bluuebunny/crossref_metadata_2025 huggingface dataset:
Islamic Theology in Thirty Topics: a Yemeni Zaydī Tradition Preserved in the Biblioteca Ambrosiana
Authors: Lucas Scott
Published: June 2020

For five centuries, Yemeni Zaydī scholars composed theological works that adhered to a thirty-topic framework. This article identifies the origins of this framework in a treatise by Qāḍī Jaʿfar al-Buhlūlī (d. 573/1177-1178) and shows that four Zaydī scholars who lived in the decades following him adopted it in at least some of their writings. I then trace the development of commentaries and versifications on the two core texts of the thirty topics tradition, Aḥmad al-Raṣṣāṣ’s (d. 621/1224) Miṣbāḥ al-ʿulūm and his al-Khulāṣa al-nāfiʿa. Altogether, I identify eighteen Zaydī writings that follow the thirty-topic framework, seventeen of which are held in manuscript in the Biblioteca Ambrosiana in Milan. The article concludes with critical editions of excerpts from three commentaries on Miṣbāḥ al-ʿulūm on the topic of the Prophet Muḥammad’s intercession on Judgement Day.
Misplaced Verses: a Qurʾānic Hermeneutic of One Early Shiite Approach
Authors: Witztum Joseph
Published: June 2020

While contemporary scholars usually highlight Shiite claims concerning the omission, addition or alteration of words in the Qurʾān, the claims about the compilation of the text have not received sufficient attention beyond the pioneering work of Ignaz Goldziher. This article expands on Goldziher’s comments, which focused on the commentary of ʿAlī b. Ibrāhīm al-Qummī, by examining the related works of Saʿd b. ʿAbd Allāh al-Qummī and Muḥammad b. Ibrāhim al-Nuʿmānī as well. A few examples are studied in detail with a focus on the exegetical logic behind the Shiite claims and on the continuity and break with Sunni exegetical traditions. Also examined is the relationship of these Shiite claims to the critiques of the Qurʾān put forth by heretics in the eighth and ninth centuries.
Trichoptera of Saur and Tarbagatay Mountains (Kazakhstan)

Authors: SMIRNOVA DINA A. , IVANOV VLADIMIR D. , MELNITSKY STANISLAV I. , SKLYAROVA OLGA N. , EPOVA JULIA V.
Published: June 2020

A Trichoptera list compiled for the first time for the Saur and Tarbagatai Mountains, northeastern Kazakhstan, comprises 38 species of 24 genera in 13 families. The region is notable as a contact zone for Siberian, Boreal, and Central Asian Trichoptera faunas. The study reveals numerous limits of distribution for species comprising more than half of the local fauna at very low level of local endemism. The fauna is poor and probably resulted from post-glacial colonization through some zoogeographic barriers.
New and variable caddisfly species (Insecta: Trichoptera) from Bạch Mã National Park in Vietnam

Authors: MURRAY-STOKER KELLY M. , MORSE JOHN C. , GENCO MADELINE S. , PHAM HONG THAI
Published: June 2020

Two new species and descriptions of variation in two previously-described species of Vietnamese Trichoptera are presented. Adult males were collected in Bạch Mã National Park, Thừa Thiên Huế Province, Vietnam. Two species in the genus Anisocentropus (Calamoceratidae) are examined here, with one new species and variations in the second species described. Two species in the family Hydroptilidae are examined, with descriptions of a new species in the genus Chrysotrichia and variation in a species of of Ugandatrichia. We provide illustrations of male genitalia for each species.
The identity of Psychomyia nipponica Tsuda (Trichoptera: Psychomyiidae), with descriptions of five allied new species from Japan

Authors: NISHIMOTO HIROYUKI
Published: June 2020

Psychomyia nipponica Tsuda is a commonly occurring species in Japan, and widely distributed throughout Honshu Island and southwestern Hokkaido Island. The male has very characteristic genitalia that allow its easy separation from other species of the genus. My recent study on the Japanese Psychomyia, however, revealed the presence of several undescribed species closely similar to and possibly confused with P. nipponica. In this paper I redescribe P. nipponica to resolve taxonomic confusion and describe five new species of the genus from Japan: P. pseudonipponica sp. nov., P. curvicacumen sp. nov., P. incisa sp. nov., P. serrata sp. nov. and P. quadridentata sp. nov.
Two new species of genus Polyplectropus Ulmer 1905 (Insecta: Trichoptera: Polycentropodidae) from the Indian Himalaya

Authors: PANDHER MANPREET SINGH , PAREY SAJAD HUSSAIN , KAUR SIMARJIT
Published: June 2020

