Emergency Surgical Intervention Research Articles

Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009-2021.

Gastrointestinal foreign bodies (FBs) are an important cause of emergency surgical intervention in cats, but little information exists in the literature evaluating the risks and outcomes in this species. The study purpose was to describe cases of feline FBs and compare perioperative factors and outcomes between linear foreign body (LFB) and discrete foreign body (DFB) surgery in cats. The medical records from the University of Georgia Veterinary Teaching Hospital were searched for cats that had undergone surgery for FB removal between August 2009 and August 2021. Perioperative data were collected and described. Data were compared between cats with an LFB and cats with a DFB. A binomial probability series was used to estimate the likelihood of postoperative septic peritonitis or mortality in an additional cat in the series. A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB. Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017). Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

Short Versus Long Antibiotic Duration for Necrotizing Soft Tissue Infection: A Systematic Review and Meta-Analysis.

Background: Necrotizing soft tissue infections (NSTIs) are rapidly spreading, life-threatening infections that require emergent surgical intervention with immediate antibiotic initiation. However, there is no consensus regarding duration of antibiotic therapy after source control. We hypothesized that a short course of antibiotic therapy is as effective as a long course of antibiotic therapy after final debridement for NSTI. Methods: A systematic review of the literature was performed using PubMed, Embase, and Cochrane Library from inception to November 2022. Observational studies comparing short (≤7 days) versus long (>7 days) antibiotic duration for NSTI were included. Primary outcome was mortality and secondary outcomes included limb amputation and Clostridium difficile infection (CDI). Cumulative analysis was performed with Fisher exact test. Meta-analysis was performed using a fixed effects model and heterogeneity was assessed using Higgins I2. Results: A total of 622 titles were screened and four observational studies evaluating 532 patients met inclusion criteria. Mean age was 52 years, 67% were male, 61% had Fournier gangrene. There was no difference in mortality when comparing short to long duration antibiotic agents on both cumulative analysis (5.6% vs. 4.0%; p = 0.51) and meta-analysis (relative risk, 0.9; 95% confidence interval, 0.8-1.0; I2 0; p = 0.19). There was no significant difference in rates of limb amputation (11% vs. 8.5%; p = 0.50) or CDI (20.8% vs. 13.3%; p = 0.14). Conclusions: Short duration antibiotic therapy may be as effective as longer duration antibiotic therapy for NSTI after source control. Further high-quality data such as randomized clinical trials are required to create evidence-based guidelines.

The Significant Burden of Iatrogenic Vascular Injury on the Vascular Surgery Workforce at an Academic Medical Center

The treatment of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other inpatient services. Vascular surgeons are called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and at the bedside. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to January 8, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, were retrospectively collected from February 1 to October 13 and prospectively collected for the remainder of the study period. Analyses were performed with R version 2022.02.03. There were 63 patients with consultations related to iatrogenic vascular injury. Of these, 29 (46%) were female and the mean age was 59 ± 18 years. The most common consulting services were cardiology (32%), cardiothoracic surgery (27%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (38%), limb ischemia (32%), and treatment for pseudoaneurysm (27%). Of the consults, 25% were intraoperative, 19% related to ECMO cannulation, and 19% related to ventricular assist devices including left ventricular assist devices and intra-aortic balloon pumps. The majority of consult requests occurred during evening and night hours (5 pm to 7 am) (60%) (Figure). Emergent intervention was required in 75% of cases and consisted of: primary open surgical repair of arterial injury (50%), endovascular intervention (15%), and open thromboembolectomy (13%). Overall, in-hospital mortality for the patient cohort was 18% and the reintervention rate was 21%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgery plays an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. These consults and complications require immediate bedside or intraoperative consultation and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to vascular surgeons.

Acute Small Bowel Obstruction Caused by Trans Epiploic Hernia in a Young Man: A Case Report

Introduction: A strangulated hernia is a surgical emergency. Hernia strangulation is manifested by a hard, painful and irreducible inguinal swelling and requires emergency surgical treatment. In some cases, it can be revealed by pathology; hence its name of hernia symptom and the diagnosis will only be rectified by gesture. Observation: We report the case of 50 year old men with no particular pathological history, admitted to the emergency for management of a strangulated right inguinal hernia and whose surgical exploration revealed appendicular peritonitis Conclusion: The diagnosis of strangulated inguinal hernia is a clinical diagnosis that most often does not require any additional examination. But in some cases it can be revealed by another pathology mimicking a strangulated hernia, the diagnosis of which is corrected during surgery.

