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American Journal of Surgery

Cassie A Barton, Marissa Hom, Nathan B Johnson, Jon Case, Ran Ran, Martin Schreiber
INTRODUCTION: Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal. METHODS: A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded...
January 5, 2018: American Journal of Surgery
Elaine McKevitt
No abstract text is available yet for this article.
January 5, 2018: American Journal of Surgery
Thomas W Clements, Michael Dunham, Andrew Kirkpatrick, Ruphus Rajakumar, Carolyn Gratton, Rohan Lall, Paul McBeth, Chad G Ball
BACKGROUND: Evidence for repeat computed tomography (CT) in minor traumatic brain injury (mTBI) patients with intracranial pathology is scarce. The aim of this study was to investigate the utility of clinical cognitive assessment (COG) in defining the need for repeat imaging. METHODS: COG performance was compared with findings on subsequent CT, and need for neurosurgery in mTBI patients (GCS 13-15 and positive CT findings). RESULTS: Of 152 patients, 65...
January 5, 2018: American Journal of Surgery
John Kuckelman, Riyad Karmy-Jones, Elizabeth Windell, Seth Izenberg, Jean-Stephane David, William Long, Matthew J Martin
BACKGROUND: Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management. METHODS: Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location. RESULTS: Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60...
January 5, 2018: American Journal of Surgery
James P Dolan
No abstract text is available yet for this article.
January 5, 2018: American Journal of Surgery
John Kuckelman, Mike Derickson, Cody Phillips, Morgan Barron, Shannon Marko, Matthew Eckert, Matthew Martin
INTRODUCTION: Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate. METHODS: Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n = 25), bladed trocar with 36Fr cannula (BTW, n = 16), bladed trocar alone (BTWO, n = 16) and surgical thoracostomy (ST = 11). Simulated tPTX was created to a pressure(p) of 20 mmHg. RESULTS: Success (p < 5 mmHg by 120 s) was seen in 41 of 68 (60%) interventions...
January 5, 2018: American Journal of Surgery
Anastasio Salazar-Bañuelos, Mauricio Monroy-Cuadros, Hoover Henriquez-Cooper
BACKGROUND: Minimizing ischemia is paramount in the procurement of kidneys for transplantation. A fast cooling and expeditious removal is ideal to minimize damage from warm ischemia, however, since the removal of kidneys is delayed in cadaver donation until all other organs are harvested, the risk of kidney damage increases due to contact with the warmer soft body tissues. Surgical techniques that expedite organ retrieval were developed to avoid organ damage. METHODS: We test a modification of Thomas Starzl's improved technique for multi-organ harvesting by interposing an ice bag between the posterior aspect of the kidney and the psoas muscle in a randomized trial with 21 multi-organ cadaver donors...
January 4, 2018: American Journal of Surgery
Steve R Siegal, James P Dolan, Elizabeth N Dewey, Alexander R Guimaraes, Brandon H Tieu, Paul H Schipper, John G Hunter
BACKGROUND: Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer. METHODS: Retrospective review of consecutive esophagectomies from 2010 to 2015. Computed tomography studies were analyzed for sarcopenia. Morbidity was analyzed using Fischer's test and survival data with Kaplan Meier curves. RESULTS: The sarcopenic group (n = 127) had lower BMI, later stage disease, and higher incidence of neoadjuvant radiation than those without sarcopenia (n = 46)...
January 4, 2018: American Journal of Surgery
Mary A Decoteau, Louis Rivera, Kristina Umali, Arden B Chan, Peter Soballe, Romeo C Ignacio
BACKGROUND: There are several factors that influence ABSITE scores, but the optimal approach for remediation of poor scores is unclear. METHODS: A structured academic curriculum and focused remediation program (FRP) were implemented to improve academic performances. Within a 15-year period, ABSITE and American Board of Surgery qualifying exam (ABS QE) results were compared before and after the establishment of the program using a paired T-test. Subgroup analysis was performed for residents who completed the FRP...
December 21, 2017: American Journal of Surgery
Sheena K Harris, Erica L Mitchell, Michael R Lasarev, Fouad Attia, John G Hunter, Brett C Sheppard
BACKGROUND: Hospital-associated UTI rates in surgery patients have not improved despite recommendations for reducing indwelling catheter days. METHODS: We performed a retrospective review of institutional NSQIP general surgery patient data, 2006-2015. During this time, a UTI-reduction policy was implemented. Demographics, HA-UTI incidence, CA-UTI incidence, indwelling catheter days, straight catheterization rates, and mortality were examined. RESULTS: Females had significantly higher risk of HA-UTI...