Two new species of the genus Polyplectropus Ulmer are described and illustrated from the Indian Himalaya viz.: Polyplectropus purolaensis sp. nov. (from Uttarakhand) and Pol. sikkimensis sp. nov. (from Sikkim). With these new additions, the genus is now represented by nine species from India.
Diversity and distribution of antennal sensilla in Glossosomatidae in comparison with other basal families of caddisflies (Insecta: Trichoptera)

Authors: VALUYSKIY MIKHAIL YU. , MELNITSKY STANISLAV I. , IVANOV VLADIMIR D.
Published: June 2020

Structure and distribution of antennal sensilla in 15 species of Glossosomatidae were studied with SEM and compared to available data for species in the families Philopotamidae (16 species previously studied) and Rhyacophilidae (25 species previously studied). Comparative analyses led to 8 different sensillar types being identified among the glossosomatids: long trichoid, curved trichoid, chaetoid, styloconic, coeloconic, mushroom-like pseudoplacoid, coronary, and Böhm’s bristles. Diversity of sensilla in Glossosomatidae is lower than reported for Rhyacophilidae and comparable to Philopotamidae. A coeloconic sensillum, unique to Glossosomatidae was identified but shows no species specificity. Distribution of most sensillum types resembles that seen in the other families: There are 2 tiers of sensilla and 4 types of distribution patterns, namely specific, non-specific, fixed, and grouped in sensory fields. Comparisons of Glossosomatidae with other Trichoptera families and data on lower Lepidoptera groups indicate a putative ground plan for antennal sensory structures among Amphiesmenoptera. In contrast, comparative data indicate a significant difference between Amphiesmenoptera and Mecoptera, a member of the sister group to Amphiesmenoptera.
Food Source for Hydropsychid Larvae during an Algae Bloom in Nan River, Nan Province, Thailand (Trichoptera: Hydropsychidae)

Authors: BUNTHA PORNPIMON , TRAICHAIYAPORN SIRIPEN , THAPANYA DECHA
Published: June 2020

During November–March, blooms of Kai algae genera are commonly seen on rocks and cobblestones in the Nan River, providing habitat for hydropsychid larvae. This study attempted to determine a dietary relationship between the caddisflies and Kai algae by comparing gut contents of hydropsychid larvae between areas with and without Kai algae (Kai-blooming and Control sites). Fourteen specimens of Hydropsyche and Potamyia larvae were collected in the Kai-blooming and Control sites, respectively. Food items in the foreguts were classified as Kai algae (KA), other filamentous algae (OFA), diatoms (DT) and other items (OI). Although the main food type of larvae in both sites was Kai algae, the proportion of KA in larval foreguts from Kai-blooming sites was significantly higher than in those from Control sites (p < 0.05). In addition, larvae in the Kai-blooming area had a significantly lower proportion of OI than in the Control area (p < 0.05). Therefore, hydropsychid larvae tended to consume more Kai algae than diatoms and other filamentous algae during blooming periods. They tended to consume more Kai algae than would be expected by chance alone, even in the area with a small amount of Kai algae.
Spermatophores in the female’s bursa copulatrix accumulated through their life span in three species of Lepidostoma (Trichoptera, Lepidostomatidae)

Authors: ITO TOMIKO
Published: June 2020

In order to estimate mating frequencies of females, spermatophores stored in the bursa copulatrix were examined in three Asian species of the genus Lepidostoma Rambur (Lepidostomatidae): L. complicatum (Kobayashi 1968), L. satoi (Kobayashi 1968), and L. itoae (Kumanski & Weaver 1992), during their flight seasons of 2011 to 2016. In all three species, several spermatophores were detected, particularly in late seasons, suggesting that multiple mating occurs in these caddisflies.
Curious Caddis Couture: Form and function among cases of Australian Hydroptilidae

Authors: WELLS ALICE
Published: June 2020

Trichoptera larvae that construct portable cases occur worldwide, in some groups building highly distinctive cases. Fifth instar larvae of several genera in the micro-caddisfly family Hydroptilidae always build cases of the same form, thus affording ready identification of their larvae and pupae to genus level. Examples are Oxyethira and Orthotrichia: the former have transparent flask-shaped silk (secretion) cases, the latter ‘wheat seed’-shaped silk cases that are generally dark brown to black in colour. Additionally, in the fauna of mainland Australia, cases of the endemic genus Orphninotrichia are unmistakable in form; enigmatically, however, quite different forms are seen in two of the four locally endemic species on the small, off-shore, oceanic island of Lord Howe. The larval cases of some other Australian genera also vary considerably, some in materials (e.g., Hydroptila) and others in both materials and shape (e.g., Hellyethira and an Australian endemic genus, Maydenoptila). Known larvae of microcaddisfly species in the Australian fauna are examined in search of patterns in the three most obviously variable attributes of cases: mode of construction, shape, and materials. Possible relationships between form and function are postulated for some of the cases.
Preliminary report on Trichoptera from the headwaters of the Cuanavale, Cuito, Cuembo and Cuando Rivers in Angola

