Surgery Commons^™

Wses Guidelines For The Management Of Acute Left Sided Colonic Diverticulitis In The Emergency Setting, Massimo Sartelli, Fausto Catena, Luca Ansaloni, Federico Coccolini, Ewen A. Griffiths, Fikri M. Abu-Zidan, Salomone Di Saverio, Jan Ulrych, Yoram Kluger, Ofir Ben-Ishay, Frederick A. Moore, Rao R. Ivatury, Raul Coimbra, Andrew B. Peitzman, Ari Leppaniemi, Gustavo P. Fraga, Ronald V. Maier, Osvaldo Chiara, Jeffry Kashuk, Boris Sakakushev, Dieter G. Weber, Rifat Latifi, Walter Biffl, Miklosh Bala, Aleksandar Karamarkovic, Kenji Inaba, Carlos A. Ordonez, Andreas Hecker, Goran Augustin, Zaza Demetrashvili, Renato Bessa Melo, Sanjay Marwah, Sanoop K. Zachariah, Vishal G. Shelat, Michael Mcfarlane, Miran Rems, Carlos Augusto Gomes, Mario Paulo Faro, Gerson Alves Pereira Júnior, Ionut Negoi, Yunfeng Cui, Norio Sato, Andras Vereczkei, Giovanni Bellanova, Arianna Birindelli, Isidoro Di Carlo, Kenneth Y. Kok, Mahir Gachabayov, Georgios Gkiokas, Konstantinos Bouliaris, Elif Çolak, Arda Isik, Daniel Rios-Cruz, Rodolfo Soto, Ernest E. Moore

Surgery Publications

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

Wses Jerusalem Guidelines For Diagnosis And Treatment Of Acute Appendicitis, Salomone Di Saverio, Arianna Birindelli, Micheal D. Kelly, Fausto Catena, Dieter G. Weber, Massimo Sartelli, Michael Sugrue, Mark De Moya, Carlos Augusto Gomes, Aneel Bhangu, Ferdinando Agresta, Ernest E. Moore, Kjetil Soreide, Ewen Griffiths, Steve De Castro, Jeffry Kashuk, Yoram Kluger, Ari Leppaniemi, Luca Ansaloni, Manne Andersson, Federico Coccolini, Raul Coimbra, Kurinchi S. Gurusamy, Fabio Cesare Campanile, Walter Biffl, Osvaldo Chiara, Fred Moore, Andrew B. Peitzman, Gustavo P. Fraga, David Costa, Ronald V. Maier, Sandro Rizoli, Zsolt J. Balogh, Cino Bendinelli, Roberto Cirocchi, Valeria Tonini, Alice Piccinini, Gregorio Tugnoli, Elio Jovine, Roberto Persiani, Antonio Biondi, Thomas Scalea, Philip Stahel, Rao Ivatury, George Velmahos, Roland Andersson

Surgery Publications

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the …

Geriatric Telemedicine: Background And Evidence For Telemedicine As A Way To Address The Challenges Of Geriatrics, Ronald C. Merrell

Surgery Publications

Objectives

The global population of elderly people is increasing at a remarkable rate, which may be expected to continue for some time. Older patients require more care, and with the current model of care delivery, the costs may be expected to rise, although higher cost is unsustainable. For this reason, a new pattern of practice is needed. Telemedicine will be presented as a highly effective and necessary tool in geriatrics.

Methods

This review will present some of the background and evidence for telemedicine as a way to address the challenges of geriatrics through geriatric telemedicine. Some of the evidence for …

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitro for adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

An Unusual Case Of Bony Styloid Processes That Extend To The Hyoid Bone, Shekhar K. Gadkaree, Christopher G. Hyppolite, Aisha Harun, Ryan H. Sobel, Young Kim

Surgery Publications

The embryological origin of the hyoid bone is a point of uncertainty, with controversy surrounding the relative contribution of the second pharyngeal arch to hyoid development. We encountered a 52-year-old male with bilateral bony styloid extension to the lesser cornu of the hyoid bone during the workup of a patient with laryngeal cancer. This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological …

Penetrating Cardiac Trauma And The Use Of Emergent Extracorporeal Membrane Oxygenation And Therapeutic Hypothermia: When Cooler Heads Prevail, Nathaniel Lee, Daniel Tang, Sudha Jayaraman

Surgery Publications

This is a case of penetrating chest trauma with traumatic arrest from cardiac tamponade, right and left ventriculotomies, mitral valve injury and ventricular septal defect. Patient underwent resuscitative thoracotomy converted to clamshell thoracotomy for haemorrhage control. Ventriculotomies were repaired on initial damage control operation. Extracorporeal membrane oxygenation cannulation and therapeutic cooling bridged to definitive cardiac repair several days later. Patient was discharged to an inpatient rehabilitation facility in 16 days.

Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients, Massimo Sartelli, Mark A. Malangoni, Fikri M. Abu-Zidan, Ewen A. Griffiths, Stefano Di Bella, Lynne V. Mcfarland, Ian Eltringham, Vishal G. Shelat, George C. Velmahos, Ciarán P. Kelly, Sahil Khanna, Zaid M. Abdelsattar, Layan Alrahmani, Luca Ansaloni, Goran Augustin, Miklosh Bala, Frédéric Barbut, Offir Ben-Ishay, Aneel Bhangu, Walter L. Biffl, Stephen M. Brecher, Adrián Camacho-Ortiz, Miguel A. Caínzos, Laura A. Canterbury, Fausto Catena, Shirley Chan, Jill R. Cherry-Bukowiec, Jesse Clanton, Federico Coccolini, Maria Elena Cocuz, Raul Coimbra, Charles H. Cook, Yunfeng Cui, Jacek Czepiel, Koray Das, Zaza Demetrashvili, Isidoro Di Carlo, Salomone Di Saverio, Irina Magdalena Dumitru, Catherine Eckert, Christian Eckmann, Edward H. Eiland, Mushira Abdulaziz Enani, Mario Faro, Paula Ferrada, Joseph Derek Forrester, Gustavo P. Fraga, Jean Louis Frossard, Rita Galeiras, Wagih Ghnnam, Carlos Augusto Gomes, Venkata Gorrepati, Mohamed Hassan Ahmed, Torsten Herzog, Felicia Humphrey, Jae Il Kim, Arda Isik, Rao Ivatury, Yeong Yeh Lee, Paul Juang, Luis Furuya-Kanamori, Aleksandar Karamarkovic, Peter K. Kim, Yoram Kluger, Wen Chien Ko, Francis D. Labarbera, Jae Gil Lee, Ari Leppaniemi, Varut Lohsiriwat, Sanjay Marwah, John E. Mazuski, Gokhan Metan, Ernest E. Moore, Frederick Alan Moore, Carl Erik Nord, Carlos A. Ordoñez, Gerson Alves Pereira Júnior, Nicola Petrosillo, Francisco Portella, Basant K. Puri, Arnab Ray, Mansoor Raza, Miran Rems, Boris E. Sakakushev, Gabriele Sganga, Patrizia Spigaglia, David B. Stewart, Pierre Tattevin, Jean Francois Timsit, Kathleen B. To, Cristian Tranà, Waldemar Uhl, Libor Urbánek, Harry Van Goor, Angela Vassallo, Jean Ralph Zahar, Emanuele Caproli, Pierluigi Viale

Surgery Publications

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficileinfection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitrofor adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

At What Age Should Screening Mammography Be Recommended For Asian Women?, Junko Tsuchida, Masayuki Nagahashi, Omar M. Rashid, Kazuaki Takabe, Toshifumi Wakai

Surgery Publications

Although regular screening mammography has been suggested to be associated with improvements in the relative survival of breast cancer in recent years, the appropriate age to start screening mammography remains controversial. In November 2009, the United States Preventive Service Task Force published updated guidelines for breast cancer, which no longer support routine screening mammography for women aged 40–49 years, but instead, defer the choice of screening in that age group to the patient and physician. The age to begin screening differs between guidelines, including those from the Task Force, the American Cancer Society and the World Health Organization. It remains …

Iroa: The International Register Of Open Abdomen., Frederico Coccolini, Fausto Catena, Giulia Montori, Marco Ceresoli, Roberto Manfredi, Gabriela Elisa Nita, Ernest E. Moore, Walter Biffl, Rao Ivatury, James Whelan, Gustavo Fraga, Ari Leppaniemi, Massimo Sartelli, Salomone Di Saverio, Luca Ansaloni

Surgery Publications

Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to …

Enucleation After Embolization Of Liver Failure-Causing Giant Liver Hemangioma, Amit Sharma, Matthew Kaspar, Mohammad Siddiqui, Joohyun Kim

Surgery Publications

Patient: Female, 73

Final Diagnosis: Giant liver hemangioma

Symptoms: Abdominal discomfort • abdominal enlargement • Icterus

Medication: —

Clinical Procedure: Enucleation after embolization of liver failure-causing giant liver

Specialty: Surgery

Objective:

Unusual clinical course

Background:

Hepatic hemangioma is a congenital tumor of the mesenchymal tissues of the liver. While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy. In such instances, surgical treatment may be warranted.

