bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Fat Accumulation and Postoperative Complications after Abdominal Surgery
Authors: Tsukada Katsuhiko , Miyazaki Tatsuya , Kato Hiroyuki , Masuda Norihiro , Fukuchi Minoru , Fukai Yasuyuki , Nakajima Masanobu , Ishizaki Masatoshi , Motegi Masahiko , Mogi Akira , Sohda Makoto , Moteki Takao , Serine Tomoaki , Kuwano Hiroyuki
Published: November 2022

The contribution of subcutaneous or intra-abdominal fat (SCF, IAF) accumulation to postoperative mortality or morbidity after elective gastric or colorectal cancer surgery was studied. One hundred thirty-nine patients who underwent gastric or colorectal cancer surgery were investigated. Data were collected on the following preoperative comorbid conditions: lung dysfunction, cardiovascular dysfunction, liver dysfunction, or diabetes mellitus (DM). The IAF and SCF areas were determined at the umbilical level by preoperative CT scanning. We investigated whether IAF or SCF was independently associated with postoperative mortality or morbidity. The mortality rate was 0.7 per cent (1/139). Nineteen (14%) of 139 patients had medical complications (pneumonitis or arrhythmia) and 27 (19%) had surgery-related complications (anastomotic leakage, intra-abdominal collections, or abdominal wound infection) postoperatively. Age (≥70 years), lung dysfunction, cardiovascular dysfunction, and IAF were significantly associated with medical complications, and surgical site (gastric/colorectal), DM, body mass index, IAF, and SCF were significant for surgery-related complications by univariate analysis. Multilogistic regression analysis showed that age, cardiovascular dysfunction, and IAF were significant for medical complications, and surgical site, DM, and SCF were independently related with surgery-related complications. Body fat accumulation is independently associated with postoperative morbidity after gastric or colorectal surgery, and assaying it may be useful for predicting postoperative complications.
The Anatomy of Teaching and the Teaching of Anatomy
Authors: Peck David , Skandalakis John E.
Published: November 2022

Professional education is one of the greatest problems currently confronting the healing professions. The incorporation of basic science departments into colleges of medicine has affected curriculum design, research, admissions criteria, and licensure. Those who are not practicing members of a particular health care profession wield undue influence in medical schools. Ideally, gross anatomy teachers should be health care professionals who use anatomy in their practices. Reorganization of medical education will heal the rift between research and clinical medicine.
Repair of Giant Abdominal Hernias: Does the Type of Prosthesis Matter?
Authors: Diaz Jose J. , Gray Brian W. , Dobson Jean M. , Grogan Eric L. , May Addison K. , Miller Richard , Guy Jeffrey , O'Neill Patrick , Morris John A.
Published: November 2022

Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (≥20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non–Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized χ2test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (±16.3), males outnumbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study ( n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non–Gore-Tex subgroup comparison results were as follows: GT ( n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG ( n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.
Subintimal Recanalization is Safe and Effective in Treating Chronic Critical Limb Ischemia in Selected Patients
Authors: Harthun Nancy L. , Cage Dorothy L. , Spinosa David J.
Published: November 2022

Subintimal recanalization is a percutaneous technique that allows revascularization in patients with limb-threatening ischemia. It was first described by Bolia (Cardiovasc Intervent Radiol 13;357–63:1990) but has not gained widespread use in the United States. Twenty-five patients with 32 threatened limbs were referred from a single surgeon's practice over a 23-month period. All patients were either high-risk surgical patients, due to severe medical comorbidities, or not surgical candidates due to poor target vessels, lack of appropriate conduit, or failed previous surgical revascularizations. The average age of patients was 69. There were 15 men and 10 women treated. Subintimal recanalization was immediately successful in 30 limbs. One peri-procedural death occurred, although this patient underwent a surgical bypass graft procedure in the same hospitalization. Three significant complications occurred (myocardial infarction, ventricular arrhythmia, and gastrointestinal hemorrhage). Primary patency is 83 per cent. Secondary patency is 90 per cent. Limb salvage rate is 88 per cent. Mean follow-up period is 10 months. Eight patients died in the follow-up period due to unrelated causes.
Diabetes Insipidus in the Head-Injured Patient
Authors: Boughey Judy C. , Yost Michael J. , Bynoe Raymond P.
Published: November 2022

