1
|
Makhdoom A, Pratt A, Kuo YH, Ahmed N. Factors associated with pediatric trauma patients leaving against medical advice. Am J Emerg Med 2024; 79:152-156. [PMID: 38432155 DOI: 10.1016/j.ajem.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Discharge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients. METHODS We performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA. RESULTS Of the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522). CONCLUSION Race, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care. LEVEL OF EVIDENCE III, retrospective study.
Collapse
Affiliation(s)
- Ali Makhdoom
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Abimbola Pratt
- Hackensack Meridian School of Medicine, Nutley, NJ, USA; Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Yen-Hong Kuo
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA; Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Nasim Ahmed
- Hackensack Meridian School of Medicine, Nutley, NJ, USA; Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA.
| |
Collapse
|
2
|
Grisel B, Gordee A, Kuchibhatla M, Ginsberg Z, Agarwal S, Haines K. Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med 2024; 79:144-151. [PMID: 38432154 DOI: 10.1016/j.ajem.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDY DESIGN Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. RESULTS Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). CONCLUSION Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.
Collapse
Affiliation(s)
- Braylee Grisel
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Alexander Gordee
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA.
| | | | - Zachary Ginsberg
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Suresh Agarwal
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Krista Haines
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|
3
|
Suzuki T, Shiraishi A, Ito K, Otomo Y. Comparative effectiveness of angioembolization versus open surgery in patients with blunt splenic injury. Sci Rep 2024; 14:8800. [PMID: 38627581 PMCID: PMC11021531 DOI: 10.1038/s41598-024-59420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
The effectiveness and safety of transcatheter splenic artery embolization (SAE) compared to those of open surgery in patients with blunt splenic injury (BSI) remain unclear. This retrospective cohort-matched study utilized data from the Japan Trauma Data Bank recorded between 2004 and 2019. Patients with BSI who underwent SAE or open surgery were selected. A propensity score matching analysis was used to balance the baseline covariates and compare outcomes, including all-cause in-hospital mortality and spleen salvage. From 361,706 patients recorded in the data source, this study included 2,192 patients with BSI who underwent SAE or open surgery. A propensity score matching analysis was used to extract 377 matched pairs of patients. The in-hospital mortality rates (SAE, 11.6% vs. open surgery, 11.2%, adjusted relative risk (aRR): 0.64; 95% confidence interval [CI]: 0.38-1.09, p = 0.10) were similar in both the groups. However, spleen salvage was significantly less achieved in the open surgery group than in the SAE group (SAE, 87.1% vs. open surgery, 32.1%; aRR: 2.84, 95%CI: 2.29-3.51, p < 0.001). Survival rates did not significantly differ between BSI patients undergoing SAE and those undergoing open surgery. Nonetheless, SAE was notably associated with a higher likelihood of successful spleen salvage.
Collapse
Affiliation(s)
- Toshinao Suzuki
- Department of Anesthesiology, Kimitsu Chuo Hospital, Chiba, Japan
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
- Interventional Radiology Center, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Atsushi Shiraishi
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan.
| | - Kensuke Ito
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
- National Disaster Medical Center, Tokyo, Japan
| |
Collapse
|
4
|
Jeong E, Park Y, Jang H, Lee N, Jo Y, Kim J. Timing of Re-Laparotomy in Blunt Trauma Patients With Damage-Control Laparotomy. J Surg Res 2024; 296:376-382. [PMID: 38309219 DOI: 10.1016/j.jss.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Damage-control laparotomy (DCL) was initially designed to treat patients with severe hemorrhage. There are various opinions on when to return to the operating room after DCL and there are no definitive data on the exact timing of re-laparotomy. METHODS All patients at regional referral trauma center requiring a DCL due to blunt trauma between January 2012 and September 2021 (N = 160) were retrospectively reviewed from patients' electronic medical records. The primary fascial closure rate, lengths of intensive care unit stay and mechanical ventilation, mortality, and complications were compared in patients who underwent re-laparotomy before and after 48 h. RESULTS One hundred one patients (70 in the ≤48 h group [early] and 31 in the >48 h group [late]) were included. Baseline patient characteristics of age, body mass index, injury severity score, and initial systolic blood pressure and laboratory finding such as hemoglobin, base excess, and lactate were similar between the two groups. Also, there were no differences in reason for DCL and operation time. The time interval from the DCL to the first re-laparotomy was 39 (29-43) h and 59 (55-66) h in the early and late groups, respectively. There were no significant differences in the rate of the primary fascial closure rate (91.4% versus 93.5%, P = 1.00), lengths of stay in the intensive care unit (10 [7-18] versus 12 [8-16], P = 0.553), ventilator days (6 [4-10] versus 7 [5-10], P = 0.173), mortality (20.0% versus 19.4%, P = 0.94), and complications between the two groups. CONCLUSIONS The timing of re-laparotomy after DCL due to blunt abdominal trauma should be determined in consideration of various factors such as correction of coagulopathy, primary fascial closure, and complications. This study showed there was no significant difference in patient groups who underwent re-laparotomy before and after 48 h after DCL. Considering these results, it is better to determine the timing of re-laparotomy with a focus on physiologic recovery rather than setting a specific time.
Collapse
Affiliation(s)
- Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| |
Collapse
|
5
|
Haim N, Kaufman JP, Gurevich M. The Use of Active Coagulation Whole Blood-An Innovative Treatment Strategy for Hard-To-Heal Wounds. Am Surg 2024; 90:710-716. [PMID: 37878333 DOI: 10.1177/00031348231207293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical treatment and has been found to be safe and effective in healing cutaneous wounds. The active coagulation whole blood (ACWB) clot treatment, using the patient's own blood, is used to treat deep and tunneling wounds, by mixing the blood with coagulation components and applying it into the wound cavity allowing the clot to re-form inside the wound. We aimed to explore ACWB treatment in hard-to-heal wounds. METHODS 5 patients with multiple comorbidities, exhibiting surgical abdominal wound, chronic pilonidal sinus, stage 4 sacral pressure ulcer with exposed bone, post-amputation surgical site wound, and non-healing wound dehiscence at the site of a prior hip replacement, were all treated with the ACWB clot treatment. RESULTS Complete wound healing was observed in 4/5 cases. In the fifth case, there was a 70% reduction in the depth and surface area of the abdominal surgical wound. DISCUSSION The ACWB treatment was found to be effective in deep wounds with cavities and exposed structures. ACWB, in its flowable form, can effectively provide coverage of the deepest interstices of the wound's cavities by virtue of its liquid properties, forming a fibrin matrix, mimicking the role of the extracellular matrix. The flowable formulation of ACWB treatment safely and efficiently provides coverage of the entirety of the wound surface to improve the time and process of complex wound surface healing.
Collapse
Affiliation(s)
- Nadav Haim
- Department of Surgery, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Jarrod P Kaufman
- Premier Surgical, Department of Surgery at Temple University School of Medicine, Brick, NJ, USA
| | - Maxim Gurevich
- Diabetic Foot Unit, Orthopedic B Department, Hillel Yaffe Medical Center, Hadera, Israel
| |
Collapse
|
6
|
Yıldırak MK, Ulgur HS, Gedik M, Sertkaya E, Kırkan EF, Ezberci F, Tolan HK, Özpek A. Is it possible to predict mortality in patients with high-grade blunt liver injury? A single trauma center study. ULUS TRAVMA ACIL CER 2024; 30:276-284. [PMID: 38634851 DOI: 10.14744/tjtes.2024.60646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Blunt abdominal trauma constitutes a significant portion of trauma cases and is often associated with liver injury. Given that high-grade liver injuries remain life-threatening, identifying patients who will likely require more vigilant attention and care is crucial. This study aims to determine the parameters that increase mortality in patients with high-grade liver trauma. METHODS This study enrolled 38 patients with Grade III or higher liver injuries, treated by the general surgery department between 2008 and 2023. Eleven patients who died were categorized into Group 1, and 27 survivors were placed in Group 2. We evaluated their respective mechanisms of injury, imaging results, Glasgow Coma Scale scores, Base Excess, Lactate levels, pH, and Injury Severity Score findings. Receiver Operating Characteristics (ROC) analysis was performed for parameters with significant differences, and certain cutoff values were determined. RESULTS The grade of liver injury and additional abdominal organ injuries were significantly higher in Group 1 (p<0.05). The difference in extra-abdominal injury sites was statistically insignificant between the groups (p>0.05). Erythrocyte suspension requirements were significantly higher in Group 1 (p<0.05). Average lactate and base deficit values were also significantly higher in Group 1 (p<0.05), while leukocyte counts were significantly lower in Group 1 (p<0.05). CONCLUSION Base deficit, hemoglobin (Hb), lactate levels, injury severity, liver injury grade, accompanying abdominal injuries at admission, and erythrocyte suspension demands were found to be associated with increased mortality rates. Certain cutoff values for the aforementioned parameters could be established. However, further data are required to confirm these findings.
