Background: Small bowel obstruction (SBO) is a common surgical emergency usually treated via standard laparotomy. But with the advancement of laparoscopic surgical skills, more surgeons are undertaking laparoscopic approach as well to treat uncomplicated SBO. We aimed to compare outcomes following laparoscopic vs. open surgical techniques in a district general hospital. Methods: A retrospective review of case notes of patients who underwent operative surgical treatment for SBO between January 2012 and July 2018 was carried out. Mann-Whitney U test was used for nominal data and Chi-square test for categorical data analysis. Results: A total of 99 surgical procedures were carried out for SBO during this period at our district general hospital with 31 laparoscopic and 68 open procedures. Fifteen out of 31 were completed laparoscopically (totally laparoscopic approach (TLA)), while 16/31 were converted to open procedure (laparoscopic-assisted group (LAG)) to complete the operation. Median age for open group was 69 years (26 - 91 years) vs. 71 years (23 - 94 years) for laparoscopic group. Median length of stay was 10 vs. 6.5 days for single band adhesions treated laparoscopically (P = 0.02). Median Charlson comorbidity index was 6 vs. 5 (TLA). Eight out of 31 in laparoscopic group had complications, whereas 27/68 in open group (P = 0.26). The 30-day mortality was 5/68 for open vs. none for laparoscopy group. The 1-year follow-up for all patients confirmed 7/68 in open vs. 1/31 laparoscopic group mortalities. Conclusion: Laparoscopic surgical approach for SBO seems to have statistically significant lower small bowel resection rate and length of stay in this hospital when compared to laparotomy in selected patients. J Curr Surg. 2021;11(1):1-7 doi: https://doi.org/10.14740/jcs430
{"title":"Laparoscopic Management for Small Bowel Obstruction: Experience From a UK District General Hospital With One-Year Follow-Up","authors":"B. Mothe, Usman Khurram Khan, C. Smart","doi":"10.14740/JCS430","DOIUrl":"https://doi.org/10.14740/JCS430","url":null,"abstract":"Background: Small bowel obstruction (SBO) is a common surgical emergency usually treated via standard laparotomy. But with the advancement of laparoscopic surgical skills, more surgeons are undertaking laparoscopic approach as well to treat uncomplicated SBO. We aimed to compare outcomes following laparoscopic vs. open surgical techniques in a district general hospital. Methods: A retrospective review of case notes of patients who underwent operative surgical treatment for SBO between January 2012 and July 2018 was carried out. Mann-Whitney U test was used for nominal data and Chi-square test for categorical data analysis. Results: A total of 99 surgical procedures were carried out for SBO during this period at our district general hospital with 31 laparoscopic and 68 open procedures. Fifteen out of 31 were completed laparoscopically (totally laparoscopic approach (TLA)), while 16/31 were converted to open procedure (laparoscopic-assisted group (LAG)) to complete the operation. Median age for open group was 69 years (26 - 91 years) vs. 71 years (23 - 94 years) for laparoscopic group. Median length of stay was 10 vs. 6.5 days for single band adhesions treated laparoscopically (P = 0.02). Median Charlson comorbidity index was 6 vs. 5 (TLA). Eight out of 31 in laparoscopic group had complications, whereas 27/68 in open group (P = 0.26). The 30-day mortality was 5/68 for open vs. none for laparoscopy group. The 1-year follow-up for all patients confirmed 7/68 in open vs. 1/31 laparoscopic group mortalities. Conclusion: Laparoscopic surgical approach for SBO seems to have statistically significant lower small bowel resection rate and length of stay in this hospital when compared to laparotomy in selected patients. J Curr Surg. 2021;11(1):1-7 doi: https://doi.org/10.14740/jcs430","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"31 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84650885","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}
K. Fujine, M. Sano, Yoshinori Katsumata, Kazuki Sato, E. Kobayashi
