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American Surgeon

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https://www.readbyqxmd.com/read/29981659/an-interdisciplinary-perioperative-management-protocol-for-patients-with-sickle-cell-anemia-a-single-surgeon-experience
#1
Sara Scarlet, Raeshell S Sweeting, Kenneth I Ataga, Rupa C Redding-Lallinger, Antony A Meyer
No abstract text is available yet for this article.
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981658/follicular-carcinoma-masquerading-as-a-hot-nodule-in-a-pediatric-patient
#2
Benzon M Dy, Nora Katabi, Laura Boucai, Ashok Shaha
Autonomous functioning thyroid nodules (AFTNs) are generally considered to be benign entities, with malignancy found in about 1 per cent considered to be rare in the general population. Because of this low rate, fine needle aspiration is generally not recommended, and these lesions are most often treated with radioactive iodine, medication, or surgery. However, AFTNs are exceedingly rare in the pediatric population and the optimal treatment is not defined. We present a 14-year-old female patient with an AFTN treated with surgical resection and found to contain a follicular carcinoma with capsular invasion...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981657/laparoscopic-appendectomy-a-report-on-1164-operations-at-a-single-institution-safety-net-hospital
#3
Ryan P Dumas, Madhu Subramanian, Erica Hodgman, Michelle Arevalo, Gabriella Nguyen, Kevin Li, Tochi Aijwe, Brian Williams, Alexander Eastman, Stephen Luk, Christian Minshall, Michael W Cripps
Laparoscopic appendectomy (LA) is the standard of care for the treatment of acute appendicitis. There is an ongoing debate regarding the optimal management of appendicitis, which led us to study outcomes after an appendectomy at a large safety-net hospital. We hypothesize that despite a high-risk population, LA remains a safe and effective treatment for acute appendicitis. A retrospective review was performed of all patients who underwent an appendectomy from 2011 to 2013. The primary end point was significant morbidity defined as a score of three or greater on the Clavien-Dindo scale of surgical morbidity...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981656/initial-experience-with-fibrin-glue-treatment-of-anal-fistulae-in-children
#4
Fan-Ting Liao, Chi-Jen Chang
Pediatric anal fistulae commonly result from recurrent perianal abscesses, of which nearly 50 per cent develop an anal fistula. The purpose of this study was to report the results of using fibrin glue to treat anal fistula in pediatric patients. Infants and children with recurrent perianal abscesses and anal fistulae were treated with either fistulectomy or fibrin glue. Demographic and clinical characteristics and outcomes were compared between the groups. A total of 34 children were included; 27 received fistulectomy (median age eight months) and seven received fibrin glue treatment (median age 14 months)...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981655/improving-pharmacologic-prevention-of-vte-in-trauma-impact-it-qi-project
#5
Audis Bethea, Elliot Adams, Frank C Lucente, Damayanti Samanta, Julton Tomanguillo Chumbe
Enoxaparin regimens commonly used for prophylaxis fail to achieve optimal anti-factor Xa levels in up to 70 per cent of trauma patients. Accordingly, trauma services at the study institution endeavored to develop a standardized approach to optimize pharmacologic prevention with enoxaparin. An enoxaparin venous thromboembolism (VTE) prophylaxis protocol implemented in October 2015 provided weight-adjusted initial dosing parameters with subsequent dose titration to achieve targeted anti-factor Xa levels. Symptomatic VTE rate was evaluated 12 months pre- and post-implementation...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981654/use-of-computerized-tomography-in-abdominal-pain
#6
Astha Bhatt, Xihua Yang, Nihaal Karnik, Anne Sill, Gopal Kowdley
Annually, approximately 70 million computed tomography (CT) scans are performed in emergency department (ED) settings in the United States of America. From 1995 to 2007, there has been a 5.9-fold increase in the use of CT scans nationally. The radiation risks and high costs associated with CT scans underscore the fact that the imaging modality, although necessary, carries a myriad of long-term risks to both patients and providers. For the workup of abdominal pain, most algorithms include the use of CT scan as an early step...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981653/predictive-factors-for-delayed-gastric-emptying-after-distal-gastrectomy-with-roux-en-y-reconstruction
#7
Sohei Matsumoto, Kohei Wakatsuki, Kazuhiro Migita, Masahiro Ito, Hiroshi Nakade, Tomohiro Kunishige, Mutsuko Kitano, Mitsuhiro Nakatani, Masayuki Sho
Delayed gastric emptying (DGE) after distal gastrectomy (DG) followed by Roux-en-Y (R-Y) reconstruction is one of the most worrisome complications, and the course of DGE has not been completely elucidated. This retrospective study aimed to evaluate the frequency of DGE after DG followed by R-Y reconstruction for gastric cancer and identify the risk factors for its development. This study included 266 patients with gastric cancer who underwent DG followed by R-Y reconstruction between 2005 and 2016. We compared clinicopathological characteristics and surgical procedures between the DGE group and non-DGE group...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981652/paramedic-and-surgeon-views-on-trauma-surgical-readiness-implications-for-guideline-implementation