Collapse
Affiliation(s)
- Muhammed Kadir Yıldırak
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Hanife Seyda Ulgur
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Mert Gedik
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Enes Sertkaya
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Emre Furkan Kırkan
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Fikret Ezberci
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Hüseyin Kerem Tolan
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Adnan Özpek
- Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul-Türkiye
| |
Collapse
|
7
|
Cakmak V, Herek D, Oskay A, Gungör G, Cakmak P, Özen M. Pancreatic injury due to blunt trauma on CT: does retropancreatic fat tissue reduce the severity of pancreatic injury? ULUS TRAVMA ACIL CER 2024; 30:263-270. [PMID: 38634850 DOI: 10.14744/tjtes.2024.60622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Pancreatic injuries from blunt abdominal trauma have a high mortality rate, often accompanied by injuries to adjacent organs. This study aims to investigate the relationship between the size of retropancreatic adipose tissue and the severity of pancreatic and adjacent organ injuries in patients with pancreatic trauma. METHODS We retrospectively screened computed tomography (CT) images of 34 patients (25 males, nine females, aged 13-69 years) and 34 controls (28 males, six females, aged 15-66 years) who suffered blunt abdominal trauma. The area of adipose tissue located posterior to the pancreatic body was measured in the axial plane for all subjects. The severity of pancreatic injury was assessed in terms of the injury site, the retropancreatic adipose tissue area, and the degree of other organ injuries. RESULTS Pancreatic injuries were located in the head for 16 patients (23.5%), in the body for four patients (5.9%), and in the tail for 14 patients (20.6%). The retropancreatic fat area was found to be significantly smaller in patients with pancreatic trauma compared to controls (p<0.0001). Furthermore, the ratio of the retropancreatic fat area to the vertebral corpus area differed significantly between patients with and without pancreatic injuries (p=0.014). CONCLUSION Retropancreatic adipose tissue protects the pancreatic body from the impacts of blunt abdominal trauma. An increased amount of retropancreatic adipose tissue is associated with a reduced rate of pancreatic injury.
Collapse
Affiliation(s)
- Vefa Cakmak
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| | - Duygu Herek
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| | - Alten Oskay
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| | - Gülay Gungör
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| | - Pinar Cakmak
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| | - Mert Özen
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli-Türkiye
| |
Collapse
|
8
|
Huang Q, Wang X, Xiang X, Qi C, Fei T, Zhou E. TPP (totally preperitoneal) making single incision laparoscopic inguinal hernia repair more feasible: a comparison with single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP). BMC Surg 2024; 24:81. [PMID: 38443886 PMCID: PMC10913552 DOI: 10.1186/s12893-024-02372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Totally preperitoneal hernioplasty (TPP) is a concept which was introduced for distinguishing with totally extraperitoneal (TEP). There is few evidence reflecting the single incision laparoscopic totally preperitoneal (SIL-TPP) characteristic. The aim of study is to demonstrate the feasibility of single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) and compare the outcomes with the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) technique. METHODS During August 2018 and July 2022, 200 inguinal hernia patients received SIL-TPP and 56 patients received SIL-TEP in the First hospital of Ningbo university. The demographics, clinical characteristics, intraoperative and postoperative parameters were retrospectively analysed. RESULTS SIL-TPP and SIL-TEP hernia repair were successfully conducted in all patients. There was no conversation happened in two group. Patients' demographics were comparable when compared between the two groups adding the comparison initial 52 cases analysis (P > 0.05). The mean unilateral hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (unilateral: 81.38 ± 25.32 vs. 95.96 ± 28.54, P: 0.001). Further study of unilateral hernia operative time revealed the mean indirect hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (indirect: 81.38 ± 25.33 vs. 95.87 ± 28.54, P: 0.001). The unilateral hernia operation time trend of initial 52 cases of two group analysis revealed the operation time of SIL-TPP reduced faster than SIL-TEP along with treating number increasing (Figs. 2 and 3). The comparison of initial equal quantity unilateral hernia patient mean operative time revealed the SIL-TPP group was significant shorter than SIL-TEP group (85.77 ± 22.76 vs. 95.87 ± 28.54, P: 0.049). The rate of peritoneum tearing of SIL-TPP group was significant high than SIL-TEP (P = 0.005). CONCLUSION SIL-TPP hernia repair is a superior procedure and possess its own distinguished advantages. We recommend it rather than SIL-TEP for treating inguinal hernia, especially for indirect hernia. However, large-scale randomized controlled trials comparing SIL-TPP and SIL-TEP are needed to confirm these results.
Collapse
Affiliation(s)
- Qing Huang
- Emergency Department of The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Xiaojun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Xionghua Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Changlei Qi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Ting Fei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Encheng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China.
| |
Collapse
|
9
|
Nan L, Kaisi F, Mengzhen Z, Yang Y, Jiaming Y, Huirong Y, Xinwei H, Chen W, Liucheng Y, Kai W. miR-375-3p targets YWHAB to attenuate intestine injury in neonatal necrotizing enterocolitis. Pediatr Surg Int 2024; 40:63. [PMID: 38431920 DOI: 10.1007/s00383-024-05653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Necrotizing enterocolitis (NEC) is a significant contributor to neonatal mortality. This study aimed to investigate the role of high levels of miR-375-3p in breast milk in the development of NEC and elucidate its mechanism. METHODS Differential expression of miR-375-3p in the intestines of breast-fed and formula-fed mice was confirmed using real-time polymerase chain reaction (RT-PCR). NEC mice models were established, and intestinal injury was assessed using HE staining. RT-PCR and Western blot were conducted to examine the expression of miR-375-3p, tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein β (YWHAB), as well as the inflammatory in IEC-6 cells, and intestinal tissues obtained from NEC mice and patients. Flow cytometry and cell counting kit-8 (CCK-8) were employed to elucidate the impact of miR-375-3p and YWHAB on cell apoptosis and proliferation. RESULTS Breastfeeding increases miR-375-3p expression in the intestines. The expression of miR-375-3p in NEC intestinal tissues exhibited a significant decrease compared to the healthy group. Additionally, the expression of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) was higher in the NEC group compared to the control group. Down-regulation of miR-375-3p inhibited IEC-6 cell proliferation, increased apoptosis, and elevated secretion of inflammatory factors. Bioinformatics revealed that YWHAB may be a target of miR-375-3p. RT-PCR and Western blot indicated a down-regulation of YWHAB expression in intestines of NEC patients and mice. Furthermore, YWHAB was found to be positively connected with miR-375-3p. Knockdown miR-375-3p down-regulated YWHAB expression in cells. Inhibition of YWHAB exhibited similar effects to miR-375-3p in IEC-6 cells. YWHAB plasmid partially reverse cellular functional impairment induced by miR-375-3p knockdown. CONCLUSIONS Breastfeeding elevated miR-375-3p expression in intestines in neonatal mice. MiR-375-3p leads to a decrease in apoptosis of intestinal epithelial cells, an increase in cell proliferation, and a concomitant reduction in the expression of inflammatory factors partly through targeting YWHAB.
Collapse
Affiliation(s)
- Li Nan
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Fan Kaisi
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhang Mengzhen
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Yang
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Jiaming
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Huirong
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Hou Xinwei
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Wang Chen
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Liucheng
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Wu Kai
- Department of Pediatric Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
10
|
Jones B, Elbakri AS, Murrills C, Patil P, Scollay J. Splenic artery embolisation for blunt splenic trauma: 10 years of practice at a trauma centre. Ann R Coll Surg Engl 2024; 106:283-287. [PMID: 37365934 PMCID: PMC10904261 DOI: 10.1308/rcsann.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Splenic artery embolisation (SAE) has transformed the management of splenic trauma. The aim of this study was to review the outcomes and postprocedural management of blunt splenic trauma patients treated with SAE at a trauma centre over a 10-year period. METHODS Details of patients undergoing SAE for blunt trauma between January 2012 and January 2022 were acquired from a prospectively maintained database. Patient records were reviewed for demographic information, splenic injury grades, embolisation efficacy, complications, and associated injuries and mortality. Data relating to Injury Severity Scores (ISS) and postprocedural practice (vaccinations, antibiotic prescribing, follow-up imaging) were also obtained. RESULTS Thirty-six patients (24 male, 12 female) with a median age of 42.5 years (range 13-97 years) were identified. American Association for the Surgery of Trauma splenic injury grades were III (n = 7), IV (n = 20) and V (n = 9). Seventeen patients had isolated splenic injury and 19 had additional injuries to other organ systems. Median ISS was 18.5 (range 5-50). SAE succeeded first time in 35/36 cases, and upon the second attempt in 1/36 cases. No patients died because of splenic injury or SAE although four patients with polytrauma died owing to other injuries. SAE complications occurred in 4/36 cases. For survivors, vaccinations were administered in 17/32 cases, and long-term antibiotics were initiated in 14/32 cases. Formal follow-up imaging was arranged in 9/32 cases. CONCLUSIONS These data show that SAE is an effective means of controlling splenic haemorrhage secondary to blunt trauma with no patient requiring subsequent laparotomy. Major complications occurred in 11% of cases. Follow-up practice varied regarding further imaging, antibiotic and vaccination administration.
Collapse
|
11
|
Marin FS, Assaf A, Doumbe-Mandengue P, Abou Ali E, Belle A, Coriat R, Chaussade S. Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method. Surg Endosc 2024; 38:1600-1607. [PMID: 38242987 DOI: 10.1007/s00464-023-10654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Several endoscopic treatments for iatrogenic perforations are currently available, with some limitations in terms of size, location, complexity, or cost. Our aims were to introduce a novel technique for closure, using an endoloop and clips, to assess its rate of technical success and post-resection complications. METHODS For closure of large perforations (diameter ≥ 10 mm), two similar techniques were implemented, using a single-channel endoscope. An endoloop was deployed through the operating channel or towed by an endoclip alongside the endoscope. Several clips were utilized to fix it on the muscular layer of defect's margins. The defect was closed, by fastening the loop either directly or after being reattached to the mobile hook. RESULTS This analysis included eleven patients (72% women, median age 68 years). Eight colorectal, one appendiceal, and two gastric lesions were resected, with a median perforation size of 15 mm. As confirmed by computed tomography, closure of wall defects was achieved successfully in all cases, using a median of 6 clips. Pneumoperitoneum was evacuated in 4 cases. The median hospitalization duration was 4 days, prophylactic antibiotics being prescribed for a median of 7 days. One patient had a small abdominal collection, without requiring drainage, while another presented post-resection bleeding from the mucosal defect. CONCLUSION The novel techniques, utilizing a single-channel endoscope, clips, and an endoloop, ensuring an edge-to-edge suture of muscular layer, proved to be safe, reproducible, and easy to implement. They exhibit an excellent technical success rate and a minimal incidence of non-severe complications.
