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Hypermagnesaemia causing mesenteric ischaemia
and small bowel infarction
Grant Hubbard,1 Robert Nerad,2 Lynn Wojtasik3
1
Department of Surgery,
Western Reserve Hospital,
Cuyahoga Falls, Ohio, USA
2
Lake Erie College of
Osteopathic Medicine, Erie,
Pennsylvania, USA
3
Department of Surgery,
University Hospitals Portage
Medical Center, Ravenna, Ohio,
USA
Correspondence to
Dr Grant Hubbard;
ghubb22@gmail.com
Accepted 18 May 2021
SUMMARY
We present a case of mesenteric ischaemia caused by
hypermagnesaemia after ingestion of a large oral dose
of magnesium citrate, which resulted in smooth muscle
relaxation, hypotension and bowel infarction. The patient
had a history of chronic bowel dysmotility and renal
impairment. On operative exploration, the bowel was
noted to have a distinct pattern of ischaemia along
its antimesenteric border. Small bowel resection was
performed, and the patient was left in discontinuity, with
definitive repair and anastomosis performed 24 hours
later. The patient’s magnesium level was 8.39 mg/dL,
which was treated with intermittent haemodialysis and
eventually normalised over several sessions. Our patient
recovered and was discharged after a month-ong
l
hospitalisation. She returned shortly after with respiratory
failure and died. On review of the literature, we
identified similar cases and present a pathophysiological
mechanism of hypermagnesaemia causing mesenteric
ischaemia, consistent between our cases and those
already reported.
BACKGROUND
© BMJ Publishing Group
Limited 2021. No commercial
u
re- se. See rights and
permissions. Published by BMJ.
To cite: Hubbard G, Nerad R,
Wojtasik L. BMJ Case
Rep 2021;14:e241928.
doi:10.1136/bcr-2021241928
Magnesium-ontaining bowel laxatives are widely
c
used for patients with constipation. These are generally not taken in excess by patients; however, when
large doses of oral magnesium are ingested, patients
are at risk for developing hypermagnesaemia and
its clinical sequelae.1–4 Overall, the incidence of
hypermagnesaemia is rare. The cause of hypermagnesaemia is multifactorial, but seems to be more
common in patients with impaired bowel motility
and can be further exacerbated in patients with
existing renal disease, who have more difficulty
clearing large doses.5–7 The symptoms of hypermagnesaemia are widely described and can range from
cardiovascular complications, such as arrhythmia
and hypotension to neurological dysfunction, and
even cardiopulmonary arrest and coma. These are
summarised in table 1 for reference.3 7–9 Given
the large number of patients who use magnesium-
containing laxatives, and the potential risk for these
serious complications, understanding the consequences of hypermagnesaemia is of utmost importance.8 9
Currently, there are few reported cases of hypermagnesaemia causing mesenteric ischaemia, and
there are even fewer reports of cases that required
surgical management.1–3 10 There is currently no
data indicating whether magnesium-
containing
laxatives are correlated with the need for surgical
intervention in a dose-ependent manner. Due
d
containing
to the common use of magnesium-
laxatives, this potential complication warrants
report and discussion so it can be more readily identified in patients. Hypermagnesaemia appears to be
seen most often in the elderly, those with delayed
bowel transit and those with renal impairment.2 3 5
The current literature has focused on treating the
underlying hypermagnesaemia with intravenous
fluid infusion, loop diuretics or haemodialysis.1–8
Delving deeper into this topic should give opportunities to identify this outcome in future patients and
manage it appropriately. The effects of different
serum levels of magnesium are outlined below in
table 2.3 11
We present a case of hypermagnesaemia-nduced
i
mesenteric ischaemia which resulted in bowel perforation and required emergent surgery. We propose a
mechanism for hypermagnesaemia-nduced meseni
teric ischaemia and discuss this complication as it
pertains to our patient with renal compromise.
CASE PRESENTATION
The patient was a 74-ear- ld woman who was
y
o
brought to the emergency department of a secondary
care centre overnight with altered mental status and
in respiratory distress. Her family reported that
she had abdominal pain and nausea/vomiting for
3 days prior to presentation. Medical history was
notable for hypertension, chronic kidney disease
(with most recent baseline serum creatinine of
1.3 mg/dL), degenerative lumbar disease, chronic
obstructive pulmonary disease and coronary artery
disease. Prior to her acute illness, she had experienced 3 months of significant constipation, which
her primary physician had been working up as an
outpatient. Her home bowel regimen consisted of
regular fleet enema and oral polyethylene glycol.
On the day prior to admission, the patient had
ingested three bottles of magnesium citrate, each
1.735 g in 300 mL solution.
INVESTIGATIONS
Her abdominal examination was notable for distention and diffuse tenderness with guarding. Her
respiratory status worsened, and she was intubated
in the emergency department. Vital signs on presentation were notable for a heart rate of 129 beats/
min, 22 respirations/min and blood pressure 91/76
mm Hg, with a per cent oxygen saturation in the
80s. Blood work was notable for a white cell count
of 20.3 × 109/L with bandaemia and neutrophilia,
haemoglobin level of 198 g/L and platelet count of
198 × 109/L. Chemistry panel was notable for a
serum creatinine of 2.42 mg/dL (glomerular filtration rate 20), aspartate aminotransferase 185 U/L,
Hubbard G, et al. BMJ Case Rep 2021;14:e241928. doi:10.1136/bcr-2021-241928
1
BMJ Case Rep: first published as 10.1136/bcr-2021-241928 on 22 June 2021. Downloaded from http://casereports.bmj.com/ on July 29, 2021 at Western Reserve Hospital. Protected by
copyright.
Case report
�Table 1 Symptoms of hypermagnesaemia3 7–9
Confusion
Lethargy
Respiratory depression
Absent tendon reflexes
Bladder paralysis
Neuromuscular
Muscle weakness/paralysis
Hypotension
Bradycardia
Cardiovascular
Inhibition of atrioventricular/interventricular conduction
Heart block
Cardiac arrest
Ventricular arrhythmia
Gastrointestinal
Electrolyte abnormalities
Paralytic ileus
Nausea/vomiting
Hyperkalaemia
Hypocalcaemia
alanine aminotransferase 161 U/L and a lactate of 6.5 mmol/L.
Serum calcium level was 8.1 mg/dL. Arterial blood gas showed a
pH 7.33 and lactate 6.5 mmol/L. CT of the abdomen and pelvis
without contrast was performed and was notable for diffuse
dilation of the small bowel, with pneumatosis intestinalis and
mesenteric oedema identified in a segment of bowel in the left
hemiabdomen. Figure 1 demonstrates these findings. These findings were consistent with mesenteric ischaemia and the patient
was taken emergently to the operating room for exploratory
laparotomy.
TREATMENT
The patient was taken emergently to the operating room. On
entry into the abdomen, frank purulence was encountered.
Cultures of this fluid were sent and would later grow Klebsiella
pneumoniae, Escherichia coli and Clostridium perfringens. The
bowel was inspected and approximately 30 cm of midjejunum
was noted to be grossly necrotic, with worsened ischaemia noted
along the antimesenteric border. This was transected, and due
to the patient’s tenuous haemodynamic status, the patient was
left in discontinuity, closed and transported to the intensive care
unit for resuscitation. She was taken back to the operating room
24 hours later for a second-ook laparotomy. At that time, an
l
additional 3 cm of bowel at the transected edge was noted to
be ischaemic and was transected. A primary anastomosis was
performed, and the patient’s abdomen was closed and she was
returned to the intensive care unit for further resuscitation.
Serum magnesium level was not checked until routine blood
work in the morning following the first operation, and at that
time it was 8.39 mg/dL (3.45 mmol/L). Phosphorus was also
noted to be elevated at 6.5 mg/dL. Sodium, potassium, chloride
Table 2 Common symptoms of hypermagnesaemia by serum
concentration3 11
Serum magnesium
Symptoms
<4 mg/dL
Somnolence, loss of deep tendon reflexes and QT
prolongation
>12 mg/dL
Muscle paralysis, complete atrioventricular block,
lethargy and decreased breathing rate. Coma and
cardiorespiratory arrest at values above 15 mg/dL
and bicarbonate levels were all within normal limits. It was at
this time that the patient’s family reported her excess intake
of magnesium citrate. Intermittent haemodialysis was started
via a temporary dialysis catheter. The patient’s hypotension,
initially present on arrival, was responsive to moderate doses of
norepinephrine drip. This pressor requirement would continue
until after the patient’s first dialysis session. Haemodialysis was
performed daily for 2 days until serum magnesium concentration
fell below 4 mg/dL, and then proceeded on an every- ther- ay
o
d
cycle. Serum magnesium levels would finally return to reference levels by hospital day 13, after several sessions of dialysis.
Calcium gluconate was not used as an adjunct treatment for this
patient’s hypomagnesaemia due to her satisfactory response to
intermittent haemodialysis. The patient remained oliguric after
the initial physiological insult and would continue dialysis after
discharge. The patient developed a prolonged ileus, likely due to
a combination of smooth muscle dysfunction from the hypermagnesaemia, as well as a postoperative ileus.
The patient’s hospital course was relatively complicated with
several further interventions and transfers between the critical care unit and step- own unit, likely due to the physiologd
ical insult of her presentation in an already comorbid patient.
Non- T elevation myocardial infarction was found on hospital
S
day 2, with troponin rising to 4.57 ng/mL; cardiac catheterisation did not demonstrate any obstructive lesions and she was
treated medically. Large volume of coffee ground fluid was evacuated from her nasogastric tube, and oesophagogastroduodenoscopy did not identify any definitive bleeding.
OUTCOME AND FOLLOW-UP
The patient would ultimately be discharged from the hospital
to a skilled nursing facility. However, she returned less than a
week later in respiratory distress due to aspiration pneumonia,
requiring intubation. Though she was able to be extubated, her
mental status did not meaningfully recover following this physiological insult, and her family ultimately decided for her to be
transitioned to comfort care; she would expire shortly thereafter.
Nausea, vomiting, bradycardia and hypotension
8.5–12 mg/dL
2
Asymptomatic
4–8 mg/dL
Figure 1 Selected axial CT image demonstrating mesenteric oedema
(arrow) and pneumatosis intestinalis in thickened bowel wall (circle)
consistent with ischaemic bowel in the left upper abdomen.
DISCUSSION
In this report, we have presented a case of hypermagnesaemia
causing mesenteric ischaemia. Prior to presentation, the patient
had consumed a large dose of magnesium citrate as an attempted
laxative. The diagnosis of mesenteric ischaemia was supported
Hubbard G, et al. BMJ Case Rep 2021;14:e241928. doi:10.1136/bcr-2021-241928
BMJ Case Rep: first published as 10.1136/bcr-2021-241928 on 22 June 2021. Downloaded from http://casereports.bmj.com/ on July 29, 2021 at Western Reserve Hospital. Protected by
copyright.
Case report
�developed ischaemic colitis and perforation, again in a patient
with acutely worsened chronic constipation, renal insufficiency
and excess magnesium ingestion.5 Their patient presented with
normal blood pressure, a mildly elevated serum magnesium (3.0
mg/dL) and without evidence of bowel ischaemia. However, the
patient’s magnesium level climbed to 6.0 mg/dL on hospital day
3, at which point she developed hypotension and signs of intestinal ischaemia. The findings in these cases form a growing body
of evidence that hypermagnesaemia secondary to magnesium
o
laxatives can cause non- cclusive mesenteric ischaemia, potentially resulting in perforation and requiring surgical intervention.
The key limitation of this issue is the rare nature of the
problem discussed. Few patients were identified in the literature
who required operative intervention with resection of ischaemic
d
bowel. However, hypermagnesaemia is a well- ocumented issue
and we feel that our review of its pathophysiological effects is
a complete one. We are confident in our proposed mechanism
of bowel ischaemia due to hypermagnesaemia, which agrees
with those previously proposed. Laboratory bench studies may
s
be able to confirm our suspicion, or a cross-ectional review
for all patients with hypermagnesaemia. Future study may also
determine if there is a larger prevalence of this pathology than
previously thought, and when it is optimal to choose surgical
management versus more conservative medical therapy.
Figure 2 Flow chart demonstrating proposed mechanism for
hypermagnesaemia causing mesenteric ischaemia.
Learning points
►► Excessive oral intake of magnesium- ontaining laxatives can
c
by the patient’s CT scan, elevated lactic acid level and peritoneal
abdomen on examination. After thorough review of the literature, there appears to be a logical pathophysiological mechanism.1–7 10 Underlying bowel dysmotility serves as the precipitant
cause of excess magnesium absorption,1 4 6 10 such as our patient’s
chronic constipation. Her renal disease caused a decrease in
urinary magnesium excretion and clearance.2 5–7 12 13 This combination of factors facilitated the accumulation of magnesium in
her serum. The hypermagnesaemia caused relaxation of smooth
muscle in the vessel walls, with resultant vasodilation and hypotension. This then led to a low- low state in the bowel mesentery
f
and a non- cclusive mesenteric ischaemia (figure 2). The unique
o
pattern of bowel ischaemia noted on operative exploration
along the antimesenteric border supports this, as the antimesenteric border is a natural watershed area in the blood supply
to the bowel. The timing of vasopressor requirements further
supports this theory. After the patient was started on dialysis,
and the serum magnesium began to be cleared, she was able to
be weaned off vasopressors.
Yamaguchi et al describe a similar mechanism in a case series
published recently, which we agree with and provide an additional
case to support this pathophysiological mechanism.3 Their study
demonstrated hypermagnesaemia in patients with both mild
and severely impaired renal function combined with impaired
bowel motility. Their patient with the most pronounced hypermagnesaemia (14.28 mg/dL) presented with severe hypotension
(78 mm Hg systolic) and with evidence of acute mesenteric
ischaemia. The authors describe a mechanism of hypermagnesaemia causing bowel ischaemia: bowel dysmotility or chronic
constipation causes increased passive absorption of magnesium,
which then induces smooth muscle relaxation and hypotension.
Three of their four patients had renal impairment, suggesting
that while bowel dysmotility is the primary risk factor for hypermagnesaemia, renal impairment may cause further elevations in
serum magnesium. Yoon et al reported a case of a patient who
Hubbard G, et al. BMJ Case Rep 2021;14:e241928. doi:10.1136/bcr-2021-241928
result in hypermagnesaemia, especially in patients with pre-
existing renal compromise.
