Acute/Critical Care Surgery

J O'Connell, S Keohane, A McGreal-Bellone, P McDonagh, S Naimimohasses, U Kennedy, C Dunne, K Hartery, J Larkin, F MacCarthy, J Meaney, S McKiernan, S Norris, D O'Toole, D Kevans
BACKGROUND AND AIMS: A significant proportion of patients presenting to the Emergency Department with gastrointestinal symptoms that result in cross-sectional imaging receive a radiological diagnosis of colitis. We aimed to review the characteristics, outcomes, and final diagnoses of new emergency department presentations with colitis diagnosed on cross-sectional imaging. METHODS: A radiology database was interrogated to identify patients admitted from the Emergency Department of St James's Hospital whose cross-sectional imaging demonstrated colitis...
January 10, 2020: Irish Journal of Medical Science
Davood Rezazadeh, Roghayeh Anvari Aliabad, Amir Hossein Norooznezhad
Cesarean delivery (CD) has been known as the most common surgery in the United States. This procedure might associate with different complications, the most important of which is surgical site infection (SSI). Among the major SSI categories, incisional type is more common than the others. Regardless of its notable expense, the use of prophylactic wound healing technics (such as negative pressure therapy) has been advised for the patients with high SSI risk. Herein, use of patient's own human amniotic membrane in an autologous form (as a free of charge treatment) would be suggested for prevention of SSI in CD wounds...
December 17, 2019: Medical Hypotheses
Robert Michael O'Connell, Sami Abd Elwahab, Kenneth Mealy
INTRODUCTION: Acute appendicitis is a common surgical emergency in children. The majority of appendicectomies in children are performed by general surgeons, rather than specialist paediatric surgeons. AIM: To assess the impact of hospital specialization, hospital volume, and surgeon volume on outcomes for children undergoing appendicectomy in Ireland. METHODS: NQAIS (National Quality Assurance and Improvement System) data for all appendicectomies performed on children in Ireland between January 2014 and November 2017 was examined...
January 2, 2020: Irish Journal of Medical Science
Kurt Ruetzler, Ashish K Khanna, Daniel I Sessler
Myocardial injury after noncardiac surgery (MINS) differs from myocardial infarction in being defined by troponin elevation apparently from cardiac ischemia with or without signs and symptoms. Such myocardial injury is common, silent, and strongly associated with mortality. MINS is usually asymptomatic and only detected by routine troponin monitoring. There is currently no known safe and effective prophylaxis for perioperative myocardial injury. However, appropriate preoperative screening may help guide proactive postoperative preventative actions...
December 26, 2019: Anesthesia and Analgesia
Matthew A Warner, Ryan D Frank, Timothy J Weister, Nageswar R Madde, Ognjen Gajic, Daryl J Kor
BACKGROUND: The relationships between the ratios of transfused allogeneic blood products and clinical outcomes in patients with acute intraoperative hemorrhage are poorly defined. METHODS: To better define these ratios, we undertook a single-center, observational cohort study of all surgical patients (≥18 years) who received rapid transfusion defined by a critical administration threshold of 3 or more units of red blood cells (RBCs) intraoperatively within 1 hour between January 1, 2011 and December 31, 2015...
December 26, 2019: Anesthesia and Analgesia
Xing-Jiang Xiong
Zhigancao decoction recorded in Treatise on Febrile Disease by Zhang Zhongjing in the Han dynasty have been widely used in treating palpitation and irregular pulse by traditional Chinese medicine physicians for thousands of years. It is all known that Zhigancao Decoction is used to treat consumptive disease. However,why it has been used to treat exogenous febrile disease? According to studies,Fumai Decoctions in Treatise on Differentiation and Treatment of Epidemic Febrile Disease,that was modified based on Zhigancao Decoction,have their names without reality...
September 2019: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Kevin McFadgen, Natisha Jensen, Pramod B Mahajan
Background: Pharmacogenomics is increasingly becoming a valuable tool for improving health outcomes, reducing health care costs and avoiding adverse drug reactions. While application of pharmacogenomics is quite common in oncology and cardiology, routine use of this technology is rare in certain other fields including Trauma and Critical Care Surgery. We are testing feasibility of applying pharmacogenomic testing to improve therapeutic outcomes of trauma and acute care patients at MercyOne Medical Center in Des Moines, IA...