Collapse
Affiliation(s)
- Flavius-Stefan Marin
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| | - Antoine Assaf
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
| | - Paul Doumbe-Mandengue
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
| |
Collapse
|
12
|
Hardin JR, Suzuki E, Seltzer JA, Suhandynata RT, Sivagnanam M, Lasoff DR. Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient. Wilderness Environ Med 2024; 35:70-73. [PMID: 38379476 DOI: 10.1177/10806032231222373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.
Collapse
Affiliation(s)
- Jeremy R Hardin
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Emi Suzuki
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Justin A Seltzer
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Raymond T Suhandynata
- Department of Pathology, UC San Diego Health, San Diego, CA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego Health, San Diego, CA
| | - Mamata Sivagnanam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Daniel R Lasoff
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| |
Collapse
|
13
|
Lee N, Chan S. Isolated injury of the caudate lobe of the liver due to cardiopulmonary resuscitation. J Forensic Sci 2024; 69:709-713. [PMID: 38233987 DOI: 10.1111/1556-4029.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
Chest compressions are the mainstay of cardiopulmonary resuscitation. Secondary injuries are frequently reported, most frequently to the thorax and less frequently to the abdomen. Review of existing literature highlights liver lacerations as the most common abdominal injury following cardiopulmonary resuscitation; however, an isolated hepatic caudate lobe injury due to CPR has not yet been reported. We discuss existing literature regarding resuscitation-related injuries, report a case of an isolated hepatic caudate lobe injury due to cardiopulmonary resuscitation, and discuss possible mechanisms of injury.
Collapse
Affiliation(s)
- Nadia Lee
- Forensic Medicine Division, Health Sciences Authority, Singapore, Singapore
| | - Shijia Chan
- Forensic Medicine Division, Health Sciences Authority, Singapore, Singapore
| |
Collapse
|
14
|
Zhuang Y, Fu H, Yan S, Shu Y. Pneumatosis cystoides intestinalis misdiagnosed as gastrointestinal perforation. Asian J Surg 2024; 47:1410-1411. [PMID: 38057221 DOI: 10.1016/j.asjsur.2023.11.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Yuandan Zhuang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Hongrui Fu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| | - Siya Yan
- Department of Hepatological Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - YiXiong Shu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| |
Collapse
|
15
|
Lenz Virreira ME, Gasque RA, Cervantes JG, Mollard L, Ruiz NS, Beltrame MC, Mattera FJ, Quiñonez EG. Laparoscopic repair of bile duct injuries: Feasibility and outcomes. Cir Esp 2024; 102:127-134. [PMID: 38141844 DOI: 10.1016/j.cireng.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/19/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Bile duct injuries (BDI) following laparoscopic cholecystectomy occurs in approximately 0.6% of the cases, often being more severe and complex. Roux-en-Y hepaticojejunostomy (RYHJ) is considered the optimal therapeutic option, with success rates ranging from 75% to 98%. Several series have demonstrated the advancements of the laparoscopic approach for resolving this condition. The objective of this study is to describe our experience in the laparoscopic repair of BDI. METHODS A retrospective, descriptive study was conducted, including patients who underwent laparoscopic repair after BDI. Demographic, clinical, surgical, and postoperative variables were analysed using descriptive statistical analyses. RESULTS Eight patients with BDI underwent laparoscopic repair (out of 81 surgically repaired patients). Women comprised 75% of the sample. A complete laparoscopic repair was achieved in 75% (6) of cases. The mean age was 40.8 ± 16.61 years (range 19-65). Injuries at or above the confluence (Strasberg-Bismuth ≥ E3) occurred in 25% of cases (2). Primary repair was performed in two cases. Half of the cases underwent a Hepp-Couinaud laterolateral RYHJ, while three patients received a terminolateral RYHJ, and one underwent a bi-terminolateral RYH. The mean operative time was 260 min (range 120-360). Overall morbidity was 37.5% (3 cases): two minor complications (bile leak grade A and drainage-related bleeding) and one major complication (bile leak grade C). No mortality was recorded. The maximum follow-up period reached 26 months (range 6-26). CONCLUSIONS Our study demonstrates the feasibility of laparoscopic RYHJ in a selected group of patients, offering the benefits of a minimally invasive approach.
Collapse
Affiliation(s)
- Marcelo Enrique Lenz Virreira
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina.
| | - Rodrigo Antonio Gasque
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - José Gabriel Cervantes
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - Lourdes Mollard
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - Natalia Soledad Ruiz
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - Magalí Chahdi Beltrame
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - Francisco Juan Mattera
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| | - Emilio Gastón Quiñonez
- Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Argentina
| |
Collapse
|
16
|
Adams-McGavin RC, Tafur M, Vlachou PA, Wu M, Brassil M, Crivellaro P, Lin HM, Gomez D, Colak E. Interrater Agreement of CT Grading of Blunt Splenic Injuries: Does the AAST Grading Need to Be Reimagined? Can Assoc Radiol J 2024; 75:171-177. [PMID: 37405424 DOI: 10.1177/08465371231184425] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Introduction: The Revised Organ Injury Scale (OIS) of the American Association for Surgery of Trauma (AAST) is the most widely accepted classification of splenic trauma. The objective of this study was to evaluate inter-rater agreement for CT grading of blunt splenic injuries. Methods: CT scans in adult patients with splenic injuries at a level 1 trauma centre were independently graded by 5 fellowship trained abdominal radiologists using the AAST OIS for splenic injuries - 2018 revision. The inter-rater agreement for AAST CT injury score, as well as low-grade (IIII) versus high-grade (IV-V) splenic injury was assessed. Disagreement in two key clinical scenarios (no injury versus injury, and high versus low grade) were qualitatively reviewed to identify possible sources of disagreement. Results: A total of 610 examinations were included. The inter-rater absolute agreement was low (Fleiss kappa statistic 0.38, P < 0.001), but improved when comparing agreement between low and high grade injuries (Fleiss kappa statistic of 0.77, P < .001). There were 34 cases (5.6%) of minimum two-rater disagreement about no injury vs injury (AAST grade ≥ I). There were 46 cases (7.5%) of minimum two-rater disagreement of low grade (AAST grade I-III) versus high grade (AAST grade IV-V) injuries. Likely sources of disagreement were interpretation of clefts versus lacerations, peri-splenic fluid versus subcapsular hematoma, application of adding multiple low grade injuries to higher grade injuries, and identification of subtle vascular injuries. Conclusion: There is low absolute agreement in grading of splenic injuries using the existing AAST OIS for splenic injuries.
Collapse
Affiliation(s)
- R Chris Adams-McGavin
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Tafur
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paraskevi A Vlachou
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Wu
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Brassil
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priscila Crivellaro
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hui-Ming Lin
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - David Gomez
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Division of General Surgery, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Errol Colak
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Bauerle WB, Reese V, Stoltzfus J, Benton A, Knipe J, Wilde-Onia R, Castillo R, Thomas P, Cipolla J, Braverman MA. Effect of Standardized Reminder Calls on Trauma Patient No-Show Rate. J Am Coll Surg 2024; 238:236-241. [PMID: 37861231 DOI: 10.1097/xcs.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Most patients who sustain a traumatic injury require outpatient follow-up. A common barrier to outpatient postadmission care is patient failure to follow-up. One of the most significant factors resulting in failure to follow-up is age more than 35 years. Recent work has shown that follow-up telephone calls reduce readmission rates. Our aim was to decrease no-show appointments by 10% in 12 months. STUDY DESIGN The electronic medical records at our level I and II trauma centers were queried for all outpatient appointments for trauma between July 1, 2020, and June 9, 2021, and whether the patient attended their follow-up appointment. Patients with visits scheduled after August 1, 2021, received 24- and 48-hour previsit reminder calls. Patients with visits scheduled between July 1, 2020, and August 1, 2021, did not receive previsit calls. Both groups were compared using multivariable direct logistic regression models. RESULTS A total of 1,822 follow-up opportunities were included in the study. During the pre-implementation phase, there was a no-show rate of 30.9% (329 of 1,064 visits). Postintervention, a 12.2% reduction in overall no-show rate occurred. A statistically significant 11.2% decrease (p < 0.001) was seen in elderly patients. Multivariate analysis showed standardized calls resulted in significantly decreased odds of failing to keep an appointment (adjusted odds ratio = 0.610, p < 0.001). CONCLUSIONS Reminder calls led to a 12.2% reduction in no-show rate and were an independent predictor of a patient's likelihood of attending their appointment. Other predictors of attendance included insurance status and abdominal injury.
Collapse
Affiliation(s)
- Wayne B Bauerle
- From the Department of Surgery (Bauerle), St. Luke's University Health Network, Bethlehem, PA
| | - Vanessa Reese
- Department of Research and Innovation (Reese), St. Luke's University Health Network, Bethlehem, PA
| | - Jill Stoltzfus
- Department of Graduate Medical Education (Stoltzfus), St. Luke's University Health Network, Bethlehem, PA
| | - Adam Benton
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Joshua Knipe
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Rebecca Wilde-Onia
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Roberto Castillo
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Peter Thomas
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - James Cipolla
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Maxwell A Braverman
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| |
Collapse
|
18
|
Altiok M, Tümer H, Sarıtaş AG. Evaluation of the predictive effects of trauma scoring systems in colorectal injuries. Eur J Trauma Emerg Surg 2024; 50:269-274. [PMID: 37555993 DOI: 10.1007/s00068-023-02328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. METHODS The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. RESULTS The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. CONCLUSION A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.
