C. Seretis, K. Wanigasooriya, M. Cleasby, Raju Tirumularaju, M. Daskalakis
Gallbladder torsion is a rare cause of acute abdominal pain and can be a diagnostic challenge for the general surgeon. We herein present a case of an 81-year-old man who presented with right-sided abdominal pain and signs of intra-abdominal infection. Transabdominal ultrasound, computed tomography (CT) and magnetic resonance cholangio-pancreatography (MRCP) scans could not identify with certainty the underlying cause of the symptoms and eventually the patient underwent a diagnostic laparoscopy, which revealed the presence of gallbladder torsion. Sequentially, a laparoscopic cholecystectomy was performed in a standard fashion and the patient had an uneventful post-operative recovery. Our case highlights the importance of diagnostic laparoscopy as a diagnostic and treatment tool in unclear cases of acute abdomen. J Curr Surg. 2020;10(3):28-31 doi: https://doi.org/10.14740/jcs405
胆囊扭转是一种罕见的急性腹痛的原因，可以是一个诊断的挑战，一般外科医生。我们在此提出一例81岁的男子谁提出了右侧腹痛和腹内感染的迹象。经腹超声、计算机断层扫描(CT)和磁共振胆管胰腺造影(MRCP)扫描不能确定症状的潜在原因，最终患者接受了诊断性腹腔镜检查，发现胆囊扭转的存在。随后，以标准方式进行腹腔镜胆囊切除术，患者术后恢复顺利。我们的病例强调了诊断腹腔镜作为诊断和治疗工具在不明原因急腹症病例中的重要性。contemporary surgery . 2020;10(3):28-31 doi: https://doi.org/10.14740/jcs405
{"title":"Gallbladder Torsion: A Rare Diagnostic Challenge","authors":"C. Seretis, K. Wanigasooriya, M. Cleasby, Raju Tirumularaju, M. Daskalakis","doi":"10.14740/jcs405","DOIUrl":"https://doi.org/10.14740/jcs405","url":null,"abstract":"Gallbladder torsion is a rare cause of acute abdominal pain and can be a diagnostic challenge for the general surgeon. We herein present a case of an 81-year-old man who presented with right-sided abdominal pain and signs of intra-abdominal infection. Transabdominal ultrasound, computed tomography (CT) and magnetic resonance cholangio-pancreatography (MRCP) scans could not identify with certainty the underlying cause of the symptoms and eventually the patient underwent a diagnostic laparoscopy, which revealed the presence of gallbladder torsion. Sequentially, a laparoscopic cholecystectomy was performed in a standard fashion and the patient had an uneventful post-operative recovery. Our case highlights the importance of diagnostic laparoscopy as a diagnostic and treatment tool in unclear cases of acute abdomen. J Curr Surg. 2020;10(3):28-31 doi: https://doi.org/10.14740/jcs405","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"1 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2020-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77676359","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}
Naina Rao, C. Persaud, Stephanie Yee, Manrique A. Guerrero, Jamshed Zuberi, Robert V. Madlinger
As the pandemic of coronavirus disease 2019 (COVID-19) continues to spread worldwide, there has been an increase in unique clinical presentations leading to delayed diagnoses and nosocomial transmissions. One of the patient populations most at risk includes patients in the critical care units. Early diagnosis and isolation are paramount to avoid nosocomial transmission amongst these closely hospitalized patients. While quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) is the current method for testing, we highlight the importance of utilizing chest computed tomography (CT) and laboratory findings for early diagnosis. We report a 48-year-old trauma patient who suddenly became hypoxemic, nine days postoperative from uncomplicated right lower extremity fracture repair. CT angiogram chest revealed bilateral extensive consolidations, hazy opacities, and pleural effusions. The patient continued to desaturate on noninvasive respiratory support and eventually required intubation. He was empirically treated with azithromycin and hydroxychloroquine due to high clinical suspicion of COVID-19, despite negative qRT-PCR results. The patient progressed clinically and was successfully extubated after 5 days. This unique presentation of acute hypoxemic respiratory failure warrants a discussion on the importance of clinical manifestations, CT findings, and laboratory findings in diagnosis of COVID-19, to prevent further nosocomial spread within a closed critical care unit. J Curr Surg. 2020;10(3):37-40 doi: https://doi.org/10.14740/jcs409