Strangulated Inguinal Hernia Revealed by Appendicular Peritonitis: Case Report

Introduction: A strangulated hernia is a surgical emergency. Hernia strangulation is manifested by a hard, painful and irreducible inguinal swelling and requires emergency surgical treatment. In some cases, it can be revealed by pathology; hence its name of hernia symptom and the diagnosis will only be rectified by gesture. Observation: We report the case of 50 year old men with no particular pathological history, admitted to the emergency for management of a strangulated right inguinal hernia and whose surgical exploration revealed appendicular peritonitis. Conclusion: The diagnosis of strangulated inguinal hernia is a clinical diagnosis that most often does not require any additional examination. but in some cases it can be revealed by another pathology mimicking a strangulated hernia, the diagnosis of which is corrected during surgery.

P333 A RARE CAUSE OF SHOCK: AORTO–PULMONARY FISTULA AS AORTIC ANEURYSM COMPLICATION

Abstract Clinical case A 69–year–old man with right shoulder discomfort, malaise for one hour and hemodynamic instability was admitted to our Emergency Department (ED). The patient had a history of arterial hypertension, diabetes, renal failure on peritoneal dialysis and ischemic cardiomyopathy with preserved ejection fraction treated by angioplasty and stent implantation on right coronary. At first medical contact out of hospital the patient appeared confused with severe hypotension (BP 70/40 mmHg). ECG transmitted to our Cardiology Unit showed sinus tachycardia with repolarization abnormalities consistent with diffuse ischemia. The patient was centralized with clinical suspicion of acute coronary syndrome complicated by cardiogenic shock. In ED, BP was 65/35 mmHg. On physical examination extremities were cold and mottled, crackles in the lower lung zones and turgid jugulars were present. Pulses were weak but present. ECG was repeated and no evolutive signs were detected. Echocardiography finding were: not dilated left ventricle with global systolic function at the lower limits, moderate aortic insufficiency, right ventricle with dimensions at the upper limits and hypocontractile, moderate tricuspid regurgitation, inferior vena cava dilated with preserved inspiratory collapse. Aortic root was non dilatated but aortic arch was 55 mm with no images of dissection flap. At blood test lactates were 4,2 with metabolic acidosis, troponin was just above the upper limit, inflammation indices were negative and electrolytes were in range. Vasopressor support with norepinephrine was started. With the high suspicion of acute aortic disease, CT angiography was performed showing a voluminous aneurysm of the aortic arch of 70x56 mm rupturing into the left pulmonary artery (Figure 1,2). Concomitant bilateral iliac artery dissection was detected. Cardiac and Vascular Surgeons were promptly alerted to plan tan emergent surgical intervention whose complexity was increased by the difficult vascular cannulation for iliac dissection. However, the patient‘s hemodynamic rapidly deteriorated requiring intubation and, after subsequent episodes of cardiac arrest in pulseless electrical activity (PEA), his death was assessed.

Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis

BackgroundUnless an emergency surgical intervention is conducted, intestinal obstruction may result in high morbidity and mortality. In Ethiopia, the magnitude and predictors of unfavorable management outcomes in surgically treated patients with intestinal obstruction are highly variable and inconsistent. The aim of this study was; therefore, to estimate the overall prevalence of unfavorable management outcome and its predictors among surgically treated patients with intestinal obstruction in Ethiopia.MethodWe searched articles from databases from June 1, 2022, to August 30, 2022. Cochrane Q test statistics and I2 tests were applied. We used a random-effect meta-analysis model to overcome the impact of heterogeneity among the included studies. In addition, the association between risk factors and unfavorable management outcome in surgically treated patients with intestinal obstruction was investigated.ResultsThis study included a total of twelve articles. The pooled prevalence of unfavorable management outcome in surgically treated patients with intestinal obstruction was 20.22% (95% CI: 17.48–22.96). According to a sub-group analysis by region, Tigray region had the highest prevalence of poor management outcome, which was 25.78% (95% CI: 15.69–35.87). Surgical site infection was the most commonly reported symptom of poor management outcome (8.63%; 95% CI: 5.62, 11.64). The length of postoperative hospital stays (95% CI: 3.02, 29.08), duration of illness (95% CI: 2.44, 6.12), presence of comorbidity (95% CI: 2.38, 10.11), dehydration (95% CI: 2.07, 17.40), and type of intraoperative procedure (95% CI: 2.12, 6.97) were all significantly associated with unfavorable management outcome of intestinal obstruction among surgically treated patients in Ethiopia.ConclusionAccording to this study, the magnitude of unfavorable management outcome was high among surgically treated patients in Ethiopia. Unfavorable management outcome was significantly associated with the length of postoperative hospital stays, duration of illness, comorbidity, dehydration, and type of intraoperative procedure. Medical, surgical and public health measures are pivotal to reduce unfavorable management outcome in surgically treated intestinal obstruction patients in Ethiopia.

The risk of abdominal aortic aneurysm rupture prediction according to computed tomography data

Background. Abdominal aortic aneurysm – is a widespread disease, which in some cases does not have any specific clinical symptoms, but possible complications of this pathology are characterized by high mortality. Aortic aneurism rupture is an extremely serious condition that requires emergency surgical treatment. A timely diagnosis of abdominal aortic aneurysm’s rupture risk remains extremely important, since the patient mortality rate is up to 7 times higher when performing an emergency surgery, than when performing a planned surgery. Aim of study: to improve the diagnosis of abdominal aortic aneurysms instability by creating an assessing scale of aortic rupture risk according to computed tomography data. Materials and methods. CT studies were performed by a 160-slice CT scanner and included the native and arterial phases of the scanning. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm were retrospectively studied, in 46 of whom the condition was complicated by an aortic rupture. CT scans can reveal a number of specific structural changes in the aorta and also surrounding tissues, which can be regarded as aortic wall rupture prediction. That specific structural changes were stratified by severity and the preliminary results were compared with the treatment tactics and the outcome of the disease. Results. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm shows that the minimum and sufficient set of abdominal aortic aneurysm rupture predictions are: aneurysm size, a sickle sign, aortic wall draping sign, paraaortic fat induration, the thickness of parietal thrombotic masses. The obtained parameters give the possibility to predict the risks of AAA rupture. The prognostic scale is represented by a 4-point scale for assessing aneurysm parameters. Depending on the influence degree of each parameter, it is assigned a number of points corresponding to the level of prognostic significance. The maximum number of risk factors is 17 points. Finding. The assessing scale of the abdominal aortic aneurysm rupture’s risk according to computed tomography data was developed.

Serratia marcescens Necrotizing Fasciitis of the Ankle: A Case Report.

Necrotizing fasciitis is a devastating inflammatory infection requiring emergent medical treatment and surgical intervention. Even with timely management, the mortality rate of necrotizing fasciitis approaches 25%. The causative bacteria invade fascial planes and express toxins that advance rapidly. Here, we document a rare case of necrotizing fasciitis from Serratia marcescens infection. Serratia marcescens is capable of inducing a necrotizing inflammatory cascade mediated by extracellular cytotoxin and lipase. In this case report, a 90-year-old man presented to our emergency department from a long-term care facility with a relatively benign-appearing ulcer with surrounding cellulitis on the right ankle. Blood cultures and wound cultures confirmed the organism to be S marcescens. A multidisciplinary team was consulted for management. The patient received antibiotic therapy and medical support, but because of his comorbid conditions and social situation, the designated medical decision maker opted for comfort care rather than aggressive surgical debridement. The patient progressed through the clinical stages of necrotizing fasciitis. Within 36 hours, the patient died as result of sepsis-induced organ failure.

Papillary fibroelastoma of the aortic valve: occlusion of the left main coronary artery.