Diabetes insipidus (DI) is an uncommon but important complication in the head-injured population. A retrospective review of all trauma patients admitted to the intensive care unit (ICU) during a 4-year period who developed DI was undertaken. The incidence of DI was 1.3 per cent in ICU trauma admissions and 2.9 per cent in traumatic head injuries admitted to the ICU. The overall mortality was 69 per cent (18/26). The mean onset time of DI in nonsurvivors (1.5 ± 0.7 days) was shorter compared to survivors (8.9 ± 10.2 days) ( P < 0.001). All patients who died developed DI within the first 3 days of hospitalization. Patients who develop DI early in their course have a higher mortality than those who develop DI later in their hospital course. The development of diabetes insipidus after head injury carries a 69 per cent mortality rate, and if the onset is within the first 3 days after injury, mortality rate rises to 86 per cent.
Is There a Racial Difference in Presentation of Primary Hyperparathyroidism?
Authors: Barker Holly , Caldwell Lauren , Lovato James , Woods Kristy F. , Perrier Nancy D.
Published: November 2022

Nearly 50,000 new cases of primary hyperparathyroidism (PHPT) are diagnosed annually in the United States. Most information about the disease focuses on the white population. We evaluated African American (AA) and white patients at our tertiary care university medical center to determine whether there was a racial difference in presentation of PHPT. A retrospective chart review of patients treated surgically for PHPT between 1997 and 2002 was performed. Demographic data, laboratory values, objective symptoms, surgical procedure, and histologic findings were recorded. The AA participants were matched to whites by age and gender. The effect of race was adjusted for the matching variables by including them in regression models. ANOVA χ2 tests were performed on the race effects. Thirty-six (14.4%) of the 286 patients treated for PHPT at Wake Forest University Baptist Medical Center during this 5-year period were AA. There was no difference in serum calcium or presence of objective symptoms, but PTH levels were significantly higher for blacks (207.5 vs 143.5 pg/mL; P = 0.02). In our study, AA patients had significantly higher parathyroid hormone levels at time of surgical intervention but did not present with a difference in symptoms or more advanced disease. Further research is recommended to characterize ethnic differences in patients with PHPT.
Hemicorporectomy for Chronic Pressure Ulcer Carcinoma: 7 Years of Follow-Up
Authors: Peterson Richard , Sardi Armando
Published: November 2022

Development of squamous cell carcinoma (Marjolin's ulcer), a well-known and rare complication of chronic ulcers, sinuses, chronic osteomyelitis and burn scars, may complicate chronic pressure ulcers. For several years, reports have suggested these cancers (pressure sore carcinoma, PSC) are highly fatal and aggressive, unlike other Marjolin's ulcers. A 39-year-old male, paraparetic from spina bifida, with history of chronic pressure sores and osteomyelitis of the pelvic bones underwent multiple resections. A descending colostomy was performed to avoid soiling of the perineum and decubitus ulcers. He developed squamous cell carcinoma in multiple pelvic areas. He was dependent on two daily visits by home care nurses for wound care. After negative workup for metastasis, as his only chance for cure he was offered hemicorporectomy, which was performed at the L4-L5 disc level. A prosthesis was applied 1 month after the surgery. As of November 2003, he remains disease-free after 7 years (90 months) from initial surgery. He is employed as a computer programmer, is self-dependent, and also drives. Aggressive treatment in select patients with PSC is essential and can lead to long-term disease control and increase in overall quality of life.
Surgical and Ablative Treatment for Metastatic Adenocarcinoma to the Liver from Unknown Primary Tumor
Authors: Hawksworth J. , Geisinger K. , Zagoria R. , Kavanagh P. , Howerton R. , Levine E.A. , Shen P.
Published: November 2022

Metastatic adenocarcinoma to the liver from an unknown primary tumor (UPT) carries a poor prognosis, with a median survival of 5 months. Chemotherapy has not significantly improved outcome, and effective treatment is yet to be established in these patients. We examined our experience with surgical resection and ablation of this disease to determine clinico-pathologic characteristics and treatment outcomes. We undertook a retrospective chart review of 157 patients who were treated for metastatic disease to the liver with resection or radiofrequency ablation (RFA) between 1999 and 2003. Seven patients were identified with unknown primary malignancy. Evaluation of the seven patients included complete history and physical examination, complete blood count, routine chemistries, stool Hemoccult test, chest radiograph, and computed tomography (CT) of the abdomen and pelvis. In addition, the three female patients had breast examinations and mammography. Adenocarcinoma histology was determined via CT-guided liver biopsy in all patients. Other diagnostic tests, including whole-body positron emission tomography to the measurement of various serum tumor markers, were performed in the majority of the patients. There were nine total lesions treated; six with RFA and three with hepatic resection. Median diameter of the lesions was 5.4 cm (range, 1.3–15). Two patients were treated with adjuvant and three patients with neoadjuvant and adjuvant chemotherapy. Extrahepatic sites of metastases, adrenal and skeletal, were discovered in 1 patient prior to treatment. With a median follow-up of 9 months, 1 patient is currently alive with no evidence of disease, 4 patients are alive with disease, and 2 patients died of disease. Median disease-free-interval following treatment was 6.5 months. To date, optimal treatment for metastatic adenocarcinoma to the liver UPT remains unclear. Localized treatment involving RFA or hepatic resection may be a promising addition to chemotherapy in the management of this disease.
Brachial Artery Pseudoaneurysm in a 6-Week-Old Infant
Authors: Gow Kenneth W. , Mykytenko James , Patrick Ellen L. , Dodson Thomas F.
Published: November 2022