Background: In rodent models, 5-aminolevulinic acid (5-ALA) was shown to prevent renal ischemia-reperfusion injury, but the data did not allow estimation of the human equivalent dose (HED). Therefore, this study evaluated the renal effects of 5-ALA and estimated the HED in micro miniature pigs, which have a metabolism closer to that of humans. Methods: We analyzed the efficacy and pharmacokinetics of 5-ALA by administering it to nine micro miniature pigs 2 days before renal ischemia-reperfusion injury. A pathological score was calculated on the basis of renal tissue damage; the blood concentration of 5-ALA required to prevent damage was estimated from the expected pathological score by back-calculating it from the obtained approximate expression. The pharmacokinetics data obtained in phase 1 human trials (5-ALA dose vs. blood concentration curve) were used to calculate the HED. Results: Dose-dependent improvement in tissue damage (rated as a pathological score) was confirmed 7 days after reperfusion. In each animal, the blood concentrations of 5-ALA correlated with the pathological score. We estimated that doses of approximately 1.6 mg/kg and 13.4 mg/kg would be required to obtain histopathology scores of 4 and 3.7 in humans, respectively. Conclusions: This is the first study to show that the HED of 5-ALA can be calculated from efficacy and pharmacokinetics data obtained in micro miniature pigs. J Curr Surg. 2021;11(1):8-14 doi: https://doi.org/10.14740/jcs429
{"title":"Predicting the Effective Dose of 5-Aminolevulinic Acid to Protect Humans From Renal Ischemia-Reperfusion Injury: A Study in Micro Miniature Pigs","authors":"K. Fujine, M. Sano, Yoshinori Katsumata, Kazuki Sato, E. Kobayashi","doi":"10.14740/JCS429","DOIUrl":"https://doi.org/10.14740/JCS429","url":null,"abstract":"Background: In rodent models, 5-aminolevulinic acid (5-ALA) was shown to prevent renal ischemia-reperfusion injury, but the data did not allow estimation of the human equivalent dose (HED). Therefore, this study evaluated the renal effects of 5-ALA and estimated the HED in micro miniature pigs, which have a metabolism closer to that of humans. Methods: We analyzed the efficacy and pharmacokinetics of 5-ALA by administering it to nine micro miniature pigs 2 days before renal ischemia-reperfusion injury. A pathological score was calculated on the basis of renal tissue damage; the blood concentration of 5-ALA required to prevent damage was estimated from the expected pathological score by back-calculating it from the obtained approximate expression. The pharmacokinetics data obtained in phase 1 human trials (5-ALA dose vs. blood concentration curve) were used to calculate the HED. Results: Dose-dependent improvement in tissue damage (rated as a pathological score) was confirmed 7 days after reperfusion. In each animal, the blood concentrations of 5-ALA correlated with the pathological score. We estimated that doses of approximately 1.6 mg/kg and 13.4 mg/kg would be required to obtain histopathology scores of 4 and 3.7 in humans, respectively. Conclusions: This is the first study to show that the HED of 5-ALA can be calculated from efficacy and pharmacokinetics data obtained in micro miniature pigs. J Curr Surg. 2021;11(1):8-14 doi: https://doi.org/10.14740/jcs429","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"114 1","pages":"8-14"},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76243434","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}
Peter Drevets, Lillie Tien, Richard Lacoursière, Todd E. Burgbacher, Elizabeth D. Fox
The majority of snakebite envenomation events in North America are attributed to rattlesnakes with pit-vipers responsible for nearly all envenomation events. Significant morbidity is associated with rattlesnake envenomation including local tissue destruction and coagulopathy. Severe oropharyngeal edema requiring emergent securing of airway has been reported in victims with no prior exposure to pit-vipers but is exceptionally rare. We present a case report of a venom-naive male in his early twenties who received a pit-viper bite to the right thumb, resulting in an anaphylactoid reaction complicated by severe oropharyngeal edema, coagulopathy, and persistent respiratory failure requiring prolonged ventilator support. This case highlights how anaphylactic and anaphylactoid reactions are nearly identical in presentation and may be associated with significant morbidity. Regardless of whether the underlying etiology is anaphylaxis or anaphylactoid, the management should focus on providing CroFab ® early in the clinical course. J Curr Surg. 2021;11(1):15-20 doi: https://doi.org/10.14740/jcs426