{"title":"A Case Report of Likely Nosocomial-Acquired COVID-19 in a Trauma Patient","authors":"Naina Rao, C. Persaud, Stephanie Yee, Manrique A. Guerrero, Jamshed Zuberi, Robert V. Madlinger","doi":"10.14740/jcs409","DOIUrl":"https://doi.org/10.14740/jcs409","url":null,"abstract":"As the pandemic of coronavirus disease 2019 (COVID-19) continues to spread worldwide, there has been an increase in unique clinical presentations leading to delayed diagnoses and nosocomial transmissions. One of the patient populations most at risk includes patients in the critical care units. Early diagnosis and isolation are paramount to avoid nosocomial transmission amongst these closely hospitalized patients. While quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) is the current method for testing, we highlight the importance of utilizing chest computed tomography (CT) and laboratory findings for early diagnosis. We report a 48-year-old trauma patient who suddenly became hypoxemic, nine days postoperative from uncomplicated right lower extremity fracture repair. CT angiogram chest revealed bilateral extensive consolidations, hazy opacities, and pleural effusions. The patient continued to desaturate on noninvasive respiratory support and eventually required intubation. He was empirically treated with azithromycin and hydroxychloroquine due to high clinical suspicion of COVID-19, despite negative qRT-PCR results. The patient progressed clinically and was successfully extubated after 5 days. This unique presentation of acute hypoxemic respiratory failure warrants a discussion on the importance of clinical manifestations, CT findings, and laboratory findings in diagnosis of COVID-19, to prevent further nosocomial spread within a closed critical care unit. J Curr Surg. 2020;10(3):37-40 doi: https://doi.org/10.14740/jcs409","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"34 1","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84277669","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}
S. Diko, Mohammed Elassa, C. Russell, Jamshed Zuberi, D. Christian
Gastric volvulus is a rare entity with the potential to become a surgical emergency if vital vascular supply is compromised. We present a case of a patient who underwent laparoscopic cholecystectomy converted to open; and after multiple admissions for intractable vomiting, she was found to have a secondary gastric volvulus during subsequent exploratory laparotomy. Due to dense adhesions, complete detorsion was deemed unsafe for the patient and a gastrojejunal bypass was created with subsequent complete resolution of symptoms. Patient has been doing well in follow-up visits. J Curr Surg. 2020;10(1-2):17-20 doi: https://doi.org/10.14740/jcs403
{"title":"First Described Case of Gastric Volvulus Following Open Cholecystectomy","authors":"S. Diko, Mohammed Elassa, C. Russell, Jamshed Zuberi, D. Christian","doi":"10.14740/jcs403","DOIUrl":"https://doi.org/10.14740/jcs403","url":null,"abstract":"Gastric volvulus is a rare entity with the potential to become a surgical emergency if vital vascular supply is compromised. We present a case of a patient who underwent laparoscopic cholecystectomy converted to open; and after multiple admissions for intractable vomiting, she was found to have a secondary gastric volvulus during subsequent exploratory laparotomy. Due to dense adhesions, complete detorsion was deemed unsafe for the patient and a gastrojejunal bypass was created with subsequent complete resolution of symptoms. Patient has been doing well in follow-up visits. J Curr Surg. 2020;10(1-2):17-20 doi: https://doi.org/10.14740/jcs403","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"6 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74060889","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}
Henrik Ghantarchyan, Karl Genovese, A. Akmal, Jamshed Zuberi
A brown tumor (BT) is a rare tumor composed of giant cells, and is a complication seen in secondary hyperparathyroidism related to chronic renal failure. Mediated by osteoclastic bone resorption, increasing bone turnover leads to the formation of a multinucleated giant cell tumor, also known as osteitis fibrosa cystica or BT. A BT is usually located at, but not limited to, the mandible, long bones, pelvis, and ribs. We present a case of a 40-year-old female with a BT and a history of chronic renal failure managed by dialysis. A concurrent parathyroid adenoma was also found on imaging. A laminectomy of T8 and partial T7 - T9 fusion was completed, followed by a complete parathyroidectomy 10 days later. J Curr Surg. 2020;10(1-2):13-16 doi: https://doi.org/10.14740/jcs400