Trauma to the wall of an artery may lead to the development of a pseudoaneurysm. There are infrequent case reports of children who have developed pseudoaneurysms after vascular access attempts. The options for management are limited in children and even more so in neonates. We describe the presentation and management of a 6-week-old infant who had attempts at insertion of an intravenous catheter as a newborn. She presented with an enlarging mass of the right upper extremity with no palpable radial pulse on examination. Workup included radiographs, Doppler ultrasound, and magnetic resonance imaging that established the diagnosis of pseudoaneurysm of the brachial artery. She underwent a repair of the right brachial artery by identifying the site of the arterial injury and oversewing the defect in the wall. Intraoperatively, she had good arterial flow with a return of the radial pulse. The patient did well immediately postoperatively and has been followed for more than a year with normal pulses and growth of the upper extremity. Patients that have had previous attempts at vascular access and subsequently develop a mass in the area of puncture should be worked up for the potential of a pseudoaneurysm. Doppler ultrasound and magnetic resonance imaging may help with diagnosis. Primary repair is advocated in this injury to ensure adequate growth of the limb.
Laryngotracheal Injuries: Does Injury Mechanism Matter?
Authors: Stassen Nicole A. , Hoth J. Jason , Scott Melanie J. , Day Carolyn S. , Lukan James K. , Rodriguez Jorge L. , Richardson J. David
Published: November 2022

Laryngotracheal injuries are potentially lethal injuries whose diagnosis can be difficult. The purpose of this study was to delineate the effect of injury mechanism on the types of injury sustained and patient outcome. Patient records during a 7-year period were reviewed for injury mechanism, patient demographics, clinical presentation, patient evaluation, injury location, associated injuries, operative interventions, and outcome. Fifteen patients with laryngotracheal injuries were studied. Blunt injuries were more common (60%). Patient demographics, mortality, average length of stay, and Injury Severity Score were similar for both groups. Prevalent physical findings on examination included subcutaneous air (53%), hoarseness (47%), stridor (20%), and neck tenderness (27%). Diagnosis was confirmed by CT scan of the neck (66% blunt, 33% penetrating) or bronchoscopy (44% blunt, 66% penetrating). Injury location, patient disposition, and associated injures were the same for both groups. The most frequent operative intervention performed for both groups consisted of a primary airway repair via a collar incision within 8 hours of injury. Only patients with a laryngeal injury required concomitant tracheostomy regardless of mechanism. Blunt and penetrating neck injuries resulted in similar types of tracheal and laryngeal injuries. Anatomic location of the injury determined the need for tracheostomy. Regardless of mechanism, the overall outcome for patients with laryngotracheal injuries is good when injuries are recognized and treated expeditiously. A high level of suspicion must be maintained when evaluating all potential laryngotracheal injury patients irrespective of the mechanism of injury.
Should Female Patients Undergoing Parathyroid-Sparing Total Thyroidectomy Receive Routine Prophylaxis for Transient Hypocalcemia?
Authors: Bove A. , Bongarzoni G. , Dragani G. , Serafini F. , Di Iorio A. , Palone G. , Stella S. , Corbellini L.
Published: November 2022

Hypocalcemia following parathyroid-sparing total thyroidectomy is frequent and can prolong hospital stay. We undertook this study to identify preoperative predictors of postoperative hypocalcemia useful in the postoperative management of these patients. We examined patients undergoing total thyroidectomy for benign disease with preservation of at least three parathyroids from January 2000 to January 2001. Low serum calcium was considered below 8.0 mg/dL. Age, gender, preoperative serum calcium, thyroid stimulating hormone (TSH), T3, T4, albumin, cholesterol, and tryglicerides were compared in patients with normal and low serum calcium level on the second postoperative day and on discharge day by using χ2test and a model of logistic regression. Data were reported using their frequency distribution among the two groups of patients. Eighty patients, 60 females (F) and 20 males (M), underwent parathyroid-sparing total thyroidectomy. On second postoperative day, hypocalcemia occurred in 42 patients, and 56 per cent were symptomatic. Only female gender (88% F vs 12% M) ( P < 0.05) and TSH <0.27 mUI/mL (38% vs 18%) ( P < 0.05) predicted hypocalcemia. Similarly, female gender predicted hypocalcemia in a logistic regression analysis ( P < 0.05). On the day of discharge, 22 patients had low serum calcium levels, and 50 per cent were symptomatic. At this time, only TSH value <0.27 mlU/mL significantly predicted hypocalcemia (48% vs 17%) ( P < 0.05). This was confirmed in a logistic regression analysis ( P < 0.05). All but one patient (98%) eventually returned to normal serum calium levels. Despite preservation of parathyroids, transient symptomatic hypocalcemia is common after total thyroidectomy. Female gender and low TSH serum level predicted hypocalcemia. Therefore, female patients undergoing total thyroidectomy with preoperative low TSH levels should receive calcium prophylaxis to decrease morbidity, shorten hospital stay, and decrease costs.
Surgeon-Performed Ultrasound in the Management of Thyroid Malignancy
Authors: Solorzano Carmen C. , Carneiro Denise M. , Ramirez Marcela , Lee Theresa M. , Irvin George L.
Published: November 2022