{"title":"Rattlesnake Envenomation in a Venom-Naive Man With Significant Coagulopathy and Severe Oropharyngeal Edema Requiring Emergent Surgical Airway","authors":"Peter Drevets, Lillie Tien, Richard Lacoursière, Todd E. Burgbacher, Elizabeth D. Fox","doi":"10.14740/JCS426","DOIUrl":"https://doi.org/10.14740/JCS426","url":null,"abstract":"The majority of snakebite envenomation events in North America are attributed to rattlesnakes with pit-vipers responsible for nearly all envenomation events. Significant morbidity is associated with rattlesnake envenomation including local tissue destruction and coagulopathy. Severe oropharyngeal edema requiring emergent securing of airway has been reported in victims with no prior exposure to pit-vipers but is exceptionally rare. We present a case report of a venom-naive male in his early twenties who received a pit-viper bite to the right thumb, resulting in an anaphylactoid reaction complicated by severe oropharyngeal edema, coagulopathy, and persistent respiratory failure requiring prolonged ventilator support. This case highlights how anaphylactic and anaphylactoid reactions are nearly identical in presentation and may be associated with significant morbidity. Regardless of whether the underlying etiology is anaphylaxis or anaphylactoid, the management should focus on providing CroFab ® early in the clinical course. J Curr Surg. 2021;11(1):15-20 doi: https://doi.org/10.14740/jcs426","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"34 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80964746","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}
Reshad Salam, Henrik Ghantarchyan, Stephanie Yee, Jamshed Zuberi, E. Ahmad
A Krukenberg tumor is a rare form of metastatic ovarian cancer. Distinctly identified by its histological appearance, a signet-ring cell, it is an uncommon and aggressive neoplasm commonly seen in pre-menopausal women. We present a rare case of a Krukenberg tumor seen in a 36-year-old Mexican female with no known past medical history. Treatment modalities for our patient included metastasectomy followed by multiple rounds of chemotherapy. J Curr Surg. 2020;10(3):32-36 doi: https://doi.org/10.14740/jcs407
Krukenberg肿瘤是一种罕见的转移性卵巢癌。其组织学表现为印戒细胞，是一种罕见的侵袭性肿瘤，常见于绝经前妇女。我们报告一例罕见的Krukenberg肿瘤，患者为36岁墨西哥女性，既往病史不详。我们患者的治疗方式包括转移瘤切除术和多轮化疗。contemporary surgery . 2020;10(3):32-36 doi: https://doi.org/10.14740/jcs407
{"title":"Rare Presentation of a Krukenberg Tumor","authors":"Reshad Salam, Henrik Ghantarchyan, Stephanie Yee, Jamshed Zuberi, E. Ahmad","doi":"10.14740/jcs407","DOIUrl":"https://doi.org/10.14740/jcs407","url":null,"abstract":"A Krukenberg tumor is a rare form of metastatic ovarian cancer. Distinctly identified by its histological appearance, a signet-ring cell, it is an uncommon and aggressive neoplasm commonly seen in pre-menopausal women. We present a rare case of a Krukenberg tumor seen in a 36-year-old Mexican female with no known past medical history. Treatment modalities for our patient included metastasectomy followed by multiple rounds of chemotherapy. J Curr Surg. 2020;10(3):32-36 doi: https://doi.org/10.14740/jcs407","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"59 1","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75995453","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}
Ashen Fernando, J. L. Francois, N. Majachani, Reshad Salam, Stephanie Yee, Jamshed Zuberi
A gastrobronchial fistula (GBF) is an abnormal connection between the stomach and the lungs, and is an extremely rare but serious complication of laparoscopic sleeve gastrectomy (LSG). GBFs are usually the result of a persistent staple line leak that leads to the formation of a subphrenic abscess. The abscess may either spread through lymphatics or directly erode into the diaphragm and result in a GBF. We present the case of a 49-year-old female who developed a GBF after being managed for recurrent staple line leaks post-LSG. This case highlights the importance of timely detection and management of leaks to prevent this potentially fatal sequela. J Curr Surg. 2020;10(3):41-44 doi: https://doi.org/10.14740/jcs413
{"title":"Gastrobronchial Fistula: A Rare Complication Post-Laparoscopic Sleeve Gastrectomy","authors":"Ashen Fernando, J. L. Francois, N. Majachani, Reshad Salam, Stephanie Yee, Jamshed Zuberi","doi":"10.14740/jcs413","DOIUrl":"https://doi.org/10.14740/jcs413","url":null,"abstract":"A gastrobronchial fistula (GBF) is an abnormal connection between the stomach and the lungs, and is an extremely rare but serious complication of laparoscopic sleeve gastrectomy (LSG). GBFs are usually the result of a persistent staple line leak that leads to the formation of a subphrenic abscess. The abscess may either spread through lymphatics or directly erode into the diaphragm and result in a GBF. We present the case of a 49-year-old female who developed a GBF after being managed for recurrent staple line leaks post-LSG. This case highlights the importance of timely detection and management of leaks to prevent this potentially fatal sequela. J Curr Surg. 2020;10(3):41-44 doi: https://doi.org/10.14740/jcs413","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"55 1","pages":"41-44"},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79201288","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}