Case Report:

We present a case of a symptomatic giant hepatic hemangioma in an elderly patient who presented …

Building Research Capacity In Africa: Equity And Global Health Collaborations, Kathryn M. Chu, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta

Surgery Publications

Summary Points

• Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).
• Partnerships with local collaborators rather than extractive research are needed.
• LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.
• This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Donor Heart Utilization Following Cardiopulmonary Arrest And Resuscitation: Influence Of Donor Characteristics And Wait Times In Transplant Regions, Mohammed Quader, Luke Wolfe, Gundars Katlaps, Vigneshwar Kasirajan

Surgery Publications

Background. Procurement of hearts from cardiopulmonary arrest and resuscitated (CPR) donors for transplantation is suboptimal. We studied the influences of donor factors and regional wait times on CPR donor heart utilization. Methods. From UNOS database (1998 to 2012), we identified 44,744 heart donors, of which 4,964 (11%) received CPR. Based on procurement of heart for transplantation, CPR donors were divided into hearts procured (HP) and hearts not procured (HNP) groups. Logistic regression analysis was used to identify predictors of heart procurement. Results. Of the 4,964 CPR donors, 1,427 (28.8%) were in the HP group. Donor characteristics that favored heart procurement …

Is The Consistency More Important Than The Ingredients For Treatment? Case Report For Eosinophilic Esophagitis, Dan W. Parrish, Shashank Sharma, Santhosh Kumar

Surgery Publications

Eosinophilic Esophagitis seems to be an ever-changing disease, from patient-to-patient and from year-to-year in the same patient. Improvements in these patients’ lives have been made with the realization that elimination of dietary antigens helped with symptom relief and treatment with topical steroids assisted in eradication of esophageal eosinophils.

This case study has two very important aspects that should be emphasized. The first is the realization that it may be consistency of the steroid mixture rather than the ingredients that infer the effectiveness of the EoE treatment, and the second aspect is the willingness of the medical team to listen to …

Care Seeking For Neonatal Illness In Low- And Middle-Income Countries: A Systematic Review, Hadley K. Herbert, Anne C. C. Lee, Aruna Chandran, Igor Rudan, Abdullah H. Baqui

Surgery Publications

Background

Despite recent achievements to reduce child mortality, neonatal deaths continue to remain high, accounting for 41% of all deaths in children under five years of age worldwide, of which over 90% occur in low- and middle-income countries (LMICs). Infections are a leading cause of death and limitations in care seeking for ill neonates contribute to high mortality rates. As estimates for care-seeking behaviors in LMICs have not been studied, this review describes care seeking for neonatal illnesses in LMICs, with particular attention to type of care sought.

Methods and Findings

We conducted a systematic literature review of studies that …

The Living Textbook Project For Affordable Higher Education, Dayanjan S. Wijesinghe

Surgery Presentations

A blue print for ensuring that community college education remains affordable to the future generations via elimination of the cost of textbooks.

Pathophysiology Of Male Hypogonadism Associated With Endogenous Hyperestrogenism — Evidence For Dual Defects In The Gonadal Axis, Johannes D. Veldhuis, James R. Sower, Alan D. Rogol, Frederick A. Klein, Norman Miller, Maria L. Dufau

Surgery Publications

FEMINIZING tumors of the adrenal cortex are associated with symptoms that presumably reflect the combined effects of estrogen excess and androgen deficiency — gynecomastia, diminished libido, attenuated potency, and testicular and prostatic atrophy.1 2 3 4 5 Although such tumors are extremely rare, they provide a unique opportunity to appraise the nature of endogenous estrogen action on the gonadal axis in men. In principle, the pathophysiologic effects of estrogen hypersecretion could be expressed at the level of either the Leydig cell or the hypothalamic–pituitary axis (or both), with consequent suppression of androgen production. In the present studies, we investigated …