►► In elderly patients with delayed bowel transit and renal
insufficiency, it is important to limit doses of magnesium and
quickly identify the symptoms of hypermagnesaemia.
►► Familiarity with the sequelae of hypermagnesaemia is
important and our report will help facilitate identification and
treatment going forward.
►► Mesenteric ischaemia may be induced by hypermagnesaemia,
potentially due to smooth muscle relaxation resulting in loss
of vascular tone which, in turn, causes systemic hypotension
and decreased oxygenation of the bowel.
►► The ischaemia develops along the antimesenteric border,
suggesting a low- ow state, and that this may also have a
fl
propensity to occur at watershed areas of the bowel.
Acknowledgements Judy Knight, MLS, AHIP, for her help in compiling the relevant
literature for review.
Contributors GH was responsible for the planning of the report, the literature
review, writing and editing of the manuscript. RN was responsible for the planning,
literature review and writing of the manuscript. LW was responsible for the planning
of the report and editing of the manuscript.
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-or- rofit sectors.
f p
Competing interests None declared.
Patient consent for publication Next of kin consent obtained.
Provenance and peer review Not commissioned; externally peer- eviewed.
r
REFERENCES
1 Bokhari SR, Siriki R, Teran FJ, et al. Fatal hypermagnesemia due to laxative use. Am J
Med Sci 2018;355:390–5.
2 Sugiyama M, Kusumoto E, Ota M, et al. Induction of potentially lethal
hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical
bowel preparation: report of a case. Surg Case Rep 2016;2:18.
3 Yamaguchi H, Shimada H, Yoshita K, et al. Severe hypermagnesemia induced by
magnesium oxide ingestion: a case series. CEN Case Rep 2019;8:31–7.
3
BMJ Case Rep: first published as 10.1136/bcr-2021-241928 on 22 June 2021. Downloaded from http://casereports.bmj.com/ on July 29, 2021 at Western Reserve Hospital. Protected by
copyright.
Case report
� 4 Kontani M, Hara A, Ohta S, et al. Hypermagnesemia induced by massive cathartic
e
ingestion in an elderly woman without pre- xisting renal dysfunction. Intern Med
2005;44:448–52.
5 Yoon HE, Kim YW, Ha KS, et al. Hypermagnesemia accompanied with colonic
perforation in a hemodialysis patient. Yonsei Med J 2013;54:797.
6 Khairi T, Amer S, Spitalewitz S, et al. Severe symptomatic hypermagnesemia associated
with over- he- ounter laxatives in a patient with renal failure and sigmoid volvulus.
t c
Case Rep Nephrol 2014;2014:1–2.
7 Nishikawa M, Shimada N, Kanzaki M, et al. The characteristics of patients with
hypermagnesemia who underwent emergency hemodialysis. Acute Med Surg
2018;5:222–9.
8 Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev
2003;24:47–66.
9 Lawrence PF, Bell RM, Dayton MT. Essentials of general surgery. Lippincott Williams &
Wilkins, 2012: 586.
1
0 Onishi S, Yoshino S. Cathartic-nduced fatal hypermagnesemia in the elderly. Intern
i
Med 2006;45:207–10.
1
1 Cascella M, Vaqar S. Hypermagnesemia. In: StatPearls. Treasure Island (FL): StatPearls
Publishing, 2021.
1
2 Felsenfeld AJ, Levine BS, Rodriguez M. Pathophysiology of calcium, phosphorus, and
magnesium dysregulation in chronic kidney disease. Semin Dial 2015;28:564–77.
1
3 Azem R, Daou R, Bassil E, et al. Serum magnesium, mortality and disease progression
in chronic kidney disease. BMC Nephrol 2020;21:49.
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�
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Title
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Hypermagnesaemia causing mesenteric ischaemia and small bowel infarction
Creator
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Hubbard G; Nerad R; Wojtasik L
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Description
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We present a case of mesenteric ischaemia caused by hypermagnesaemia after ingestion of a large oral dose of magnesium citrate, which resulted in smooth muscle relaxation, hypotension and bowel infarction. The patient had a history of chronic bowel dysmotility and renal impairment. On operative exploration, the bowel was noted to have a distinct pattern of ischaemia along its antimesenteric border. Small bowel resection was performed, and the patient was left in discontinuity, with definitive repair and anastomosis performed 24 hours later. The patient's magnesium level was 8.39 mg/dL, which was treated with intermittent haemodialysis and eventually normalised over several sessions. Our patient recovered and was discharged after a month-long hospitalisation. She returned shortly after with respiratory failure and died. On review of the literature, we identified similar cases and present a pathophysiological mechanism of hypermagnesaemia causing mesenteric ischaemia, consistent between our cases and those already reported.
Subject
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fluid electrolyte and acid-base disturbances; gastrointestinal surgery; general surgery; renal medicine; surgery
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<a href="http://doi.org/10.1136/bcr-2021-241928" target="_blank" rel="noreferrer noopener">10.1136/bcr-2021-241928</a>
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NEOMED College
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Department of General Surgery
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Title
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Hypermagnesaemia causing mesenteric ischaemia and small bowel infarction
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BMJ Case Reports
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2021
Description
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We present a case of mesenteric ischaemia caused by hypermagnesaemia after ingestion of a large oral dose of magnesium citrate, which resulted in smooth muscle relaxation, hypotension and bowel infarction. The patient had a history of chronic bowel dysmotility and renal impairment. On operative exploration, the bowel was noted to have a distinct pattern of ischaemia along its antimesenteric border. Small bowel resection was performed, and the patient was left in discontinuity, with definitive repair and anastomosis performed 24 hours later. The patient's magnesium level was 8.39 mg/dL, which was treated with intermittent haemodialysis and eventually normalised over several sessions. Our patient recovered and was discharged after a month-long hospitalisation. She returned shortly after with respiratory failure and died. On review of the literature, we identified similar cases and present a pathophysiological mechanism of hypermagnesaemia causing mesenteric ischaemia, consistent between our cases and those already reported.
Subject
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fluid electrolyte and acid-base disturbances; gastrointestinal surgery; general surgery; renal medicine; surgery
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Department of General Surgery
fluid electrolyte and acid-base disturbances
gastrointestinal surgery
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Hubbard G
NEOMED College of Medicine
renal medicine
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Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 23 (2021) 100228
Contents lists available at ScienceDirect
Journal of Clinical Tuberculosis and Other
Mycobacterial Diseases
journal homepage: www.elsevier.com/locate/jctube
Tuberculous appendicitis: A review of reported cases over the past 10 years
Grant Hubbard *, Walter Chlysta
Western Reserve Hospital, Department of Surgery, 1900 23rd St, Cuyahoga Falls, OH 44223, USA
A R T I C L E I N F O
A B S T R A C T
Keywords:
Tuberculous appendicitis
Appendix
Extrapulmonary tuberculosis
Gastrointestinal tuberculosis
Surgery
Public health
Background: Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear
summarization or consensus on its management.
Data sources: Case reports were gathered from several online literature databases by searching terms “tubercu
losis”, “tuberculous”, and “appendicitis”.
Report eligibility criteria: Cases of appendicitis due to M. tuberculosis identified on operative histology. Exclusion
criteria: appendicitis caused by a mycobacterium other than M. tuberculosis, and appendiceal tuberculosis
identified incidentally during procedures for other reasons.
Results: Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant
abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/
fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging
which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in
15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment
(ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months.
Limitations: Data was gathered from case reports without complete uniformity in diagnostic work-up. The po
tential for larger scale study is limited due to disease rarity.
Conclusions: Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points
may suggest the disease on a clinician’s differential diagnosis if they present with a combination of the following:
born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of
abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young
patient; positive AFB stain of abdominal fluid or peritoneal tissue.
1. Background
An overall reduction in the prevalence of Tuberculosis (TB) has been
noted over the last decade in both the developed and developing world,
due in large part to systematic efforts toward its treatment and eradi
cation [1]. Tuberculous appendicitis is a rare clinical entity, with a re
ported incidence of 1.5–3.0% among patients with tuberculosis [2].
Tuberculous appendicitis was first described by Corbin in 1873 and has
seen little change in its incidence since that time. The challenge pre
sented by this disease lies in its prompt identification and diagnosis.
Patients present identically to patients with non-tuberculous cases of
appendicitis, with the final diagnosis of tuberculous appendicitis only
made upon report of histologic findings [3]. Oftentimes, these patients
will present without a previous history of pulmonary tuberculosis, or
even without suggestive symptoms. According to prior literature, only
14% of gastrointestinal TB will demonstrate suggestive findings on chest
X-ray [4].
The time spent between presentation, operation, and diagnosis yields
an amount of time during which a patient with appendiceal tuberculosis
will remain on a nursing floor, in a non-isolated room, exposed to other
patients and healthcare workers. This is a concerning statistic when
considering prior reviews and prior reports from the World Health Or
ganization (WHO) which state that rates of TB infection in healthcare
workers are twice that of the general population [5,6]. The risk is further
exacerbated in countries with endemic TB [7]. This window of exposure
presents a risk of transmission, and raises the question “how can we
improve?”
In the US, extrapulmonary disease is seen in 20–30% of patients with
TB [8]. Of the extrapulmonary manifestations, it is reported that bone
involvement by TB is most common (30%), followed by the urinary tract
(24%), and perihilar lymph nodes (13%) [9]. Involvement of the
gastrointestinal tract varies widely in the literature, with a reported
* Corresponding author.
E-mail address: ghubbard@westernreservehospital.org (G. Hubbard).
https://doi.org/10.1016/j.jctube.2021.100228
Available online 18 March 2021
2405-5794/© 2021 The Authors.
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
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�G. Hubbard and W. Chlysta
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 23 (2021) 100228
prevalence between 3 and 10% [10]. Tuberculous appendicitis occurs
even less frequently, constituting 10% of gastrointestinal infections, or
0.03–0.1% of extrapulmonary infection [11,12]. Ileocecal infection
comprises 75% of all intestinal TB infections [10]. It should be noted
that two of the most recently published series of patients do not report a
single case involving the appendix [13,14].
The characteristic histologic findings to make the diagnosis of
tuberculous appendicitis include caseating granulomas, epithelioid
histiocytes, and Langhans giant cells [12]. Fig. 1 below includes exam
ples of these findings within appendiceal tissue for reference.
Following diagnosis, patients with tuberculous appendicitis have
been treated with standard antituberculosis therapy (ATT) [15] and
appendectomy. Other forms of gastrointestinal tuberculosis often do not
require surgery, with the majority of cases of tuberculosis affecting the
gastrointestinal tract successfully treated with ATT [16]. These forms of
infection are frequently discovered as part of other work-up for pul
monary tuberculosis, chronic diarrhea, chronic abdominal pain, etc.
appendicitis caused by a mycobacterium other than M. tuberculosis, and
appendiceal tuberculosis identified incidentally during procedures for
other reasons (e.g. right hemicolectomy for colon cancer). The cases
were then categorized and grouped based on presenting demographics,
symptoms, diagnostic findings, treatment modalities, and surgical
findings.
4. Results
Thirty four cases of Tuberculous Appendicitis were reported in 27
papers [2,9,10,16,17,25–46]. Baseline characteristics are reported in
Table 1. Twenty patients were male and 16 were female. Presenting
symptoms are reported in Table 2. The average age of patients was 25.5
± 8.8 years. Twenty eight patients (82%) presented with acute onset or
worsening of right lower quadrant abdominal pain. Twelve patients
(35%) of patients complained of vague or generalized chronic abdom
inal pain (defined as greater than 7 days). Eleven patients (33.3%)
described chronic symptoms of cough, night sweats, or weakness/fa
tigue; including 1 patient with known active pulmonary TB, 2 patients
with known extrapulmonary TB, and 1 patient with previously identi
fied latent TB at the time of appendicitis symptom onset.
Fig. 2 demonstrates the country of origin for patients. Eighteen cases
were reported from India and East/Southeast Asia; 6 cases from the
Middle East; 6 cases from Africa; 2 cases from South America; and 2
cases from Europe.
Diagnostic data is reported in Table 3. Leukocytosis was noted in 19
patients (56%). Diagnostic methodology was reported in 28 cases.
Fourteen patients (41%) were diagnosed by ultrasound (US), 10 patients
2. Objectives
This study aimed to review case report findings over the past 10
years. The primary objective was to evaluate the disease burden,
symptomatology, diagnostic methodology, and diagnostic difficulties
associated with tuberculous appendicitis.
3. Methods
PubMed and Google Scholar databases were queried with the terms
“tuberculosis”, “tuberculous”, and “appendicitis”. The databases BIOSIS,
DeepDyve, Science Citation Index Expanded (SCI-EXPANDED), Social
Sciences Citation Index (SSCI), and Conference Proceedings Citation
Index- Science (CPCI-S) were also queried with the same MeSH terms
and searches did not yield any additional reports. Case reports from the
years 2010 through 2021 reviewed for patient presentation, methods of
diagnosis, and treatments. This timeframe was chosen due to the ease of
access in literature databases. Exclusion criteria were: cases of
Table 1
Baseline characteristics.
Variable
Total patients = 34 (% total)
Average age, years (SD)
Male sex
Prior diagnosis of tuberculosis
25.5 (8.81)
20 (59)
2 (6)
Fig. 1. a–d: Caseating granulomas with Langhans giant cells and epithelioid histiocytes.
2
�G. Hubbard and W. Chlysta
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 23 (2021) 100228
Table 2
Presenting signs and symptoms.
Table 4
Operative management and intraoperative findings.
Variable
Total patients = 34 (% total)
Variable
Total patients = 34 (% total)
Acute onset or worsening of RLQ abdominal pain
Vague or generalized abdominal pain
Palpable abdominal mass
Fever
Nausea or vomiting
Diarrhea
Anorexia, weight loss, or loss of appetite
Cough
Hypotension
Median duration of symptoms, days (IQR)
Reported chronic symptoms
28 (82)
12 (35)
2 (6)
24 (71)
15 (44)
4 (12)
10 (29)
4 (12)
5 (15)
10 (3.5–60)
17 (50)
Laparoscopic appendectomy
Open appendectomy/RLQ incision
Exploratory laparotomy/midline incision
Ruptured, perforated, or necrotic appendix
Peritoneal studding with tubercles
Peritoneal fluid AFB positive
7
13
13
8 (24)
7 (21)
5 (15)
nodules/lesions on either the appendix, mesentery, or peritoneum. All
34 patients had final diagnosis determined on histology, with all samples
displaying characteristic caseating granulomas, epithelioid histiocytes,
and Langhans giant cells. AFB stain from either the appendix or peri
toneal fluid sample was reported in 12 patients. AFB were present in the
tissue or fluid samples of 5 patients (15%), and negative in 7 patients.