Vincent Marcucci, Stephanie Yee, Roberto C. Castillo, E. Fakhoury, Jamshed Zuberi
Background: Ultrasonography (US) has largely become the primary diagnostic imaging modality for the diagnosis of acute appendicitis (AA) in pediatric patients. The purpose of this study was to determine and compare the diagnostic accuracy of helical computed tomography (CT) scans and graded compression US for the diagnosis of AA in the pediatric population. Methods: Between January 2011 and December 2013, 431 pediatric patients (aged 5 - 18 years) who presented with acute abdominal pain and received either a CT scan, US, or both for the diagnosis of AA were retrospectively reviewed from an IRB-approved institution-wide database. Sensitivities and specificities of both imaging modalities were calculated and compared. Results: Patients were allocated into two cohorts depending on whether they received an US (239/431) or CT (192/431). Clinical symptoms and laboratory values were noted and analyzed for the significance of mesenteric lymphadenitis in conjunction with appendicitis and for differential diagnosis. A total of 182 CT cases and 227 US cases were verified as appendicitis via histopathology report. The overall sensitivity and specificity of CT imaging were determined to be 91.2% and 70%, respectively, while the sensitivity and specificity for US imaging were 52.8% and 83.3%. Conclusion: Helical CT imaging in the pediatric population has provided a higher sensitivity and diagnostic accuracy for AA. However, the diagnostic benefit of US cannot be excluded in this patient population. Further research is needed on whether CT imaging should be used primarily for the diagnostic approach to AA in pediatric patients complaining of acute abdominal pain. J Curr Surg. 2020;10(3):21-27 doi: https://doi.org/10.14740/jcs404
{"title":"A Retrospective Comparison Study of Ultrasonography and Computed Tomography Scan in Diagnosis of Acute Appendicitis in the Pediatric Population","authors":"Vincent Marcucci, Stephanie Yee, Roberto C. Castillo, E. Fakhoury, Jamshed Zuberi","doi":"10.14740/jcs404","DOIUrl":"https://doi.org/10.14740/jcs404","url":null,"abstract":"Background: Ultrasonography (US) has largely become the primary diagnostic imaging modality for the diagnosis of acute appendicitis (AA) in pediatric patients. The purpose of this study was to determine and compare the diagnostic accuracy of helical computed tomography (CT) scans and graded compression US for the diagnosis of AA in the pediatric population. Methods: Between January 2011 and December 2013, 431 pediatric patients (aged 5 - 18 years) who presented with acute abdominal pain and received either a CT scan, US, or both for the diagnosis of AA were retrospectively reviewed from an IRB-approved institution-wide database. Sensitivities and specificities of both imaging modalities were calculated and compared. Results: Patients were allocated into two cohorts depending on whether they received an US (239/431) or CT (192/431). Clinical symptoms and laboratory values were noted and analyzed for the significance of mesenteric lymphadenitis in conjunction with appendicitis and for differential diagnosis. A total of 182 CT cases and 227 US cases were verified as appendicitis via histopathology report. The overall sensitivity and specificity of CT imaging were determined to be 91.2% and 70%, respectively, while the sensitivity and specificity for US imaging were 52.8% and 83.3%. Conclusion: Helical CT imaging in the pediatric population has provided a higher sensitivity and diagnostic accuracy for AA. However, the diagnostic benefit of US cannot be excluded in this patient population. Further research is needed on whether CT imaging should be used primarily for the diagnostic approach to AA in pediatric patients complaining of acute abdominal pain. J Curr Surg. 2020;10(3):21-27 doi: https://doi.org/10.14740/jcs404","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85198895","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}
Stephanie Yee, T. Daniel, Ahmad Hlayhel, Lindsey Foran, Jamshed Zuberi, M. Ingram