{"title":"A Rare Presentation of a Brown Tumor on the Spinal Column Secondary to Chronic Renal Failure Managed by Dialysis","authors":"Henrik Ghantarchyan, Karl Genovese, A. Akmal, Jamshed Zuberi","doi":"10.14740/jcs400","DOIUrl":"https://doi.org/10.14740/jcs400","url":null,"abstract":"A brown tumor (BT) is a rare tumor composed of giant cells, and is a complication seen in secondary hyperparathyroidism related to chronic renal failure. Mediated by osteoclastic bone resorption, increasing bone turnover leads to the formation of a multinucleated giant cell tumor, also known as osteitis fibrosa cystica or BT. A BT is usually located at, but not limited to, the mandible, long bones, pelvis, and ribs. We present a case of a 40-year-old female with a BT and a history of chronic renal failure managed by dialysis. A concurrent parathyroid adenoma was also found on imaging. A laminectomy of T8 and partial T7 - T9 fusion was completed, followed by a complete parathyroidectomy 10 days later. J Curr Surg. 2020;10(1-2):13-16 doi: https://doi.org/10.14740/jcs400","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"25 1","pages":"13-16"},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78998686","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}
We present an unusual case of pneumatosis intestinalis and portal venous gas due to massive fecal impaction resulting in ischemic infarction of three separate bowel segments. The patient was taken emergently to the operating room for an exploratory laparotomy with resection and anastomosis of a proximal loop of the jejunum, distal loop of the jejunum, and most of the terminal ileum, with creation of a loop ileostomy. In our review of the literature, there have been only two similar cases of pneumatosis intestinalis/portal venous gas caused by fecal impaction requiring operative intervention. J Curr Surg. 2020;10(1-2):10-12 doi: https://doi.org/10.14740/jcs398
{"title":"Pneumatosis Intestinalis and Portal Venous Gas: An Unusual Complication of Fecal Impaction","authors":"Abdo Zeinoun, C. Persaud, Jamshed Zuberi","doi":"10.14740/jcs398","DOIUrl":"https://doi.org/10.14740/jcs398","url":null,"abstract":"We present an unusual case of pneumatosis intestinalis and portal venous gas due to massive fecal impaction resulting in ischemic infarction of three separate bowel segments. The patient was taken emergently to the operating room for an exploratory laparotomy with resection and anastomosis of a proximal loop of the jejunum, distal loop of the jejunum, and most of the terminal ileum, with creation of a loop ileostomy. In our review of the literature, there have been only two similar cases of pneumatosis intestinalis/portal venous gas caused by fecal impaction requiring operative intervention. J Curr Surg. 2020;10(1-2):10-12 doi: https://doi.org/10.14740/jcs398","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"1 1","pages":"10-12"},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89950642","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}
Tanisha Wandhare, Manrique A. Guerrero, Robert V. Madlinger, Jamshed Zuberi
Gastrointestinal neuroendocrine tumors (NETs) are a common, yet relatively less understood subset of gastrointestinal tumors with a myriad of clinical presentations and prognostic outcomes. Although most NETs are more indolent than carcinomas, prognostic outcomes are still heavily reliant on several variables such as tumor location, stage, differentiation and metastasis amongst others. Additionally, NETs also present with a range of clinical symptoms, both localized and systemic. In this case report we discuss a patient, who had a longstanding symptom at presentation and was found to have a duodenal polyp upon endoscopy. Further evaluation established the presence of a well differentiated NET that was later resected surgically. J Curr Surg. 2020;10(1-2):7-9 doi: https://doi.org/10.14740/jcs397
{"title":"A Rare Case of Duodenal Carcinoid Tumors in a Patient With Atypical Symptoms","authors":"Tanisha Wandhare, Manrique A. Guerrero, Robert V. Madlinger, Jamshed Zuberi","doi":"10.14740/jcs397","DOIUrl":"https://doi.org/10.14740/jcs397","url":null,"abstract":"Gastrointestinal neuroendocrine tumors (NETs) are a common, yet relatively less understood subset of gastrointestinal tumors with a myriad of clinical presentations and prognostic outcomes. Although most NETs are more indolent than carcinomas, prognostic outcomes are still heavily reliant on several variables such as tumor location, stage, differentiation and metastasis amongst others. Additionally, NETs also present with a range of clinical symptoms, both localized and systemic. In this case report we discuss a patient, who had a longstanding symptom at presentation and was found to have a duodenal polyp upon endoscopy. Further evaluation established the presence of a well differentiated NET that was later resected surgically. J Curr Surg. 2020;10(1-2):7-9 doi: https://doi.org/10.14740/jcs397","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"98 1","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79219306","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}
Trisha Kaundinya, Nikhilesh Mazumder, Kofi Atiemo, Ari Spellman, Amna Daud, Laura Marie Curtis, Daniela Patricia Ladner
Background: The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed.
