Pub Date : 2019-11-26DOI: 10.1201/9780429316944-93
Mary E. Condron
A pulmonary embolism occurs when a blood clot moves through the bloodstream and becomes lodged in a blood vessel in the lungs. This can make it hard for blood to pass through the lungs to get oxygen. Diagnosing a pulmonary embolism can be difficult because half of patients with a clot in the lungs have no symptoms. Others may experience shortness of breath, chest pain, dizziness, and possibly swelling in the legs. If you have a pulmonary embolism, you need medical treatment right away to prevent a blood clot from blocking blood flow to the lungs and heart.
{"title":"Pulmonary Embolism","authors":"Mary E. Condron","doi":"10.1201/9780429316944-93","DOIUrl":"https://doi.org/10.1201/9780429316944-93","url":null,"abstract":"A pulmonary embolism occurs when a blood clot moves through the bloodstream and becomes lodged in a blood vessel in the lungs. This can make it hard for blood to pass through the lungs to get oxygen. Diagnosing a pulmonary embolism can be difficult because half of patients with a clot in the lungs have no symptoms. Others may experience shortness of breath, chest pain, dizziness, and possibly swelling in the legs. If you have a pulmonary embolism, you need medical treatment right away to prevent a blood clot from blocking blood flow to the lungs and heart.","PeriodicalId":282445,"journal":{"name":"50 Landmark Papers","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126232594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As surgeons we are deeply affected by our postoperative complications, no matter how minor some may initially seem. We are also not infrequently called upon to personally treat or to help colleagues manage difficult clinical situations, whether as a result of the underlying disease process or from therapeutic endeavors. Although many are easily remedied, others leave us pondering as to how to proceed. Enterocutaneous fistulas (ECF), unfortunately, too often tend to fall into this latter group. With their wide-ranging etiology and variety of clinical factors potentially affecting management, each is extremely challenging in diverse aspects for both patient and physician alike. Confounding the situation, patients with ECF may present in a wide array of physiologic states spanning from a chronic draining wound to florid sepsis. As such, clinicians caring for these patients must possess a sound, and often stepwise, approach for evaluation and treatment. In this issue of Clinics in Colon and Rectal Surgery, our objective was to fully explore the complex nature of caring for patients with ECFs to help optimize patient outcomes in what is likely an already problematical state of affairs. Drs. Lundy and Fischer set the stage for the issue by providing an overview of ECF, including a fascinating look at the historical perspectives of this condition. Drs. Bleier and Hedrick discuss the metabolic support of the fistula patient including superb guidance on the initial goals of sepsis control, nutritional support, and available adjuncts for supportive care. Following patient stabilization, Drs. Lee and Stein present an in-depth review of the evaluation of fistula anatomy through both radiographic and endoscopic studies. The authors highlight the importance of detailing ECF anatomy to aid in successful outcomes, as well as the emerging role of minimally invasive alternatives for treatment. As a crucial component of the initial goals of ECF care, Drs. Hoedema and Suryadevara outline the principles of wound care along with the various techniques and tools available for enterostomal therapy to enhance patient comfort, recovery, and facilitate fistula healing. As the presence of ECF in assorted clinical settings can have a major impact on both diagnostic and therapeutic considerations, the authors have compiled a comprehensive review with respect to the patient’s underlying condition. Dr. Orangio begins with a thorough summary detailing the importance of a multidisciplinary approach to ECF care, the surgeon’s role as the leader within that team, as well as some technical aspects with emphasis on those patients with Crohn’s disease. Drs. de Campos-Lobato and Vogel tackle the difficult scenario of ECF management in those patients with underlying malignancy and prior radiation therapy, while Drs. Dubose and Lundy explore ECF management in the critically ill, posttraumatic, and thermally injured patient with an open abdomen including techniques to optimize fistula pre