Surgeon-controlled real-time ultrasound (US) is a new adjunct in the management of patients with thyroid malignancy. The introduction of US as a routine evaluation tool has increased the recognition of nonpalpable thyroid cancers and cervical lymph node metastases. We report our experience and the change in management of patients with thyroid cancer due to the use of US. We reviewed the records of all patients undergoing neck operations for thyroid cancer since 2002. US was performed by a surgeon preoperatively in all patients and intraoperatively when nonpalpable cervical lymph nodes were present. Suspicious nonpalpable thyroid nodules underwent US-guided fine-needle aspiration (FNA) for cytology. Seventy-two patients underwent operations for thyroid cancer. US influenced the management in 57 per cent (41/72) of patients. US was useful in 1) identification and guidance for the FNA of nonpalpable cancers in 28 per cent (20/72), 2) identification of nonpalpable nodules in the contralateral lobe in 38 per cent (27/72), 3) preoperative diagnosis of nonpalpable metastatic lymph nodes in 24 per cent (17/72), and intraoperative guidance for their excision. Surgeon-performed US changed and enhanced the pre- and intraoperative management in more than half the patients with thyroid cancer.
Subareolar Injection of Radioactive Colloid for Sentinel Lymph Node Identification in Breast Cancer Patients
Authors: Péley Gábor , Sinkovics István , Tóth József , Farkas Emil , Keresztes Sándor , Köves István
Published: November 2022

Sentinel lymph node biopsy (SLNB) is becoming the standard for staging the axilla in breast cancer patients in many institutions. The best method of injection is still questionable. The purpose of this study was to compare the results of SLNB using the peritumoral or the subareolar injection site. Between December 1997 and March 2000, we performed 100 SLNBs. Technecium-labeled colloidal human serum albumin was injected peritumorally (Group A, 31 patients; Group B, 31 patients) or subareolarly (Group C, 38 patients). Patent blue dye was given periareolarly (Group A) or peritumorally (Groups B and C). Preoperative lymphoscintigraphy was performed in all patients. SLNB was successful in 94 patients (94%). The identification rate improved from 80 per cent (first 25 patients) to 99 per cent (last 75). The subareolar injection of the colloid did not adversely influence the results of SLNB compared with the peritumoral injection (identification rate, 100% vs 97%; false negative rate, 6% vs 14%). The subareolar injection of colloid is a simple and at least as accurate technique as the peritumoral one. This technique can also improve the identification rate of SLNB for breast cancer patients.
Resident Work Hours: Can We Meet the ACGME Requirements?
Authors: Cockerham W. Todd , Cofer Joseph B. , Lewis Patricia L. , Scroggins Candice M. , Burns R. Phillip
Published: November 2022

The Accreditation Council for Graduate Medical Education (ACGME) requires all programs to limit resident work hours to 80 hours per week with some programs allotted an extra 10 per cent for specific educational purposes. The purpose of this study was to evaluate data reflecting changes in resident schedules made in 2002–2003 to be compliant with ACGME requirements without compromising patient care or resident education. Surgery residents originally completed a work-hour survey in May 2002. The survey contained 14 daily time sheets. Residents were asked to document how their time was spent between 14 different categories delineating in-house and out-of-house hours. Changes were made to resident schedules in order to become compliant with the new regulations. After making changes in the schedule, two more surveys were completed and evaluated, once in May 2003 and again in November 2003. Final analyses compared results from May 2002 to November 2003. Surveys were distributed to 30 residents in May 2002. Twenty-two residents completed the survey with 16 surveys eligible for analysis following exclusion of abnormal rotations (i.e., research and vacation). Eighty-eight per cent of junior residents (PGY 1, 2, and 3), 50 per cent of senior residents (PGY 4–5), and 33 per cent of chief residents (PGY 6) worked more than 88 hours per week. In November 2003, surveys were sent to 32 residents. Twenty-four residents who were on our normal call schedule completed the survey. Fourteen per cent of junior residents, 33 per cent of senior residents, and 0 per cent of chief residents worked more than 88 hours per week. By making the changes described, we have substantially reduced the number of resident work-hours while maintaining our academic and patient care missions.
Laparoscopic Fundoplication: 5-Year Follow-up
Authors: Dassinger M.S. , Torquati A. , Houston H.L. , Holzman M.D. , Sharp K.W. , Richards W.O.
Published: November 2022