Methods: After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read.
Results: The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05).
Conclusions: The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources.
背景:美国的平均可读性水平为六年级，慢性疾病患者的可读性水平更低。肝硬化是一种流行的慢性疾病，需要复杂的知识和指导来管理。没有关于肝硬化患者在线教育内容可理解性的研究。患者可以找到由一般健康平台和大容量肝移植中心策划的在线材料，因此这些材料被分析。方法:在确定排除标准后，对排名前20位的综合健康平台网站结果和排名前20位的大容量肝病中心网站进行分析。使用患者教育材料评估工具(视听材料)(PEMAT-A/V)、Flesch-Kincaid年级水平测试、单词数、句子数、每句单词数和平均六年级学生阅读时间来评估可读性。结果:普通资源和移植中心资源的平均阅读等级分别为12.3和11.3。在线资源从9到389个句子不等，平均阅读时间为9.8分钟。普通资源的平均pmat - a /V评分为70.05%，移植中心资源的平均pmat - a /V评分为72.45%。在Flesch-Kincaid年级水平、句子数、每句字数、字数、平均六年级学生阅读一般资源和移植中心资源的时间方面，差异有统计学意义(P < 0.05)。结论:肝硬化患者可获得的健康平台和肝病学中心在线资源太长、太复杂，需要更简单、更短的资源。
{"title":"Health Literacy Gaps in Online Resources for Cirrhotic Patients.","authors":"Trisha Kaundinya, Nikhilesh Mazumder, Kofi Atiemo, Ari Spellman, Amna Daud, Laura Marie Curtis, Daniela Patricia Ladner","doi":"10.14740/jcs401","DOIUrl":"https://doi.org/10.14740/jcs401","url":null,"abstract":"<p><strong>Background: </strong>The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed.</p><p><strong>Methods: </strong>After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read.</p><p><strong>Results: </strong>The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05).</p><p><strong>Conclusions: </strong>The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources.</p>","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"10 1-2","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462081/pdf/nihms-1588224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38435719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manrique A. Guerrero, M. Sridhar, Stephanie Yee, Jacob Miller, J. Haghshenas, Jamshed Zuberi, Robert V. Madlinger
Background: Blood transfusion and old age have been independently associated with worse outcomes and higher mortality in the trauma population. Determining specific volumes and ratios of blood products for the elderly population, a special population with varied hemodynamic responses to traumatic injury, is a challenge. This study was aimed at delineating the relationship between specific transfusion volumes and mortality with an ultimate goal of finding an optimal threshold where risk outweighs benefit. Methods: A retrospective study of data from patients aged 65 and older at a level II urban trauma center was conducted. All patients who were included in the study presented to the emergency department between January 2013 and January 2016 and received a blood product transfusion (n = 93). The primary outcome was defined as mortality 24 h after transfusion, while the secondary outcome measured was length of hospital stay. Optimal cut-off points were estimated using Youden J coefficients, and Cox proportional hazard ratio (HR) was performed to calculate mortality risk. Results: Patients receiving less than 5 units of blood product had a shorter length of stay (5.19 days) and decreased risk of mortality (HR = 2.48, P = 0.01). Patients receiving ≥ 5 units of a blood product had a statistically significant increase in risk of mortality (HR = 6.207, P < 0.001) and length of hospital stay (12.47 days), regardless of injury severity score. The administration of fresh frozen plasma was also an independent predictor of mortality. Patients who received a plasma transfusion had an increased risk of mortality (HR = 3.25, P < 0.001). Conclusion: In this study, a threshold point of greater than 5 units of blood products has been associated with increased mortality and length of hospital stay. A more restrictive transfusion strategy has potential for improved outcomes. J Curr Surg. 2019;9(4):45-50 doi: https://doi.org/10.14740/jcs392