Authors: DE MOOR FERDINAND C. , FERREIRA INA S.
Published: June 2020

Trichoptera larvae and adults were collected as part of an overall assessment of aquatic macroinvertebrate diversity in the major headwater tributaries of the Okavango and Zambezi River basins in Angola. This report documents one of the National-Geographic-funded, Okavango-Wilderness-Project expeditions undertaken between October and November 2016. A total of 21 sites on the Cuanavale, Cuito, Cuando, and Cuembo Rivers and some of their tributaries were sampled. Biotopes sampled in source lakes, headwater streams, pools, and large rivers included mostly sandy substrates, aquatic emergent and submerged vegetation, marginal vegetation and (rarely) bedrock, stones, or gravel. Light trap collecting was possible at only seven sites. With both adults and larvae collected, at least 55 species in seven families (Philopotamidae, Dipseudopsidae, Ecnomidae, Hydropsychidae, Hydroptilidae, Leptoceridae, and Sericostomatidae) were recorded. The Leptoceridae were the most abundant family, represented by ten genera and 22 species. There are a number of unnamed species which will be described in a separate paper.
A revision of the family Archinotodelphyidae Lang, 1949 (Copepoda: Cyclopoida: Oithonida), with the recognition of 15 new species
Authors: KIM IL-HOI , BOXSHALL GEOFF A.
Published: June 2020

The family Archinotodelphyidae Lang, 1949 is reviewed. Only the type genus, Archinotodelphys Lang, 1949, is accepted as valid and the genus Pararchinotodelphys Lang, 1949 is recognized as its junior subjective synonym. The two species formerly placed in the latter genus are transferred to the type genus as Archinotodelphys gurneyi (Illg, 1955) comb. nov. and A. phallusiae (Hansen, 1923) comb. nov. The species A. polynesiensis Monniot, 1986 was regarded as highly variable by Monniot (1986) but here we separate out his material from the host Herdmania momus (Savigny, 1816) which we recognise as a distinct species, A. momus sp. nov. Another 14 new species are described for the first time, from material collected at numerous localities across the global ocean. The new species are: A. curtus sp. nov. from Styela sp., A. illgi sp. nov. from an unknown host, A. hexasetosus sp. nov. from Molgula platybranchia Monniot C., 1970, A. cinctus sp. nov. from Bathystyeloides enderbyanus (Michaelsen, 1904), A. antarcticus sp. nov. from Molgula pedunculata (Herdman, 1881), A. monnioti sp. nov. from Pareugyrioides galatheae Millar, 1959 (type host) and P. digitus Monniot C., 1997, A. bimerus sp. nov. from an unidentified species of the family Molgulidae, A. longiseta sp. nov. from Styela sigma Hartmeyer, 1912, A. reductus sp. nov. from Pyura gangelion (Savigny, 1816), A. elegans sp. nov. from Polycarpa argentata (Sluiter, 1898), A. rostralis sp. nov. from Polycarpa nigricans Heller, 1878, A. longicaudatus sp. nov. from Microcosmus longicloa Monniot C. & Monniot F., 1991, A. nudus sp. nov. from a Polycarpa sp., and A. unisetosus sp. nov. from an unidentified phlebobranch ascidian host. A key to species is provided.
Diagnosis of the inachoidid subfamily Paradasygyiinae subfam. nov (Crustacea, Decapoda, Brachyura, Majoidea)
Authors: GUINOT DANIÈLE , VAN BAKEL BARRY W.M.
Published: June 2020

The name for the brachyuran subfamily Dasygyiinae Holmes, 1900, recently recognised by Guinot & Van Bakel (2020) in the majoid family Inachoididae Dana, 1851, cannot be used as it is a junior synonym of Collodinae Stimpson, 1871. The present note diagnoses a new name, Paradasygyiinae subfam. nov., for the monotypic genus Paradasygyius Garth, 1958.
Four new tri-forked species of the Australian genus Abantiades Herrich-Schäffer (Lepidoptera: Hepialidae) from the “dark obscura clade”
Authors: MOORE MICHAEL D. , BEAVER ETHAN P. , VELASCO-CASTRILLÓN ALEJANDRO , STEVENS MARK I.
Published: June 2020