A 53-year-old woman with palpitations and respiratory distress as her main symptoms, which had resulted in a cardiac arrest, was referred to the emergency room. Coronary angiography (CAG) with percutaneous cardiopulmonary support (PCPS) was performed, but no severe stenosis was found. The patient was diagnosed with vasospastic angina, treated medically, and discharged to her home. Six months later, however, during hospitalization for sick sinus syndrome, she suddenly developed runs of ventricular tachycardia. Therefore, CAG with PCPS was again carried out and revealed an occlusion of the left main trunk (LMT) of the coronary artery (Panel A, arrow). Intravascular ultrasound imaging was also performed (Panel B), and a plausible thrombus formation associated with coronary spasm was diagnosed. An emergency surgical intervention was therefore carried out. Intraoperative transoesophageal echocardiography imaging showed both a large mass at the aortic valve that may have occluded the LMT (Panel C, Supplementary data online, Video S1), and a previously undiagnosed severe aortic valve regurgitation caused by the mass. Aortic cross-clamping and a cardiac arrest were conducted; a huge mass originating from the right coronary cusp (RCC) of the valve was found (Panels D and E, arrowheads) and resected. No thrombus formation in the coronary artery was observed. Post-operatively, the patient's angina resolved without any sign of aortic regurgitation. The pathology report revealed a papillary fibroelastoma (PFE). This series of symptoms was caused by embolization within the coronary artery and the presence of a huge PFE, which together caused this rare condition.

Spontaneous bilateral epidural hematomas caused by chronic sinusitis: illustrative case.

Spontaneous bilateral epidural hematomas (EDHs) are rare. The aim of this study was to report a 21-year-old male with spontaneous bilateral EDHs to discuss the pathogenesis of spontaneous bilateral EDHs caused by chronic sinusitis. A 21-year-old male with no history of head trauma was admitted to the hospital for headache and unconsciousness. The patient had bilateral nasal bleeding on the day before admission and had chronic sinusitis since childhood. The head computed tomography examination after admission showed bilateral EDHs and bilateral sinusitis, the head magnetic resonance imaging showed chronic sinusitis, and the endoscopic examination during surgery further confirmed that the patient had severe sinusitis with erosion of the bilateral nasal mucosae. The patient underwent emergent surgical treatment. The cerebral vascular malformation, autoimmune diseases, low intracranial pressure, blood system diseases (such as sickle cell disease), abnormal blood coagulation, and skull or meningeal lesions were all excluded after operation. Chronic sinusitis may lead to EDHs through causing vascular degeneration, and abruption of the dura mater and skull. For young patients with spontaneous EDHs, neurosurgeons should carefully ask patients whether they have a history of chronic sinusitis to exclude the possibility of bleeding caused by chronic sinusitis.

The Choice of Tactics for Surgical Treatment of Acute De Bakey Type I Aortic Dissection in a Multidisciplinary Surgical Hospital

BACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority.

Histopathological Study of Appendectomy Specimens in a Rural Tertiary Care Hospital in Bangladesh

Background: Appendicitis is one of the most common causes of the acute abdomen that demands emergency surgical intervention. It is a clinical condition that is frequently encountered as a diagnostic challenge. Sometimes grossly normal-appearing appendix, removed from patients with suspected acute appendicitis, on histopathological examination may reveal a more serious underlying pathology. Hence, histopathological studies form the gold standard for the diagnosis of appendicitis. Aim: To study the histopathological patterns of appendicitis in patients who underwent appendectomy. Methods: This study was carried out in the department of Pathology, Jahurul Islam Medical College, Bajitpur, Kishoreganj from January 2020 to December 2020. All the appendectomy specimens were received in 10% formalin as fixative. Sections obtained were studied to determine various histopathological patterns in appendectomy specimens. Results: A total of 252 specimens were undertaken for histopathological examination. There were 154 (61.1%) males and 98 (38.1%) females with male to female ratio of 1.6:1. The most common lesion observed was acute appendicitis (51.98%) followed by recurrent appendicitis (28.17%), acute suppurative appendicitis (07.15%), gangrenous appendicitis (06.36%), eosinophilic appendicitis (02.38%), follicular lymphoid hyperplasia (02.38%), mucinous adenoma (0.40%) and mucinous adenocarcinoma (02.38%). Conclusion: Most of the cases in this study were diagnosed with the usual features of appendicitis, though a few of them were incidental diagnoses that were missed clinically. These important incidental diagnoses undisputedly support the notion that every appendectomy specimen must be sent routinely for histopathological examination. Mediscope 2023;10(1): 17-21