There are few published reports on outcomes of 5 or more years following laparoscopic fundoplication. Gastroesophageal reflux disease (GERD) specific quality of life questionnaires (QOLRAD), short form health surveys (SF12), and queries regarding current medication use and long-term satisfaction were mailed to all patients who underwent laparoscopic fundoplication at our institution. Results are reported as mean ± SEM. Seventy-six patients underwent laparoscopic fundoplication (63 Nissen, 13 Toupet) between November 1992 and December 1997. Fifty-two patients completed questionnaires (68%). Mean follow-up was 5.1 ± 0.2 years (range, 4–9 years). Mean QOLRAD scores were 5.8 ± 0.2, (scale 0–7, a higher score reflecting improved QOL), which is comparable to the general population (6.0 mean). SF-12 mental and physical scores were 46.6 ± 1.7 and 34.2 ± 1.6, respectively, versus 50.7 and 51.2 for the general population. Forty-seven patients (92%) would have the procedure again. Eleven (21%) remained on antisecretory medications (15% proton pump inhibitor and 6% H2 receptor antagonists). None of the 11 patients underwent 24-hour pH testing to document persistent acid exposure. Furthermore, postoperative symptoms of heartburn, dysphagia, and abdominal bloating were rated as none to mild in the majority of patients. Laparoscopic fundoplication is an effective long-term treatment for GERD, resulting in high patient satisfaction, improved quality of life, and elimination of antisecretory medicines in the majority of patients.
Infectious Complications after Hepatic Resection
Authors: Garwood Robert A. , Sawyer Robert G. , Thompson Lee , Adams Reid B.
Published: November 2022

The purpose of this study was to assess the characteristics of surgical infections after hepatic resection (HR) to identify factors accounting for increased postoperative mortality. Advances in operative technique and care have decreased morbidity and mortality after HR. However, infections after HR continue to be a major contributor to postoperative morbidity and mortality. All HR done during a 7-year period were analyzed and compared to our prospective surgical infection database. Factors contributing to infectious complications and mortality were identified. HR (n = 207) were performed with an overall mortality of 5.8 per cent. Nine patients (3.3%) had 18 infections; 6 (60%) had multiple infection sites, most commonly the peritoneum, blood, or wound. Three infected patients died. Lung and line infections occurred in 2 (67%) infection-related deaths. No single comorbidity increased postoperative infection risk, but an average of 6.7 co-morbid conditions were present. All infection-related deaths were associated with ventilator-dependence. All infection-related deaths occurred after resection of a mean of four segments. Additional procedures at the time of HR, operative drains, or transfusion requirements did not impact infectious complications or mortality. Methicillin-resistant Staphylococcus sp. was isolated in all infection-related deaths. The mean time from HR to initiation of treatment was 8 days for infection survivors and 13.3 days for infection-related deaths. Infectious mortality after HR remains significant. Contributing risk factors are advanced age, multiple comorbid conditions, and extent of HR. Ventilator-dependence and delays in antibiotic therapy were associated with infectious mortality. Although gram-negative enteric infections were more common, abdominal, lung, and line infections with gram-positive cocci had higher associated mortality; especially when antibiotic resistant strains were present.
Management of Blunt Splenic Injury in Patients with Concurrent Infectious Mononucleosis
Authors: Meguid Ahmed A. , Ivascu Felicia A. , Bair Holly A. , Kerr Hugh , Bendick Phillip J. , Mcfall Roberta K. , Howells Greg A.
Published: November 2022

Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.3 per cent of our total trauma population with blunt splenic injury treated during that interval. Two patients underwent immediate splenectomy because of hemodynamic instability. Seven patients were admitted with the intent to treat nonoperatively. Five patients were successfully managed nonoperatively. Two patients failed nonoperative management and underwent splenectomy, one because of hemodynamic instability and one because of an infected splenic hematoma. Concurrent infectious mononucleosis does not preclude the successful nonoperative management of blunt splenic injury. This small subset of patients may be managed nonoperatively using the same criteria as for patients whose splenic injuries are not complicated by infectious mononucleosis.
Cholecystectomy and Acquired Factor VIII Inhibitor Coagulopathy
Authors: Walsh Jason D. , Landercasper Jeffrey , Bottner Wayne A. , Boyd William C.
Published: November 2022