Nearly all patients subsequently underwent pharmacotherapy on the
HRZE regimen (isoniazid, rifampicin, pyrazinamide, and ethambutol),
or a WHO-recommended alternative [18]. The average duration of
treatment was 7.2 ± 1.7 months. Two patients completed an ATT course
for less than 6 months and were reportedly well at their routine follow
up exam. One patient completed a WHO-recommended alternative for
multi-drug resistant TB.
5. Discussion
The pathophysiology of appendiceal tuberculosis is complex and
relatively uncertain. Singh and colleagues proposed classifications and
subgroupings regarding the etiology of tuberculous appendicitis: pri
mary appendicitis due to appendiceal contact with infected intestinal
contents, direct hematogenous spread from a distant source such as the
lung; or secondary appendicitis due to local extension of ileocecal
tuberculosis, retrograde lymphatic spread in the ileum/ascending colon,
or appendiceal serositis/periappendicitis from peritoneal involvement
[19]. It was noted in the pair of cases from Akbulut et al. that 2 patients
who developed tuberculous appendicitis had lesions noted at the
appendiceal orifice on colonoscopy performed 2 months prior to onset of
appendicitis [17]. Logic would dictate that primary inoculation from
swallowing of the expectorated phlegm of pulmonary TB should offer
the most easily identifiable risk factor for developing tuberculous
appendicitis [20]. However, from our review of published cases, only
one patient presented with appendicitis in the setting of active pulmo
nary tuberculosis. Appendicitis was the initial presentation and primary
mode for diagnosis of TB in the remaining patients.
Because of the lack of capability for pre-operative diagnosis, prompt
identification is dependent upon a high index of suspicion, considering
patient demographics, as well as history and presenting symptoms.
Radiologic and laboratory results will support clinical suspicion.
In the US, patients who are born in a country with endemic TB
(especially from Asia, the Middle East, or Africa), who present with
vague chronic complaints prior to acute abdominal pain, or who
complain of chronic abdominal pain represent the highest likelihood of
tuberculous appendicitis. Necrotic lymph nodes represent the only po
tential differentiating finding on abdominal imaging.
The only reported cases of tuberculous appendicitis in North America
over the past 10 years involved patients who had immigrated to the
continent after childhood. According to the Centers for Disease Control
(CDC), 70% of TB diagnoses in 2017 were made in foreign-born in
dividuals [21]. In the clinical experience of the primary author, tuber
culous appendicitis has been seen only once, and was diagnosed in a
patient who had immigrated to the US from China for education. This
data does not imply that only foreign-born patients will develop tuber
culous appendicitis, but it does offer a data point from the patient’s
history that should raise clinical suspicion of the disease for surgeons in
the US. For reference, the World Health Organization (WHO) lists 22
Fig. 2. Breakdown of patient country of origin.
Table 3
Diagnostic work up.
Variable
Total patients = 34 (%
total)
Leukocytosis
Diagnostic modality
Physical exam
Ultrasound
Computed Tomography
Enlarged or necrotic peri-appendiceal lymph nodes on
imaging
Evidence of tuberculosis on chest CT or X-ray
Sputum AFB positive
19 (56)
4 (12)
14 (41)
10 (29)
5 (15)
7 (21)
6 (18)
(29%) by computed tomography of the abdomen/pelvis (CT), and 4
patients (12%) were diagnosed on physical exam alone. Chest X-ray
(CXR) or chest CT results were reported in 24 patients. Seven of these
patients (29%) had radiographic evidence of pulmonary tuberculosis.
Data regarding operative management and findings are reported in
Table 4. Twenty six patients (76%) underwent an open surgery,
including 13 who underwent exploratory laparotomy and 13 who un
derwent open appendectomy via right lower quadrant incision. Seven
patients underwent laparoscopic appendectomy. Eight cases (24%)
noted a perforated or ruptured appendix. Seven cases (21%) noted white
3
�G. Hubbard and W. Chlysta
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 23 (2021) 100228
countries which see 80% of worldwide TB diagnoses [22].
A preoperative chest X-ray can be considered if the surgeon has a
high index of suspicion for tuberculous appendicitis. Due to the often
urgent nature of appendicitis, the young age of affected patients, and
typical lack of notable medical history, a chest X-ray is frequently not
performed. However, if there is a high index of suspicion for tuberculous
etiology in a hemodynamically stable patient with appendicitis, a pre
operative chest X-ray can be performed to support clinical judgement.
Characteristic chest X-ray findings for tuberculosis include infiltrates,
consolidations, cavitating nodules, with or without mediastinal/hilar
lymphadenopathy [21].
Peritoneal implants were noted in a quarter of patients. This may be a
useful finding intraoperatively. In older patients, peritoneal studding is
more worrisome for carcinomatosis. However in patients with tuber
culous appendicitis, who are noted to typically be younger, this could
support a suspicion of TB as the causative organism for the patient’s
appendicitis.
Our review notes that AFB stain is positive in abdominal fluid in less
than 30% of patients, making the culture of M. tuberculosis difficult.
While these numbers are low, sending peritoneal fluid and appendiceal
tissue for Ziehl-Neelsen (acid fast) stain will typically yield a result
within 24 h of sample arrival to the laboratory. This may provide an
earlier diagnosis of tuberculous appendicitis and an earlier indication or
justification for placing the patient in isolation than would be afforded
by pathology results. Culture of abdominal fluid will also take longer to
yield results, but will only aid in making the final diagnosis and support
histology findings.
At institutions where it is available, nucleic acid amplification (NAA)
is a useful adjunct to the classic mode of histologic diagnosis. If perito
neal fluid is found during surgery, samples can be sent for amplification.
NAA tests are highly sensitive and specific for TB, and a result can be
obtained in a matter of hours. However as with any rare disease, their
positive predictive value is usually quite low. The CDC and WHO both
recommend NAA tests as adjunctive data points for early detection of a
likely TB infection, when available. However, this testing alone is not
considered diagnostic and a positive result must be later confirmed and
diagnosed by culture. NAA was scarcely reported in the literature
reviewed by this study, and so commentary on its usefulness in the
diagnosis of tuberculous appendicitis has been omitted, but it is worth
considering for future study as a modality for more prompt identifica
tion of tuberculous appendicitis (Fig. 3).
Initiation of ATT still requires tissue diagnosis at this time. While
guidelines exist for treatment of latent disease [23], tuberculous
appendicitis is an extrapulmonary manifestation of active disease, which
is typically treated according to the WHO’s guidelines of 6 months
treatment duration (WHO tx). This strategy proved effective in curing all
cases of tuberculous appendicitis reported in this literature review. Two
reported cases completed a course of treatment for less than 4 months,
with successful eradication of symptoms and no evidence of tuberculosis
at follow-up. However, this is not recommended as it carries the risk of
sub-cidal treatment and the generation of multi-drug resistant tuber
culosis (MDR-TB) [24].
The major limitation of this paper is the quality of data due to the
nature of is collection. Presenting symptoms, diagnosis, and manage
ment were not standard between case reports. Because of this, the data
collected was incomplete in several variables. However, due to the low
incidence of tuberculous appendicitis, it is felt that more intense study
will likely not be possible. Due to the low incidence of tuberculous
appendicitis, a high powered study will also likely not be possible.
Another factor not discussed earlier is the possibility of incorrect diag
nosis by a pathologist. While tuberculosis has several characteristic
histologic findings, it is possible to identify granulomas, both caseating
and noncaseating, in a number of other conditions. These include Yer
sinia enterocolitica infection, parasitic infections, Crohn’s disease,
sarcoidosis, or foreign body reactions [12,25]. While these conditions
will likely not be seen in combination with both epithelioid histiocytes
and Langhans giant cells, it nonetheless bears consideration when
assessing the patient [26].
While this paper attempted an exhaustive search of the literature
over the past 10 years, it remains distinctly possible that some case re
ports remain omitted due to a lack of reporting in the included data
bases. While this review may be considered an extensive search of the
available literature, it certainly may not be a complete one. It should be
noted that all reports encountered in Pubmed and Google Scholar were
encountered in the other databases that were searched. A search of the
other databases did not yield any additional case reports outside of those
already encountered in Pubmed and Google Scholar that fit the inclusion
and exclusion criteria.
6. Conclusions
We do not yet possess the means to definitively identify appendiceal
tuberculosis in patients pre-operatively. In lieu of a method of formal
preoperative diagnosis, our aim is to provide a summary characteriza
tion of patients with tuberculous appendicitis so that higher risk patients
may be identified. Nearly one third of tuberculous appendicitis patients
will present with chronic “classic” symptoms of tuberculosis prior to the
onset of abdominal symptoms. These patients often originate from
countries with endemic tuberculosis. Even with cases seen in North
America or Europe, patients will typically have immigrated from
endemic regions. Tuberculous appendicitis is a disease primarily
affecting young patients, especially males. Objective data offers sug
gestions of tuberculous appendicitis, but there does not appear to be a
sensitive or specific enough laboratory or imaging finding to make a
preoperative diagnosis. Radiologic evidence of tuberculous appendicitis
does not appear to differ significantly from non-tuberculous appendi
citis; the only notable difference being necrotic lymph nodes mentioned
on CT scans in 5 cases. Less than a third of patients will have identifiable
lesions on perioperative chest X-ray. Intraoperatively, approximately a
quarter of patients will have tubercles or studding noted either on the
appendix, mesentery, or peritoneum. Open surgery has largely been
performed on these patients. At this point, tuberculous appendicitis can
only be considered amongst a patient’s differential diagnosis, taking into
consideration multiple history, physical, and laboratory/radiologic data
points. A high index of suspicion can be generated with these data
points, but we do not yet possess the means to diagnose tuberculous
appendicitis prior to histologic examination.
7. Declarations and statements
The Corresponding Author has the right to grant on behalf of all
authors and does grant on behalf of all authors, an exclusive licence on a
Fig. 3. Tubercles studded on visceral peritoneum [9].
4
�G. Hubbard and W. Chlysta
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 23 (2021) 100228
worldwide basis to the to permit this article (if accepted) to be published
in the Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
and sublicences such use and exploit all subsidiary rights, as set out in
the licence.
Transparency declaration: The lead author affirms that the manuscript
is an honest, accurate, and transparent account of the study being re
ported; no important aspects of the study have been omitted.
Ethics statement: this study did not require ethical approval as it
pulled information and analyzed data from already published and
available work.
Funding: this study did not receive any funding.
Author role details: Grant Hubbard: lead data collection and writer.
Walter Chlysta: writer, editor, research mentor.
Patient and public involvement: neither the public nor any patients
were involved in the writing of this manuscript.
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Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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[13] Singh A, Sahu MK, Panigrahi M, Behera MK, UthanSingh K, Kar C, Narayan J.
Abdominal tuberculosis in Indians: Still very pertinent. J Clin Tubercul Other
Mycobact Dis 2019;15:100097.
[14] Cheng W, Zhang S, Li Y, Wang J, Li J. Intestinal tuberculosis: clinico-pathological
profile and the importance of a high degree of suspicion. Trop Med Int Health
2019;24(1):81–90.
[15] Vinay HG, Girish TU, Sharath Chandra BJ, Thrishuli PB. Primary tuberculosis of
the appendix: a rare cause of a common disease. J Surg Tech Case Report 2013;5
(1):32.
[16] Chong VH, Telisinghe PU, Yapp SKS, Chong CF. Tuberculous appendicitis: a review
of clinical presentations and outcomes. Singapore Med J 2011;52(2):91–3.
5
�
Text
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<a href="http://doi.org/10.1016/j.jctube.2021.100228" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jctube.2021.100228</a>
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NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
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Hubbard G; Chlysta W
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<a href="http://doi.org/%2010.1016/j.jctube.2021.100228" target="_blank" rel="noreferrer noopener"> 10.1016/j.jctube.2021.100228</a>
Title
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Tuberculous appendicitis: A review of reported cases over the past 10 years
Publisher
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Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Description
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Background: Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear summarization or consensus on its management.
Data sources: Case reports were gathered from several online literature databases by searching terms "tuberculosis", "tuberculous", and "appendicitis".Report eligibility criteria: Cases of appendicitis due to M. tuberculosis identified on operative histology. Exclusion criteria: appendicitis caused by a mycobacterium other than M. tuberculosis, and appendiceal tuberculosis identified incidentally during procedures for other reasons.
Results: Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in 15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment (ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months.
Limitations: Data was gathered from case reports without complete uniformity in diagnostic work-up. The potential for larger scale study is limited due to disease rarity.
Conclusions: Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points may suggest the disease on a clinician's differential diagnosis if they present with a combination of the following: born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young patient; positive AFB stain of abdominal fluid or peritoneal tissue.
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Appendix; Extrapulmonary tuberculosis; Gastrointestinal tuberculosis; Public health; Surgery; Tuberculous appendicitis
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journalArticle
2021
Appendix
Chlysta W J
Department of General Surgery
Extrapulmonary tuberculosis
Gastrointestinal tuberculosis
Hubbard G
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
NEOMED College of Medicine
Public Health
Surgery
Tuberculous appendicitis
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Text
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<a href="http://doi.org/10.1097/JTN.0000000000000597" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/JTN.0000000000000597</a>
Pages
275-280
Issue
4
Volume
28
ISSN
1078-7496
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NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Title
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A Critical Pathway for Mass Casualty Incident Preparedness.