背景:在创伤人群中，输血和年老与较差的预后和较高的死亡率独立相关。老年人是对创伤性损伤有不同血流动力学反应的特殊人群，确定老年人血液制品的特定体积和比例是一项挑战。本研究旨在描述特定输血量与死亡率之间的关系，最终目标是找到风险大于收益的最佳阈值。方法:回顾性分析某二级创伤中心65岁及以上患者的资料。所有纳入研究的患者均于2013年1月至2016年1月期间到急诊科就诊并接受了血液制品输血(n = 93)。主要终点定义为输血后24小时的死亡率，而次要终点测量的是住院时间。采用约登J系数估计最佳分界点，并采用Cox比例风险比(HR)计算死亡风险。结果:接受小于5单位血液制品的患者住院时间较短(5.19 d)，死亡风险较低(HR = 2.48, P = 0.01)。无论损伤严重程度评分如何，接受≥5单位血液制品的患者死亡风险(HR = 6.207, P < 0.001)和住院时间(12.47天)均有统计学意义的增加。新鲜冷冻血浆的使用也是死亡率的独立预测因子。接受血浆输血的患者死亡风险增加(HR = 3.25, P < 0.001)。结论:在本研究中，大于5单位血液制品的阈值点与死亡率和住院时间的增加有关。更严格的输血策略有可能改善结果。中华外科杂志，2019;9(4):45-50 doi: https://doi.org/10.14740/jcs392
{"title":"Analysis of Transfusion Volumes in the Elderly Trauma Population","authors":"Manrique A. Guerrero, M. Sridhar, Stephanie Yee, Jacob Miller, J. Haghshenas, Jamshed Zuberi, Robert V. Madlinger","doi":"10.14740/jcs392","DOIUrl":"https://doi.org/10.14740/jcs392","url":null,"abstract":"Background: Blood transfusion and old age have been independently associated with worse outcomes and higher mortality in the trauma population. Determining specific volumes and ratios of blood products for the elderly population, a special population with varied hemodynamic responses to traumatic injury, is a challenge. This study was aimed at delineating the relationship between specific transfusion volumes and mortality with an ultimate goal of finding an optimal threshold where risk outweighs benefit. Methods: A retrospective study of data from patients aged 65 and older at a level II urban trauma center was conducted. All patients who were included in the study presented to the emergency department between January 2013 and January 2016 and received a blood product transfusion (n = 93). The primary outcome was defined as mortality 24 h after transfusion, while the secondary outcome measured was length of hospital stay. Optimal cut-off points were estimated using Youden J coefficients, and Cox proportional hazard ratio (HR) was performed to calculate mortality risk. Results: Patients receiving less than 5 units of blood product had a shorter length of stay (5.19 days) and decreased risk of mortality (HR = 2.48, P = 0.01). Patients receiving ≥ 5 units of a blood product had a statistically significant increase in risk of mortality (HR = 6.207, P < 0.001) and length of hospital stay (12.47 days), regardless of injury severity score. The administration of fresh frozen plasma was also an independent predictor of mortality. Patients who received a plasma transfusion had an increased risk of mortality (HR = 3.25, P < 0.001). Conclusion: In this study, a threshold point of greater than 5 units of blood products has been associated with increased mortality and length of hospital stay. A more restrictive transfusion strategy has potential for improved outcomes. J Curr Surg. 2019;9(4):45-50 doi: https://doi.org/10.14740/jcs392","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84074412","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}
Jazmín M. Cole, Paulette I. Abbas, Aparna A. Kamat, M. Curtis, Daniel J. Bonville
While uterine prolapse is not uncommon in postmenopausal women, vaginal rupture and evisceration of small bowel in a patient without prior abdominal or pelvic surgery is a rare entity. We present a case of a 79-year-old woman with a prolonged history of uterine prolapse and rectocele who presented with vaginal rupture with subsequent evisceration and incarceration of her small bowel mandating emergent surgery. J Curr Surg. 2019;9(4):57-60 doi: https://doi.org/10.14740/jcs393