Surgery versus antibiotics in pyocele: a case report

BackgroundEpididymitis has several etiologies that can be related to infectious and non-infectious causes, autoimmune conditions, aseptic causes, and even certain pharmaceutical medications (amiodarone and chemotherapeutic agents). Some cases of epididymitis are complicated with pyocele formation that requires emergent surgical intervention to prevent testicular gangrene. This report describes the case of a 66-year-old male who developed severe bilateral epididymitis complicated by bilateral pyocele and ensuing sepsis. Astonishingly, the condition resolved completely without surgical intervention.Case presentationWe are presenting a case of a non-sexually active male who developed bilateral severe epididymitis complicated by pyocele that led to the development of septic shock. Further history revealed that the patient was not sexually active with male or female partners and denied any form of trauma. Physical examination demonstrated scrotal swelling and erythema on inspection and severe tenderness on palpation. Digital rectal examination as well as abdominal examinations was unremarkable. Laboratory investigations disclosed severe leukocytosis with a neutrophil predominance (39,000 K/UL, normal range 4500–11,000 K/UL), as well as an elevation of systemic inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein. Urine culture was positive for Escherichia coli. Ultrasound revealed bilateral epididymitis and pyocele. This patient was managed with a course of meropenem, resolving the epididymitis and pyocele without the need of surgical intervention.ConclusionsSurgical intervention is considered the standard of care and the approved management for pyocele to avoid further complications such as Fournier’s gangrene. However, this patient was treated solely with antibiotics, and his condition was stabilized without the need of surgical intervention that would result in additional cost and length of stay for the patient. This case raises further questions regarding the potentially better bioavailability of this antibiotic in the scrotum compared to elsewhere in the body and the potential for a non-surgical alternative approach in the management of patients with pyocele and requires further research.

Emergent surgical interventions in noncritical traumatic long bone fractures and lactate monitoring: a retrospective cohort study.

A total of 164 patients, ages 18 and above with long bone fractures and ISS less than 16 were sampled in the last 5 years. Demographic data was ascertained. Patients were placed into two cohorts with a serum preoperative lactate greater than or equal to 2.0mmol/l and a serum preoperative lactate less than 2.0mmol/l. Key endpoints included hospital mortality, length of hospitalization (LOH), discharge designation, and postoperative complications. A total of 148 patients had a lactate level less than 2.0mmol/l and 16 had a lactate greater than or equal to 2.0mmol/l. There was no significant difference in demographics between these two preoperative lactate groups. There was no statistical difference when considering mortality, discharge designation, LOH, and postoperative complications. Lactate levels assist providers in guide resuscitative efforts in trauma patients. However, this study finds that preoperative lactate measurements and efforts made to normalize lactate level are not correlated with mortality, LOH, and postoperative complications in trauma patients with an ISS less than 16. This study does not support preoperative lactate normalization in guiding surgical timing.