The purpose of this study was to describe the outcome of patients undergoing surgery with recognized and unrecognized factor VIII inhibitor. The setting was a tertiary care center with a community-based general surgery training program. Two patients with acquired factor VIII inhibitor coagulopathy required cholecystectomy. Interventions included intravenous immunoglobulin (IVIG) and factor VIII transfusions. An elderly patient undergoing urgent open cholecystectomy for acute cholecystitis exsanguinated despite postoperative recognition and treatment of factor VIII inhibitor. A second patient with known factor VIII inhibitor underwent laparoscopic cholecystectomy with perioperative transfusions of factor VIII and IVIG. No hemorrhage occurred, but cost to the patient exceeded $50,000. Acquired factor VIII inhibitor coagulopathy is rare and potentially lethal. Preoperative recognition and appropriate hematologic intervention is crucial to achieve a successful outcome.
Breast Conservation Therapy for Invasive Lobular Carcinoma: The Impact of Lobular Carcinoma in Situ in the Surgical Specimen on Local Recurrence and Axillary Node Status
Authors: Stolier A.J. , Barre G. , Bolton J.S. , Fuhrman G.M. , Looney S.
Published: November 2022

Forty patients undergoing breast-conserving therapy for invasive lobular carcinoma were studied for the volume of lobular carcinoma in situ (LCIS) in the surgical specimen and its relationship to the surgical margins. The pathology of all cases was reviewed for margin status as well as the volume of LCIS in the surgical specimen. Mean follow-up time was 67 months. There were no local recurrences despite the fact that 38 per cent of patients had close or involved margins. There was one cancer-related death. Increasing tumor size and moderate or extensive involvement of the surgical specimen with LCIS were found to be independent predictors of axillary node metastases. The volume of LCIS in the surgical did not appear to have an impact on local recurrence. This paper adds to the growing body of literature suggesting that in patients undergoing breast-conserving therapy, LCIS in the surgical margin does not impact the risk of local recurrence and therefore may not require reexcision for close or involved surgical margins.
Abdominal Wall Necrotizing Fasciitis from Dislodged Percutaneous Endoscopic Gastrostomy Tubes: A Case Series
Authors: Maclean Alexandra A. , Miller George , Bamboat Zubin M. , Hiotis Karen
Published: November 2022

We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.
Impact of Neoadjuvant Therapy on Postoperative Complications in Patients Undergoing Resection for Rectal Adenocarcinoma
Authors: Turner Immanuel I. , Russell Gregory B. , Blackstock A. William , Levine Edward A.
Published: November 2022

Surgical resection continues to be the mainstay of treatment for rectal cancer. Neoadjuvant therapy (chemotherapy and radiation) has also been shown to be efficacious. The impact of preoperative chemotherapy and radiation on postoperative complications is unclear. The purpose of this study is to evaluate the relationship of neoadjuvant therapy on postoperative complications in patients undergoing a resection of rectal cancer. A total of 325 patients who underwent curative resection for rectal cancer from 1984 to 2001 were retrospectively reviewed. Only cases with complete data sets who had undergone surgery at this institution were evaluable (257). The patients were divided into groups based on the operative procedure performed; abdominoperineal resection (APR) versus sphincter-sparing (SS) procedures (LAR/Transanal) and whether or not preoperative chemotherapy or radiation was administered. There was no significant difference between complication rates for APR and SS with 19 per cent and 14 per cent, respectively. The preoperative therapy had no effect on complications after APR. However, the SS group showed 21 per cent of the patients who received radiation had complications compared to 11 per cent in those who did not ( P = 0.087). Complications in the SS group included leaks, wound infections, abscess, embolism, cardiac dysrhythmias, and myocardial infarctions. The 30-day mortality was 1.9 per cent for the entire cohort with no clear difference between groups. There was no significant difference in complication rate between APR and SS. In the APR group, neoadjuvant therapy had no impact on the incidence of complications. However, the SS group did show a trend between preoperative chemotherapy and radiation and complication rate. However, this may not outweigh the advantages of preoperative therapy in this setting.
A Review of Upper Extremity Fasciotomies in a Level I Trauma Center
Authors: Dente Christopher J. , Feliciano David V. , Rozycki Grace S. , Cava Raymond A. , Ingram Walter L. , Salomone Jeffrey P. , Nicholas Jeffrey M. , Kanakasundaram D. , Ansley Joseph P.
Published: November 2022