December 2019: Trauma Case Reports
Shalini Dhir, Achal Dhir
Biomarkers aided perioperative cardiac assessment is a relatively new concept. Cardiac biomarkers with historical significance (aspartate transaminase, dehydrogenase, creatinine kinase and myoglobin) have paved the way for traditional biomarkers (cardiac troponin, C-reactive protein, lipoprotein). Contemporary biomarkers like natriuretic peptides (BNP and ProBNP) are validated risk markers in both acute and chronic cardiac diseases and are showing remarkable promise in predicting serious cardiovascular complications after non-cardiac surgery...
October 11, 2019: Journal of Cardiothoracic and Vascular Anesthesia
David Astapenko, Jan Benes, Jiri Pouska, Christian Lehmann, Sufia Islam, Vladimir Cerny
The endothelial glycocalyx (EG) is the thin sugar-based lining on the apical surface of endothelial cells. It has been linked to the physiological functioning of the microcirculation and has been found to be damaged in critical illness and after acute care surgery. This review aims to describe the role of EG in severely injured patients undergoing surgery, discuss specific situations (e.G. major trauma, hemorrhagic shock, trauma induced coagulopathy) as well as specific interventions commonly applied in these patients (e...
December 20, 2019: BMC Anesthesiology
Hiroyuki Okura, Yasuki Nakada, Satomi Ishihara, Maki Nogi, Kenji Onoue, Tsunenari Soeda, Satoshi Okayama, Makoto Watanabe, Rika Kawakami, Yoshihiko Saito
BACKGROUND: Takotsubo cardiomyopathy (TC) is characterized as a transient segmental cardiac dysfunction mimicking acute coronary syndrome triggered by emotional or physical stress. Although neurological disorders, infection, malignant diseases, trauma and surgery are known triggers for the development of TC, role of cardiac diseases as underlying conditions for the development of TC is uncertain. The aim of this study was to investigate incidence and clinical characteristics of TC among critically ill cardiac disease patients and to verify that TC may coexist with other cardiac diseases...
December 13, 2019: Journal of Echocardiography
Matteo Marconi, Diego Mariani, Antonio La Greca, Isidro Martinez Casas, Jorge Pereira, Antonio Rodrigues da Silva, Luis Pinheiro, Andrea Casamassima, Gary Bass, Luca Ponchietti, Mauro Zago
For a long time surgeons have been discussing the need to improve their skills in the use of ultrasound (US). However in the recent years it has become evident the importancxe for general aklnd trauma surgeons treating critically-ill patients to learn basic and advanced US. The two last editions (9th and 10th) of the ATLS manual have officially included FAST and e-FAST in the primary assessment of trauma patients, making this tool an essential skill for surgeons. In the acute care setting FAST, e-FAST and other applications have gained a pivotal, evidence-based role in this fields...
2019: Annali Italiani di Chirurgia
Ami Hommel, Martin Magnéli, Bodil Samuelsson, Kristina Schildmeijer, Desirée Sjöstrand, Katarina E Göransson, Maria Unbeck
BACKGROUND: For decades, patient safety has been recognized as a critical global healthcare issue. However, there is a gap of knowledge of all types of adverse events sensitive to nursing care within hospitals in general and within orthopaedic care specifically. OBJECTIVES: The aim of this study is to explore the incidence and nature of nursing-sensitive adverse events following elective or acute hip arthroplasty at a national level. DESIGN: A retrospective multicenter cohort study...
November 13, 2019: International Journal of Nursing Studies
R M O'Connell, S Abd Elwahab, K Mealy
INTRODUCTION: Acute Appendicitis and appendicectomy are common surgical emergencies worldwide. However, there is a lack of published data on the impact of hospital grade, surgeon- and hospital-volumes on patient outcomes following appendicectomy. AIM: To establish if hospital grade, hospital-volume, or surgeon-volume impacted patient outcomes following appendicectomy. METHODS: Using the National Quality Assurance and Improvement System (NQAIS) data for all appendicectomies performed in Ireland between January 2014 and November 2017 were examined...