Collapse
Affiliation(s)
- Merih Altiok
- Department of General Surgery, Ortadoğu Hospital, 01250, Seyhan/Adana, Turkey.
| | - Haluk Tümer
- Department of General Surgery, Seyhan State Hospital, Adana, Turkey
| | | |
Collapse
|
19
|
Lanier MH, Mellnick VM. Invited Commentary: Agreement for Blunt Splenic Injuries Has Room for Improvement. Can Assoc Radiol J 2024; 75:26-27. [PMID: 37531212 DOI: 10.1177/08465371231189681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- M Hunter Lanier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
20
|
Giarda F, Contro D, Fasano M, Poli M, Giacchino M. An insidious rectus abdominis muscle injury in an elite volleyball player: a case report. J Med Case Rep 2024; 18:54. [PMID: 38254134 PMCID: PMC10804748 DOI: 10.1186/s13256-023-04299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/01/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Structural muscle injuries are characterized by acute and localized onset of pain. Abdominal muscle injuries are an insidious pathology in overhead athletes. However, only a few cases are reported in literature related to volleyball players, where clinical presentation may not have reflected the severity of the lesion. CASE PRESENTATION An elite volleyball player, a 21-year-old Caucasian female, reported the onset of mild abdominal muscular pain, confirmed on clinical evaluation findings and self-reported symptoms. Abdominal muscle ultrasound was performed following 2 weeks of continuing symptoms. This evidenced a more serious structural muscle injury of the rectus abdominis (type 3b). Having this correct diagnosis allowed a personalized rehabilitation program to be instituted to enable a safe return to play. CONCLUSION In presence of persistent abdominal muscle pain, even if mild, the possibility of a structural muscle injury must be considered. Clinical evaluation must be complemented by an instrumental evaluation including an ultrasound by an experienced operator for correct diagnosis and the setting of functional recovery related to biological healing.
Collapse
Affiliation(s)
- Federico Giarda
- Rehabilitation Medicine and Neurorehabilitation Unit, Neuroscience Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, Milan, Italy.
| | - Diego Contro
- Technical Director at Medical Lab, Sport Medicine and Physiotherapy Center, Piazza Luigi Rey, Turin, Italy
| | - Maurizio Fasano
- Sport Medicine and Physiotherapy Center, Medical Lab Asti, 226, Alessandria, Asti, Italy
| | - Mirko Poli
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Niguarda, Piazza Maggiore 3, Milan, Italy
| | - Maurizio Giacchino
- Sport Medicine and Physiotherapy Center, Medical Lab Asti, 226, Alessandria, Asti, Italy
| |
Collapse
|
21
|
Moreno S, Ksontini R. Intrahepatic biloma after intraoperative cholangiography. BMJ Case Rep 2024; 17:e257688. [PMID: 38182172 PMCID: PMC10773284 DOI: 10.1136/bcr-2023-257688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
A woman in her 30s presented to the emergency department with a month-long history of postprandial epigastric pain radiating to her back. The diagnosis of cholecystolithiasis and suspected choledocholithiasis was made, and the patient underwent cholecystectomy with cholangiography using standard technique. The surgery was complicated by an intrahepatic bile duct injury attributed to high injection pressure during cholangiography. She developed an intrahepatic collection that was drained and confirmed the diagnosis of biloma. In this case report, we discuss a rare complication of intraoperative cholangiography during laparoscopic cholecystectomy and consider a way to prevent it.
Collapse
Affiliation(s)
- Samara Moreno
- Soins intensifs, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Riadh Ksontini
- Soins intensifs, Hôpital Riviera-Chablais, Rennaz, Switzerland
| |
Collapse
|
22
|
Hsu WC, Cheng HT, Lin CT, Lin JH, Chiu HY, Yu WP, Lu YY. Factors affecting quality of life among patients with corrosive injury. Medicine (Baltimore) 2024; 103:e36853. [PMID: 38181240 PMCID: PMC10766280 DOI: 10.1097/md.0000000000036853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
This study aimed to investigate the factors influencing quality of life (QOL) among patients with corrosive injuries, considering the rising incidence of such cases, particularly in developing countries. Corrosive ingestion is a serious global public health problem and a common form of self-harm. This was a cross-sectional study using purposive sampling. A total of 82 patients with corrosive injuries who were admitted to the gastroenterology ward of a medical center in Taiwan between June 2018 and July 2020 completed the Perceived Stress Scale, Coping Strategy Scale, and World Health Organization Quality of Life Scale. We used an independent t-test and analysis of variance to examine the distribution and differences in demographic and disease characteristics, perceived stress, and the coping strategy scale. Multiple linear regression was then used to analyze the main predictors of QOL. The mean patient age was 58.2 (standard deviation = 2.4) years. A significant difference was observed between patients with a history of mental illness and perceived stress (P < .05). The patients were highly stressed and used emotional coping strategies to solve problems. Stress perception was significantly negatively correlated with overall QOL. Multiple linear regression analysis showed that a history of mental illness was a significant factor for overall QOL. The results of this study suggest that a history of mental illness significantly affects the QOL of patients with corrosive gastrointestinal injuries, and regular assessment and monitoring are essential.
Collapse
Affiliation(s)
- Wen-Chuan Hsu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Health Care, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Hao-Tsai Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Division of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiu-Tzu Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jui-Hsiang Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry and Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Pin Yu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yen-Yi Lu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Nursing- Linkou Campus, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| |
Collapse
|
23
|
Santos JW, Grigorian A, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Nahmias J. Predictors of fetal delivery in pregnant trauma patients: A multicenter study. J Trauma Acute Care Surg 2024; 96:109-115. [PMID: 37580875 DOI: 10.1097/ta.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies. METHODS All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. RESULTS Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001). CONCLUSION The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
Collapse
Affiliation(s)
- Jeffrey W Santos
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Xue Z, Wen B. Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care. Int Wound J 2024; 21:e14647. [PMID: 38272795 PMCID: PMC10805531 DOI: 10.1111/iwj.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Orthopaedic trauma care frequently necessitates prompt and precise assessment of musculoskeletal injuries and wound depth. The potential for improved diagnostic accuracy and patient outcomes exists with the integration of sophisticated imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) with focused assessment with sonography for trauma (FAST). The purpose of this research was to examine the benefits and drawbacks of this integrative method in the clinical environment. From June 2022 to September 2023, 250 patients who were admitted to Ningbo University Affiliated People's Hospital, participated in this cross-sectional observational study. Following the administration of FAST, CT and MRI were utilized to evaluate orthopaedic injuries and skin wounds in patients. Analyses of data centred on the precision of diagnoses, the influence of treatment decisions and patient outcomes. Aged and gendered differently, the study participants sustained the variety of injuries and superficial wounds that were predominantly the result of traffic accidents. The FAST assay exhibited sensitivity of 65%, specificity of 80% and 72% overall accuracy. MRI demonstrated the finest diagnostic performance (85% sensitivity, 95% specificity and 89% accuracy), whereas CT scans offered improved diagnostic efficacy (80% sensitivity, 90% specificity and 84% accuracy). Treatment decisions were substantially impacted by integration of these imaging modalities, resulting in modifications in 20%-35% of cases, depending on the specific modality employed. Specifically, MRI played a pivotal role in informing treatment approaches, influencing non-surgical as well as surgical procedures. This study substantiates the significant advantages of integrating FAST with CT and MRI in orthopaedic trauma care, particularly in the accurate assessment of wound depth. The synergistic use of these imaging techniques not only enhances diagnostic precision but also positively impacts treatment strategies and patient outcomes, emphasizing the need for a comprehensive diagnostic approach in trauma care settings.
Collapse
Affiliation(s)
- Zujun Xue
- OrthopedicsNingbo University Affiliated People's HospitalNingboChina
| | - Bi Wen
- Infection DepartmentNingbo University Affiliated People's HospitalNingboChina
| |
Collapse
|
25
|
Visconti D, Parini D, Mariani D, Biloslavo A, Bellio G, Ceolin M, Cozza V, Musetti S, Pivetta E, Kurihara H, Zago M, Santarelli M, Chiarugi M. Spread and feasibility of non-operative management (NOM) of traumatic splenic injuries in adults: a national survey. Updates Surg 2024; 76:245-253. [PMID: 38103166 DOI: 10.1007/s13304-023-01718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
In hemodynamically stable adults sustaining a splenic trauma, non-operative management (NOM) represents the standard approach even in high-severity injuries. However, knowledge, structural, and logistic limitations still reduce its wider diffusion. This study aims to identify such issues to promote the safe and effective management of these injuries.A survey was developed using the SurveyMonkey® software and spread nationally in Italy. The survey was structured into: (1) Knowledge of classification systems; (2) Availability to refer patients; (3) Patients monitoring and follow-up; (4) Center-related.The survey was filled in by 327 surgeons, with a completeness rate of 63%. Three responders out of four are used to manage trauma patients. Despite most responders knowing the existing classifications, their use is still limited in daily practice. If a patient needs to be centralized, the concern about possible clinical deterioration represent the main obstacle to achieving a NOM. The lack of protocols does not allow standardization of patient surveillance according to the degree of injury. The imaging follow-up is not standardized as well, varying between computed tomography, ultrasound, and contrast-enhanced ultrasound.The classification systems need to be spread to all the trauma-dedicated physicians, to speak a common language. A more rational centralization of patients should be promoted, ideally through agreements between peripheral and reference centers, both at regional and local level. Standardized protocols need to be shared nationally, as well as the clinical and imaging follow-up criteria should be adapted to the local features.