Pseudomyxoma peritonei (PMP) is a rare disease that most commonly results from the rupture of an appendiceal mucinous neoplasm. It is characterized by mucinous ascites that disseminates throughout the abdomen and pelvis, and at times to the inguinal canal, in which some patients may complain of inguinal hernia as the initial complaint. The incidence of PMP with concomitant inguinal hernia is reported to be 7.3-9.6% in the current literature. We report a 70-year-old Hispanic male who initially presented with signs of a right inguinal hernia, and on computed tomography (CT) scan, was subsequently found to have a large collection of right lower quadrant cysts extending into the right inguinal canal and hemiscrotum. Patient underwent exploratory laparotomy and was found to have a large right retroperitoneal mass with PMP with mucinous contents herniating through the right inguinal canal encased within peritoneal sac and had surgical debulking of peritoneal cavity and right hemiscrotum. The patient was discharged 9 days later. PMP that presents with an inguinal hernia is a special entity that warrants a discussion on the optimal management of inguinal involvement of a mucinous tumor. J Curr Surg. 2020;10(3):49-53 doi: https://doi.org/10.14740/jcs415
{"title":"A Case of Pseudomyxoma Peritonei With a Synchronous Inguinal Hernia","authors":"Stephanie Yee, T. Daniel, Ahmad Hlayhel, Lindsey Foran, Jamshed Zuberi, M. Ingram","doi":"10.14740/jcs415","DOIUrl":"https://doi.org/10.14740/jcs415","url":null,"abstract":"Pseudomyxoma peritonei (PMP) is a rare disease that most commonly results from the rupture of an appendiceal mucinous neoplasm. It is characterized by mucinous ascites that disseminates throughout the abdomen and pelvis, and at times to the inguinal canal, in which some patients may complain of inguinal hernia as the initial complaint. The incidence of PMP with concomitant inguinal hernia is reported to be 7.3-9.6% in the current literature. We report a 70-year-old Hispanic male who initially presented with signs of a right inguinal hernia, and on computed tomography (CT) scan, was subsequently found to have a large collection of right lower quadrant cysts extending into the right inguinal canal and hemiscrotum. Patient underwent exploratory laparotomy and was found to have a large right retroperitoneal mass with PMP with mucinous contents herniating through the right inguinal canal encased within peritoneal sac and had surgical debulking of peritoneal cavity and right hemiscrotum. The patient was discharged 9 days later. PMP that presents with an inguinal hernia is a special entity that warrants a discussion on the optimal management of inguinal involvement of a mucinous tumor. J Curr Surg. 2020;10(3):49-53 doi: https://doi.org/10.14740/jcs415","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"111 1","pages":"49-53"},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72900295","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}
A. Akoluk, S. Douedi, Jaraad Dattadeen, Victoria Grille, E. Kaufman, E. Liu, G. Parker, Kenneth Nahum
Pazopanib, under the trade name of votrient, is a potent tyrosine-kinase growth factor receptor inhibitor used in the treatment of late-stage kidney cancer and soft tissue sarcoma. Rarely this drug has been associated with gastrointestinal perforations; however, prior studies have not shown an association with necrotizing fasciitis. We present a case of suspected pazopanib-induced extensive colonic perforation resulting in a severe necrotizing fasciitis. As this is a potentially rare complication of this targeted therapy, our goal is to heighten the awareness of colonic perforation as it is only seen in 0.9% of patients on pazopanib. The staged operative management and multidisciplinary approach throughout this patient’s care allowed for complete recovery from a life-threatening diagnosis. J Curr Surg. 2020;10(3):54-58 doi: https://doi.org/10.14740/jcs416
{"title":"Colonic Perforation Associated with Necrotizing Fasciitis in a Patient Receiving Tyrosine Kinase Inhibitor (Pazopanib) for Recurrent Retroperitoneal Renal Cell Carcinoma","authors":"A. Akoluk, S. Douedi, Jaraad Dattadeen, Victoria Grille, E. Kaufman, E. Liu, G. Parker, Kenneth Nahum","doi":"10.14740/jcs416","DOIUrl":"https://doi.org/10.14740/jcs416","url":null,"abstract":"Pazopanib, under the trade name of votrient, is a potent tyrosine-kinase growth factor receptor inhibitor used in the treatment of late-stage kidney cancer and soft tissue sarcoma. Rarely this drug has been associated with gastrointestinal perforations; however, prior studies have not shown an association with necrotizing fasciitis. We present a case of suspected pazopanib-induced extensive colonic perforation resulting in a severe necrotizing fasciitis. As this is a potentially rare complication of this targeted therapy, our goal is to heighten the awareness of colonic perforation as it is only seen in 0.9% of patients on pazopanib. The staged operative management and multidisciplinary approach throughout this patient’s care allowed for complete recovery from a life-threatening diagnosis. J Curr Surg. 2020;10(3):54-58 doi: https://doi.org/10.14740/jcs416","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"25 1","pages":"54-58"},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90765698","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}
