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urgent surgery

R Pandey, L Chen, C Manca, S Jenkins, L Glaser, C Vinnard, G Stone, J Lee, B Mathema, E L Nuermberger, R A Bonomo, B N Kreiswirth
As a consequence of a growing population of immunocompromised individuals, including transplant recipients and cystic fibrosis patients, there has been a dramatic increase in chronic infections caused by Mycobacterium abscessus complex (MABC) strains that are usually recalcitrant to effective antibiotic therapy. The recent rise of macrolide resistance in MABC has further complicated this clinical dilemma, dramatizing the need for novel agents. The repurposing of current antibiotics is one rapid path from discovery to patient care...
February 12, 2019: MBio
Ana Marija Sola, Daniel E Johnson, Jennifer R Grandis
Despite advances in treatment, head and neck squamous cell carcinoma (HNSCC) survival rates remain stagnant. Current treatment is associated with significant toxicities and includes chemotherapy, radiation, surgery and few targeted treatments. Targeted treatments, epidermal growth factor receptor (EGFR)-targeted agent, cetuximab, and immune checkpoint inhibitors, pembrolizumab and nivolumab, show improved toxicity profiles and modestly improved survival in select patients. An urgent need remains to identify novel targeted treatments for single-agent or combined therapy use...
February 12, 2019: Expert Opinion on Investigational Drugs
Nikhil Crain, Talar Tejirian
Although inguinal herniorrhaphy is low risk, patients still return to the urgent care or ED. We performed a retrospective study on 19,296 inguinal hernia operations across 14 Southern California Kaiser Permanente medical centers over five years. Unplanned returns within the first postoperative week were evaluated focusing on four potentially avoidable diagnoses (AD): pain, constipation, urinary retention, and nausea/vomiting. Overall, 1370 (7%) patients returned to the urgent care/emergency department, of which 537 (39%) had an AD...
October 1, 2018: American Surgeon
Neda Valizadeh, Kunal Suradkar, Ravi P Kiran
The aim of this study was to identify preoperative characteristics that may determine the need for emergency surgery for diverticulitis and assess postoperative outcomes for these patients when compared with elective surgery. All patients included in the ACS-NSQIP-targeted colectomy database from 2012 to 2013 who underwent colectomy with an underlying diagnosis of diverticulitis were included. Preoperative characteristics and 30-day postoperative outcomes were evaluated for patients who underwent elective versus emergent/urgent surgery using univariable and multivariable analyses...
November 1, 2018: American Surgeon
Wolfgang Reinpold, Ferdinand Köckerling, Reinhard Bittner, Joachim Conze, René Fortelny, Andreas Koch, Jan Kukleta, Andreas Kuthe, Ralph Lorenz, Bernd Stechemesser
Introduction: Recently, the promising results of new procedures for the treatment of rectus diastasis with concomitant hernias using extraperitoneal mesh placement and anatomical restoration of the linea alba were published. To date, there is no recognized classification of rectus diastasis (RD) with concomitant hernias. This is urgently needed for comparative assessment of new surgical techniques. A working group of the German Hernia Society (DHG) and the International Endohernia Society (IEHS) set itself the task of devising such a classification...
2019: Frontiers in Surgery
Antonio Baule, Federico Cabigiosu, Bastianina Zanda, Alessandra Sanna, Claudia Mongili, Antonio Manca
Introduction: Dabigatran is one of the nonvitamin K antagonist oral anticoagulants. Thrombolytic treatment with intravenous recombinant tissue plasminogen activator is contraindicated in patients taking a DOAC. Idarucizumab was recently approved for dabigatran-activity reversing in severe bleeding, emergency surgery, or urgent procedures, but many attempts have been made to use idarucizumab in patients presenting with acute ischemic stroke in order to be eligible for thrombolysis. Case: Our patient was an 89-year-old woman with severe aphasia who was treated with dabigatran for nonvalvular atrial fibrillation...