The purpose of this study was to review recent experience with upper extremity fasciotomy. This study is a retrospective review of injured patients undergoing fasciotomy in the upper extremity at an urban trauma center. Mechanisms of injury, indications for and timing of fasciotomy, role of compartment pressures, techniques of closure, amputation rate, and patient outcomes were collected. Over a 3-year period, 201 fasciotomies were performed in the extremities of 157 injured patients, including 37 in the upper extremities of 27 patients. The mechanisms of injury were penetrating trauma in 13 patients (10 GSW, three SW), blunt or crush in 9, and burns (4 electric, 1 flame) in 5. Vascular injuries and fractures were present in 15 (56%) and 9 (33%) patients, respectively. The decision to perform a fasciotomy was a clinical one in 21 patients (75%), and only 6 patients had compartment pressures measured (range, 40–87 mm Hg; mean, 52). Upper extremity fasciotomy was performed at a first operation in 24 patients, whereas only 3 patients had a delayed fasciotomy from 6 to 48 hours after injury. Two patients died on the first hospital day, and 5 others had an amputation of an upper extremity at a mean of 8 days (range 2 to 26) after injury; however, no amputation was due to the failure to perform a timely fasciotomy. In the remaining 20 patients, closure of the fasciotomy site was performed at a mean of 9 days (range, 2 to 22) after injury, most commonly by split thickness skin grafting. Hospital stay was a mean of 20 days (range, 7–35). We conclude that 1) upper extremity fasciotomy accounts for less than 20 per cent of all fasciotomies performed; 2) a clinical decision is the most common reason for performing upper extremity fasciotomy, and only 11 per cent of patients underwent a delayed fasciotomy in this review; 3) the need for upper extremity fasciotomy is associated with a length of stay longer than expected for overall injury severity.
The Coexistence of Anaplastic and Papillary Carcinomas of the Thyroid: A Case Presentation and Literature Review
Authors: Fortson James K. , Durden Frederick L. , Patel Vijaykumar , Darkeh Ayim
Published: November 2022

Papillary carcinomas of the thyroid are the most common malignant growth affecting the thyroid, currently representing 60–65 per cent of malignant thyroid neoplasm. Although the etiology of this neoplasm is unknown, they are thought to be related to neck irradiation, adenoma transformation, and Hashimoto thyroiditis. Papillary carcinomas are usually purely papillary but occasionally have areas of histologically different neoplasm, most commonly follicular. Overall, these carcinomas represent an indolent group of neoplasm and have an excellent prognosis. The occurrence of an anaplastic area in a papillary carcinoma represents the dedifferentiation of the primary neoplasm. This is an extremely rare occurrence and is considered to have negative prognostic significance. The purpose of this presentation is to discuss an unusual clinical case of a coexisting anaplastic and papillary carcinoma of the thyroid, diagnosed by fine needle aspiration (FNA) analysis presenting in a 67-year-old African-American woman. Evaluation and treatment will be discussed.
Perinatal mental health and COVID-19: Navigating a way forward
Authors: Smith Katharine A , Howard Louise M , Vigod Simone N , D’Agostino Armando , Cipriani Andrea
Published: November 2022

The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians. However, a systematic search of the available resources showed only a small amount of guidance from a few countries, with a focus on the acute phase of the pandemic rather than the challenges of new variants and variable rates of infection. Telepsychiatry offers advantages during times of restricted social contact and also as an additional route for accessing a wide range of digital technologies. While there is a strong evidence base for general telepsychiatry, the particular issues in perinatal mental health need further examination. Clinicians will need expertise and training to navigate a hybrid model, flexibly combining in person and remote assessments according to risk, clinical need and individual patient preferences. There are also wider issues of care planning in the context of varying infection rates, restrictions and vaccination access in different countries. Clinicians will need to focus on prevention, treatment, risk assessment and symptom monitoring, but there will also need to be an urgent and coordinated focus on guidance and planning across all organisations involved in perinatal mental health care.
Occupational (Therapy's) Possibilities: A Queer Reflection on the Tangled Threads of Oppression and Our Collective Liberation
Authors: Trentham Barry
Published: November 2022

This presentation stems from the work of occupational therapy and science scholars who have critically described how systems of dominance perpetuate health inequities and limit the occupational possibilities of those we aim to support. Liberation is discussed as a communal process and outcome of untangling, undoing, and reconfiguring systems of dominance that negatively impact health and limit the occupational possibilities of individuals, groups, and communities. In critically reflecting on my personal, professional, and ongoing journey toward liberation as a gay, white, able-bodied, man, I draw parallels between the systemic and intersecting oppressive forces that limit the occupational possibilities of historically marginalized groups and the need for our profession to consider its own liberation. Informed by queer theory, I question the binary discourses that separate the “Us” from the “Them,” illustrating how our struggles to transform practice based on anti-oppressive principles and the liberation of our full potential as occupational therapists must be tied to the liberation of the communities we aim to support. Drawing on lessons from liberation movements, I argue for the necessity of a representative and compassionate professional community to support collective action and to position the celebration of communal achievements as resistance and acts of gratitude.
Visual servoing control of omnidirectional mobile robots based on disturbance observer
Authors: Xing Kexin , Lin Yegui , He Defeng , Dong Wei
Published: November 2022