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Journal Of Trauma Nursing
Date
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2021
2021-07
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Moran ME; Blecker N; Gothard MD; George RL
Description
An account of the resource
Background: Rates of mass casualty incidents (MCIs) have been on the rise in the United States, highlighting the need for health care systems to have an emergency response plan. Trauma centers are fundamental during MCIs and serve a crucial leadership role in preparedness for them.; Objective: The purpose of this study was to describe the design and implementation of simulated MCI drills at an American College of Surgeons verified Level I trauma center in the Midwest.; Methods: A quasi-experimental time-series design was utilized to determine MCI simulation effects on staff performance using an emergency department checklist to measure emergency department throughput time. A multidisciplinary MCI design team developed a checklist for the emergency department, which identified tasks required to complete it. The 16-item checklist, Critical Pathway Management methodology, was used to identify the critical pathway for patient throughput during a surge. Two in situ MCI simulation drills were conducted in the emergency department (October and December 2019), and Critical Pathway Management identified the primary patient throughput rate limiters as notification and inpatient nursing staff presentation.; Results: Emergency department throughput decreased from a mean of 15 to 11 min (reduction of 26.7%) between the two time periods after focusing on rate-limiting tasks.; Conclusion: This quality improvement project demonstrated that the use of institution-specific checklists and Critical Pathway Management to identify critical pathways and potential rate limiters led to patient throughput improvements. (Copyright © 2021 Society of Trauma Nurses.)
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<a href="http://doi.org/10.1097/JTN.0000000000000597" target="_blank" rel="noreferrer noopener">10.1097/JTN.0000000000000597</a>
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journalArticle
2021
Blecker N
Department of General Surgery
George RL
Gothard MD
Journal Of Trauma Nursing
journalArticle
July 2021 List
Moran ME
NEOMED College of Medicine
Summa Health System Akron City Hospital
-
Text
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<a href="http://doi.org/10.7759/cureus.15858" target="_blank" rel="noreferrer noopener">http://doi.org/10.7759/cureus.15858</a>
Issue
6
Volume
13
ISSN
2168-8184
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July 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Title
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Staff Perspectives of Mass Casualty Incident Preparedness
Publisher
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Cureus
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-06-23
Subject
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qualitative; DISASTER; emergency preparedness; emergency response plan; in situ simulation; mass casualty incident; quality improvement projects; RESPOND; SIMULATION; STUDENTS
Creator
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Moran ME; Zimmerman JR; Chapman AD; Ballas DA; Blecker N; George RL
Description
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Introduction Mass casualty incidents (MCI) are low-frequency, high-risk events that disrupt the day-to-day operations of medical centers. Day-to-day protocols are insufficient for effectively managing MCI events, creating a need to develop and test MCI-specific protocols. The aim of this project was to utilize interviews to gain insight into staff experience and perspective on MCIs and their institution's response plans. Methods Staff members who participated in an MCI drill were asked semi-structured interview questions regarding their perspectives on their current priorities, the information needed to perform their role, and their greatest concerns about an MCI. This quality improvement (QI) project utilized a qualitative methodology to thematically organize the results of the staff responses. Results A total of 64 staff members with various levels of patient care experience were interviewed to reach thematic saturation. The use of staff interviews helped to identify the four primary themes that emerged, which were: 1) process, 2) supplies and resources, 3) communication, and 4) roles. Furthermore, each theme also included a number of subthemes. Conclusions This project demonstrated the importance of staff experiences related to MCI simulation training and preparedness, which may be useful for future training and emergency response planning. Additionally, the results may be helpful for other institutions when building a robust MCI simulation training program or designing an emergency response plan.
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<a href="http://doi.org/10.7759/cureus.15858" target="_blank" rel="noreferrer noopener">10.7759/cureus.15858</a>
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journalArticle
2021
Ballas DA
Blecker N
Chapman AD
Cureus
Department of General Surgery
disaster
emergency preparedness
emergency response plan
George RL
in situ simulation
journalArticle
July 2021 List
mass casualty incident
Moran ME
NEOMED College of Medicine
Qualitative
quality improvement projects
RESPOND
simulation
Students
Summa Health System Akron City Hospital
Zimmerman JR
-
Text
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<a href="http://doi.org/10.4293/JSLS.2020.00115" target="_blank" rel="noreferrer noopener">http://doi.org/10.4293/JSLS.2020.00115</a>
Issue
1
Volume
25
ISSN
1086-8089
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July 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Title
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Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique
Publisher
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JSLS-Journal Of The Society Of Laparoendoscopic Surgeons
Date
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2021
2021-01
Subject
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Laparoscopy; Catheter placement; PD catheter; Peritoneal dialysis
Creator
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Smith B; Mirhaidari S; Shoemaker A; Douglas D; Dan AG
Description
An account of the resource
Background: Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique. Methods: All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys. Results: A total of 100 patients with a mean age of 56 years underwent laparoscopic PD catheter placement over the 5-year study period. In total, 103 laparoscopic PD catheter placement attempts were made in 100 patients. Placement was successful in 98 (95.1%) attempts and no placement required conversion to an open operation. Omentopexy was performed in 82 (83.7%) patients. There was no mortality reported within 30 days of the index operation. For patients who successfully underwent laparoscopic PD placement, early complications developed in 9 (9.2%) patients, of which 6 (6.1%) complications were directly related to the PD catheter. Midterm complications developed in 25 (25.5%) patients. Complication-related catheter repositioning was required for 12 (12.2%) catheters and catheter-related complication removal was required for 18 (18.4%) catheters. Conclusion: Laparoscopic placement of PD catheters can be successfully performed using a combination of described standardized laparoscopic maneuvers for optimal placement resulting in acceptable perioperative and short and midterm complication rates with negligible mortality rates.
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<a href="http://doi.org/10.4293/JSLS.2020.00115" target="_blank" rel="noreferrer noopener">10.4293/JSLS.2020.00115</a>
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journalArticle
2021
Catheter placement
Dan AG
Department of General Surgery
Douglas D
journalArticle
Jsls-Journal of the Society of Laparoendoscopic Surgeons
July 2021 List
Laparoscopy
Mirhaidari S
NEOMED College of Medicine
PD catheter
Peritoneal Dialysis
Shoemaker A
Smith B
Summa Health System Akron City Hospital
-
Text
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<a href="http://doi.org/10.1016/j.jaapos.2021.02.009" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jaapos.2021.02.009</a>
ISSN
1528-3933 1091-8531
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Update Year & Number
June 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Surgery
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Title
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Analysis of anomalous head posturing in patients with infantile nystagmus syndrome.
Publisher
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Journal Of AAPOS : The Official Publication Of The American Association For Pediatric Ophthalmology And Strabismus
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-06-01
Creator
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Hertle RW; Kelleher C; Bruckman D; McNinch N; Ricker I; Bouhenni R; Wiseman K
Description
An account of the resource
PURPOSE: To investigate anomalous head posturing in patients with INS. METHODS: This was a prospective, cohort analysis of clinical and anomalous head posture (AHP) data in 34 patients with INS and an AHP. Particular outcome measures included measurement of AHP in three dimensions of pitch (anterior posterior flexion/extension), yaw (lateral rotation), and roll (lateral flexion) during best-corrected binocular acuity testing and during their subjective sense of straight. Patients were also queried as to their subjective sense of head posture in forced straight position and in their preferred AHP. The paired t test was used to determine significance in differences between measures. RESULTS: A total of 34 patients (19 males [56%]) 9-56 years of age (mean, 16.5 ± 6) were included. Associated systemic or ocular system deficits were present in 30 patients (88%). AHP during best-corrected visual acuity testing averaged 16.5° ± 8.20° (range, 10°-51°), which was significantly different from the mean voluntary "comfortable" position only in the pitch and roll directions (P < 0.001). There was a significant noncongruous response during subjective response to head posturing with most sensing their head as "crooked" (76.5%) when manually straightened (P = 0.001). CONCLUSIONS: The clinical AHP of patients with INS exists in all three spatial dimensions of pitch, yaw, and roll. Although the visual system may be causally related to the onset, amount, and direction of a compensatory AHP in patients with INS, its persistence over time or after surgical intervention is likely due to a combination of visual system (eg, nystagmus, strabismus) and nonvisual system (egocentric and musculo-skeletal) factors.
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<a href="http://doi.org/10.1016/j.jaapos.2021.02.009" target="_blank" rel="noreferrer noopener">10.1016/j.jaapos.2021.02.009</a>
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journalArticle
2021
Bouhenni R
Bruckman D
Department of General Surgery
Hertle RW
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus
journalArticle
June 2021 List
Kelleher C
McNinch N
NEOMED College of Medicine
Ricker I
Wiseman K
-
Text
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener">http://doi.org/</a>
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June 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
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Title
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Lower Genitourinary Trauma.
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StatPearls
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-01
Creator
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Tullington JE; Blecker N
Description
An account of the resource
Traumatic injuries can range from minor wounds to major, complex injuries causing shock and multi-system organ dysfunction. Trauma is the leading cause of death in patients between the ages of 15 and 24. It accounts for approximately 30% of all ICU admissions annually. The lower urogenital (GU) tract is composed of the bladder, urethra, vagina, uterus, ovaries, penis, scrotum, and testes. The lower GU tract is typically protected by the bony pelvis. The pelvis is a ring structure composed of the sacrum, the coccyx, and the innominate bones: the pubis, ischium, and ilium. The innominate bones join anteriorly at the pubic symphysis. Bladder Anatomy The urinary bladder functions as a reservoir. The size, shape, and spatial relation to surrounding organs differs depending on the volume within the bladder. An empty bladder lies within the protection of the bony pelvis. However, as the bladder fills, it extends superiorly into the abdominal cavity and is more prone to traumatic forces. The base of the bladder is closely related to the vagina in females and the rectum in males. The bladder neck is the most inferior portion and is generally the most fixed portion of the bladder. The pubovesical ligaments fix the bladder neck to the pubic bones in both males and females. It is essentially the internal urethral orifice. The anterior bladder is separated from the transverses fascia by adipose tissue, which is the retropubic space (space of Retzius). Bilateral ureters drain into the bladder at the ureteral orifices located on the trigone. The inferolateral surfaces are not covered by peritoneum. In males, the superior portion of the bladder is covered with peritoneum, which continues posteriorly and over the rectum to form the rectovesical pouch. In females, the superior surface is also mostly covered in peritoneum being reflected at the uterus, forming the vesicouterine pouch. The remainder of the superior bladder is separated from the cervix by areolar tissue. As the bladder fills and becomes distended, the anterior portion, which is not covered by peritoneum, is exposed over the pubic bones. The blood supply is mainly from the superior and inferior vesical arteries. These arise from the internal iliac artery. The veins that drain the bladder form a plexus on the inferolateral surface of the bladder and then drain into the internal iliac veins. Lymphatic drainage is generally to the external iliac nodal basin. There is both sympathetic (T10-L2) and parasympathetic (S2-S4) innervation to the bladder, which arises from the pelvic plexus. The bladder consists of 4 layers, the urothelium, lamina propria, muscularis propria, and serosa. The muscularis propria is the detrusor muscle and consists of 3 layers: inner and outer longitudinal and a circular layer. The detrusor is a smooth muscle. It relaxes to allow the bladder to fill and then contracts to empty the bladder. Bladder contraction is via parasympathetic actions. Urethra Anatomy The male urethra is about 18 to 20 cm in length. It is a conduit from the inferior bladder to the external urethral meatus. The posterior urethra is about 4 cm in length and is located above the corpus spongiosum. The prostatic urethra is a portion of the posterior urethra. The lowest portion of the prostatic urethra is fixed in place by the puboprostatic ligament rendering it immobile. The anterior urethra is surrounded by corpus spongiosum. The urethral artery branches from the internal pudendal artery just below the perineal membrane and travels within the spongiosum to the glans penis, giving off branches to the urethra. The dorsal penile artery helps provide blood to the urethra via the circumflex branches. The anterior urethra has venous drainage via the dorsal veins of the penis and the internal pudendal veins. These then drain into the prostatic plexus. The posterior urethra drains into the prostatic and vesicle plexus, which then drains into the internal iliac veins. The posterior urethra generally drains into the internal iliac nodes, whereas the anterior urethra drains into the deep inguinal lymph nodes. The prostatic plexus supplies the prostatic urethra. The internal urethra sphincter receives sympathetic innervation from the pelvic plexus to prevent retrograde ejaculation. Parasympathetic innervation is from S2 to S4. The female urethra is about 4 cm in total length. It is fixed anteriorly by the suspensory ligament of the clitoris and beneath the pubis by the posterior pubourethral ligaments. Female urethras are primarily supplied by the vaginal artery, with some flow coming from the inferior vesicle artery. The urethral veinous plexus drains into the vestal venous plexus around the bladder and into the internal pudendal veins. The lymphatics drain into both the internal and external iliac nodal basins. Parasympathetic innervation, similar to males, originates from the S2 to S4 nerves. Vagina, Uterus, and Ovaries Anatomy Female external genitalia consists of the mons pubis, labia minora and majora, clitoris, vestibule, and vestibular bulb. The mons pubis is the rounded area of adipose tissue anterior to the pubic symphysis. The labia majora are two folds that run longitudinally from the mons pubis to the perineum. Each is composed of adipose tissue, smooth muscles, and a deep membranous layer called Colles fascia, which is continuous with Scarpa’s fascia. The vestibule is the cavity between the labia minora; it contains the vaginal and external urethral orifices. Blood supply to the external genitalia arises from superficial and deep branches of the external pudendal branches of the femoral artery superior and the internal pudendal artery inferiorly. The vagina is a tube structure composed of fibromuscular tissue that goes from the vestibule to the uterus. The anterior vaginal wall supports the inferior bladder and the urethra. The upper portion of the posterior vagina is separated from the rectum by Denonvillier’s fascia and peritoneum (rectouterine pouch). The vagina receives its blood supply from the azygos arteries, which are branches of the uterine artery coming from the internal iliac artery. They run along the anterior and posterior vaginal walls. The venous drainage is via the vaginal veins, which empty into the internal iliac veins. The lymphatic vessels drain into the internal iliac, external iliac, and superficial inguinal basins. The pudendal nerve supplies the lower vagina; S2 to S4 nerves supply the upper vagina. The uterus is a muscular organ that is located between the bladder anteriorly and the rectum posteriorly. The uterus is a mobile organ, so its position can vary depending on the contents of the bladder and rectum. The uterus is very thick and muscular. It is composed of three layers: inner endometrium, middle myometrium, and the outer serosa. The anterior surface is covered in peritoneum that folds back to the bladder (uterovesical fold), whereas the posterior surface’s peritoneum continues onto the rectum (rectouterine pouch, or pouch of Douglas). The cervix communicates with the uterus at the internal os and the vaginal canal at the external os. The uterus receives its blood supply from the uterine artery. The uterine artery branches from the internal iliac and traverses the ureter anteriorly at the broad ligament. It is important to remember this relationship to avoid injury to the ureter while ligating the uterine artery. It then inserts into the uterus around the uterocervical junction. The uterine veins drain into the internal iliac veins. The lymphatic vessels drain into three nodal basins: the internal