#8
Jerome Manson, Kristen Burke, Catherine P Starnes, Kristin Long, Paul A Kearney, Andrew Bernard
Centers for disease control (CDC) Guidelines for Field Triage are effective when proper implementation by EMS personnel is paired with surgeon willingness to care for trauma victims. We hypothesized that in a state with an immature trauma system, a discrepancy exists between medic and surgeon perception of surgical readiness, coinciding with inconsistent implementation of protocols. Surveys were conducted among medics and general surgeons. Destination protocols, trauma center locations, surgeon readiness, and interest in trauma were assessed...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981651/association-of-treatment-for-critical-limb-ischemia-with-gender-and-hospital-volume
#9
Maria J Schaumeier, Alexander T Hawkins, Nathanael D Hevelone, Rosh K V Sethi, Louis L Nguyen
Critical limb ischemia (CLI) is a frequent and major vascular problem and can lead to amputation and death despite surgical revascularization. Women have been shown to have 3 to 4 per cent lower revascularization rates for CLI compared with men as well as inferior outcomes. We hypothesize that this difference is a result of women being more likely admitted to low-volume hospitals, which in turn perform fewer revascularizations. Prospective cohort study. Data from the Nationwide Inpatient Sample 2007 to 2010 were used to identify admissions with primary International Classification of Diseases-9 codes for CLI (International Classification of Diseases-9 codes: 440...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981650/adenoma-detection-rate-in-colonoscopy-does-the-participation-of-a-resident-matter
#10
Jacquelyn S Turner, Desmond Henry, Ayana Chase, Dzifa Kpodzo, Michael C Flood, Clarence E Clark
Presently, endoscopic procedures are a requirement for training competency for completion of a general surgery residency. There are no studies to date that have assessed whether having a resident perform a colonoscopy impacts quality indicators such as adenoma detection rate (ADR). To retrospectively review ADR in adult patients, who undergo screening colonoscopy at a single institution with (ColFacR) and without (ColFac) the participation of a general surgery resident. A total of 792 patients were identified in the database screening colonoscopies between the ages of 45 and 80 from July 2013 to June 2015...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981649/importance-of-markers-of-sepsis-in-surgical-patients
#11
Marek Smolár, Ivana Dedinská, Michal Hošala, Július Mazúch, L'udovit Laca
Sepsis, severe sepsis, and septic shock represent a serious medicinal and general social problem and still maintain an important position among the present issues in the basic and clinical research. In the prospective analysis of patients satisfying the criteria of septic condition, we determined serum levels of bioparameters in three consecutive days from the first signs of sepsis depending on the stage or advancement of the septic condition. We determined the most significant parameter/parameters which are able to determine the stage of sepsis or to predict patient's death...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981648/comparison-of-outcomes-for-pediatric-trauma-at-different-types-of-trauma-centers-the-unresolved-mystery
#12
Adel Elkbuli, Jennifer R Lopez, Paul Perales Villarroel, Darwin Ang, Huazhi Liu, Dessy Boneva, Orlando Morejon, Shaikh Hai, Mark McKenney
In Florida, injured children can receive emergent care at one of three types of state-approved trauma centers (TCs). A Level 1 combined adult/pediatric TC (L1, A + P), a Level 2 TC with an associated pediatric hospital (L2 + PH) or a pediatric TC at a pediatric hospital (PTH). This study aims to compare the mortality outcomes between Florida L1, A + Ps, to L2 + PHs, and PTHs. A retrospective review of dataset from the Agency for Health Care Administration compared outcomes from 2013 to 2016 at all three types of TCs...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981647/correlating-geographic-location-with-incidence-of-motor-vehicle-induced-pedestrian-injury
#13
Neal Bhutiani, Keith R Miller, Matthew V Benns, Nicholas A Nash, Glen A Franklin, Jason W Smith, Brian G Harbrecht, Matthew C Bozeman
To date, no studies have examined the relationship between geographic and socioeconomic factors and the frequency of pedestrians sustaining traumatic injuries from a motor vehicle. The objective of this study was to analyze the impact of location on the frequency of pedestrian injury by motor vehicle. The University of Louisville Trauma Registry was queried for patients who had been struck by a motor vehicle from 2010 to 2015. Demographic and injury information as well as outcome measures were evaluated to identify those impacting risk of pedestrian versus motor vehicle accidents...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981646/ultrasound-guided-breast-conservative-surgery-decreases-the-rate-of-reoperations-for-palpable-breast-cancer
#14
Salvatore Vieni, Giuseppa Graceffa, Roberta Priola, Martina Fricano, Stefania Latteri, Mario A Latteri, Calogero Cipolla