A distinct group of Abantiades Herrich-Schäffer species is here confirmed as a valid clade that we refer to as the “dark obscura clade” supported by morphological and mtDNA evidence. The clade is the sister group of A. obscura Simonsen of north-western Australia and comprises four new species: Abantiades centralia sp. nov., A. kayi sp. nov., A. zonatriticum sp. nov., and A. hutchinsoni sp. nov. These species together with A. obscura, are reciprocally allopatric and have a combined distribution spanning much of the western half of Australia and this distribution is consistent with their each differentiating locally from a widespread ancestor. The four new species raise the diversity of Abantiades to 42 species. [Zoobank urn:lsid:zoobank.org:pub:C05458D1-0D34-4432-8EC4-D031ED6B7BEF]
The first fossil pycnocheiridiine pseudoscorpion (Pseudoscorpiones: Cheiridiidae: Procheiridium gen. nov.) from Cretaceous Burmese amber
Authors: PORTA ANDRÉS O. , MICHALIK PETER , FRANCHI EZEQUIEL , PROUD DANIEL N.
Published: June 2020

Procheiridium judsoni n. gen. et n. sp. is described from Burmese cretaceous amber. This species represents the earliest record of the pseudoscorpion subfamily Pycnocheiridiinae and the first fossil taxon of the subfamily to be recorded. The phylogenetic position of the new genus in the superfamily Cheiridioidea is discussed.
Determining Standards for Laparoscopic Proficiency Using Virtual Reality
Authors: Brunner William C. , Korndorffer James R. , Sierra Rafael , Dunne J. Bruce , Yau C. Lillian , Corsetti Ralph L. , Slakey Douglas P. , Townsend Michael C. , Scott Daniel J.
Published: June 2020

Laparoscopic training using virtual reality has proven effective, but rates of skill acquisition vary widely. We hypothesize that training to predetermined expert levels may more efficiently establish proficiency. Our purpose was to determine expert levels for performance-based training. Four surgeons established as laparoscopic experts performed 11 repetitions of 12 tasks. One surgeon (EXP-1) had extensive Minimally Invasive Surgical Trainer–Virtual Reality (MIST VR) exposure and formal laparoscopic fellowship training. Trimmed mean scores for each were determined as expert levels. A composite score (EXP-C) was defined as the average of all four expert levels. Thirty-seven surgery residents without prior MIST VR exposure and two research residents with extensive MIST VR exposure completed three repetitions of each task to determine baseline performance. Scores for EXP-1 and EXP-C were plotted against the best score of each participant. On average, the EXP-C level was reached or exceeded by 7 of the 37 (19%) residents. In contrast, the EXP-1 level was reached or exceeded by 1 of 37 (3%) residents and both research residents on all tasks. These data suggest the EXP-C level may be too lenient, whereas the EXP-1 level is more challenging and should result in adequate skill acquisition. Such standards should be further developed and integrated into surgical education.
Areolar-Cutaneous Junction Injection Boosts Activity in Sentinel Node by More than 50 Times Compared to Perilesional Injection: Implications for Morbidity Reduction
Authors: Kim Sunhee , Kim Chun K. , Krynyckyi Borys R.
Published: June 2020

The combination of concurrently administered perilesional radiotracer injections and areolar-cutaneous junction radiotracer injections during one imaging session in the detection of sentinel nodes (SN) in breast cancer is new. A case is presented where the perilesional injections of radiotracer produced a faint node. Subsequently, 45 minutes later, the same patient received an injection of radiotracer at the areolar-cutaneous junction, which “boosted” the activity in the original SN by more than 50 times. This case illustrates the marked improvement in SN counts that can occur with the addition of areolar-cutaneous junction injections to perilesional injections. The perilesional component of this hybrid injection technique maintains the ability to visualize internal mammary and extra-axillary SN. Even more importantly, these “hotter” nodes have significant implications for morbidity reduction, the main goal of sentinel lymph node biopsy in itself.
Outcome of Hepatic Resection for Metastatic Gastric Cancer
Authors: Roh Hye Rin , Suh Kyung-Suk , Lee Hyuk-Joon , Yang Han-Kwang , Choe Kuk Jin , Lee Kuhn Uk
Published: June 2020

The role of hepatic resection for metastatic gastric cancer is less well defined due to the tendency of gastric cancer to widely metastasize. The purpose of this study is to examine the beneficial effect of hepatic resection in patients with metastatic gastric cancer. The clinicopathologic features and long-term results of 11 patients who underwent hepatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seoul National University Hospital were analyzed retrospectively. All resected hepatic metastases were solitary lesions. Among eight patients with synchronous hepatic metastases, one patient with early gastric cancer and lymph node metastases (T1N2M1) remained alive for 8 years 6 months after hepatic resection without recurrence. Among three patients with metachronous hepatic metastases, two patients with advanced gastric cancer and lymph node metastases (T3N2M0, T2N1M0 at the initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival times of synchronous and metachronous hepatic metastases were 13.0 and 74.3 months, respectively. In solitary hepatic metastatic lesions from gastric cancer, surgical resection should be considered as one of the treatment options.
Delayed Rupture of a Left Ventricular Aneurysm after Blunt Trauma
Authors: Rodriguez Aurelio , Ong Adrian
Published: June 2020