iliac, external iliac, and obturator. Innervation to the uterus is primarily from the inferior hypogastric plexus. Fallopian tubes run from the upper body of the uterus, with an opening into the uterus, to the abdominal os where the fimbria extends toward the ovary. The fallopian tube is broken into four sections: intramural, isthmus, ampulla, and infundibulum. The fimbriae are finger-like projections that extend from the infundibulum toward to ovary and aid in capturing oocytes as they are released from the ovary. Blood supply to the fallopian tubes is from branches of the ovarian and uterine arteries. The lateral two-thirds of the Fallopian tube drains into the pampiniform plexus to the ovarian veins. The medial portion drains into the uterine plexus. The lymphatic vessels drain into the para-aortic nodes and the internal iliac nodal basin. The ovaries lie on each side of the uterus, close to the abdominal wall. The ovaries are suspended in the mesovarium, a double fold of peritoneum. Ovaries consist of an inner medulla and an outer cortex. The ovary is surrounded by a capsule of connective tissue called the tunica albuginea. The suspensory ligament attaches to the superolateral surface of the ovary and contains the ovarian vessels and nerve. The ovarian ligament attaches the inferomedial portion of the ovary to the lateral uterus. The ovaries are supplied by the ovarian arteries, which branch directly from the aorta below the renal arteries. The veins draining the ovary form a plexus known as the pampiniform plexus. These form into the ovarian vein, which drains into the inferior vena cava on the right and the left renal vein on the left. Lymphatics drain into the para-aortic lymph nodes. Penis, Scrotum, and Testes Anatomy The penis is composed of four parts: base, shaft, glans, and foreskin (in uncircumcised males). The base is attached to the pubis by two suspensory ligaments, which are continuous with Buck’s fascia. The penis contains 2 columns of erectile tissue: 2 corpus cavernosa anteriorly and the corpus spongiosum posteriorly. The corpus spongiosum enlarges at the distal end and forms the glans of the penis. The glans is covered by foreskin in uncircumcised males. The skin overlying the shaft is mobile due to the lack of connections to the underlying fascia, whereas the skin of the glans is immobile due to its attachment to the underlying tunica albuginea. Under the penile skin lies the dartos fascia of the penis, then the deeper, tougher Buck’s fascia. Buck’s fascia covers both corpus cavernosum and splits to cover the corpus spongiosum. Blood supply to the corporal bodies rises from the penile artery, a branch of the internal pudendal artery. The penile artery has 3 main branches that supply the penis: cavernous artery, bulbourethral artery, and the dorsal penile artery. It is important to note these branches are highly variable. Three venous systems drain the penis: superficial, intermediate, and deep. The superficial system is within the dartos fascia; it forms a single superficial dorsal vein. The superficial dorsal vein is located just below the dartos fascia and ultimately drains into the great saphenous vein. The intermediate drainage occurs through the circumflex and deep dorsal veins. These are located within and deep to Buck’s fascia. They drain into the prostatic plexus. The deep system drains the proximal third of the penis via the deep and crural cavernous veins, ultimately draining into the internal dental vein. Lymphatic vessels drain into the superficial and deep inguinal nodal basins and the internal iliac nodes. The glans penis has the most sensation and is provided by the dorsal nerve. The dorsal nerve runs deep to Buck’s fascia on either side of the deep dorsal vein. Parasympathetic and sympathetic innervation to the corpus cavernosa is provided by the cavernous nerve, coming from the pelvic plexus. The scrotum is a dual-chambered sac composed of multiple tissue layers and contains the testicles, the vas deferens, and the epididymis. The scrotal layers include skin, dartos muscle, spermatic fascia, cremasteric fascia, and the internal spermatic fascia. Dartos is continuous with Colle’s fascia of the perineum and the dartos fascia of the penis. The gubernaculum fixes the testis in place within the scrotum. Arterial supply is from the external pudendal artery (from the femoral artery), scrotal branches of the internal pudendal artery, and cremasteric branches from the inferior epigastric artery. Venous drainage follows the arterial supply. Lymphatic drainage is to the ipsilateral superficial inguinal nodal basins. Innervation is provided by the ilioinguinal nerve (L1), genitofemoral nerve (L1, L2), posterior scrotal branches of the perineal nerve (S2-S4), and the perineal branch of the posterior femoral cutaneous nerve (S1-S3). The testes are suspended in the scrotum by the spermatic cord with the left testis lying lower than the right. Within the testis are the seminiferous tubules. Spermatogenesis occurs within the tubules. The testis is enclosed in a capsule that is composed of 3 layers: tunica vasculosa (innermost), tunica albuginea (middle), and the outer tunica vaginalis. The tunica vasculosa contains a plexus of blood vessels. The tunica albuginea is a dense layer composed mainly of collagen fibers. Posteriorly, it injects inward to form an incomplete fibrous septum within the testis. The tunica vaginalis is an extension of the peritoneal processus vaginalis; failure to obliterate the processus vaginalis results in direct communication between the peritoneal cavity and the scrotum. The testis receives its blood supply from multiple arteries. The testicular artery supplies about two-thirds of the testis. The remaining one-third comes from a combination of small arteries, including the vasal artery and the cremasteric arteries. The testicular artery arises from the aorta. The vasal artery arises from the superior vesicle artery, and the cremasteric artery is a branch of the inferior epigastric artery. The testis drains into the pampiniform plexus, which ultimately forms a single vein that drains into the inferior vena cava on the right and the left renal vein on the left. The lymphatic vessels drain predominantly into the inter-aortocaval and para-caval nodes. Sympathetic innervation is by the T10 nerve; sensory innervation is via T10 and the genitofemoral nerve (L1 and L2).
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
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bookSection
2021
Blecker N
bookSection
Department of General Surgery
June 2021 List
NEOMED College of Medicine
StatPearls
Tullington JE
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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<a href="http://doi.org/10.1016/j.ijscr.2021.105881" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ijscr.2021.105881</a>
Pages
105881
Volume
82
ISSN
2210-2612
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NEOMED College
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NEOMED Department
Department of General Surgery
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Adult Hirschsprung's disease: A case report and literature review.
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International Journal Of Surgery Case Reports
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2021
2021-04-10
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Surgery; Adult hirschprung; Duhamel’s; Obstruction; Small bowel; Volvulus
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Gamez C; de Boer TO; Saca N; Umbu L; Shoukry S; Mashburn P; DeVito PM
Description
An account of the resource
INTRODUCTION & IMPORTANCE: Adult Hirschsprung's disease (AHD) is a difficult diagnosis to make due to its rarity, frequently after emergency interventions have been conducted. We present a case of possible AHD and sketch a classic presentation of Adult Hirschsprung's Disease. This would help recognize and include AHD in the differential diagnoses of chronic constipation where appropriate. CASE PRESENTATION: The case involved a 41-year-old male with a history of multiple abdominal surgeries for volvuli and a ventral hernia repair complicated by post-operative SBO. Presenting symptoms were chronic constipation, abdominal colic, and dilation. SBO secondary to volvulus was discovered, decompressed, and emptied of 3000cc fecal material in the OR. His case was again complicated twice by SBO which led to the suspicion of AHD and instigated this systematic review. Papers were extracted from the EBSCO and PubMed databases. Papers were excluded if patients were younger than 10 years old. CLINICAL DISCUSSION: The classic patient will be a male over the age of 10 years old with an average age of 30 years old and a long history of chronic constipation, often complicated by an acute symptomatic obstruction. Patients may have had a history of multiple surgical or non-surgical interventions to relieve their constipation. CONCLUSION: AHD is being seen more frequently with the increasing availability of healthcare in underserved areas of the world. Duhamel's procedure is the most effective procedure after diagnosis has been made. Barium enema and a biopsy show hypo- or a-ganglionic segments that are to be resected for curative purposes.
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<a href="http://doi.org/10.1016/j.ijscr.2021.105881" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2021.105881</a>
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journalArticle
2021
Adult hirschprung
de Boer TO
Department of General Surgery
DeVito PM
Duhamel’s
Gamez C
International Journal Of Surgery Case Reports
journalArticle
Mashburn P
May 2021 List
NEOMED College of Medicine
NEOMED Student Publications
obstruction
Saca N
Shoukry S
Small bowel
Surgery
Umbu L
Volvulus
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener">http://doi.org/</a>
Volume
82
ISSN
2210-2612
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May 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
NEOMED Student Publications
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Adult Hirschsprung’s disease: A case report and literature review
Publisher
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International Journal Of Surgery Case Reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-05-01
Subject
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Surgery; Adult hirschprung; Duhamel’s; Obstruction; Small bowel; Volvulus
Creator
An entity primarily responsible for making the resource
Gamez C; de Boer TO; Saca N; Umbu L; Shoukry S; Mashburn P; DeVito PM
Description
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Highlights •Adult Hirschprung’s Disease (AHD) can be a difficult diagnosis to make, due to its rarity.•We report a possible case of AHD and conduct a systematic review of the literature.•A typical patient would be male, average age of 30-years-old, with a history of chronic constipation complicated by repeated acute obstruction.•Surgical resection, such as with Duhamel’s procedure, is curative.•Early identification of these patients and definitive diagnoses would eliminate unnecessary and ineffective surgical interventions.
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
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journalArticle
2021
Adult hirschprung
de Boer TO
Department of General Surgery
DeVito PM
Duhamel’s
Gamez C
International Journal Of Surgery Case Reports
journalArticle
Mashburn P
May 2021 List
NEOMED College of Medicine
NEOMED Student Publications
obstruction
Saca N
Shoukry S
Small bowel
Surgery
Umbu L
Volvulus
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.soard.2020.11.025" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.soard.2020.11.025</a>
Pages
614-615
Issue
3
Volume
17
ISSN
1550-7289
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NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
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Comment on: High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry (SOReg)
Publisher
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Surgery For Obesity And Related Diseases
Date
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2021
2021-03
Creator
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Dan AG
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<a href="http://doi.org/10.1016/j.soard.2020.11.025" target="_blank" rel="noreferrer noopener">10.1016/j.soard.2020.11.025</a>
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journalArticle
2021
Dan AG
Department of General Surgery
journalArticle
May 2021 List
NEOMED College of Medicine
Surgery For Obesity And Related Diseases
-
Text
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URL Address
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener">http://doi.org/</a>
Pages
10-11
Issue
4
Volume
18
ISSN
15513572
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Update Year & Number
April 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Who were the giants we lost in 2020?
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Bariatric Times
Date
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2021
2021-04
Subject
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BARIATRIC surgery; GASTRIC bypass; COVID-19 treatment; INTRA-abdominal hypertension; SLEEVE gastrectomy
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Dan A
Description
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Among them were Dr. Harvey Sugerman, Dr. Nicola Scopinaro, and the father of bariatric surgery, Dr. Edward Mason. It is fascinating to know that his interest in bariatric surgery started after he read Edward Mason's fi rst article on gastric bypass surgery for the treatment of obesity in 1967. Patients scheduled for bariatric surgery (surgical group) and patients on the surgery waiting list (control group) were prospectively assessed and were similar at baseline. In 2005, while I was a surgery fellow at the Cleveland Clinic, we hosted a large obesity surgery symposium. [Extracted from the article]
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journalArticle
2021
April 2021 List
Bariatric Surgery
Bariatric Times
COVID-19 treatment
Dan A
Department of General Surgery
Gastric Bypass
INTRA-abdominal hypertension
journalArticle
NEOMED College of Medicine
SLEEVE gastrectomy
Summa Health System Akron City Hospital
-
Text
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URL Address
<a href="http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/JTN.0000000000000569</a>
Pages
119-125
Issue
2
Volume
28
ISSN
1078-7496
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1097/JTN.0000000000000569</a>
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April 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Internal Medicine
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Improving a mature palliative care program at a Level I trauma center.
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Journal Of Trauma Nursing
Date
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2021
2021-04-03
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Advance Directives; Confidence Intervals; Data Analysis Software; Depression; Descriptive Statistics; Documentation; Electronic Health Records; Fisher's Exact Test; Frailty Syndrome; Hospital Programs; Human; Palliative Care; Pearson's Correlation Coefficient; Quality Improvement; Questionnaires; Simulations; Trauma Centers
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Moran ME; Soltis M; Politis T; Gothard MD; George RL
Description
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Background: Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients. Objective: In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program. Methods: The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities. Results: A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (>85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (>90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019. Conclusion: This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.
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<a href="http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">10.1097/JTN.0000000000000569</a>
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journalArticle
2021
Advance Directives
April 2021 List
Confidence Intervals
Data Analysis Software
Department of General Surgery
Department of Internal Medicine
Depression
Descriptive Statistics
Documentation
Electronic Health Records
Fisher's Exact Test
Frailty Syndrome
George RL
Gothard MD
Hospital Programs
Human
Journal Of Trauma Nursing
journalArticle
Moran ME
NEOMED College of Medicine
Palliative Care
Pearson's Correlation Coefficient
Politis T
Quality Improvement
Questionnaires
Simulations
Soltis M
Summa Health Systems Akron City Hospital
Trauma Centers
-
Text
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URL Address
<a href="http://doi.org/10.3928/01913913-20210105-01" target="_blank" rel="noreferrer noopener">http://doi.org/10.3928/01913913-20210105-01</a>
Pages
93-104
Issue
2
Volume
58
ISSN
0191-3913
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April 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Akron Children's Hospital
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Title
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Clinical and electrophysiological outcomes after eye muscle surgery in 81 adults with infantile nystagmus syndrome
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Journal Of Pediatric Ophthalmology & Strabismus
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-04
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Hertle RW; Curtis M; Boydstun I; Juric A; Evliyaoglu F; Ricker I
Description
An account of the resource
Purpose: To characterize the effects of eye muscle surgery on patients older than 18 years with infantile nystagmus syndrome (INS) who have had only optical treatment. Methods: This was a prospective, single-center, interventional case series analysis of clinical and electrophyisological data before and after surgery. Outcome measures included: clinical characteristics, surgical procedure, and preoperative and postoperative binocular best corrected visual acuity (BCVA) in the null position, anomalous head posture (AHP), contrast sensitivity, strabismic deviation, and nystagmus acuity function (NAFX). Postoperative data used were collected for a minimum of 12 months after surgery. Parametric and non-parametric statistical analysis of the outcome measures was performed. Results: Ages ranged from 18 to 72 years (average: 36 years) and follow-up from 12 to 74 months (average: 26 months). A surgical algorithm of nine separate procedures involving at least two recti muscles on each eye was used for each patient. Most patients had associated systemic and/or ocular diagnoses, including albinism (35%), amblyopia (23%), optic nerve or retinal disorders (48%), refractive error (80%), AHP (44%), aperiodicity (27%), and strabismus (69%). There were no serious surgical complications, with a reoperation rate of 12%. There were significant group mean increases in BVCA, AHP, contrast sensitivity, strabismic deviation, and NAFX after surgery. Sixty percent of patients who were legally ineligible for driving prior to surgery became eligible after eye muscle surgery. Conclusions: Adult patients with INS showed sustained improvement in many afferent and efferent measures of visual function after eye muscle surgery.