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O. Adesina, John Wemambu, Taofiq Opaleye, A. Salami
Background: Maxillofacial fractures constitute a substantial proportion of trauma globally. The main causes worldwide are road traffic accidents (RTAs), falls, assaults, sports, firearm injuries and industrial trauma. The highest incidence is commonly seen in the young age group with majority being male. The most common site in maxillofacial injuries is the mandible followed by the zygomatic complex, maxilla, and alveolar process. Maxillofacial trauma also poses a significant socioeconomic burden on affected individuals. Hence appropriate treatment and prevention of these morbidities and possible mortality is necessary. This study is therefore aimed at analyzing the prevalence, pattern of presentation of maxillofacial injuries at Lagos State University Teaching Hospital (LASUTH) in Western Nigeria. Methods: A retrospective review of 182 patients diagnosed and treated for maxillofacial injuries at the Oral and Maxillofacial Department of the LASUTH was conducted. Data were obtained from clinical notes and records of radiological findings noting patient’s age, gender, etiologic factors (RTA, assault, sport, and fall), anatomic site of injury and different definitive treatment modalities. The data were analyzed by SPSS version 20 using various descriptive statistical tools. Mean and standard deviation were calculated for quantitative variable like age while frequency and percentage were calculated for qualitative variables like gender and site of fracture. Results: Majority of patients were male (72.0%) with a male to female ratio of 1:0.4. Most patients were between 31 and 40 (34.1%) years of age. RTA accounting for 73.1% of the injuries was the most common cause for maxillofacial injury followed by assault (19.2%). Majority of injuries due to RTA were of motorcycles accidents (33.6%). The most common sites of fracture out of 226 sites were in the mandible (62.8%, P = 0.003). Among the mandibular fracture sites, 28.2% affected the body of the mandible. Majority (31.9%) of the studied patients presented within 24 h (≤ 1 day). Out of the 182 patients, 68.1% were treated by close reduction. Conclusions: RTA represented the major etiological factor of maxillofacial injuries. The mandible remains the most affected bone of the facial skeleton. Closed reduction is the most common approach used for treatment. J Curr Surg. 2019;9(4):51-56 doi: https://doi.org/10.14740/jcs387
背景:颌面部骨折在全球创伤中占相当大的比例。世界范围内的主要原因是道路交通事故、跌倒、袭击、运动、火器伤害和工业创伤。发病率最高的通常是年轻年龄组，大多数是男性。颌面部损伤最常见的部位是下颌骨，其次是颧复合体、上颌骨和牙槽突。颌面部创伤也对受影响的个体造成重大的社会经济负担。因此，适当的治疗和预防这些发病率和可能的死亡率是必要的。因此，本研究旨在分析尼日利亚西部拉各斯州立大学教学医院(LASUTH)颌面部损伤的患病率和表现模式。方法:对我院口腔颌面科收治的182例颌面部损伤患者进行回顾性分析。数据来自临床记录和影像学表现记录，包括患者的年龄、性别、病因(RTA、攻击、运动和跌倒)、损伤的解剖部位和不同的最终治疗方式。数据分析采用SPSS version 20，使用各种描述性统计工具。年龄等定量变量计算平均值和标准差，性别、骨折部位等定性变量计算频率和百分比。结果:患者以男性居多(72.0%)，男女比例为1:0.4。大多数患者年龄在31 ~ 40岁之间(34.1%)。颌面部损伤最常见的原因是RTA，占73.1%，其次是殴打(19.2%)。RTA造成的伤害以摩托车事故为主(33.6%)。226个骨折部位中最常见的是下颌骨(62.8%，P = 0.003)。下颌骨骨折部位中，影响下颌骨体的占28.2%。大多数(31.9%)患者在24小时(≤1天)内出现。在182例患者中，68.1%的患者接受了闭合复位治疗。结论:RTA是颌面部损伤的主要病因。下颌骨仍然是面部骨骼中受影响最严重的骨骼。闭合复位是最常用的治疗方法。中华外科杂志，2019;9(4):51-56 doi: https://doi.org/10.14740/jcs387
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