{"title":"Enterocutaneous Fistulas","authors":"Edward B. Lineen, P. Lopez","doi":"10.1201/b19015-46","DOIUrl":"https://doi.org/10.1201/b19015-46","url":null,"abstract":"As surgeons we are deeply affected by our postoperative complications, no matter how minor some may initially seem. We are also not infrequently called upon to personally treat or to help colleagues manage difficult clinical situations, whether as a result of the underlying disease process or from therapeutic endeavors. Although many are easily remedied, others leave us pondering as to how to proceed. Enterocutaneous fistulas (ECF), unfortunately, too often tend to fall into this latter group. With their wide-ranging etiology and variety of clinical factors potentially affecting management, each is extremely challenging in diverse aspects for both patient and physician alike. Confounding the situation, patients with ECF may present in a wide array of physiologic states spanning from a chronic draining wound to florid sepsis. As such, clinicians caring for these patients must possess a sound, and often stepwise, approach for evaluation and treatment. In this issue of Clinics in Colon and Rectal Surgery, our objective was to fully explore the complex nature of caring for patients with ECFs to help optimize patient outcomes in what is likely an already problematical state of affairs. Drs. Lundy and Fischer set the stage for the issue by providing an overview of ECF, including a fascinating look at the historical perspectives of this condition. Drs. Bleier and Hedrick discuss the metabolic support of the fistula patient including superb guidance on the initial goals of sepsis control, nutritional support, and available adjuncts for supportive care. Following patient stabilization, Drs. Lee and Stein present an in-depth review of the evaluation of fistula anatomy through both radiographic and endoscopic studies. The authors highlight the importance of detailing ECF anatomy to aid in successful outcomes, as well as the emerging role of minimally invasive alternatives for treatment. As a crucial component of the initial goals of ECF care, Drs. Hoedema and Suryadevara outline the principles of wound care along with the various techniques and tools available for enterostomal therapy to enhance patient comfort, recovery, and facilitate fistula healing. As the presence of ECF in assorted clinical settings can have a major impact on both diagnostic and therapeutic considerations, the authors have compiled a comprehensive review with respect to the patient’s underlying condition. Dr. Orangio begins with a thorough summary detailing the importance of a multidisciplinary approach to ECF care, the surgeon’s role as the leader within that team, as well as some technical aspects with emphasis on those patients with Crohn’s disease. Drs. de Campos-Lobato and Vogel tackle the difficult scenario of ECF management in those patients with underlying malignancy and prior radiation therapy, while Drs. Dubose and Lundy explore ECF management in the critically ill, posttraumatic, and thermally injured patient with an open abdomen including techniques to optimize fistula pre","PeriodicalId":282445,"journal":{"name":"50 Landmark Papers","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114254190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1201/9780429316944-11
R. Parrado, D. Notrica
Results: Four cases were found in our records over this long period indicating its rarity. The patients were two females and two males with age ranging from 22 to 61 years. The presentation was right lower quadrant pain in two patients and bowel obstruction in the other two. Radiological investigation was done for all, but the diagnosis was confirmed on exploratory laparatomy. Most of them were of ileo-ileal origin. No malignancy was reported.
{"title":"Adult Intussusception","authors":"R. Parrado, D. Notrica","doi":"10.1201/9780429316944-11","DOIUrl":"https://doi.org/10.1201/9780429316944-11","url":null,"abstract":"Results: Four cases were found in our records over this long period indicating its rarity. The patients were two females and two males with age ranging from 22 to 61 years. The presentation was right lower quadrant pain in two patients and bowel obstruction in the other two. Radiological investigation was done for all, but the diagnosis was confirmed on exploratory laparatomy. Most of them were of ileo-ileal origin. No malignancy was reported.","PeriodicalId":282445,"journal":{"name":"50 Landmark Papers","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123496251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1201/9780429316944-43
Elisabeth R. Benjamin
{"title":"Management of Internal Hemorrhoids","authors":"Elisabeth R. Benjamin","doi":"10.1201/9780429316944-43","DOIUrl":"https://doi.org/10.1201/9780429316944-43","url":null,"abstract":"","PeriodicalId":282445,"journal":{"name":"50 Landmark Papers","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130855522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1201/9780429316944-84
C. Coopersmith
{"title":"Time to Treatment and Mortality during Mandated Emergency Care for Sepsis","authors":"C. Coopersmith","doi":"10.1201/9780429316944-84","DOIUrl":"https://doi.org/10.1201/9780429316944-84","url":null,"abstract":"","PeriodicalId":282445,"journal":{"name":"50 Landmark Papers","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130980572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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