Collapse
Affiliation(s)
- Diego Visconti
- Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Dario Parini
- Ospedale Santa Maria della Misericordia ULSS 5 Polesana, Rovigo, Italy
| | | | | | - Gabriele Bellio
- Ospedale di Piove di Sacco, ULSS 6 Euganea, Piove di Sacco, Padua, Italy
| | - Martina Ceolin
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Valerio Cozza
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Emanuele Pivetta
- University of Turin and Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Hayato Kurihara
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Zago
- Ospedale A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mauro Santarelli
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | | |
Collapse
|
26
|
Shao Y, Li L, Yang Y, Ye Y, Guo Z, Liu L, Huang J, Chen Y, Gao X, Sun B. DNase aggravates intestinal microvascular injury in IBD patients by releasing NET-related proteins. FASEB J 2024; 38:e23395. [PMID: 38149880 DOI: 10.1096/fj.202301780r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
Neutrophils accumulate in the inflammatory mucosa of patients with inflammatory bowel disease (IBD), and excessive release of NETs (neutrophil extracellular traps may be one of the important factors that cause IBD progression. However, the specific mechanism underlying vascular injury caused by NETs remains unclear. Immunofluorescence, ELISA, and flow cytometry were used in this study to detect the expression of NETs and DNase in the tissue and peripheral blood samples of patients with IBD. DSS mouse model was used to detect colon injury and vascular permeability. We found that NETs and DNase levels increased in the colon of patients with IBD. We found an increase in the activity of NET-related MPO released by DNase. DNase released NET-related proteins and damaged vascular endothelial cells in vitro. In DSS mouse model, the synchronous increase of DNase and NETs in the colon leads to an increase in vascular injury markers (CD44, sTM). DNase aggravated colon injury and increased vascular permeability in vivo, which was inhibited by gentamicin sulfate (GS). GS does not reduce the expression of DNase, but rather reduces the release of NET-related proteins to protect vascular endothelium by inhibiting DNase activity. MPO and histones synergistically damaged the vascular endothelium, and vascular injury can be improved by their active inhibitors. We further found that H2 O2 is an important substrate for MPO induced vascular damage. In conclusion, in IBD, DNase, and NET levels increased synchronously in the lesion area and released NET-related proteins to damage the vascular endothelium. Therefore, targeting DNase may be beneficial for the treatment of IBD.
Collapse
Affiliation(s)
- Yiming Shao
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jining Medical University, Jining, China
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Linbin Li
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yunxi Yang
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yulan Ye
- Department of Gastroenterology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zaiwen Guo
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lu Liu
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jiamin Huang
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yi Chen
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xi Gao
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Bingwei Sun
- Research Center for Neutrophil Engineering Technology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| |
Collapse
|
27
|
Abboud B, Dar R, Bramnick Z, Farraj M. Gastric Perforation Secondary to Prolonged Multiple Foreign Body Ingestions in a Patient with Schizophrenia. Isr Med Assoc J 2024; 26:52-53. [PMID: 38420644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Tzafon Medical Center, Lower Galilee, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ron Dar
- Department of General Surgery, Tzafon Medical Center, Lower Galilee, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Zakhar Bramnick
- Department of General Surgery, Tzafon Medical Center, Lower Galilee, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Moaad Farraj
- Department of General Surgery, Tzafon Medical Center, Lower Galilee, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| |
Collapse
|
28
|
Cyphers ED, Acord MR, Gaballah M, Schoeman S, Nance ML, Srinivasan A, Vatsky S, Krishnamurthy G, Escobar F, Cajigas-Loyola S, Cahill AM. Embolization for pediatric trauma. Pediatr Radiol 2024; 54:181-196. [PMID: 37962604 DOI: 10.1007/s00247-023-05803-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The management of pediatric trauma with trans-arterial embolization is uncommon, even in level 1 trauma centers; hence, there is a dearth of literature on this subject compared to the adult experience. OBJECTIVE To describe a single-center, level 1 trauma center experience with arterial embolization for pediatric trauma. MATERIALS AND METHODS A retrospective review was performed to identify demographics, transfusion requirements, pre-procedure imaging, procedural details, adverse events, and arterial embolization outcomes over a 19-year period. Twenty children (age 4.5 months to 17 years, median 13.5 years; weight 3.6 to 108 kg, median 53 kg) were included. Technical success was defined as angiographic resolution of the bleeding-related abnormality on post-embolization angiography or successful empiric embolization in the absence of an angiographic finding. Clinical success was defined as not requiring additional intervention after embolization. RESULTS Seventy-five percent (n=15/20) of patients required red blood cell transfusions prior to embolization with a mean volume replacement 64 ml/kg (range 12-166 ml/kg) and the median time from injury to intervention was 3 days (range 0-16 days). Technical success was achieved in 100% (20/20) of children while clinical success was achieved in 80% (n=16/20). For the 4 children (20%) with continued bleeding following initial embolization, 2 underwent repeat embolization, 1 underwent surgery, and 1 underwent repeat embolization and surgery. Mortality prior to discharge was 15% (n=3). A post-embolization mild adverse event included one groin hematoma, while a severe adverse event included one common iliac artery pseudoaneurysm requiring open surgical ligation. CONCLUSIONS In this single-center experience, arterial embolization for hemorrhage control in children after trauma is feasible but can be challenging and the clinical failure rate of 20% in this series reflects this complexity. Standardization of pre-embolization trauma assessment parameters and embolic techniques may improve outcomes.
Collapse
Affiliation(s)
- Eric D Cyphers
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA.
| | - Michael R Acord
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marian Gaballah
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sean Schoeman
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Michael L Nance
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abhay Srinivasan
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Seth Vatsky
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ganesh Krishnamurthy
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Escobar
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Cajigas-Loyola
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne Marie Cahill
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
29
|
Gasanov MA, Danielyan SN, Chernousov FA, Gasanov AM, Rabadanov KM, Tatarinova EV, Barmina TG, Titova GP, Nevdah SK. [Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations]. Khirurgiia (Mosk) 2024:21-28. [PMID: 38258684 DOI: 10.17116/hirurgia202401121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.
Collapse
Affiliation(s)
- M A Gasanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - Sh N Danielyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- National Institute of Health, Yerevan, Armenia
| | - F A Chernousov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A M Gasanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - K M Rabadanov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E V Tatarinova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - T G Barmina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - G P Titova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - S K Nevdah
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| |
Collapse
|
30
|
Choi D, Choi SH, Jung H, Kim J. CT findings of inferior vena cava trauma according to the level of injury: a retrospective analysis of 19 cases in a single trauma centre. Clin Radiol 2024; 79:e182-e188. [PMID: 37925364 DOI: 10.1016/j.crad.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
AIM To analyse the clinicoradiological characteristics of traumatic inferior vena cava (IVC) injury level on preoperative computed tomography (CT). MATERIALS AND METHODS This retrospective study evaluated patients from a single trauma centre treated for traumatic IVC injury between January 2014 and January 2021. Data on demographics, mechanism of injury, Injury Severity Score, radiological findings on CT and angiography, IVC injury level in surgical findings, complications, and clinical outcomes were collected. RESULTS During the 8-year study period, 36 patients presented with traumatic IVC injury: 19 underwent preoperative CT with 17 (89%) blunt and two (11%) penetrating injuries. The most common primary CT sign was contour abnormality (53%, n=10), followed by intraluminal flap and active extravasation (21%, n=4). Among the secondary signs, hepatic laceration (53%, n=10) and retroperitoneal haemorrhage (53%, n=10) were the most common. Frequencies of primary and secondary signs were higher in the infrarenal and suprarenal than in the retrohepatic vena cava injuries. Diagnostic capability of preoperative CT for IVC injury differed according to the IVC level. The detection rate was the highest for an infrarenal vena cava injury at 100% (n=4), followed by that for a suprarenal, suprahepatic, and retrohepatic vena cava injuries at 75% (n=3), 43% (n=3), and 25% (n=1), respectively. CONCLUSION CT findings of traumatic IVC injuries may vary depending on the mechanism and anatomical site of injury. Familiarity with IVC injury imaging features may help in diagnosis and surgical treatment planning.
Collapse
Affiliation(s)
- D Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - S H Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - H Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - J Kim
- Department of Radiology, Ajou University School of Medicine, Republic of Korea.
| |
Collapse
|
31
|
Singh PK, Sethi MK, Mishra TS, Kumar P, Ali SM, Sasmal PK, Mishra SS. Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial. Langenbecks Arch Surg 2023; 409:19. [PMID: 38150073 DOI: 10.1007/s00423-023-03202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE NPWT has been tried in many surgical fields, including colorectal, thoracic, vascular, and non-healing wounds, for the prevention of SSI. However, its efficacy in the prevention of SSI-grade IV closed abdominal wounds is yet to be explored. METHODS All patients with grade IV abdominal wounds were included in the study. They were randomized into the conventional arm and the VAC arm after confirming the diagnosis intra-operatively. The sheath was closed, and the skin was laid open in the postoperative period. In the VAC arm, the NPWT dressing was applied on postoperative day (POD)-1 and removed on POD-5. In the conventional arm, only regular dressing was done postoperatively. The skin was closed with a delayed primary intention on POD-5 in both arms. The sutures were removed after 7 to 10 days of skin closure. RESULTS The rate of SSI (10% in the VAC arm vs. 37.5% in the conventional arm, p-value = 0.004) was significantly lower in the VAC arm, as were the rates of seroma formation (2.4% in the VAC arm vs. 20% in the conventional arm, p = 0.014) and wound dehiscence (7.3% vs. 30%, p = 0.011). The conventional arm had a significant delay in skin closure beyond POD5 due to an increased rate of SSI, which also led to a prolonged hospital stay (5 days in the VAC arm vs. 6.5 days in the conventional arm, p-value = 0.005). CONCLUSION The VAC dressing can be used routinely in grade IV closed abdominal wounds to reduce the risk of SSI and wound dehiscence.