We report a case where a 17-year-old male involved in a motor vehicle crash was admitted after seemingly minor blunt chest trauma. The patient was discharged the following day without complications. He was subsequently found dead 45 days later from a ruptured traumatic left ventricular aneurysm. We review briefly the epidemiology of patients with this complication and also suggest that the optimal method and timing of following and identifying discharged patients at risk for this rare but devastating complication is still unclear based on current literature.
Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients
Authors: Koontz Curt S. , Bhatia Amina , Forbess Joe , Wulkan Mark L.
Published: June 2020

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.
Twenty-Millimeter Laparoscopic Cholecystectomy: Fewer Ports Results in Less Pain, Shorter Hospitalization, and Faster Recovery
Authors: Osborne Dana , Boe Brian , Rosemurgy Alexander S. , Zervos Emmanuel E.
Published: June 2020

Improvements in technology offer the ability to refine operations without compromising safety. In this study, we determine whether a modified method of laparoscopic cholecystectomy using three ports and an aggregate incision length of 20 mm offers any advantage or poses increased risk. Using a 5-mm, 30° laparoscope, clip applier, and dissector, the gall bladder is removed through an extended umbilical incision. Standard safety principles were followed: achieving the “critical view,” lateral retraction of the fundus, double ligation of the proximal structures, and maintaining sterility for specimen removal. Forty-one consecutive standard laparoscopic cholecystectomies were used as a control group to compare complications, length of stay and surgery, pain scores, and return to work. Sixty patients have undergone the modified technique. There were no differences between the modified and standard technique with regard to cost or complications. Length of surgery was significantly shorter, as was length of stay, narcotics use, and return to work for the modified group versus the control. A modified technique for laparoscopic cholecystectomy poses no increased risk to patients but offers potential for shorter surgery and hospital stays, less need for narcotic analgesia, and faster recovery.
Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem?
Authors: Stawicki Stanislaw P. , Grossman Michael D. , Cipolla James , Hoff William S. , Hoey Brian A. , Wainwright Gail , Reed James F.
Published: June 2020

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.
Treatment of Isolated Penetrating Flank Trauma
Authors: Dissanaike Sharmila , Griswold John A. , Frezza Eldo E.
Published: June 2020

We present our experience during the past 5 years with isolated penetrating flank trauma. We examined the evaluation process, treatment plan, length of stay, outcome, and complications of patients with isolated penetrating injuries to the flank. There were four patient groups: 1) laparotomy (n = 5); 2) local wound exploration (n = 1); 3) laparoscopy (n = 8); and 4) observation and triple contrast CT scan (n = 9). All patients were male. The mean length of stay was 15 days for group 1, one day for group 2, two days in group 3, and 1.5 days in group 4. Three patients had diaphragmatic injuries, which were repaired laparoscopically. One patient with local wound exploration re-presented with a diaphragm hernia. A negative triple contrast CT scan resulted in no subsequent intervention. There were no missed injuries or complications from CT scan + observation or from diagnostic laparoscopy. We believe that laparoscopy may emerge as a useful adjunct in the treatment of patients with flank trauma. We present an algorithm for the management of penetrating flank trauma.
Cryptosporidiosis Presenting as Acute Appendicitis: A Case Report
Authors: Buch Kerri , Nguyen Scott , Divino Celia M. , Weber Kaare , Morotti Raffaella A.
Published: June 2020

Although uncommon in the United States, cryptosporidiosis can be life-threatening in an immunosuppressed host. Rarely, an acute infection of this gastrointestinal illness can present as another disease entity. We present only the third reported case of cryptosporidial infection presenting as acute appendicitis in a 17-year-old HIV+ patient.
Recombinant Activated Factor VII as an Adjunct to Packing for Liver Injury with Hepatic Venous Disruption
Authors: Chino Joachim , Paolini David , Tran Anh , Mathew Prasad , Howdieshell Thomas R.
Published: June 2020

Injuries to the juxtahepatic veins represent a small proportion of all liver injuries but constitute the most challenging and deadly form of hepatic trauma. Recombinant activated factor VII, established as a crucial therapy for enhancing hemostasis in hemophiliacs with inhibitors, has also been used to correct coagulopathy after traumatic injury. We report two children with hepatic venous injury requiring perihepatic packing and recombinant activated factor VII to successfully control hemorrhage.
Minimally Invasive Management of Obstructive Gastroduodenal Tuberculosis
Authors: Padussis James , Loffredo Brett , Mcaneny David
Published: June 2020