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<a href="http://doi.org/10.3928/01913913-20210105-01" target="_blank" rel="noreferrer noopener">10.3928/01913913-20210105-01</a>
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journalArticle
2021
Akron Children's Hospital
April 2021 List
Boydstun I
Curtis M
Department of General Surgery
Evliyaoglu F
Hertle RW
Journal Of Pediatric Ophthalmology & Strabismus
journalArticle
Juric A
NEOMED College of Medicine
Ricker I
-
Text
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<a href="http://doi.org/10.1177/2151459321996169" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/2151459321996169</a>
Pages
2151459321996169
Volume
12
ISSN
2151-4585 2151-4593
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Update Year & Number
April 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Orthopaedics
NEOMED Student Publications
Department of General Surgery
Affiliated Hospital
Cleveland Clinic Akron General Hospital
Dublin Core
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Title
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Prior admissions as a risk factor for readmission in patients surgically treated for femur fractures: Implications for a potential hip fracture bundle.
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Geriatric Orthopaedic Surgery & Rehabilitation
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
1905-07
Subject
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bundled payments; hip fracture; prior admission; readmission; SHFFT
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Erlichman R; Kolodychuk N; Gabra JN; Dudipala H; Maxhimer B; DiNicola N; Elias JJ
Description
An account of the resource
INTRODUCTION: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. METHODS: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. RESULTS: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). DISCUSSION: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. CONCLUSIONS: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.
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<a href="http://doi.org/10.1177/2151459321996169" target="_blank" rel="noreferrer noopener">10.1177/2151459321996169</a>
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journalArticle
2021
April 2021 List
bundled payments
Cleveland Clinic Akron General Hospital
Department of General Surgery
Department of Orthopaedics
DiNicola N
Dudipala H
Elias JJ
Erlichman R
Gabra JN
Geriatric Orthopaedic Surgery & Rehabilitation
hip fracture
journalArticle
Kolodychuk N
Maxhimer B
NEOMED College of Medicine
NEOMED Student Publications
prior admission
readmission
SHFFT
-
Text
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URL Address
<a href="http://doi.org/10.1016/j.ijscr.2020.10.012" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ijscr.2020.10.012</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Pages
361-363
Volume
76
ISSN
2210-2612
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Update Year & Number
March 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
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Title
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A case of simultaneous abdominal wall reconstruction and creation of diverting ostomy in a ventral hernia with loss of domain
Publisher
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International Journal Of Surgery Case Reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
1905-07
Subject
The topic of the resource
Surgery; Case report; Hernia; Reconstruction; Abdominoplasty; Ostomy
Creator
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DeVito R; Shoukry S; Yglesias B; Fullmer R; Zarnoth B; Kerestes T
Description
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INTRODUCTION: Diverting ostomies are traditionally used as a bridge to primary resection in patients with an obstructing mass, or severe inflammatory bowel disease [1] some cases, severe infections or non-healing wounds can be better managed after the diversion of fecal material away from the area [2]. In this case report, we discuss a patient who underwent a diverting loop colostomy placement through a ventral hernia defect with primary repair of the hernia in one procedure. PRESENTATION OF CASE: A 67-year-old female presented with a large, stage four sacral decubitus ulcer and an incarcerated ventral hernia. She was taken to the operating room for a transverse loop diverting colostomy through a large, pre-existing ventral hernia. The ostomy site was passed through the ventral defect at the midline. The remainder of the ventral hernia was closed primarily, and the initial incision was stapled closed. At post-operative day 11, the ostomy remained functional and intact, with no hernia recurrence, and significantly improved healing of the ulcer was seen. DISCUSSION: The large ventral hernia presented a significant obstacle during pre-operative planning. It was decided that a midline stoma was to be created simultaneously with an abdominal wall reconstruction, as any other site to bring up the ostomy would have been too far laterally. CONCLUSION: The patient was discharged in stable condition. This case presents a novel and viable method for the creation of an ostomy in patients with large ventral hernias. Further study regarding long-term outcomes may be beneficial in establishing utility. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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<a href="http://doi.org/10.1016/j.ijscr.2020.10.012" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2020.10.012</a>
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The file format, physical medium, or dimensions of the resource
journalArticle
2020
Abdominoplasty
Case report
Department of General Surgery
DeVito R
Fullmer R
Hernia
International Journal Of Surgery Case Reports
journalArticle
Kerestes T
March 2021 List
NEOMED College of Medicine
Ostomy
reconstruction
Shoukry S
Surgery
Yglesias B
Zarnoth B
-
Text
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URL Address
<a href="http://doi.org/10.1007/s11695-020-05150-7" target="_blank" rel="noreferrer noopener">http://doi.org/10.1007/s11695-020-05150-7</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
ISSN
0960-8923
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Update Year & Number
February 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
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Title
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Analysis of Early Job Market Experiences and Perceptions Among Bariatric Surgery Fellowship Graduates and Bariatric Surgery Program Directors
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-01
Subject
The topic of the resource
Training; Surgery; Bariatric; Fellow; Job market; Job market analysis
Creator
An entity primarily responsible for making the resource
Lu Y;Juo Y;Martin MJ;Dan AG;Banerjee A;Jones DB;Dakin GF;Jain-Spangler K;Chen Y
Description
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Purpose Over the past decade, an increasing number of bariatric surgeons are trained in fellowships annually despite only a modest increase in nationwide bariatric surgery volume. The study surveys the bariatric surgery job market trend in order to inform better career-choice decisions for trainees interested in this field. Materials and Methods A national retrospective cohort survey over an 11-year period was conducted. Bariatric surgery fellowship graduates from 2008 to 2019 and program directors (PDs) were surveyed electronically. Univariate analysis was performed comparing responses between earlier (2008-2016) and recent graduates (2017-2019). Results We identified a total of 996 graduates and 143 PDs. Response rates were 9% and 20% respectively (n = 88, 29). Sixty-eight percent of graduates felt there are not enough bariatric jobs for new graduates. Seventy-nine percent of PDs felt that it is more difficult to find a bariatric job for their fellows now than 5-10 years ago. Forty-eight percent of PDs felt that we are training too many bariatric fellows. Seventy-seven percent of all graduates want the majority of their practice to be comprised bariatric cases; however, only 42% of them reported achieving this. In the univariate analysis, recent graduates were less likely to be currently employed as a bariatric surgeon (64% vs. 86%, p = 0.02) and were less satisfied with their current case volume (42% vs. 66%, p = 0.01). Conclusions The temporal increase in bariatric fellowship graduates over the past decade has resulted in a significant decline in the likelihood of employment in a full-time bariatric surgical practice and a decline in surgeons' bariatric case volumes.
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<a href="http://doi.org/10.1007/s11695-020-05150-7" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-05150-7</a>
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journalArticle
Publisher
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Obesity Surgery
2021
Banerjee A
Bariatric
Chen Y
Dakin GF
Dan AG
Department of General Surgery
February 2021 List
Fellow
Jain-Spangler K
Job market
Job market analysis
Jones DB
journalArticle
Juo Y
Lu Y
Martin MJ
NEOMED College of Medicine
Obesity Surgery
Summa Health System Akron City Hospital
Surgery
Training
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener">http://doi.org/</a>
Pages
1-10
Issue
1
Volume
18
ISSN
15513572
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Update Year & Number
January 2021 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health Akron City Hospital
Dublin Core
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Title
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Full acceptance of bariatric surgery? ... Let's face reality and demand better evidence!
Publisher
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Bariatric Times
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
2021-01
Subject
The topic of the resource
BARIATRIC surgery; MEDICAL personnel; GASTRIC bypass; CAROTID endarterectomy; EVIDENCE
Creator
An entity primarily responsible for making the resource
Dan A
Identifier
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
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journalArticle
2021
Bariatric Surgery
Bariatric Times
Carotid endarterectomy
Dan A
Department of General Surgery
EVIDENCE
Gastric Bypass
January 2021 List
journalArticle
MEDICAL personnel
NEOMED College of Medicine
Summa Health Akron City Hospital
-
Text
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URL Address
<a href="http://doi.org/10.1016/j.ymgme.2020.09.006" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ymgme.2020.09.006</a>
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ISSN
1096-7206 1096-7192
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Update Year & Number
October 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Pediatrics
Department of General Surgery
NEOMED Student Publications
Affiliated Hospital
Akron Children's Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Biochemical phenotype and its relationship to treatment in 16 individuals with PCCB c.1606A > G (p.Asn536Asp) variant propionic acidemia.
Publisher
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Molecular Genetics and Metabolism
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-10-03
Subject
The topic of the resource
Treatment; Phenotype; Biomarker; Propionic acidemia
Creator
An entity primarily responsible for making the resource
Wenger O;Brown M;Smith B;Chowdhury D;Crosby AH;Baple EL;Yoder M;Laxen W;Tortorelli S;Strauss KA
Description
An account of the resource
Propionic acidemia (PA) is caused by inherited deficiency of mitochondrial propionyl-CoA carboxylase (PCC) and results in significant neurodevelopmental and cardiac morbidity. However, relationships among therapeutic intervention, biochemical markers, and disease progression are poorly understood. Sixteen individuals homozygous for PCCB c.1606A > G (p.Asn536Asp) variant PA participated in a two-week suspension of therapy. Standard metabolic markers (plasma amino acids, blood spot methylcitrate, plasma/urine acylcarnitines, urine organic acids) were obtained before and after stopping treatment. These same markers were obtained in sixteen unaffected siblings. Echocardiography and electrocardiography were obtained from all subjects. We characterized the baseline biochemical phenotype of untreated PCCB c.1606A > G homozygotes and impact of treatment on PCC deficiency biomarkers. Therapeutic regimens varied widely. Suspension of therapy did not significantly alter branched chain amino acid levels, their alpha-ketoacid derivatives, or urine ketones. Carnitine supplementation significantly increased urine propionylcarnitine and its ratio to total carnitine. Methylcitrate blood spot and urine levels did not correlate with other biochemical measures or cardiac outcomes. Treatment of PCCB c.1606A > G homozygotes with protein restriction, prescription formula, and/or various dietary supplements has a limited effect on core biomarkers of PCC deficiency. These patients require further longitudinal study with standardized approaches to better understand the relationship between biomarkers and disease burden.
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<a href="http://doi.org/10.1016/j.ymgme.2020.09.006" target="_blank" rel="noreferrer noopener">10.1016/j.ymgme.2020.09.006</a>
Format
The file format, physical medium, or dimensions of the resource
journalArticle
2020
Baple EL
Biomarker
Brown M
Chowdhury D
Crosby AH
Department of General Surgery
Department of Pediatrics
journalArticle
Laxen W
Molecular Genetics and Metabolism
NEOMED College of Medicine
NEOMED Student Publications
October 2020 List
Phenotype
Propionic acidemia
Smith B
Strauss KA
Tortorelli S
Treatment
Wenger O
Yoder M
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.survophthal.2020.08.006" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.survophthal.2020.08.006</a>
ISSN
1879-3304
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Akron Children's Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Enough sight to fight? The history of military visual system requirements.
Publisher
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Survey Of Ophthalmology
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-09-09
Subject
The topic of the resource
Military History; Ophthalmic History; Vision Testing Methods
Creator
An entity primarily responsible for making the resource
Hertle RW
Description
An account of the resource
Medicine has a six-fold role to play in war; (1) Selection of suitable military personnel, (2) To protect against disease, (3) To give medical attention and treatment to those who are ill and injured, (4) To assist in the rehabilitation of the disabled, (5) Research to improve etiology and treatments of disease, and 6) The unit surgeon serves as a special staff officer to the military commander at all levels battalion and above, long with the attorney and chaplain, and supplies medical input into all plans whether it be training or combat operations. This paper focuses on the realization by soldiers, since antiquity, of the importance of the visual system in battle, how this was measured, and how modern military visual requirements have evolved along with the science of Ophthalmology. Necessity and natural selection were the driving forces for recruitment and assignment in ancient and medieval armies. Since the advent of mechanized warfare more soldiers can perform more tasks, more uniformly, radically changing the way soldiers are selected. Modern military duty eligibility requirements and assignments are now the result of special tests and documentation procedures resulting from a mixture of medical knowledge, science and potential legal consequences. Nowhere is this more evident in the stringent visual system requirements for military service. (Copyright © 2020 Elsevier Inc. All rights reserved.)
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<a href="http://doi.org/10.1016/j.survophthal.2020.08.006" target="_blank" rel="noreferrer noopener">10.1016/j.survophthal.2020.08.006</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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journalArticle
2020
Akron Children's Hospital
Department of General Surgery
Hertle RW
journalArticle
Military History
NEOMED College of Medicine
Ophthalmic History
September 2020 List
Survey of Ophthalmology
Vision Testing Methods
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1097/qmh.0000000000000266" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/qmh.0000000000000266</a>
Pages
218-225
Issue
4
Volume
29
ISSN
1550-5154
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Cleveland Clinic Akron General Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Addressing behavioral health concerns in trauma: Using lean six sigma to implement a depression screening protocol in a level I trauma center
Publisher
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Quality Management In Health Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-12-10
Creator
An entity primarily responsible for making the resource
Moran ME;Sedorovich A;Kish J;Gothard A;George RL
Description
An account of the resource
Background: Patients with physical injuries or chronic conditions may be impacted by mental health conditions, which significantly affect their participation and progress in treatment. The Patient Health Questionnaire-2 (PHQ-2) depression screening can identify patients who are at greatest risk for depression to provide better whole-person care.; Objective: The quality improvement project objective was to identify and design a process that would result in the PHQ-2 depression screening for admitted trauma patients with a minimum 75% completion rate.; Methods: Lean Six Sigma (LSS) process design methodology, DMADV (define, measure, analyze, design, and verify), drove process improvement. Medical records from before (December 2018 through February 2019) and after (March 2019 through May 2019) the intervention were evaluated using frequencies, percentages, χ, and multivariable logistic regression to determine the effectiveness of the intervention.; Results: PHQ-2 document location was imperative to successful compliance, which increased from 60.74% (78 of 128) to 80.56% (87 of 108). Specifically, weekend compliance increased from 42.9% (18 of 42) to 82.8% (24 of 29).; Conclusion: LSS DMADV methodology helped health care professionals design a process to facilitate compliance with the PHQ-2 depression screening protocol in trauma patients. Adherence with this screening can help increase the number of behavioral health consultations, which in turn improves the treatment of traumatic injury survivors.