Collapse
Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Mahesh Kumar Sethi
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - S Manwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | | | | |
Collapse
|
32
|
Wang Y, Chen XP. Comparison of the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy. Langenbecks Arch Surg 2023; 409:17. [PMID: 38147122 DOI: 10.1007/s00423-023-03205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy (DLC). METHODS From June 2021 to August 2022, data from 100 patients undergoing DLC at Nanjing Hospital of Traditional Chinese Medicine were analyzed retrospectively. Patients were divided into two groups: the experimental group (LC with the ampulla-guided realignment) and the control group (conventional LC with triangular gallbladder anatomy), with 50 patients per group. The intraoperative blood loss, operation time, postoperative drainage tube indwelling time, hospitalization time, bile duct injury rate, operation conversion rate, and incidence of postoperative complications were recorded and compared between the two groups. The pain response and daily activities of the patients in the two groups were evaluated 48 h after the operation. RESULTS The amount of intraoperative blood loss, postoperative drainage tube indwelling time, hospital stay, operation conversion rate, pain degree at 24 and 48 h after operation, bile duct injury incidence, and total postoperative complication rate were shorter or lower in the experimental group than those in the control group (p < 0.05). The Barthel index scores of both groups were higher 48 h after the operation than before the operation, and the experimental group was higher than the control group (p < 0.05). CONCLUSION The ampulla-guided alignment in DLC surgery was more beneficial in promoting postoperative recovery, reducing postoperative pain response, reducing the incidence of postoperative complications, and reducing bile duct injury.
Collapse
Affiliation(s)
- Yong Wang
- Department of General Surgery, PuKou Branch of Nanjing Hospital of Traditional Chinese Medicine, Nanjing, 211800, China
| | - Xiao-Peng Chen
- Department of Hepatobiliary Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241004, China.
| |
Collapse
|
33
|
陈 赛超, 张 明昌. [Death due to gastric perforation caused by congenital defect of gastric musculature in a toddler: A case report]. Fa Yi Xue Za Zhi 2023; 39:612-613. [PMID: 38228482 DOI: 10.12116/j.issn.1004-5619.2023.430309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
|
34
|
Hosseinpour H, Nelson A, Bhogadi SK, Spencer AL, Alizai Q, Colosimo C, Anand T, Ditillo M, Magnotti LJ, Joseph B. Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. Am J Surg 2023; 226:823-828. [PMID: 37543482 DOI: 10.1016/j.amjsurg.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL). METHODS This is a 4-year (2017-2020) analysis of the ACS-TQIP. Adult trauma patients with severe liver injuries (AAST-OIS grade ≥ III) who underwent DCL and hepatic resection were included. We excluded patients with early mortality (<24 h). Patients were stratified into those who received hepatic resection within the initial operation (Early) and take-back operation (Delayed). RESULTS Of 914 patients identified, 29% had a delayed hepatic resection. On multivariable regression analyses, although delayed resection was not associated with mortality (aOR:1.060,95%CI[0.57-1.97],p = 0.854), it was associated with higher complications (aOR:1.842,95%CI[1.38-2.46],p < 0.001), and longer hospital (β: +0.129, 95%CI[0.04-0.22],p = 0.005) and ICU (β:+0.198,95%CI[0.14-0.25],p < 0.001) LOS, compared to the early resection. CONCLUSION Delayed hepatic resection was associated with higher adjusted odds of major complications and longer hospital and ICU LOS, however, no difference in mortality, compared to early resection.
Collapse
Affiliation(s)
- Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Qaidar Alizai
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| |
Collapse
|
35
|
Atkins K, Schneider A, Charles A. Splenic Salvage: Is There a Role for Splenorrhaphy in the Management of Adult Splenic Trauma? Am Surg 2023; 89:5599-5608. [PMID: 36878857 DOI: 10.1177/00031348231156760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Nonoperative management of splenic injuries is recommended. Total splenectomy is the primary operative management, and the current role of splenorrhaphy in splenic salvage is not well delineated. METHODS We reviewed the National Trauma Data Bank (2007-2019) for adult splenic injuries. Operative splenic injury management were compared. We performed bivariate analysis and multivariable logistic regression to estimate the effect of surgical management on mortality. RESULTS 189,723 patients met the inclusion criteria. Splenic injury management was stable, with 18.2% undergoing a total splenectomy and 1.9% splenorrhaphy. Splenorrhaphy patients had lower crude mortality (2.7% vs 8.3%, P < .001) than total splenectomy patients. Failed splenorrhaphy patients had higher crude mortality (10.1% vs 8.3%, P < .001) than patients who underwent initial total splenectomy. Patients who underwent total splenectomy had an adjusted odd of 2.30 (95% CI 1.82-2.92, P < .001) for mortality compared to successful splenorrhaphy. Patients who failed splenorrhaphy had an adjusted odd of 2.36 (95% CI 1.19-4.67, P < .014) for mortality compared to successful splenorrhaphy. CONCLUSION Adults with splenic injuries requiring operative intervention have twice the odds of mortality when a total splenectomy is performed or when splenorrhaphy fails compared to successful splenorrhaphy.
Collapse
Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
36
|
Kuo YC, Chien CY, Li PH, Hsu TA, Fu CY, Bajani F, Mis J, Poulakidas S, Bokhari F. Validation of the Twenty-Four-Hour Threshold for Bladder Repair: Impact on Infection Rates Using the National Trauma Data Bank. World J Surg 2023; 47:3116-3123. [PMID: 37851065 DOI: 10.1007/s00268-023-07224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE This study aimed to validate the previously reported association between delayed bladder repair and increased infection rates using the National Trauma Data Bank (NTDB). METHODS Bladder injury patients with bladder repair in the NTDB from 2013 to 2015 were included. Propensity score matching (PSM) was used to compare mortality, infection rates, and hospital length of stay (LOS) between patients who underwent bladder repair within 24 h and those who underwent repair after 24 h. Linear regression and multivariate logistic regression analyses were also performed. RESULTS A total of 1658 patients were included in the study. Patients who underwent bladder repair after 24 h had significantly higher infection rates (5.4% vs. 1.2%, p = 0.032) and longer hospital LOS (17.1 vs. 14.0 days, p = 0.032) compared to those who underwent repair within 24 h after a well-balanced 1:1 PSM (N = 166). Linear regression analysis showed a positive correlation between time to bladder repair and hospital LOS for patients who underwent repair after 24 h (B-value = 0.093, p = 0.034). Multivariate logistic regression analysis indicated that bladder repair after 24 h increased the risk of infection (odds = 3.162, p = 0.018). Subset analyses were performed on patients who underwent bladder repairs within 24 h and were used as a control group. These analyses showed that the time to bladder repair did not significantly worsen outcomes. CONCLUSIONS Delayed bladder repair beyond 24 h increases the risk of infection and prolongs hospital stays. Timely diagnosis and surgical intervention remain crucial for minimizing complications in bladder injury patients.
Collapse
Affiliation(s)
- Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Ying Chien
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung Branch, Chang Gung University, Keelung, Taiwan
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Faran Bokhari
- Emergency Surgical Services, St. Francis Hospital, OSF Healthcare System, Peoria, IL, USA
| |
Collapse
|
37
|
Owen RP, Chidambaram S, Griffiths EA, Sultan J, Phillips AW, Vohra R, Preston S, Gossage J, Hanna GB, Underwood TJ, Maynard N, Markar SR. Multicenter, Prospective Cohort Study of Oesophageal Injuries and Related Clinical Outcomes (MUSOIC study). Ann Surg 2023; 278:910-917. [PMID: 37114497 DOI: 10.1097/sla.0000000000005889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify prognostic factors associated with 90-day mortality in patients with oesophageal perforation (OP), and characterize the specific timeline from presentation to intervention, and its relation to mortality. BACKGROUND OP is a rare gastro-intestinal surgical emergency with a high mortality rate. However, there is no updated evidence on its outcomes in the context of centralized esophago-gastric services; updated consensus guidelines; and novel non-surgical treatment strategies. METHODS A multi-center, prospective cohort study involving eight high-volume esophago-gastric centers (January 2016 to December 2020) was undertaken. The primary outcome measure was 90-day mortality. Secondary measures included length of hospital and ICU stay, and complications requiring re-intervention or re-admission. Mortality model training was performed using random forest, support-vector machines, and logistic regression with and without elastic net regularisation. Chronological analysis was performed by examining each patient's journey timepoint with reference to symptom onset. RESULTS The mortality rate for 369 patients included was 18.9%. Patients treated conservatively, endoscopically, surgically, or combined approaches had mortality rates of 24.1%, 23.7%, 8.7%, and 18.2%, respectively. The predictive variables for mortality were Charlson comorbidity index, haemoglobin count, leucocyte count, creatinine levels, cause of perforation, presence of cancer, hospital transfer, CT findings, whether a contrast swallow was performed, and intervention type. Stepwise interval model showed that time to diagnosis was the most significant contributor to mortality. CONCLUSIONS Non-surgical strategies have better outcomes and may be preferred in selected cohorts to manage perforations. Outcomes can be significantly improved through better risk-stratification based on afore-mentioned modifiable risk factors.