Pulmonary tuberculosis (TB) is prevalent in Western urban centers, especially among immuno-compromised patients and immigrants. However, TB enteritis is a rare sequela, occurring in less than 1 per cent of this population. Tuberculosis may affect any portion of the gastrointestinal (GI) tract, and 85 per cent of cases manifest in the ileocecal region. However, the stomach and duodenum are involved in just 0.3–2.3% of TB cases that affect the gut. Gastric outlet obstruction due to TB has been traditionally treated by a surgical bypass operation, followed by anti-TB chemotherapy. In a recent review of 17 cases of TB-related gastric outlet obstruction, gastrojejunostomy or duodenojejunostomy was performed in all patients. We present a case of gastric outlet obstruction due to TB that was treated successfully with a minimally invasive approach, without the need for a gastric bypass.
Is Repeated Head Computed Tomography Necessary for Traumatic Intracranial Hemorrhage?
Authors: Schuster Rob , Waxman Kenneth
Published: June 2020

This study was performed to determine the need for repeat head computed tomography (CT) in patients with blunt traumatic intracranial hemorrhage (ICH) who were initially treated nonoperatively and to determine which factors predicted observation failure or success. A total of 1,462 patients were admitted to our level II trauma center for treatment of head injury. Seventeen per cent (255/1,462) were diagnosed with ICH on initial head CT. Craniotomy was initially performed in 15.7 per cent (40/255) of patients with ICH. Two hundred sixteen patients with ICH were initially observed. Ninety-seven per cent (179/184) of observed patients with ICH and repeat head CT never underwent a craniotomy, 2.7 per cent (5/184) of patients with ICH initially observed underwent craniotomy after repeat head CT, and four patients (80%) had deteriorating neurologic status. Multivariate analysis revealed the following significant admission risk factors were associated with a need for repeat head CT indicating the need for craniotomy: treatment with anti-coagulation and/or antiplatelet medications, elevated prothrombin time (PT), and age greater than 70 years. In patients with blunt traumatic intracranial hemorrhage initially observed, there is little utility of repeated head CT in the absence of deteriorating neurologic status. The only admission risk factors for a repeat CT indicating the need for craniotomy were advanced age and coagulopathy.
The Impact of MRI on the Treatment of DCIS
Authors: Chung Alice , Saouaf Rola , Scharre Karen , Phillips Edward
Published: June 2020

Magnetic resonance imaging (MRI) has been shown to detect occult invasive breast cancers with a sensitivity of 97 per cent to 100 per cent. Mammography and ultrasonography does not accurately assess the extent of ductal carcinoma in situ (DCIS), which results in a high reoperation rate. Breast MRI can improve the surgical planning in women with DCIS, improving the adequacy of initial treatment while reducing reoperation. We examined 54 patients with predominantly DCIS (>50%) who underwent breast MRI from January 2003 to November 2004. MRI altered the surgical management in 14 (26%) patients: unilateral changed to bilateral mastectomy (5); lumpectomy or reexcision to mastectomy (3); unilateral lumpectomy or mastectomy had additional biopsies for lesions detected by MRI in the ipsilateral or contralateral breast (6). There were 8 true-positives and 7 false-positives: sensitivity 86 per cent, positive predictive value 84 per cent. MRI changed the surgical management to more appropriate therapy in 15 per cent of patients avoiding additional surgery, while 11 per cent underwent negative surgical interventions. Breast MRI is a sensitive diagnostic imaging tool in patients with DCIS. However, any suspicious finding should be biopsied before a definitive operation is planned.
Positive Intraoperative Cholangiography during Laparoscopic Cholecystectomy: Is Laparoscopic Common Bile Duct Exploration Necessary?
Authors: Akopian Gabriel , Blitz James , Vander Laan Thomas
Published: June 2020

The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques.
CT Angiography in Penetrating Neck Trauma Reduces the Need for Operative Neck Exploration
Authors: Woo Karen , Magner David P. , Wilson Matthew T. , Margulies Daniel R.
Published: June 2020

The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA ( P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA ( P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast esophagram. Of the 64 patients in nCTA who did not undergo a neck exploration, 19 (29%) underwent angiography, and 17 (26%) received a contrast esophagram. The use of CT angiogram increased over time with a concomitant decrease in the rate of neck explorations.
Does Pelvic Hematoma on Admission Computed Tomography Predict Active Bleeding at Angiography for Pelvic Fracture?
Authors: Brown Carlos V.R. , Kasotakis George , Wilcox Alison , Rhee Peter , Salim Ali , Demetriades Demetrios
Published: June 2020