Y. Iizuka, Yuji Otsuka, T. Nakatomi, Koichi Yoshinaga, A. Lefor, M. Sanui
During the coronavirus disease 2019 (COVID-19) outbreak, efforts to minimize healthcare workers’ exposure to aerosols have expanded. In the operating room, many patients suspected to have or infected with COVID-19 present for surgery. To prevent aerosol exposure, rapid sequence induction (RSI) after adequate preoxygenation with a tight-fitting mask and use of a video laryngoscope are recommended [1]. During these procedures, anesthesiologists and other operating room staff are faced with potential contamination; droplets are created by coughing and aerosolized particles leak from the mask. Recently, an “aerosol box” was introduced [2] and is widely used in intensive care units and operating rooms. The aerosol box is useful to prevent direct droplet exposure during awake intubation, in which coughing is inevitable. It is also used for patients with severe hypoxemia or who are anticipated to have a difficult airway. However, in the operating room, most patients undergo RSI and do not cough after adequate muscle relaxation. Conventional operating rooms have ventilation systems to produce a minimum of 15-air changes per hour [3]. Even if aerosolized particles leak from the mask during preoxygenation, filtered air from the ceiling to the exhaust duct should remove them immediately without an aerosol box. Using an aerosol box can retain the aerosolized particles in the box due to interruption of ventilation. The importance of the aerosol box in the operating room is unclear. To visualize aerosolized particles with or without an aerosol box in the operating room, a simulation model with a mannequin connected to an ultrasound nebulizer (UN-511, Alfresa, Osaka, Japan) generating mist was used. The level of aerosolized particles was measured using a particulate matter (< 2.5 μm, PM2.5) detector (DM106, Dienmern, Shenzhen, China). The mannequin was set below the ceiling duct which supplies filtered air. The PM2.5 detector was placed near the mannequin’s head. We simulated changing levels of aerosolized particles around the head of the mannequin with a facemask (aerosol leakage model during preoxygenation) with or without an aerosol box. We used two types of aerosol boxes. Aerosol box A is an acrylic cube with two circular ports (Fig. 1a, b) and box B is a semicircular metal frame with disposable drapes (Fig. 1c, d). Aerosol box B has two small slits allowing the anesthesiologist’s hands to pass to a cranial drape and we covered the chest with a drape to increase airtightness. Aerosol box A was recently acquired, and we have been using aerosol box B clinically. Figure 2 shows resulting levels of aerosolized particles around the head of the mannequin with a facemask. Without an aerosol box, the generated mist was forced to flow to the floor. The level of PM2.5 was 42 μg/m3. With aerosol box A, downstream flow from the ceiling was interrupted, the
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C. Seretis, F. Seretis, Lucy Archer, L. Lalou, A. Elhassan, L. Kretzmer, P. Lim, K. Zayyan
The surgical management of complicated appendicitis, especially when clinical diagnosis has been delayed substantially, can be challenging for the emergency general surgery team. The treatment plan needs to be tailored on an individual basis, with careful evaluation of the preoperative imaging studies, patients’ prior intra-abdominal surgery and assessment for potential role of combining laparoscopic techniques with percutaneous interventions and/or open surgery. Herein, we present a clinical case with extensive extraperitoneal collections secondary to misdiagnosed appendicitis, which was treated using a single-stage laparoscopic transabdominal pre-peritoneal (TAPP) approach, bypassing the need for additional interventional radiology procedures or open surgeries, which are the most commonly used approaches in similar cases. J Curr Surg. 2020;10(3):45-48 doi: https://doi.org/10.14740/jcs414
复杂阑尾炎的外科治疗，特别是当临床诊断大大延迟时，对急诊普通外科团队来说是具有挑战性的。治疗方案需要根据个人情况量身定制，仔细评估术前影像学检查、患者既往腹部手术情况，评估腹腔镜技术与经皮介入和/或开放手术相结合的潜在作用。在此，我们报告了一例因阑尾炎而继发的大量腹膜外积液的临床病例，该病例采用单阶段腹腔镜经腹腹膜前(TAPP)入路治疗，而不需要额外的介入放射学程序或开放手术，这是类似病例中最常用的方法。contemporary surgery . 2020;10(3):45-48 doi: https://doi.org/10.14740/jcs414
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