December 2, 2019: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Paul Zajic, Stefan Heschl, Michael Schörghuber, Petra Srekl-Filzmaier, Tatjana Stojakovic, Viktoria Weixler, Sieglinde Zelzer, Karin Amrein
BACKGROUND: There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. METHODS: In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed...
December 4, 2019: Wiener Klinische Wochenschrift
Glaucia Galvão, Ana Luiza Mezzaroba, Fernanda Morakami, Meriele Capeletti, Olavo Franco Filho, Marcos Tanita, Tiago Feronato, Barbara Charneski, Lucienne Cardoso, Larissa Andrade, Cintia Grion
OBJECTIVE: To evaluate seasonal variations of clinical characteristics, therapeutic resource use, and outcomes of critically ill patients admitted to an intensive care unit. METHODS: A retrospective cohort study conducted from January 2011 to December 2016 in adult patients admitted to the intensive care unit (ICU) of a University Hospital. Data were collected on the type of admission, APACHE II, SOFA, and TISS 28 scores at ICU admission. Length of hospital stay and vital status at hospital discharge were recorded...
November 2019: Revista da Associação Médica Brasileira
Laurence Weinberg, Amelia Russell, Lois Mackley, Charles Dunnachie, Joshua Meyerov, Chong Tan, Michael Li, Raymond Hu, Dharshi Karalapillai
BACKGROUND: The relationship between hyperkalaemia and metabolic acidosis is well described in the critical care setting; however, the relationship between acute respiratory acidosis and plasma potassium concentration is less well understood. In a controlled model of increasing levels of hypercarbia, we tested the hypothesis of whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations. AIM: To determine whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations...
November 26, 2019: World Journal of Clinical Cases
Dongho Kang, Kyung Yeon Yoo
Fluid therapy to restore and/or maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Kinetic analyses and outcome-oriented studies have provided more insight into fluid management. Crystalloids are slowly distributed to the interstitial space, and the efficiency (proportion of infused fluid retained in the bloodstream) is 50%-75% as long as infusion continues and may increase up to 100% when the arterial pressure has decreased. Elimination of the infused fluid during general anesthesia and surgery is very slow, amounting to only 10%-20% compared with that in conscious patients...
November 2019: Acute and critical care
Barbara Delmore, Jill Cox, Daniel Smith, Andy S Chu, Linda Rolnitzky
OBJECTIVE: The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population. METHODS: Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without...
November 27, 2019: Advances in Skin & Wound Care
W H Yin, X T Wang, D W Liu, Y Kang, Y G Chao, L N Zhang, H M Zhang, J Wu, L X Liu, R Zhu, W He
Transesophageal echocardiography(TEE) is valuable in intensive care unit (ICU) because its application meets the requirements of diagnosis and treatment of critically ill patients.However, the current application has not fully adapted to the specialty of critical care. TEE could be more valuablein ICU when used with a new way that under the guidance of the theory of critical care and embedded into the treatment workflow. We have expanded and improved the application of traditional TEE and integrated the concept of critical care, established the concept of transesophageal echocardiography for critical care (TEECC)...
December 1, 2019: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
You-Yen Lin, Chi-Tan Hu, Der-Shan Sun, Te-Sheng Lien, Hsin-Hou Chang
Thrombocytopenia is usually associated with liver injury, elevated plasma aspartate aminotransferase and alanine aminotransferase levels, and high antiplatelet immunoglobulin (Ig) titers, although the mechanism behind these effects remains elusive. Deciphering the mechanism behind acute liver disease-associated thrombocytopenia may help solve difficulties in routine patient care, such as liver biopsy, antiviral therapy, and surgery. To determine whether liver damage is sufficient per se to elicit thrombocytopenia, thioacetamide (TAA)-induced hepatitis rodent models were employed...
November 25, 2019: Scientific Reports
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