Pelvic angiography plays an increasing role in the management of pelvic fractures (PFs). Little has been written regarding the size of pelvic hematoma on admission computed tomography (CT) and how it relates to angiography results after PF. This is a retrospective review of trauma patients with PF who underwent an admission abdominal/pelvic CT scan and pelvic angiography from 2001 to 2003. CT pelvic hematoma was measured and classified as minimal or significant based on hematoma dimensions. Presence of a contrast blush on CT scan was also documented. Thirty-seven patients underwent an admission CT scan and went on to pelvic angiography. Of the 22 patients with significant pelvic hematoma, 73 per cent (n = 16) had bleeding at angiography. Fifteen patients had minimal pelvic hematoma, with 67 per cent (n = 10) showing active bleeding at angiography. In addition, five of six patients (83%) with no pelvic hematoma had active bleeding at angiography. Six patients had a blush on CT scan, with five of these (83%) having a positive angiogram. But, 22 of 31 (71%) patients with no blush on CT scan had bleeding at angiography. The absence of a pelvic hematoma or contrast blush should not alter indications for pelvic angiography, as they do not reliably exclude active pelvic bleeding.
The Quality of Surgical Resident Interpretation of After-Hour CT Scans of the Head and Abdomen in Trauma
Authors: Wong Charles , Taubman Kevin , Hoehne Francesca , Siddharth Malhotra , Naidu Murali , Parent Donna , Taylor Edward W.
Published: June 2020

Computed tomography (CT) is an important diagnostic tool in the evaluation of trauma patients. Accurate interpretation of CT scans remains critical in decision-making and the resultant quality of care. In our study, the records of a consecutive cohort of trauma patients who underwent after-hour CT scans of the head and abdomen between January 23 and June 30, 2004, at Kern Medical Center were reviewed. Three hundred thirty-five CT studies were collected in 211 patients. The accuracy of resident interpretation was 92.8 per cent for abdominal and 97.5 per cent for head CT. Resident readings were 93.2 per cent sensitive and 95.4 per cent specific with a positive predictive value of 85.2 per cent and a negative predictive value of 98.0 per cent. There were 16 (4.8%) instances of interpretation discrepancy between the surgical resident and attending radiologist. Most differences occurred in the evaluation of abdominal CT. In no instance was management or outcome for these patients affected. This data demonstrates a low error rate in resident interpretation of after-hour CT scans of the head and abdomen in trauma, but there remains a need for the continued review of the quality of surgical resident radiologic interpretation in situations when an attending radiologist is not immediately available.
Cardiac Morbidity and Mortality after Surgery for Gastrointestinal Carcinomas
Authors: Lin Matthew , Haukoos Jason , Tahernia Amir , De Virgilio Christian
Published: June 2020

The number of Americans undergoing surgery for gastrointestinal (GI) cancer is increasing, as is the prevalence of cardiovascular disease. Clinical risk factors have been found to be useful in predicting cardiac events after vascular procedures. Their utility for predicting cardiac events after GI carcinoma surgery is unclear. We performed a retrospective review in order to determine whether clinical risk factors are useful in predicting cardiac events in patients undergoing GI carcinoma surgery and to ascertain the incidence of postoperative cardiac events. From 1998 to 2003, 333 patients were identified, with an average age of 56 years. One hundred one (30.3%) patients had one or more clinical risk factors. The overall cardiac event rate was 3.9 per cent. Age >70 years was the only risk factor associated with a cardiac event. There was a trend toward increased cardiac risk with increasing number of risk factors. In the absence of clinical risk factors, cardiac events after surgery for GI carcinoma are low. There is an increased cardiac risk in patients >70 years and a trend toward increased cardiac events as the number of clinical risk factors increases.
Impact of Length of Stay on Functional Outcomes of TBI Patients
Authors: Hawkins M.L. , Lewis F.D. , Medeiros R.S.
Published: June 2020

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient
Protocol for Bedside Laparotomy in Trauma and Emergency General Surgery: A Low Return to the Operating Room
Authors: Diaz Jose J. , Mejia Vicente , Subhawong Andrea Proctor , Subhawong Ty , Miller Richard S. , O'Neill Patrick J. , Morris John A.
Published: June 2020

Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were abdominal compartment syndrome, decompensation due to hemorrhage, washout/closure, and sepsis in a patient too unstable for safe transport to the OR. Primary outcomes were mortality, emergent return to OR, and primary fascial closure (PFC). Trauma operating room charges and OR time were analyzed. One hundred thirty-three BSL were performed on 60 patients with an overall mortality of 23.3 per cent (14/60). There was an average of 2.2 BSL per patient (range 1–8). Indications for BSL were 1) explore/washout (n = 100, 75.2%), 2) decompression (n = 14, 10.5%), 3) infection/abscess (n = 12, 9.0%), 4) hemorrhage (n = 7, 5.3%). Five of 133 BSL (5.8%) were emergently returned to the OR because of perforation or compromised bowel. Trauma OR charges were $5,300 per cases with 2.12 hours per cases. The protocol standardized the conduct of BSL procedure to allow for a low return to OR rate of 5.8 per cent and had an overall in-hospital mortality rate of 23.3 per cent. Primary fascial closure of the abdomen had a significantly reduced hospital stay. BSL allowed trauma OR charges of $5,300 per cases with 2.12 hours per cases savings.
Newly Diagnosed Breast Cancer Patients Choose Bilateral Mastectomy over Breast-Conserving Surgery When Testing Positive for a BRCA1/2 Mutation
Authors: Stolier Alan J. , Corsetti Ralph L.
Published: June 2020