November 2018: Journal of Vascular and Interventional Neurology
Amer Harky, Mohamad Bashir, Ciaran Grafton-Clarke, Martin Lees, Sarah Fendius, Neil Roberts
Intraventricular conduction abnormalities following cardiac surgery have been thoroughly described, especially after valvular surgery. It is also widely known that several anesthetic factors can cause autonomic disturbances resulting in the unmasking of sinus node dysfunction, significant bradycardia, and cardiovascular collapse during the intraoperative period. However, little is known about asymptomatic episodes, especially those occurring prior to coronary artery bypass grafting (CABG). We report a rare occurrence of an intraventricular conduction defect that presented in an asymptomatic patient following non-ST-elevation myocardial infarction prior to urgent CABG...
July 2018: Journal of Tehran Heart Center
Angshuman Rudra Pal, Suparna Mitra, Sobhan Aich, Jyotsna Goswami
Background and Aims: Enhanced recovery after surgery (ERAS) protocol in colorectal surgery has been shown to result in reduced rates of postoperative complications and length of stay (LOS) in the hospital. Although there is clear guideline and evidences available, their implementation into daily clinical practice faces some difficulties. We aimed to audit the existing practice of perioperative care in colorectal surgeries and find out the adherence to ERAS protocol. Methods: We collected data from medical record of 215 patients undergoing colorectal surgery in a regional cancer institute of eastern India...
January 2019: Indian Journal of Anaesthesia
S G Lum, B S Gendeh, S Husain, H S Gendeh, M R Ismail, C J Toh, A Izaham, H J Tan
Iatrogenic internal carotid artery injury is a catastrophic but uncommon complication of endonasal sinus surgery. We present our experience in managing this emergency situation. A 52-year-old man underwent revision endoscopic repair of recurrent cerebrospinal fluid leak that was complicated with profuse haemorrhage during removal of the anterior wall of sphenoid sinus using a Hajek sphenoid punch forceps. Immediate packing of the sphenoid sinus controlled the haemorrhage. Urgent angiography revealed injury at the paraclival segment of the left internal carotid artery...
January 31, 2019: Acta Otorhinolaryngologica Italica
Kosuke Fujii, Toshihiko Saga, Masahiko Onoe, Susumu Nakamoto, Toshio Kaneda, Masato Imura, Takako Nishino, Shintaro Yukami, Naoya Miyashita, Ryusuke Hamada
PURPOSE: We performed antegrade thoracic endovascular aneurysm repair via the ascending aorta in selected high-risk patients scheduled for open surgery, in whom an iliofemoral or abdominal aortic approach was not feasible. We present our initial experience with this approach. METHODS: Of 16 consecutive patients who underwent antegrade endovascular aneurysm repair via the ascending aorta at our institution, 3 had an emergency intervention for rupture and 3 had an urgent intervention for impending rupture or complicated aortic dissection...
February 11, 2019: Asian Cardiovascular & Thoracic Annals
Elvira Grandone, Angelo Ostuni, Giovanni L Tiscia, Francesco Marongiu, Doris Barcellona
The number of hip fractures in anticoagulated patients is predicted to increase, due to people living longer. However, evidence regarding urgent perioperative management of elderly patients with hip fracture who take oral anticoagulants (vitamin K antagonists or direct oral anticoagulants) is scarce. In this article, the authors present a narrative review of the evidence to date supporting the urgent management of hip fracture in anticoagulated elderly patients. They discuss the complexity of managing the high risk of procedure-related bleeding and, at the same time, the high risk of thromboembolism...
February 11, 2019: Seminars in Thrombosis and Hemostasis
Ali Fuat Kaan Gök, Ilker Özgür, Meral Altunsoy, Muhammed Zübeyr Üçüncü, Adem Bayraktar, Mehmet Türker Bulut, Metin Keskin
BACKGROUND: Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting...
January 2019: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Andrew Jones, Steven Livesey
Left ventricular outflow tract (LVOT) obstruction (LVOTO) is a rare but recognized complication of mitral valve surgery. Concomitant factors can cause significant clinical deterioration which requires urgent intervention. We present the case of a female patient who underwent closed valvotomy at age 20 for mitral stenosis secondary to rheumatic heart disease. Seventeen years later, a re-stenosed valve prompted mitral valve replacement (MVR) with a Carbomedics mechanical prosthesis. 8 years later, she re-presented with increasing dyspnoea...
January 2019: Journal of Surgical Case Reports
Yasser Menaissy, Ihab Omar, Basem Mofreh, Mohamed Alassal
BACKGROUND:  The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes...