MP02-04 IS THERE A WEEKEND EFFECT IN THE MANAGEMENT OF TESTICULAR TORSION? ANALYSIS OF THE SPARCS DATABASE FOR PEDIATRIC AND ADULT PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP02-04 IS THERE A WEEKEND EFFECT IN THE MANAGEMENT OF TESTICULAR TORSION? ANALYSIS OF THE SPARCS DATABASE FOR PEDIATRIC AND ADULT PATIENTS Micah Levy, Chih Peng Chin, Evan B. Garden, Krishna T. Ravivarapu, Christopher Connors, Olamide O. Omidele, Hasan Bilal, Jeffrey A. Stock, and Michael A. Palese Micah LevyMicah Levy More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Evan B. GardenEvan B. Garden More articles by this author , Krishna T. RavivarapuKrishna T. Ravivarapu More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Olamide O. OmideleOlamide O. Omidele More articles by this author , Hasan BilalHasan Bilal More articles by this author , Jeffrey A. StockJeffrey A. Stock More articles by this author , and Michael A. PaleseMichael A. Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The “weekend effect” refers to patients experiencing worse outcomes when presenting to the hospital on the weekend. This phenomenon has been evaluated for several surgical procedures but has yet to be studied in patients with testicular torsion, a condition requiring emergent surgical intervention to preserve testicular function. We evaluated for the presence of a weekend effect in the management of testicular torsion in both a pediatric and adult patients. METHODS: The Statewide Planning and Research Cooperative System, a New York State all payer data reporting system, was queried from 2010-2017. All patients presenting with testicular torsion requiring surgical management were stratified into pediatric (<16 years old) or adult (>17 years old) groups, and then sub-stratified by admission on weekday (WD) or weekend (WE). Patient age, rate of orchiectomy vs. orchiopexy, rate of bilateral orchiopexy, length of stay (LOS), operative time (OPT), total hospital cost (THC), and incidence of evaluation of torsion within 7 days prior to current admission were analyzed. RESULTS: Of 1,445 cases, 807 were pediatric (WD: 600 [74.3%], WE: 207 [25.7%]) and 638 were adult (WD: 464 [72.7%], WE: 174 [27.3%]) with no difference in rate of weekend admission between populations (p=0.487). WE pediatric patients had a greater rate of orchiectomy (WE: 11.6%, WD: 6.7%, p=0.024), and bilateral orchiopexy (WE: 71.0%, WD: 62.7%, p=0.040). They were also older (WE: 11.9, WD: 10.6, p=0.002), had a greater LOS (WE: 0.45, WD: 0.27, p=0.037) and THC (WE: $18,257, WD: $12,460, p=0.016) though these are likely clinically insignificant. There was no difference in OPT or prior torsion evaluations [Table 1A]. The adult cohorts had no significant differences for any analyses [Table 1B]. CONCLUSIONS: On weekends, pediatric patients had a greater rate of orchiectomy and of bilateral orchiopexy, suggesting a possible weekend effect in the pediatric population. This may be due to delays in presenting to the hospital by either the patient or parent. No evidence of a weekend effect was found in the adult population. Patients and parents should continue to be educated on the symptoms of testicular torsion and be encouraged to always seek immediate medical attention to improve the chances for testicular salvage. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e11 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Levy More articles by this author Chih Peng Chin More articles by this author Evan B. Garden More articles by this author Krishna T. Ravivarapu More articles by this author Christopher Connors More articles by this author Olamide O. Omidele More articles by this author Hasan Bilal More articles by this author Jeffrey A. Stock More articles by this author Michael A. Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Idiopathic Left Ventricular Apical Aneurysm in a Sailor With Moderate Transient Chest Pain: A Unique Perspective on an Atypical Presentation in the Military Population.

Left ventricular (LV) apical aneurysm is a rare condition that carries a high risk of fatal cardiac rupture. Wall ruptures are an uncommon catastrophic complication after acute transmural myocardial infarction. Rarely is the rupture only contained by an adherent pericardium or hematoma creating a pseudoaneurysm. This clinical finding calls for emergent surgical intervention. If no ruptures are detectable and myocardium wall integrity is verified, the diagnosis of a true aneurysm can be made to be repaired via elective surgery. The etiological differential for a patient with an LV aneurysm in the setting of normal coronaries and in the absence of prior cardiac surgery remains broad, including traumatic, infectious, and infiltrative causes. In this case report, we demonstrate an atypical and rare presentation of an idiopathic LV apical aneurysm in a physically fit, active duty male in the U.S. Navy.

A stretchable wireless wearable bioelectronic system for multiplexed monitoring and combination treatment of infected chronic wounds.

Chronic nonhealing wounds are one of the major and rapidly growing clinical complications all over the world. Current therapies frequently require emergent surgical interventions, while abuse and misapplication of therapeutic drugs often lead to an increased morbidity and mortality rate. Here, we introduce a wearable bioelectronic system that wirelessly and continuously monitors the physiological conditions of the wound bed via a custom-developed multiplexed multimodal electrochemical biosensor array and performs noninvasive combination therapy through controlled anti-inflammatory antimicrobial treatment and electrically stimulated tissue regeneration. The wearable patch is fully biocompatible, mechanically flexible, stretchable, and can conformally adhere to the skin wound throughout the entire healing process. Real-time metabolic and inflammatory monitoring in a series of preclinical in vivo experiments showed high accuracy and electrochemical stability of the wearable patch for multiplexed spatial and temporal wound biomarker analysis. The combination therapy enabled substantially accelerated cutaneous chronic wound healing in a rodent model.