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<a href="http://doi.org/10.1097/qmh.0000000000000266" target="_blank" rel="noreferrer noopener">10.1097/qmh.0000000000000266</a>
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journalArticle
2020
Cleveland Clinic Akron General Hospital
Department of General Surgery
George RL
Gothard A
journalArticle
Kish J
Moran ME
NEOMED College of Medicine
Quality management in health care
Sedorovich A
September 2020 List
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.4103/ijo.ijo_586_20" target="_blank" rel="noreferrer noopener">http://doi.org/10.4103/ijo.ijo_586_20</a>
Pages
2190-2195
Issue
10
Volume
68
ISSN
1998-3689
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Akron Children's Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Topical lambda-cyhalothrin in reducing eye oscillations in a canine model of infantile nystagmus syndrome.
Publisher
An entity responsible for making the resource available
Indian Journal Of Ophthalmology
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-10
Subject
The topic of the resource
infantile nystagmus; Canine nystagmus; eye-drop treatment
Creator
An entity primarily responsible for making the resource
Hertle RW;Dell'Osso LF;Jacobs JB;Yang D;Dumire J;Evano-Chapman M
Description
An account of the resource
Purpose: To determine the ocular and systemic safety of using topical Lambda-Cyhalothrin (LCL) in a canine model of infantile nystagmus syndrome (INS). The rationale for this proposal is based on a case study of a patient whose INS improved after inadvertent ocular exposure to a pyrethroid pesticide containing LCL.; Methods: After in-vitro safety testing and IUCAC approval, we studied increasing concentrations of topical LCL drops (0.002% to 0.07%) in canines with a purposely bred defect in the RPE65 gene resulting in both retinal degeneration and INS. We collected data on ocular and systemic effects and performed eye-movement recordings (EMR).; Results: At the 0.07% concentration dose of LCL, there was minimal, reversible, conjunctival hyperemia. There was no other ocular or systemic toxicity. At the 0.06% dose, there was a visible decrease in the INS and EMR showed a 153%-240% increase in the nystagmus acuity function and a 30%-70% decrease in amplitude across gaze. There was also a 40%-60% decrease in intraocular pressure while on the drop in both eyes.; Conclusion: This animal study suggests this new pharmacological agent has potential for topical treatment of both INS and diseases with raised intraocular pressure. Further, this new treatment approach confirms the importance of extraocular muscle proprioception in ocular motor diseases and their treatment.
Identifier
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<a href="http://doi.org/10.4103/ijo.ijo_586_20" target="_blank" rel="noreferrer noopener">10.4103/ijo.ijo_586_20</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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journalArticle
2020
Akron Children's Hospital
Canine nystagmus
Dell'Osso LF
Department of General Surgery
Dumire J
Evano-Chapman M
eye-drop treatment
Hertle RW
Indian journal of ophthalmology
infantile nystagmus
Jacobs JB
journalArticle
NEOMED College of Medicine
September 2020 List
Yang D
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.urolonc.2020.07.026" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.urolonc.2020.07.026</a>
ISSN
1873-2496
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Inguinal lymph node dissection in the era of minimally invasive surgical technology.
Publisher
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Urologic Oncology
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-08-25
Subject
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Melanoma; Penile cancer; Endoscopic; Inguinal lymph nodes; Inguinal lymphadenectomy; Minimally invasive; Robotic; Video-assisted; Vulvar cancer
Creator
An entity primarily responsible for making the resource
Nabavizadeh R;Petrinec B;Nabavizadeh B;Singh A;Rawal S;Master VA
Description
An account of the resource
Background: Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications.; Methods: The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000-2020.; Findings: There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes. (Copyright © 2020 Elsevier Inc. All rights reserved.)
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<a href="http://doi.org/10.1016/j.urolonc.2020.07.026" target="_blank" rel="noreferrer noopener">10.1016/j.urolonc.2020.07.026</a>
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journalArticle
2020
Department of General Surgery
Endoscopic
Inguinal lymph nodes
Inguinal lymphadenectomy
journalArticle
Master VA
Melanoma
Minimally invasive
Nabavizadeh B
Nabavizadeh R
NEOMED College of Medicine
Penile cancer
Petrinec B
Rawal S
Robotic
September 2020 List
Singh A
Summa Health System Akron City Hospital
Urologic Oncology
Video-assisted
Vulvar cancer
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.soard.2020.07.018" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.soard.2020.07.018</a>
ISSN
1878-7533
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.soard.2020.07.018" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.soard.2020.07.018</a>
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Comment on: Colectomy for patients with super obesity: Current practice and surgical morbidity in the United States.
Publisher
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Surgery For Obesity And Related Diseases
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-08-01
Creator
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Dan AG;Fondran JC
Identifier
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<a href="http://doi.org/10.1016/j.soard.2020.07.018" target="_blank" rel="noreferrer noopener">10.1016/j.soard.2020.07.018</a>
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journalArticle
2020
Dan AG
Department of General Surgery
Fondran JC
journalArticle
NEOMED College of Medicine
September 2020 List
Summa Health System Akron City Hospital
Surgery For Obesity And Related Diseases
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.eucr.2020.101345" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.eucr.2020.101345</a>
Volume
33
ISSN
2214-4420
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.eucr.2020.101345" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.eucr.2020.101345</a>
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Update Year & Number
August 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Urology
Department of General Surgery
NEOMED Student Publications
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Scrotal emphysema with characteristics of
Fournier's gangrene in a community setting
Publisher
An entity responsible for making the resource available
Urology Case Reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-11-01
Subject
The topic of the resource
Fournier's gangrene; Scrotal emphysema
Creator
An entity primarily responsible for making the resource
Cook BP; Verdone C; Ricchiuti D
Description
An account of the resource
Fournier's gangrene is a life-threatening type of necrotizing fasciitis associated with a high rate of morbidity and mortality. The patient is a 29-year-old incarcerated male who presented to the ED with left-sided scrotal crepitus extending into the axilla and testicular swelling. The patient endorsed a pimple on his left scrotum accompanied with groin pain. He had a prior history of foreign body removal and self-mutilating behaviors. The patient was taken for surgical exploration out of concern due to a subcutaneous emphysema secondary to a necrotizing soft tissue infection.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.eucr.2020.101345" target="_blank" rel="noreferrer noopener">10.1016/j.eucr.2020.101345</a>
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journalArticle
2020
August 2020 List
Cook BP
Department of General Surgery
Department of Urology
Fournier's gangrene
journalArticle
NEOMED College of Medicine
NEOMED College of Medicine Student
NEOMED Student Publications
Ricchiuti D
Scrotal emphysema
Urology case reports
Verdone C
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1093/jscr/rjaa163" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/jscr/rjaa163</a>
Pages
rjaa163
Issue
6
Volume
2020
ISSN
2042-8812
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Update Year & Number
August 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
NEOMED Student Publications
Affiliated Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Parotid adenocarcinoma metastasis to the breast: A case report.
Publisher
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Journal of Surgical Case Reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-06
Creator
An entity primarily responsible for making the resource
Smith BM; Azouz V; Liu L; Williams G
Description
An account of the resource
Metastatic salivary gland tumors are rare clinical entities of the head and neck. Parotid gland carcinoma with distant metastases heralds a poor prognosis with a median survival of 4.3-7.3 months. The lungs, long bones, liver and brain are the most common sites of metastasis for parotid gland cancer, along with a few reported cases describing metastasis to the ileum, spleen and iliac crest. We present the first case to our knowledge of parotid adenocarcinoma metastasis to the breast.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1093/jscr/rjaa163" target="_blank" rel="noreferrer noopener">10.1093/jscr/rjaa163</a>
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journalArticle
2020
August 2020 List
Azouz V
Department of General Surgery
Journal of Surgical Case Reports
journalArticle
Liu L
NEOMED College of Medicine
NEOMED College of Medicine Student
NEOMED Student Publications
Smith BM
Summa Health System Akron City Hospital
Williams G
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1177/2382120520925061" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/2382120520925061</a>
Pages
2382120520925061
Volume
7
ISSN
2382-1205
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Update Year & Number
August 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Medical decision-making in the physician hierarchy: A pilot pedagogical evaluation
Publisher
An entity responsible for making the resource available
Journal of Medical Education and Curricular Development
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-07
Subject
The topic of the resource
education; clinical judgment; medical judgment; simulation; care; decision-making; medical education; students; improve; knowledge retention; medical judgment; Skill retention
Creator
An entity primarily responsible for making the resource
Rosasco J; McCarroll ML; Gothard MD; Myers Jerry; Hughes P; Schwartz A; George RL; Ahmed RA
Description
An account of the resource
Purpose: Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. Methods: The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjustedztests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set atP < .05. Effect sizes were determined and reported to inform future studies. Results: A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant (P = .002) interaction for total simulation time between groups RP: 6.2 minutes (+/- 1.58); MP: 8.7 minutes (+/- 2.46); and AP: 10.3 minutes (+/- 2.78). The AP MJM scores, 12.3 (+/- 2.66), for the RC simulation were significantly (P = .010) lower than the RP 14.7 (+/- 1.15) and MP 14.7 (+/- 1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups (P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. Conclusions: Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.
Identifier
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<a href="http://doi.org/10.1177/2382120520925061" target="_blank" rel="noreferrer noopener">10.1177/2382120520925061</a>
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journalArticle
2020
Ahmed RA
August 2020 List
care
clinical judgment
Decision-making
Department of General Surgery
Education
George RL
Gothard MD
Hughes P
improve
Journal of medical education and curricular development
journalArticle
knowledge retention
McCarroll ML
Medical education
medical judgment
Myers Jerry
NEOMED College of Medicine
Rosasco J
Schwartz A
simulation
Skill retention
Students
Summa Health System Akron City Hospital
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1213/ANE.0000000000004872" target="_blank" rel="noreferrer noopener">http://doi.org/10.1213/ANE.0000000000004872</a>
Pages
61–73
Issue
1
Volume
131
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<p>Users with a NEOMED Library login can search for full-text journal articles at the following url: <a href="https://libraryguides.neomed.edu/home">https://libraryguides.neomed.edu/home</a></p>
Update Year & Number
July 2020 List
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pediatric airway management in COVID-19 patients: consensus guidelines from the society for pediatric anesthesia's pediatric difficult intubation collaborative and the Canadian Pediatric Anesthesia Society.
Publisher
An entity responsible for making the resource available
Anesthesia and Analgesia
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-07
Subject
The topic of the resource
Adolescent; Humans; Child; Preschool; Infant; Newborn; Guidelines as Topic; Pneumonia; Intubation; Infection Control; Infectious Disease Transmission; Consensus; Pandemics; Airway Management/ methods; Anesthesia/methods; Anesthesiology/ methods/standards; Coronavirus Infections/ therapy; Pediatrics/ methods/standards; Intratracheal/ methods/standards; Patient-to-Professional/prevention & control; Viral/ therapy
Creator
An entity primarily responsible for making the resource
Matava CT; Kovatsis PG; Lee JK; Castro P; Denning S; Yu J; Park R; Lockman JL; Von Ungern-Sternberg B; Sabato S; Lee LK; Ayad I; Mireles S; Lardner D; Whyte S; Szolnoki J; Jagannathan N; Thompson N; Stein ML; Dalesio N; Greenberg R; McCloskey J; Peyton J; Evans F; Haydar B; Reynolds P; Chiao F; Taicher B; Templeton T; Bhalla T; Raman VT; Garcia-Marcinkiewicz A; Gálvez J; Tan J; Rehman M; Crockett C; Olomu P; Szmuk P; Glover C; Matuszczak M; Galvez I; Hunyady A; Polaner D; Gooden C; Hsu G; Gumaney H; Pérez-Pradilla C; Kiss EE; Theroux MC; Lau J; Asaf S; Ingelmo P; Engelhardt T; Hervías M; Greenwood E; Javia L; Disma N; Yaster M; Fiadjoe JE
Description
An account of the resource
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1213/ANE.0000000000004872" target="_blank" rel="noreferrer noopener">10.1213/ANE.0000000000004872</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Format
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journalArticle
2020
Adolescent
Airway Management/ methods
Anesthesia and Analgesia
Anesthesia/methods
Anesthesiology/ methods/standards
Asaf S
Ayad I
Bhalla T
Castro P
Chiao F
Child
Consensus
Coronavirus Infections/ therapy
Crockett C
Dalesio N
Denning S
Department of General Surgery
Disma N
Engelhardt T
Evans F
Fiadjoe JE
Galvez I
Gálvez J
Garcia-Marcinkiewicz A
Glover C
Gooden C
Greenberg R
Greenwood E
Guidelines as Topic
Gumaney H
Haydar B
Hervías M
Hsu G
Humans
Hunyady A
Infant
Infection Control
Infectious Disease Transmission
Ingelmo P
Intratracheal/ methods/standards
Intubation
Jagannathan N
Javia L
journalArticle
July 2020 List
Kiss EE
Kovatsis PG
Lardner D
Lau J
Lee JK
Lee LK
Lockman JL
Matava CT
Matuszczak M
McCloskey J
Mireles S
NEOMED College of Medicine
Newborn
Olomu P
Pandemics
Park R
Patient-to-Professional/prevention & control
Pediatrics/ methods/standards
Pérez-Pradilla C
Peyton J
Pneumonia
Polaner D
Preschool
Raman VT
Rehman M
Reynolds P
Sabato S
Stein ML
Szmuk P
Szolnoki J
Taicher B
Tan J
Templeton T
Theroux MC
Thompson N
Viral/ therapy
Von Ungern-Sternberg B
Whyte S
Yaster M
Yu J
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1097/QMH.0000000000000252" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/QMH.0000000000000252</a>
Pages
95-99
Issue
2
Volume
29
ISSN
1550-5154 1063-8628
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.1097/QMH.0000000000000252" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1097/QMH.0000000000000252</a>
<p>Users with a NEOMED Library login can search for full-text journal articles at the following url: <a href="https://libraryguides.neomed.edu/home">https://libraryguides.neomed.edu/home</a></p>
Update Year & Number
June 2020 Update II
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health Akron
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Timeliness of Care for Injured Patients Initially Seen at Freestanding Emergency Departments: A Pilot Quality Improvement Project.