December 14, 2017: American Journal of Surgery
Eun Cho, Eun-Kyung Kim, Hee Jung Moon, Jung Hyun Yoon, Vivian Y Park, Jin Young Kwak
BACKGROUND: To evaluate the utility of ultrasound (US) patterns based on the 2015 American Thyroid Association (ATA) guidelines and cytologic diagnosis of the Bethesda System for Reporting Thyroid Cytopathology as predicting markers for lymph node metastasis (LNM) in classical papillary thyroid carcinoma (PTC). METHODS: A retrospective analysis of 657 patients with classical PTC who underwent ultrasound-guided fine-needle aspiration (US-FNA) and surgery were included in this study...
December 14, 2017: American Journal of Surgery
Giovanni Marchegiani, Stefano Andrianello, Rafael Pieretti-Vanmarcke, Giuseppe Malleo, Tiziana Marchese, Francesca Panzeri, Carlos Fernandez-Del Castillo, Keith D Lillemoe, Claudio Bassi, Roberto Salvia, Cristina R Ferrone
BACKGROUND: Distal pancreatectomy (DP) continues to carry a significant risk of morbidity resulting in hospital readmissions and increased costs. Prognostic factors predicting 30-day readmission after DP were evaluated. METHODS: Data were collected from 946 patients undergoing DP at the University of Verona Hospital Trust and the Massachusetts General Hospital between 2004 and 2014. Patients were divided into a derivation and a validation cohort. RESULTS: The 30-day readmission rate was 13...
December 14, 2017: American Journal of Surgery
Tomoko Mizota, Yo Kurashima, Saseem Poudel, Yusuke Watanabe, Toshiaki Shichinohe, Satoshi Hirano
BACKGROUND: Despite its advantages, few trainees outside of North America have access to simulation training. We hypothesized that a stepwise training method using tele-mentoring system would be an efficient technique for training in basic laparoscopic skills. METHODS: Residents were randomized into two groups and trained to proficiency in intracorporeal suturing. The stepwise group (SG) practiced the task step-by-step, while the other group practiced comprehensively (CG)...
December 14, 2017: American Journal of Surgery
L D Britt
The term, Festschrift, is defined as a volume of learned articles or essays by colleagues and admirers, serving as a tribute to a scholar. The recognition of LaSalle D. Leffall, Jr., M.D., F.A.C.S. adds credence to the merits of such a tribute.
December 12, 2017: American Journal of Surgery
Greg Wynn, Panagis Lykoudis, Pasquale Berlingieri
BACKGROUND: Contemporary surgical training can be compromised by fewer practical opportunities. Simulation can fill this gap to optimize skills' development and progress monitoring. A structured virtual reality (VR) laparoscopic sigmoid colectomy curriculum is constructed and its validity and outcomes assessed. METHODS: Parameters and thresholds were defined by analysing the performance of six expert surgeons completing the relevant module on the LAP Mentor simulator...
December 12, 2017: American Journal of Surgery
Lies Ter Beek, Louise B D Banning, Linda Visser, Jan L N Roodenburg, Wim P Krijnen, Cees P van der Schans, Robert A Pol, Harriët Jager-Wittenaar
BACKGROUND: Malnutrition is an important risk factor for adverse post-operative outcomes. The prevalence of risk for malnutrition is unknown in patients prior to vascular surgery. We aimed to assess prevalence and associated factors of risk for malnutrition in this patient group. METHODS: Patients were assessed for risk for malnutrition by the Patient-Generated Subjective Global Assessment Short Form. Demographics and medical history were retrieved from the hospital registry...
December 9, 2017: American Journal of Surgery
Michael E Zenilman, Julie-Ann Freischlag
With expansion of health care systems across the country, close relationships need to be developed between academic medical centers and their affiliated community hospitals. This creates opportunity to integrate surgical programs across different hospitals. Herein we describe a model of surgical integration at the system level of five large hospitals. We discuss utilizing advantages that both the academic and community hospital bring to the model. A close relationship between an interdisciplinary team, which includes the academic surgical chair, a regional director liaison who was embedded in the community, individual hospital leadership, and practice plan leaders was created...
December 8, 2017: American Journal of Surgery
Michael B Goldberg, Michael Mazzei, Zoë Maher, Joel H Fish, Richard Milner, Daohai Yu, Amy J Goldberg
BACKGROUND: Stress management programs improve efficacy in aviation, military, and professional sports; however, similar educational strategies have not been adopted in surgical training. We have evaluated the effectiveness of a stress management program for surgical residents. METHODS: From 2011 to 2016, 137 surgical residents participated in a prospective, blinded study. The intervention group (n = 65) underwent training in self-awareness, focus, relaxation, positive self-talk, visualization, and team building...
December 8, 2017: American Journal of Surgery
Electron Kebebew
Ethnic disparity in disease incidence, prevalence, and outcome has been documented for a variety of diseases and cancers. Dr. LaSalle D. Leffall was one of the first to note that genetic susceptibility is one important aspect that needed to be studied to better understand cancer disparity. In this article, we cover disparity in endocrine neoplasm presentation and new, emerging genetic data that may explain this disparity.
December 8, 2017: American Journal of Surgery
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