a rollover accident when compared to those greater than 65...
March 16, 2023: American Surgeon
https://read.qxmd.com/read/36924199/social-determinants-of-health-in-trauma
#12
JOURNAL ARTICLE
Hoi Lam, Nate Harshaw, Kellie Bresz, Catherine Ting Brown, Lindsey L Perea
Social determinants (SD) refer to a variety of environmental factors that can influence certain clinical outcomes. SD that affect clinical outcomes in trauma patients are largely understudied. We hypothesized that patients with an "at risk" (AR) classification for any SD will have a greater frequency of negative outcomes when compared to their "not at risk" (NAR) counterparts. A retrospective review was performed (1/2021-2/2022) of all trauma patients that met the inclusion criteria. 2225 patients were included...
March 16, 2023: American Surgeon
https://read.qxmd.com/read/36921342/evaluating-the-efficacy-of-surgical-consent
#13
JOURNAL ARTICLE
Carlos A Delgado, Michelle R McCullers, Scott W Bloom
BACKGROUND: Patient autonomy is the most important of the core values of medical ethics, yet the process of obtaining surgical consent remains a lesser scrutinized area of modern surgical practice. Informed consent implies a patient's understanding of nature of the operation, indications, risks, benefits, and alternatives. Surgical consent has traditionally been obtained through verbal communication and formalized by signing a legal document. This process oftentimes leaves patients unequipped with adequate knowledge about the procedure they just consented to...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36921062/the-development-of-breast-cancer-related-lymphedema-after-mastectomy-in-a-rural-population
#14
JOURNAL ARTICLE
Devin J Clegg, Erica N Whiteaker, Brett J Salomon, Ashton J Brooks, John L Bell, Stefanos Boukovalas, Patricia N E Roberson, Jillian M Lloyd
Breast cancer-related lymphedema (BCRL) is a lifelong condition that can impact the quality of life, affecting approximately 20% of breast cancer patients. Risk factors for the development of BCRL after mastectomy in rural populations have not been studied.Retrospective review of mastectomy patients from 2017 to 2021 was performed at a single institution. Statistical analysis included logistic and linear regression models.475 patients were included, and 40 (8.4%) patients were diagnosed with BCRL. Increased odds of developing BCRL were significantly associated with tumor-involved lymph nodes, radiation therapy, axillary lymphadenectomy, adjuvant chemotherapy, and endocrine therapy...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36920989/utility-of-abbreviated-small-bowel-follow-through-study-in-the-management-of-small-bowel-obstruction
#15
JOURNAL ARTICLE
John Peterson, Caroline Cox, Emily Unrue, R Steed, Caleb Mentzer, Cragin Currence, Michael Mount
INTRODUCTION: Small bowel obstruction is a common surgical complaint. Most small bowel obstructions are managed successfully nonoperatively. Unanimous guidelines for nonoperative management of small bowel obstruction do not exist. METHODS: A standardized protocol for water-soluble contrast administration and abbreviated small bowel follow through imaging was implemented in January of 2021. A retrospective chart review identified 111 patients admitted for SBO from 6/2019 to 9/2019 for a control group...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36920153/consistency-is-key-additional-education-and-outreach-in-a-rural-trauma-system-reduces-excess-imaging-studies
#16
JOURNAL ARTICLE
Shaye D Brummet, Christian S Tobin, Keith J Bernis, Breanna M O'Neil, Hilla I Sang, Valerie Reed, Paul M Bjordahl
BACKGROUND: Repeat imaging for trauma patients is common in rural health care systems after transfer to a tertiary trauma center which subjects patients to increased radiation, excess costs, and delays to definitive care. A previous retrospective review at our regional trauma center found that pre-transfer CT scans were frequently performed with little change in management. To improve this rate, additional emphasis was placed on (1) best imaging practices during Rural Trauma Team Development Courses (RTTDC), (2) management feedback during regional trauma case reviews, and (3) implementation of practice management guidelines for an inter-provider telehealth system...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36919894/a-case-of-argatroban-refractory-heparin-induced-thrombocytopenia-and-thrombosis
#17
JOURNAL ARTICLE
Joclyn A Seiler, Adam Khan Durrani, Mentor Ahmeti
Prophylaxis for deep vein thrombosis is a standard of care for most hospitalized patients. This is typically given in the form of chemical prophylaxis by either, unfractionated heparin or low molecular weight heparin. One complication of administration, besides bleeding, is heparin induced thrombocytopenia (HIT). Of patients receiving therapeutic anticoagulation with heparin an estimated, .5%-1% will go on to develop heparin induced thrombocytopenia.1 We will present a case of argatroban refractory HIT after a coronary artery bypass grafting resulting in a massive left ventricular thrombus and death...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36919528/a-current-view-of-sars-cov-2-vaccine-policies-amongst-pediatric-renal-transplant-centers-and-relationships-to-state-policy
#18
JOURNAL ARTICLE
James B Littlejohn, Rachel L Pace, Kyle L Curtis, Maggie E Jones-Carr, Felicitas L Koller
Given its mortality benefit, renal transplantation remains the ideal treatment modality for end stage renal disease in children. Despite the recent expansion of use in young children, the novel SARS-CoV-2 vaccine has not been universally accepted. Similarly, vaccine related state regulations are heterogenous. We present a cross-sectional analysis of institutional specific vaccination policies at US pediatric renal transplant centers and relationships to state legislation. We found that 36.1% of institutions require COVID-19 vaccination prior to transplant, while 17 states have current legislation prohibiting proof of vaccination as a means of access to public services...
March 15, 2023: American Surgeon
https://read.qxmd.com/read/36918193/retention-of-knowledge-after-opioid-education-in-surgical-interns
#19
JOURNAL ARTICLE
Kevin R Arndt, Kortney A Robinson, Brian Yorkgitis, Gabriel Brat
BACKGROUND: In many academic centers, opioid prescribing is managed primarily by residents with little or no formal opioid education. The present study evaluates intern knowledge and comfort with appropriate opioid prescribing 7 months after an organized opioid education effort. MATERIALS AND METHODS: A repeat knowledge and attitude survey was sent to surgical interns who had completed an initial opioid education training session 7 months before the study...
March 14, 2023: American Surgeon
https://read.qxmd.com/read/36917997/hypercoagulable-factors-attributing-to-superior-mesenteric-vein-thrombosis-and-acute-mesenteric-ischemia
#20
JOURNAL ARTICLE
Alexandra L Van Horn, Alexa P Soult
Acute mesenteric ischemia is rare and can be difficult to diagnose due to vague symptoms often endorsed by patients. It can be fatal if not discovered in time, as it can lead to bowel ischemia, sepsis, and ultimately death. Here, we present a case of a 23-year-old female with hepatic steatosis, obesity, and 5-year history of birth control use who developed acute mesenteric ischemia secondary to superior mesenteric venous (SMV) thrombosis, requiring small bowel resection of 238 cm out of 480 cm (49...
March 14, 2023: American Surgeon
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