February 9, 2019: Thoracic and Cardiovascular Surgeon
Stergios Boussios, Mehmet Akif Ozturk, Michele Moschetta, Afroditi Karathanasi, Nikolaos Zakynthinakis-Kyriakou, Konstantinos H Katsanos, Dimitrios K Christodoulou, Nicholas Pavlidis
Colorectal cancer (CRC) is the third most common malignancy worldwide. Surgery remains the most important treatment for non-metastatic CRC, and the administration of adjuvant chemotherapy depends mainly on the disease stage, which is still the strongest prognostic factor. A refined understanding of the genomics of CRC has recently been achieved thanks to the widespread use of next generation sequencing with potential future therapeutic implications. Microsatellite instability (MSI) has been suggested as a predictive marker for response to anti-programmed-cell-death protein 1 (PD-1) therapy in solid tumors, including CRC...
February 7, 2019: Journal of Personalized Medicine
Vincenza Girgenti, Gloria Pelizzo, Salvatore Amoroso, Gregorio Rosone, Marco Di Mitri, Mario Milazzo, Salvatore Giordano, Rosaria Genuardi, Valeria Calcaterra
Introduction: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection of the kidney. To date, very few cases of EPN have been described in the pediatric age. The first case of EPN in a toddler occurring after ureterovesical reimplantation for congenital obstructive megaureter is reported with a literature review. Case Report: A 23-month-old male, with a prenatal diagnosis of obstructive megaureter and incomplete duplication of the left urinary tract, was admitted to our Unit where he underwent surgery to treat increased dilatation of the renal pelvis and appearance of an obstructive curve...
2019: Frontiers in Pediatrics
Yin Liu, Puspa R Pandey, Sambad Sharma, Fei Xing, Kerui Wu, Amar Chittiboyina, Shih-Ying Wu, Abhishek Tyagi, Kounosuke Watabe
PURPOSE: Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer which could progress to or recur as invasive breast cancer. The underlying molecular mechanism of DCIS progression is yet poorly understood, and appropriate biomarkers to distinguish benign form of DCIS from potentially invasive tumor are urgently needed. METHODS: To identify the key regulators of DCIS progression, we performed gene-expression analysis of syngeneic breast cancer cell lines MCF10A, DCIS...
February 6, 2019: Breast Cancer Research and Treatment
Gitanjali Srivastava, Valerie O'Hara, Nancy Browne
Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12⁻19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or extreme childhood obesity, many children in weight management programs do not achieve a healthy weight. Most often, these patients will go on to require metabolic and bariatric surgery (MBS), but challenges and limitations may prohibit MBS on adolescents...
February 4, 2019: Children
Naoya Yoshida, Hiroyuki Yamamoto, Hideo Baba, Hiroaki Miyata, Masayuki Watanabe, Yasushi Toh, Hisahiro Matsubara, Yoshihiro Kakeji, Yasuyuki Seto
OBJECTIVE: We aimed to elucidate whether minimally invasive esophagectomy (MIE) can be safely performed by reviewing the Japanese National Clinical Database. SUMMARY OF BACKGROUND DATA: MIE is being increasingly adopted, even for advanced esophageal cancer that requires various preoperative treatments. However, the superiority of MIE's short-term outcomes compared with those of open esophagectomy (OE) has not been definitively established in general clinical practice...
January 31, 2019: Annals of Surgery
Anja Lautem, Frank Simon, Maria Hoppe-Lotichius, Jens Mittler, Johanna Vollmar, Arno Schad, Christoph Düber, Peter Robert Galle, Gerd Otto, Tim Zimmermann, Hauke Lang
Hepatocellular carcinoma (HCC) is one of the most common human malignancies, the incidence of which is growing worldwide. The prognosis of HCC is very poor and it is often accompanied by a high rate of recurrence. Conventional chemotherapeutic approaches are largely inefficient. In order to develop novel effective methods for the early detection and prognosis of HCC, novel markers and therapeutic targets are urgently required. The present study focused on the effects of the expression of the tumor suppressor gene insulin‑like growth factor‑2 receptor (IGF2R) on patient survival and tumor recurrence in patients with HCC; this study paid specific attention to the influence of transarterial chemoembolization (TACE) prior to surgery...
February 1, 2019: Oncology Reports
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