Post-traumatic giant thrombosis of inferior vena cava induced right-sided blunt traumatic diaphragmatic injury: a case report

BackgroundInferior vena cava thrombosis is a severe disease as it carries a higher risk of developing pulmonary embolism associated with a high mortality rate. The incidence of inferior vena cava thrombosis is extremely low and is commonly associated with outflow obstruction of the inferior vena cava. The frequency of traumatic diaphragmatic injuries is less than 1% of all traumatic injuries. In addition, it was not a typical cause of inferior vena cava obstruction. We report the case of the patient who presented with giant thrombosis of the inferior vena cava, which required surgical treatment-induced right-sided blunt traumatic diaphragmatic injury.Case presentationA 60-year-old male presented to the emergency department with pelvic and lower leg pain. He was working on a dump truck with the bed raised position. Suddenly, the bed came down, and his body was crushed and injured. Primary CT showed a right lung contusion and elevation of the right diaphragm but no apparent liver injury. The right pleural effusion gradually worsened after admission, as the traumatic diaphragmatic injury was highly suspected. Repeat CT showed aggravation of elevation of the right-sided diaphragm, narrowing of the inferior hepatic vena cava due to left cephalic deviation of the liver, and formation of a giant thrombus in the inferior vena cava. No adverse hemodynamic effects were observed due to thrombus formation, and we performed thrombolytic therapy. The day after starting thrombolytic therapy, the patient developed pulmonary embolism due to a dropped in SpO2 needed oxygen, and dyspnea triggered by coughing. Thrombolytic therapy was continued after the diagnosis of pulmonary embolism. However, thrombolytic therapy was ineffective, so we decided on surgical thrombectomy and inferior vena cava filter placement. The postoperative course was not eventful, and an anticoagulant was started. The patient was transferred to the hospital on the 62nd day for rehabilitation.ConclusionsWhen a diaphragmatic hernia is suspected of causing hepatic hernia and narrowing of the inferior vena cava, it may be necessary to consider emergency surgical treatment to prevent secondary inferior vena cava thrombosis and fatal pulmonary embolism.

Role of Helicopter Transfer and Cloud-Type Imaging for Acute Type A Aortic Dissection.

This study explored if long-distance transfer was safe for patients suffering from acute aortic dissection type A (AADA) and also analyzed the effectiveness of helicopter transfer and cloud-type imaging transfer systems for such patients in northern Hokkaido, Japan. The study included 112 consecutive patients who underwent emergency surgical treatment for AADA from April 2014 to September 2020. The patients were divided into two groups according to the location of referral source hospitals: the Asahikawa city group (group A, n = 49) and the out-of-the-city group (group O, n = 63). Use of helicopter transfer (n = 13) and cloud-type telemedicine (n = 20) in group O were reviewed as subanalyses.Transfer distance differed between groups (4.2 ± 3.5 km in group A vs 107.3 ± 69.2 km in group O; p = 0.0001), but 30-day mortality (10.2% in group A vs 7.9% in group O; p = 0.676) and hospital mortality (12.2% in group A vs 9.5% in group O; p = 0.687) did not differ. Operative outcomes did not differ with or without helicopter and cloud-type telemedicine, but diagnosis-to-operation time was shorter with helicopter (240.0 ± 70.8 vs 320.0 ± 78.5 minutes; p = 0.031) and telemedicine (242.0 ± 75.2 vs 319.0 ± 83.8 minutes; p = 0.007). We found that long-distance transfer did not impair surgical outcomes in AADA patients, and both helicopter transfer and cloud-type telemedicine system could contribute to the reduction of diagnosis-to-operation time in the large Hokkaido area. Further studies are mandatory to investigate if both the systems will improve clinical outcomes.