The purpose of this study is to verify whether the performance of ultrasound-guided quadrantectomy (USGQ) versus palpation-guided quadrantectomy (PGQ) can reduce the incidence of positive margins and if it can change the attitude of the surgeon. A retrospective study was conducted on 842 patients underwent quadrantectomy for breast cancer, 332 of them underwent USGQ, whereas 550 underwent PGQ. The histological type of the tumors and the margin status obtained with the histological examination were compared...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981645/assessing-the-veterans-affairs-surgical-quality-improvement-program-risk-calculator-in-cholecystectomy
#15
Jonathan B Imran, Oswaldo Renteria, Maria Ruiz, Thai H Pham, Ali A Mokdad, Sergio Huerta
The Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk calculator has been validated for several operations but has not been assessed specifically for cholecystectomy. Our aim was to externally validate the VASQIP calculator's accuracy in predicting 30-day morbidity and mortality (M&M) for patients undergoing cholecystectomy. A retrospective review of patients undergoing cholecystectomy at the North Texas Veterans Affairs hospital was performed. The VASQIP risk calculator was used to determine predicted 30-day M&M, which was compared with actual M&M...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981644/splenic-bed-laparoscopic-splenectomy-approach-for-massive-splenomegaly-secondary-to-portal-hypertension-and-liver-cirrhosis
#16
Guangjin Tian, Deyu Li, Haibo Yu, Yadong Dong, Huanzhou Xue
This study was performed to evaluate the feasibility of the splenic bed laparoscopic splenectomy approach (SBLS) for massive splenomegaly (≥30 cm) in patients with hypersplenism secondary to portal hypertension and liver cirrhosis. Patients who underwent laparoscopic splenectomy (LS) from January 2012 to December 2016 were retrospectively reviewed. We performed LS in 83 patients with massive splenomegaly (≥30 cm) secondary to portal hypertension and liver cirrhosis. Of these patients, 37 underwent the SBLS and 46 underwent anterior LS (ALS)...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981643/wiser-with-age-increased-per-surgeon-elderly-patient-volume-is-associated-with-lower-postinjury-complications
#17
Elizabeth Warnack, Joshua Simon, Quoc Dang, Joseph Catino, Marko Bukur
We hypothesize that higher elderly patient volume per trauma surgeon is associated with fewer clinical complications. This is a retrospective cohort study which included elderly patients admitted to trauma surgery service within a five-year period, from 2009 to 2013, at two Level I trauma centers in Florida. Trauma surgeons were stratified into three groups depending on patient volume. Primary outcomes were postinjury complications and in-hospital mortality, and secondary outcomes were hospital length of stay (LOS), intensive care unit LOS, and ventilator days...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981642/heller-myotomy-to-wrap-or-not-to-wrap
#18
Jordan Brown, Michael Egger, Farid J Kehdy
Heller myotomy (HM) is widely recognized as the most effective treatment of achalasia. Although effective in improving dysphagia symptoms, HM is associated with reflux. Over a five-year period, 63 laparoscopic HM were performed. Patients underwent myotomy alone or HM plus reconstitution of the angle of His without any fundoplication, anterior, or posterior partial fundoplication. Two postoperative outcomes were examined: dysphagia and reflux. Twenty-two patients received no fundoplication (34.9%). Forty-one (65...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981641/the-role-of-noncontrast-ct-in-the-evaluation-of-surgical-abdomen-patients
#19
Pei-Hua Li, Yu-San Tee, Chih-Yuan Fu, Chien-Hung Liao, Shang-Yu Wang, Yu-Pao Hsu, Chun-Nan Yeh, En-Haw Wu
Acute surgical abdomen is commonly encountered in the ED and CT is widely used as an informative diagnostic tool to evaluate potential surgical indications. However, the adverse effects of contrast material used in CT scanning have been documented. We sought to delineate the role of noncontrast CT in the evaluation of patients with acute surgical abdomen. Between August 2015 and December 2015, patients with nontraumatic surgical abdomen who underwent preoperative CT were enrolled in the current study. The patients for whom the CT results permitted surgical decision-making were the focus of this study...
June 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29981640/cost-analysis-of-direct-oral-anticoagulants-compared-with-warfarin-in-patients-with-blunt-traumatic-intracranial-hemorrhages
#20
Laura C Lamb, Monica DiFiori, Christopher Comey, James Feeney
Direct oral anticoagulants (DOACs) are rapidly gaining popularity as alternatives to warfarin in the prevention of stroke or systemic embolic events because of the simplicity of their dosing and lack of monitoring requirement. Many physicians feared that these novel agents would be cost-prohibitive not only in their administration but also in their sequelae of bleeding, given the few reversal agents available. Whereas the medication itself is more expensive than traditional warfarin, the total cost of a hospital admission has not been compared between patients on DOACs and warfarin who have sustained a blunt traumatic intracranial hemorrhage (ICH)...
June 1, 2018: American Surgeon
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