In women diagnosed with breast cancer and testing positive for a BRCA1/2 mutation, decisions as to whether to undergo prophylactic risk-reduction surgery may differ from those women who test positive in a presymptomatic phase. Eighty-four women were identified who had undergone genetic testing at the time of breast cancer diagnosis. The study group consisted of 46 of these women who had initially undergone breast-conserving surgery. Eight patients (17.4%) tested positive for a mutation. Seven of the eight underwent bilateral prophylactic mastectomy prior to receiving radiation therapy. The only patient not undergoing bilateral mastectomy was awaiting liver transplant. Women who are candidates for breast-conserving surgery and who test positive for a breast cancer gene mutation choose mastectomy over surveillance.
Metastatic Colon Cancer to the Hand
Authors: Gamblin T. Clark , Santos Ricardo S. , Baratz Mark , Landreneau Rodney J.
Published: June 2020

A 72-year-old male presented with a painful index finger 18 months after sigmoid colon resection for T2 N1 adenocarcinoma. A presumptive diagnosis of gout was made but directed therapy failed to alleviate symptoms. A bone scan was positive for the index finger only and plain films demonstrated a lytic lesion of the distal phalanx. The patient underwent ray amputation of the involved digit and shortly later resection of a solitary pulmonary nodule consistent with colonic metastasis. At 18-month follow-up from these surgeries, the patient was doing well, without evidence of recurrent disease.
Thoracoscopic Management of Primary Spontaneous Pneumothorax
Authors: Santillán-Doherty Patricio , Argote-Greene Luis Marcelo , Guzman-Sanchez Martin
Published: June 2020

Primary spontaneous pneumothorax is defined as that which appears in patients without history of previous pathology that could explain the event. Management includes pleural drainage with or without pleurodesis and surgical resection of affected lung tissue with pleurodesis. Thoracoscopic approach has proved to be useful with low morbidity and mortality as well as low recurrence rate. This paper describes the experience with thoracoscopic management of primary spontaneous pneumothorax with pulmonary wedge resection of affected tissue, parietal pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura. Fifty-five patients have been submitted to this approach (24 female, 31 male). Fifty-three patients had past history of at least one previous pneumothorax (second event, n = 41; third event, n = 9; fourth event or more, n = 3). Computed tomography was abnormal in 19 patients. Operative time was 57 minutes (±17). There were no transoperative complications. Macroscopic findings were presence of small type I bullae in the lung apex in 48; three more had apical pleural thickening. None of the patients presented postoperative air leak. Chest tubes were removed after 24–48 hours on average. Adequate pain control was achieved in 51 patients; 4 patients presented mild chronic intercostal pain for 3–5 months. Median follow-up was 48 months (range 6–72); no recurrence has been observed. Primary spontaneous pneumothorax can be managed thoracoscopically; management should include wedge resection of affected lung, apical pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura.
Nonocclusive Mesenteric Ischemia after off-Pump Coronary Artery Bypass Surgery: A word of Caution
Authors: Katz Michael G. , Schachner Arie , Ezri Tiberiu , Kravtsov Vladimir , Freidman Victoria , Hauptman Eli , Sasson Lior
Published: June 2020

We present a series of five cases of off-pump coronary artery bypass surgery complicated with fatal nonocclusive mesenteric ischemia. We review a total of 489 patients aged 65 and older (mean age 74.9 ± 3.2 years) who underwent off-pump coronary artery bypass surgery. The diagnosis of nonocclusive mesenteric ischemia was confirmed by computed tomography-angiography and/or selective angiography of the superior mesenteric artery, or intraoperatively. Three patients underwent laparotomy with bowel resection. In two cases, resection of bowel was not feasible. Of the possible predisposing factors, we found that four of the patients (two preoperative and two perioperative) had received epinephrine and two had an intra-aortic balloon counter pulsation due to acute myocardial infarction and cardiogenic shock. All patients were over 65 years of age, and all had acute anterior wall myocardial infarction and hemodynamic instability or postmyo-cardial infarction unstable angina. Nonocclusive mesenteric ischemia is a difficult clinical entity to recognize, has no clear-cut effective management, has a poor prognosis as a result of low cardiac output, and can be aggravated by off-pump coronary artery bypass grafting.