Collapse
Affiliation(s)
- Richard P Owen
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- The Ludwig Institute for Cancer Research, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, UK
| | - Swathikan Chidambaram
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK
| | - Ewen A Griffiths
- Department of Surgery, Birmingham University Hospitals NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Javed Sultan
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
| | - Alexander W Phillips
- Northern Esophago-Gastric Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Ravindra Vohra
- Trent Esophago-Gastric Unit, Nottingham University Hospitals Trust, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Shaun Preston
- Department of Surgery, Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, UK
| | - James Gossage
- Department of Surgery, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK
| | - Tim J Underwood
- Cancer Sciences Academic Unit, University of Southampton, University Rd, Southampton, UK
| | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Sheraz R Markar
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| |
Collapse
|
38
|
Haussner F, Maitz A, Rasche V, Hoffmann A, Braumüller S, Lupu L, Ignatius A, Neff TA, Palmer A, Huber-Lang M. INTESTINAL DAMAGE AND IMMUNE RESPONSE AFTER EXPERIMENTAL BLUNT ABDOMINAL TRAUMA. Shock 2023; 60:784. [PMID: 38153806 DOI: 10.1097/shk.0000000000002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
|
39
|
Krulewitz N, Levin NM, Youngquist S, Kelly C, Hoareau G, Johnson MA, Ockerse P. Evaluation of esophageal injuries after defibrillation with transesophageal ultrasound probe in the mid-esophagus in pigs. Am J Emerg Med 2023; 74:14-16. [PMID: 37734202 DOI: 10.1016/j.ajem.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Transesophageal echocardiography (TEE) is becoming increasingly utilized by emergency medicine providers during cardiac arrest. Intra-arrest, TEE confers several benefits including shorter pauses in chest compressions and direct visualization of cardiac compressions. Many ultrasound probe manufacturers recommend against performing defibrillation with the TEE probe in the mid-esophagus for fear of causing esophageal injury or damage to the probe, however no literature exists that has investigated this concern. To assess this, we performed cardiopulmonary resuscitation (CPR) and multiple defibrillations in 8 swine with a TEE probe in place. METHODS We performed TEE on 8 adult swine during CPR and performed multiple 200 J defibrillations with the TEE probe in the mid-esophagus. Post-mortem, esophagi were dissected and inspected for evidence of injury. RESULTS On macroscopic inspection of 8 esophagi, no evidence of hematoma, thermal injury, or perforation was noted. CONCLUSION Our study suggests that performing defibrillation during CPR with a TEE probe in place in the mid-esophagus is likely safe and low risk for significant esophageal injury. This further bolsters the use of TEE in CPR and would enable continuous visualization of cardiac activity without the need to remove the TEE probe for defibrillation.
Collapse
Affiliation(s)
- Neil Krulewitz
- University of Vermont, Department of Emergency Medicine, Burlington, VT, United States of America.
| | - Nicholas M Levin
- Stanford Health Care, Department of Pulmonary, Allergy and Critical Care Medicine, Stanford, CA, United States of America
| | - Scott Youngquist
- University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT, United States of America
| | - Christopher Kelly
- University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT, United States of America
| | - Guillaume Hoareau
- University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT, United States of America
| | - Michael Austin Johnson
- University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT, United States of America
| | - Patrick Ockerse
- University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT, United States of America
| |
Collapse
|
40
|
Chen KA, Joisa CU, Stem JM, Guillem JG, Gomez SM, Kapadia MR. Prediction of Ureteral Injury During Colorectal Surgery Using Machine Learning. Am Surg 2023; 89:5702-5710. [PMID: 37133432 PMCID: PMC10622328 DOI: 10.1177/00031348231173981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ureteral injury (UI) is a rare but devastating complication during colorectal surgery. Ureteral stents may reduce UI but carry risks themselves. Risk predictors for UI could help target the use of stents, but previous efforts have relied on logistic regression (LR), shown moderate accuracy, and used intraoperative variables. We sought to use an emerging approach in predictive analytics, machine learning, to create a model for UI. METHODS Patients who underwent colorectal surgery were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were split into training, validation, and test sets. The primary outcome was UI. Three machine learning approaches were tested including random forest (RF), gradient boosting (XGB), and neural networks (NN), and compared with traditional LR. Model performance was assessed using area under the curve (AUROC). RESULTS The data set included 262,923 patients, of whom 1519 (.578%) experienced UI. Of the modeling techniques, XGB performed the best, with an AUROC score of .774 (95% CI .742-.807) compared with .698 (95% CI .664-.733) for LR. Random forest and NN performed similarly with scores of .738 and .763, respectively. Type of procedure, work RVUs, indication for surgery, and mechanical bowel prep showed the strongest influence on model predictions. CONCLUSIONS Machine learning-based models significantly outperformed LR and previous models and showed high accuracy in predicting UI during colorectal surgery. With proper validation, they could be used to support decision making regarding the placement of ureteral stents preoperatively.
Collapse
Affiliation(s)
- Kevin A. Chen
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Chinmaya U. Joisa
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - Jonathan M. Stem
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Jose G. Guillem
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Shawn M. Gomez
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - Muneera R. Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
41
|
Feldman LS, Brunt LM. New Technology and Bile Duct Injuries. JAMA Surg 2023; 158:1311. [PMID: 37728913 DOI: 10.1001/jamasurg.2023.4404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Liane S Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - L Michael Brunt
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
42
|
Wang Y, Li Y, Li H, Li Y, Li X, Zhang D. Small peptide formulas versus standard polymeric formulas in critically ill patients with acute gastrointestinal injury: a systematic review and meta-analysis. Sci Rep 2023; 13:20469. [PMID: 37993565 PMCID: PMC10665341 DOI: 10.1038/s41598-023-47422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
Small peptide formulas versus standard polymeric formulas for enteral nutrition in critically ill patients with acute gastrointestinal injury (AGI) have been a topic of debate. A systematic review and meta-analysis were conducted to compare their clinical and nutritional outcomes. Relevant studies from January 1980 to June 2022 were searched in PubMed, Cochrane, and Embase databases. Randomized controlled trials involving AGI grade I-IV patients were included, while children, non-AGI patients, and non-critically ill patients were excluded. Results indicated no significant difference in all-cause mortality. Patients receiving small peptide formulas showed higher daily protein intake, greater albumin growth, and higher prealbumin levels. They also had shorter lengths of stay in the intensive care unit and hospital. Conversely, patients receiving standard polymeric formulas had a higher daily calorie intake. In conclusion, the choice of formula may not affect mortality in critically ill patients with AGI. Small peptide formulas were more conducive to increase daily protein intake, decrease intensive care unit and hospital length of stay. Further large-scale randomized controlled trials evaluating the effects of these two nutritional formulas on clinical and nutritional outcomes in critically ill patients with AGI are needed to confirm these results.
Collapse
Affiliation(s)
- Youquan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China
| | - Yanhua Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China
| | - Hongxiang Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China
| | - Yuting Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China
| | - Xinyu Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Chaoyang District, Changchun City, 130021, Jilin Province, China.
| |
Collapse
|
43
|
Ding P, Zhou Y, Zhou X, Sun W, Gao P. Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study. J Vis Exp 2023. [PMID: 38009746 DOI: 10.3791/64784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine's acupuncture techniques offer an alternative approach to treating digestive disorders by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment's effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.
Collapse
Affiliation(s)
- Peng Ding
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yuan Zhou
- Department of Geriatrics, The General Hospital of Western Theater Command
| | - Xiujuan Zhou
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Weiting Sun
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Peiyang Gao
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine;
| |
Collapse
|
44
|
Julian K, Vasekar M. Thoracic splenosis: an important consideration in oncology patients. BMJ Case Rep 2023; 16:e257091. [PMID: 37940196 PMCID: PMC10632802 DOI: 10.1136/bcr-2023-257091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
SummarySplenosis is the implantation of ectopic splenic tissue after splenic injury or splenectomy. Signs and symptoms of splenosis vary based on anatomic location; however, it remains asymptomatic in many cases. On radiographic imaging, splenosis often appears as a soft tissue mass and can be diagnosed using heat-damaged red blood cell scintigraphy, a non-invasive imaging modality. Radiographic findings of splenosis on imaging may be suspicious for metastatic disease in patients with known solid organ tumours. It is important to have a high degree of suspicion for splenosis with known history of splenic trauma or splenectomy in order to avoid invasive procedures and guide appropriate management.