This study studies a critical issue that linear velocity and steering angular velocity of the wheels of omni-directional mobile robot are easily affected by the unknown external disturbances such as wind direction and road flatness during the visual servoing stabilization task. To overcome such challenging problems, this study proposes a disturbance observer based visual servoing control strategy. In configuration, the controller is divided into two parts: the quasi-min-max model predictive controller is designed to accommodate the state constraint and input constraint of the system, and complete the visual stabilization task without disturbance. A nonlinear disturbance observer is designed to estimate the external disturbance and feedback compensate the effect of the actual disturbance on the wheel speed. The simulation results and real experiments show that the proposed control strategy can stably accomplish the visual servoing stabilization task even with a large external disturbance.
The Relationship between Non-Native Perception and Phonological Patterning of Implosive Consonants
Authors: Oakley Madeleine , Sande Hannah
Published: November 2022

This study uses non-native perception data to examine the relationship between perceived phonetic similarity of segments and their phonological patterning. Segments that are phonetically similar to one another are anticipated to pattern together phonologically, and segments that share articulatory or acoustic properties are also expected to be perceived as similar. What is not yet clear is whether segments that pattern together phonologically are perceived as similar. This study addresses this question by examining how L1 English listeners and L1 Guébie listeners perceive non-native implosive consonants compared with plosives and sonorants. English does not have contrastive implosives, whereas Guébie has a bilabial implosive. The bilabial implosive phonologically patterns with sonorants in Guébie, to the exclusion of obstruents. Two perception experiments show English listeners make more perceptual categorization errors between implosives and voiced plosives than Guébie listeners do, but both listener groups are more likely to classify implosives as similar to voiced plosives than sonorants. The results also show that Guébie listeners are better at categorizing non-native implosive consonants (i.e., alveolar implosives) than English listeners, showing that listeners are able to extend features or gestures from their L1 to non-native implosive consonants. The results of these experiments suggest a cross-linguistic perceptual similarity hierarchy of implosives compared with other segments that are not affected by L1 phonological patterning.
Evaluation of Psychological Resilience, Alexithymia, and Impulsivity Characteristics in Persons Who Attempted Suicide with Drugs
Authors: Çavdar Toraman Merve , Sarigedik Enes , Özçetin Adnan
Published: November 2022

Objective

In this study, it was aimed to research the connection between psychological resilience, alexithymia, depression, anxiety and impulsivity in patients who attempted suicide with drugs.

Methods

The patient group ( n = 66) who attempted suicide with drugs and the control group ( n = 66) without any psychiatric diagnosis were examined in the study. Sociodemographic data form, Psychological Resilience Scale, Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale (BIS-11) were used in the study.

Results

It was found that PRS dedication and challenge are significantly higher in the control group ( p = .039 and p = .003, respectively). When the undiagnosed group who attempted suicide were compared with the control group, it was observed that there is a significant difference between BIS-11 total and TAS total after bonferonni correction (respectively; p = .002; p = .001), while, there is no statistically significant difference in terms of PRS total score ( p = .483)

Conclusion

It was observed that patients who attempted suicide with drugs had low levels of psychological resilience, high alexithymia levels. In the absence of an additional diagnosis of depression, psychological resilience did not differ in terms of suicide attempts. In the suicide group, those who did not receive any additional diagnosis were not more impulsive than those who were depressed.
De-escalating ‘dataveillance’ in schools
Authors: Nichols T. Philip , Monea Alexander
Published: November 2022

T. Philip Nichols and Alexander Monea explore the spread of data-driven surveillance (i.e., dataveillance) technologies in schools, which are increasingly used as a strategy for mitigating safety risks. They argue that the sense of security schools derive from these technologies often comes at the cost of students’ actual well-being and privacy. Drawing on research with teachers and administrators, they highlight several ethical challenges dataveillance technologies raise as they are incorporated into classrooms. They conclude with suggestions for how educators might de-escalate their dependence on dataveillance without compromising students’ safety.
Helping schools prepare for and prevent the worst: A conversation with Jaclyn Schildkraut
Authors: Vail Kathleen
Published: November 2022

About 95% of schools nationwide hold lockdown drills for students and staff in response to security concerns, including an active shooter. Jaclyn Schildkraut, the interim executive director of the Regional Gun Violence Research Consortium, talks about the importance of performing lockdown drills in a trauma-informed way. Through her work and research with the Syracuse City School District, she recommends best practices and stresses the importance of training for school staff.
No more nice mentors
Authors: Weisling Nina F. , Gardiner Wendy
Published: November 2022

There is a cultural mismatch between teachers and students in classrooms across the U.S. that, despite teachers’ best intentions, too often leads to student harm. Mentors are uniquely positioned to interrupt conscious and unconscious bias that leads to inequitable practices but often have difficulty holding the necessary hard conversations. Among the reasons for this is socialized niceness, particularly in women, which prioritizes comfort and avoids conflict at all costs. Nina F. Weisling and Wendy Gardiner provide insights for recognizing, naming, and working through socialized niceness in mentoring to ensure all students have opportunities to learn in safe and rigorous classrooms.