Collapse
Affiliation(s)
- Katherine Julian
- Internal Medicine, University of Colorado, Aurora, Colorado, USA
| | - Monali Vasekar
- Hematology/Oncology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
45
|
Donaldson RI, Fisher TC, Graham TL, Buchanan OJ, Cambridge JS, Armstrong JK, Goldenberg D, Tanen DA, Ross JD. Thermoreversible Reverse-Phase-Shift Foam for Treatment of Noncompressible Torso Hemorrhage, a Safety Trial in a Porcine Model. Mil Med 2023; 188:3330-3335. [PMID: 35820028 PMCID: PMC10629983 DOI: 10.1093/milmed/usac206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been developed that can be easily administered by a medic in austere settings to temporarily tamponade noncompressible torso hemorrhage. The purpose of this study was to assess the long-term safety and physical characteristics of using Fast Onset Abdominal Management (FOAM; Critical Innovations LLC) in swine. MATERIALS AND METHODS Yorkshire swine (40-60 kg) were sedated, intubated, and placed on ventilatory support. An external jugular catheter was placed for sampling of blood. Continuous heart rate, temperature, saturation of peripheral oxygen, end-tidal carbon dioxide, and peak airway pressures were monitored for a 4-hour period after intervention (i.e., FOAM agent injection or a sham introducer without agent delivery). The FOAM agent was injected to obtain an intra-abdominal pressure of 60 mmHg for at least 10 minutes. After 4 hours, the animals were removed from ventilatory support and returned to their housing for a period of 7-14 days. Group size analysis was not performed, as this was a descriptive safety study. Blood samples were obtained at baseline and at 1-hour post-intervention and then on days 1, 3, 7, and 14. Euthanasia, necropsy, and harvesting of samples for histologic analysis (from kidneys, terminal ilium, liver, pancreas, stomach, spleen, and lungs) were performed upon expiration. Histologic scoring for evidence of ischemia, necrosis, and abdominal compartment sequela was blinded and reported by semi-quantitative scale (range 0-4; 0 = no change, 1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). Oregon Health & Science University's Institutional Animal Care and Use Committee, as well as the U.S. Army Animal Care and Use Review Office, approved this protocol before the initiation of experiments (respectively, protocol numbers IP00003591 and MT180006.e002). RESULTS Five animals met a priori inclusion criteria, and all of these survived to their scheduled endpoints. Two animals received sham injections of the FOAM agent (one euthanized on day 7 and one on day 14), and three animals received FOAM agent injections (one euthanized on day 7 and two on day 14). A transitory increase in creatinine and lactate was detected during the first day in the FOAM injected swine but resolved by day 3. No FOAM agent was observed in the peritoneal cavity upon necropsy at day 7 or 14. Histologic data revealed no clinically relevant differences in any organ system between intervention and control animals upon sacrifice at day 7 or 14. CONCLUSIONS This study describes the characteristics, survival, and histological analysis of using FOAM in a porcine model. In our study, FOAM reached the desired intra-abdominal pressure endpoint while not significantly altering basic hematologic parameters, except for transient elevations of creatinine and lactate on day 1. Furthermore, there was no clinical or histological relevant evidence of ischemia, necrosis, or intra-abdominal compartment syndrome. These results provide strong support for the safety of the FOAM device and will support the design of further regulatory studies in swine and humans.
Collapse
Affiliation(s)
- Ross I Donaldson
- Critical Innovations LLC, Los Angeles, CA 90260, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA
- Department of Epidemiology, UCLA-Fielding School of Public Health, Los Angeles, CA 90095, USA
| | | | - Todd L Graham
- Military & Health Research Foundation, Laurel, MD 20723, USA
- Charles T Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | | | | | - David A Tanen
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA
| | - James D Ross
- Military & Health Research Foundation, Laurel, MD 20723, USA
- Charles T Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, OR 97239, USA
- Center for Regenerative Medicine, Oregon Health & Science University School of Medicine, Portland, OR 97239, USA
| |
Collapse
|
46
|
Yao Z, Zhang Y, Jiang L. Commentary on 'A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study' [Int J Surg 2023; 109:1620-28]. Int J Surg 2023; 109:3673-3674. [PMID: 37598375 PMCID: PMC10651283 DOI: 10.1097/js9.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Zengwu Yao
- Yantai Yuhuangding Hospital, Shandong University
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital affiliated with Qingdao University
| | - Yifei Zhang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital affiliated with Qingdao University
| | - Lixin Jiang
- Yantai Yuhuangding Hospital, Shandong University
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital affiliated with Qingdao University
- General Surgery, Yantai Yeda Hospital, Shandong Province, People’s Republic of China
| |
Collapse
|
47
|
Griffin C, Crute W, White W. Robotic-assisted Laparoscopic Repair of a Penetrating Extraperitoneal Bladder Injury. Urology 2023; 181:e205. [PMID: 37619701 DOI: 10.1016/j.urology.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Traumatic intraperitoneal or complicated extraperitoneal bladder injuries are conventionally managed with open exploration and repair. There are rare reports in the literature of laparoscopic repair of intraperitoneal bladder injury secondary to blunt abdominal trauma, as well as two reports of laparoscopic repair of extraperitoneal bladder injuries from blunt abdominal trauma. There are no reported cases of a minimally invasive surgical repair of a penetrating bladder injury. There are also no reported cases of a robotic-assisted laparoscopic repair of a traumatic bladder injury, regardless of the injury mechanism. OBJECTIVE In this video, we demonstrate a surgical technique for a robotic-assisted laparoscopic repair of a penetrating traumatic bladder injury. METHODS We present a case of a 43-year-old male with a penetrating extraperitoneal bladder injury secondary to a gunshot wound. Our patient underwent emergent primary vascular repair of an associated vascular injury. Hemodynamic instability delayed immediate exploration and bladder repair. Cross-sectional imaging and flexible sigmoidoscopy ruled out further visceral injury. Unfortunately, difficulty maintaining catheter patency prompted further surgical intervention. An attempt to evacuate all clots by rigid cystoscopy was unsuccessful, and the decision was made to proceed with a robotic-assisted laparoscopic cystorrhaphy. RESULTS The retropubic space was developed and the extraperitoneal bladder injury was identified. All clot was evacuated and no active bleeding was noted. The bladder mucosa was inspected confirming no additional injury. The cystotomy was closed in two running layers using absorbable sutures. Two leak tests were performed confirming a water-tight repair. The bladder was reapproximated to the anterior abdominal wall to reestablish the retropubic space. A cystogram 1week postoperatively confirmed a successful bladder repair. CONCLUSION Robotic-assisted laparoscopic cystorrhaphy may be a feasible approach for a penetrating extraperitoneal bladder injury in highly select, hemodynamically stable patients.
Collapse
Affiliation(s)
- Chase Griffin
- Department of Urology, University of Tennessee Medical Center, Knoxville, TN.
| | - Winston Crute
- Department of Urology, University of Tennessee Medical Center, Knoxville, TN
| | - Wesley White
- Department of Urology, University of Tennessee Medical Center, Knoxville, TN
| |
Collapse
|
48
|
Krige JE, Jonas EG, Nicol AJ, Navsaria PH. Letter to the Editor: Management and Outcome of Blunt Pancreatic Trauma: A Retrospective Cohort Study. World J Surg 2023; 47:2940-2941. [PMID: 37505310 DOI: 10.1007/s00268-023-07120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Jake E Krige
- HPB Unit, Surgical Gastroenterology and Trauma Centre, Department of Surgery, Groote Schuur Hospital and University of Cape Town Health Sciences Faculty, Observatory, Cape Town, 7925, South Africa.
| | - Eduard G Jonas
- HPB Unit, Surgical Gastroenterology and Trauma Centre, Department of Surgery, Groote Schuur Hospital and University of Cape Town Health Sciences Faculty, Observatory, Cape Town, 7925, South Africa
| | - Andrew J Nicol
- HPB Unit, Surgical Gastroenterology and Trauma Centre, Department of Surgery, Groote Schuur Hospital and University of Cape Town Health Sciences Faculty, Observatory, Cape Town, 7925, South Africa
| | - Pradeep H Navsaria
- HPB Unit, Surgical Gastroenterology and Trauma Centre, Department of Surgery, Groote Schuur Hospital and University of Cape Town Health Sciences Faculty, Observatory, Cape Town, 7925, South Africa
| |
Collapse
|
49
|
Hsu TA, Fu CY. A natural armor of obese patients. Asian J Surg 2023; 46:4768-4769. [PMID: 37268468 DOI: 10.1016/j.asjsur.2023.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
| |
Collapse
|
50
|
Sheff ZT, Zhang A, Geisse K, Wiesenauer C, Engbrecht BW. Treatment of Severe Blunt Splenic Injury Varies Across Race and Insurance Type of Pediatric Patients. J Surg Res 2023; 291:80-89. [PMID: 37352740 DOI: 10.1016/j.jss.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Racial and ethnic disparities in the management of adult patients with blunt splenic injuries (BSIs) have been previously demonstrated. It is unknown if similar disparities exist in pediatric patients with BSIs. Management of BSIs can include operative management, but nonoperative management (NOM) is preferred. This study assesses the association of race and insurance status on use of NOM among pediatric (aged < 18 y) patients following BSI. MATERIALS AND METHODS Data were abstracted from the American College of Surgeons Trauma Quality Improvement Program Participant Use Files for calendar years 2013-2017. Multivariate logistic regression was used to evaluate the associations between race or insurance status and NOM while controlling for injury severity, age, and facility type. Secondary outcomes included blood transfusion within 24 h and hospital length of stay. RESULTS We analyzed 1436 pediatric BSI patients. Black, non-Hispanic patients were less likely (odds ratio: 0.45, 95% confidence interval: 0.21-1.02, P = 0.043) to undergo NOM and stayed 0.6 d longer (P = 0.010) than White, non-Hispanic patients. Uninsured patients were less likely (odds ratio: 0.52, 95% CI: 0.25-1.11, P = 0.080) to undergo NOM and publicly insured patients stayed 0.24 d (P = 0.048) longer than privately insured patients. CONCLUSIONS We found disparities in use of NOM for Black patients and uninsured patients as well as differences in length of stay. These results extend the literature on racial and socioeconomic disparities in care of trauma patients to pediatric BSI patients. Addressing these disparities requires additional studies aimed at identifying the underlying causes.
Collapse
Affiliation(s)
| | - Abbie Zhang
- School of Public Health, Boston University, Boston, Massachusetts
| | - Karla Geisse
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana
| | | | | |
Collapse
|