Publisher
An entity responsible for making the resource available
Quality management in health care
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-06
Subject
The topic of the resource
centers; delay; freestanding emergency department; golden hour; impact; injured patients; interfacility transfer; level I trauma center; mortality; Trauma; trauma patients; urgent care
Creator
An entity primarily responsible for making the resource
Birmingham Lauren E; Richner Gwendolyn; Moran Mary; Hatridge Kindra M; George Richard L
Description
An account of the resource
BACKGROUND: The impact of freestanding emergency departments (FSEDs) on timeliness of care for trauma patients is not well understood. This quality improvement project had 2 objectives: (1) to determine whether significant delays in definitive care existed among trauma patients initially seen at FSEDs compared with those initially seen at other outlying sites prior to transfer to a level I trauma center; and (2) to determine the feasibility of identifying differences in time-to-definitive care and emergency department length of stay (ED LOS) based on initial treatment location. METHODS: Trauma registry data from January 1, 2017, through December 31, 2017, from a verified level I trauma center were analyzed by location of initial presentation. Appropriate statistical tests are used to make comparisons across transport groups. RESULTS: Patients initially seen at non-FSEDs experienced ED LOS that were, on average, 24.5 minutes greater than patients seen initially at FSEDs, although the difference was not statistically significant (P = .3112). Several challenges were identified in the feasibility analysis that will inform the design for a larger study including large quantities of missing time stamp data and potential selection bias. Prospective solutions were identified. CONCLUSION: This project found that there were not significant differences in ED LOS for injured patients presenting initially to FSEDs or other non-FSED facilities, suggesting that timeliness of care was similar across location types.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1097/QMH.0000000000000252" target="_blank" rel="noreferrer noopener">10.1097/QMH.0000000000000252</a>
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Information about rights held in and over the resource
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Format
The file format, physical medium, or dimensions of the resource
journalArticle
2020
Birmingham Lauren E
centers
delay
Department of General Surgery
Freestanding emergency department
George Richard L
golden hour
Hatridge Kindra M
impact
injured patients
interfacility transfer
journalArticle
June 2020 Update II
level I trauma center
Moran Mary
Mortality
NEOMED College of Medicine
Quality management in health care
Richner Gwendolyn
Summa Health Akron
trauma
trauma patients
urgent care
-
Text
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<a href="http://doi.org/10.1111/anae.15105" target="_blank" rel="noreferrer noopener">http://doi.org/10.1111/anae.15105</a>
ISSN
1365-2044 0003-2409
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Update Year & Number
June 2020 Update II
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Dublin Core
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Title
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Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations.
Publisher
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Anaesthesia
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-04-28
Subject
The topic of the resource
acute respiratory syndrome; anaesthesia; cesarean delivery; coronavirus; COVID-19; COVID-19; dispersion; exhaled air; hypotension; management
Creator
An entity primarily responsible for making the resource
Uppal V; Sondekoppam R V; Landau R; El-Boghdadly K; Narouze S; Kalagara H K P
Description
An account of the resource
Coronavirus disease 2019 (COVID-19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID-19 contamination in operating rooms and significantly exposes the healthcare teams to COVID-19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol-generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID-19 pandemic are limited. The goal of this review is to provide up-to-date, evidence-based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID-19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post-anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.
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<a href="http://doi.org/10.1111/anae.15105" target="_blank" rel="noreferrer noopener">10.1111/anae.15105</a>
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journalArticle
2020
acute respiratory syndrome
anaesthesia
cesarean delivery
coronavirus
COVID-19
Department of General Surgery
DISPERSION
El-Boghdadly K
exhaled air
hypotension
journalArticle
June 2020 Update II
Kalagara H K P
Landau R
Management
Narouze S
NEOMED College of Medicine
Sondekoppam R V
Uppal V
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1136/rapm-2020-101530" target="_blank" rel="noreferrer noopener">http://doi.org/10.1136/rapm-2020-101530</a>
ISSN
1532-8651 1098-7339
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Update Year & Number
June 2020 Update II
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Twitter as a powerful tool for communication between pain physicians during COVID-19 Pandemic.
Publisher
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Regional anesthesia and pain medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-04-21
Subject
The topic of the resource
education; pain management; technology
Creator
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Ghosh Priyanka; Schwartz Gary; Narouze Samer
Identifier
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<a href="http://doi.org/10.1136/rapm-2020-101530" target="_blank" rel="noreferrer noopener">10.1136/rapm-2020-101530</a>
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journalArticle
2020
Department of General Surgery
Education
Ghosh Priyanka
journalArticle
June 2020 Update II
Narouze Samer
NEOMED College of Medicine
Pain Management
Regional anesthesia and pain medicine
Schwartz Gary
Technology
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1093/asj/sjaa078" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/asj/sjaa078</a>
ISSN
1527-330X 1090-820X
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Update Year & Number
June 2020 Update II
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Dublin Core
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Title
A name given to the resource
Response to "The Benefit of Acellular Dermal Matrix Placement in Primary Breast Surgery May Outweigh the Cost in Patients at High Risk of Capsular Contracture".
Publisher
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Aesthetic surgery journal
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-04-18
Creator
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Mirhaidari Shayda; Wagner Douglas S
Identifier
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<a href="http://doi.org/10.1093/asj/sjaa078" target="_blank" rel="noreferrer noopener">10.1093/asj/sjaa078</a>
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journalArticle
2020
Aesthetic Surgery Journal
Department of General Surgery
journalArticle
June 2020 Update II
Mirhaidari Shayda
NEOMED College of Medicine
Wagner Douglas S
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1111/anae.15076" target="_blank" rel="noreferrer noopener">http://doi.org/10.1111/anae.15076</a>
ISSN
1365-2044 0003-2409
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Update Year & Number
June 2020 Update II
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel.
Publisher
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Anaesthesia
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-04-07
Subject
The topic of the resource
chronic pain; COVID-19; COVID-19; epidural steroid injections; immune; management; opioid therapy; opioids; population; prevalence; prevention; quality-of-life; recommendations; risk; steroids; united-states
Creator
An entity primarily responsible for making the resource
Shanthanna H; Strand N H; Provenzano D A; Lobo C A; Eldabe S; Bhatia A; Wegener J; Curtis K; Cohen S P; Narouze S
Description
An account of the resource
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the
Identifier
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<a href="http://doi.org/10.1111/anae.15076" target="_blank" rel="noreferrer noopener">10.1111/anae.15076</a>
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journalArticle
2020
anaesthesia
Bhatia A
Chronic pain
Cohen S P
COVID-19
Curtis K
Department of General Surgery
Eldabe S
epidural steroid injections
Immune
journalArticle
June 2020 Update II
Lobo C A
Management
Narouze S
NEOMED College of Medicine
opioid therapy
Opioids
Population
Prevalence
Prevention
Provenzano D A
quality-of-life
recommendations
Risk
Shanthanna H
Steroids
Strand N H
united-states
Wegener J
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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<a href="https://www.ncbi.nlm.nih.gov/books/NBK556070/">https://www.ncbi.nlm.nih.gov/books/NBK556070/</a>
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<a href="https://www.ncbi.nlm.nih.gov/books/NBK556070/">https://www.ncbi.nlm.nih.gov/books/NBK556070/</a>
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Update Year & Number
June 2020 Update I
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System
Dublin Core
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Title
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Pelvic Trauma
Publisher
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StatPearls
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-01
Creator
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Tullington Jessica E; Blecker Nathan
Description
An account of the resource
Traumatic injuries can range from minor wounds to major, complex injuries causing shock and multi-system organ dysfunction. Trauma is the leading cause of death of patients between the ages of 15 and 24. It accounts for approximately 30% of all ICU admissions annually.[1] Pelvic trauma raises concern due to the high energy that is generally required to cause the injury. It is frequently associated with additional injuries, transfusions requirements, and prolonged rehabilitation. The pelvis is a ring structure composed of bone. It consists of the sacrum, coccyx, and the innominate bones: the pubis, ischium, and ilium. The innominate bones join to form the acetabulum. The innominate bones join anteriorly at the pubic symphysis. It contains blood vessels, nerves, urogenital organs, and the rectum. The pelvis is anatomically associated with a number of vascular structures. The aorta divides into the common iliac arteries at about the L4 level. The common iliac arteries then further divide into the internal and external branches at the sacroiliac joint. The superior gluteal artery is the most commonly injured vessel in pelvic trauma; it branches from the internal iliac artery and exits the pelvis at the sciatic notch. Other intrapelvic arteries that are associated with injuries include the inferior gluteal artery, rectal arteries, obturator artery, and the vesical artery. Veins accompany the arteries and are also prone to injury. The proximity of the veins and arteries accounts for the high incidence of combined injury. The seriousness of pelvic fractures comes from the association of other injuries, as well as the potential for hematoma and hemorrhagic shock.[2] Hemorrhage from pelvic fractures is a major cause of morbidity and mortality. Nerve injuries are less common than vascular injuries with pelvic trauma. Lumbosacral plexus injuries account for the majority of nerve injuries after pelvic trauma. The plexus is in close proximity to the sacroiliac joint and the acetabulum, two of the more common pelvic injury locations. Root avulsion is possible and is typically only seen in more severe pelvic trauma. The lumbar plexus can be injured, though this is less common. Usually, injury occurs from traction or compression from a retroperitoneal bleed.[3]
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<a href="https://www.ncbi.nlm.nih.gov/books/NBK556070/">NBK556070/</a>
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bookSection
2020
Blecker Nathan
Book Chapter
bookSection
Department of General Surgery
June 2020 Update I
NEOMED College of Medicine
StatPearls
Summa Health System
Tullington Jessica E
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.ijscr.2020.03.022" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ijscr.2020.03.022</a>
Pages
28-31
Volume
69
ISSN
2210-2612 2210-2612
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Update Year & Number
June 2020 Update I
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery; Department of Pathology
Affiliated Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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A case report of mantle cell lymphoma presenting as intussuscepting colon mass.
Publisher
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International journal of surgery case reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
1905-07
Subject
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Case report; Colo-colonic intussusception; Colo-colonic intussusception; follicular lymphoma; gastrointestinal-tract; Mantle cell lymphoma; polyposis; Primary GI lymphoma
Creator
An entity primarily responsible for making the resource
Smith Brandon M; Reilly Kyle; Baker Elena; Deeken Amy; Dan Adrian G
Description
An account of the resource
INTRODUCTION: Mantle Cell Lymphoma (MCL) is a non-Hodgkin lymphoma accounting for 2.5% of lymphoid neoplasms in the United States. Primary gastrointestinal (GI) lymphomas account for 1-4% of all GI malignancies, with few reports of primary mantle cell lymphoma presenting as a single colonic mass and none to our knowledge with colon-colonic intussusception as the presenting finding. Accurate and timely diagnosis is imperative because MCL has rapid progression and early chemotherapeutic intervention results in improved patient outcomes. This work is reported in line with the SCARE criteria [1] for case report publication. PRESENTATION OF CASE: A 61-year-old male presented with 1 month history of nonspecific right sided abdominal pain. Computed Tomography (CT) of the abdomen identified an intussuscepting mass in the proximal ascending colon and an additional 8 mm hepatic lesion. Colonoscopy identified a large mass in the corresponding area of colon identified on CT. Histology and immunohistochemistry of biopsied specimen diagnosed MCL. DISCUSSION: Planned surgical intervention was deferred and the patient was referred for oncologic treatment. We report the first case to our knowledge of MCL presenting as colon-colonic intussusception and discuss the work-up of this rare lymphoma that clinicians may be required to diagnose and manage. CONCLUSION: This report serves as a reminder to maintain a broad differential inclusive of uncommon diseases and unanticipated pathology. Practicing with a thorough understanding of medical principles and clinical acumen is essential for optimal patient care and, as demonstrated in this case, preventing a potentially unnecessary surgical intervention thus delaying appropriate chemotherapy.
Identifier
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<a href="http://doi.org/10.1016/j.ijscr.2020.03.022" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2020.03.022</a>
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journalArticle
2020
Baker Elena
Case report
Colo-colonic intussusception
Dan Adrian G
Deeken Amy
Department of General Surgery
Department of Pathology
Follicular lymphoma
gastrointestinal-tract
International Journal Of Surgery Case Reports
Journal Article
journalArticle
June 2020 Update I
Mantle cell lymphoma
NEOMED College of Medicine
polyposis
Primary GI lymphoma
Reilly Kyle
Smith Brandon M
Summa Health System Akron City Hospital
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1007/s00268-020-05447-9" target="_blank" rel="noreferrer noopener">http://doi.org/10.1007/s00268-020-05447-9</a>
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Update Year & Number
March 2020 Update
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Mercy Health St Elizabeth Youngstown Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting.
Publisher
An entity responsible for making the resource available
World journal of surgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-03
Creator
An entity primarily responsible for making the resource
Bingmer Katherine; Walsh Danielle S; Gantt Nancy L; Sanfey Hilary A; Stein Sharon L
Description
An account of the resource
BACKGROUND: The increase in female surgeons has resulted in scrutiny of widely variable parental leave policies. We hypothesized that academic and private practice surgeons have different experiences based on difference in workplace expectations. METHODS: A 25-question survey was disseminated via social media and through the Association of Women Surgeons social media platforms from June 1 to September 15, 2017. An analysis of attending surgeons working in the USA in an academic or private practice setting was performed. RESULTS: Of 1115 total respondents, 477 were attending surgeons practicing in the USA. Practice distribution was 34% private and 47% academic. There was no difference in marital status, work status, or the number who report having been pregnant between the groups. Compared to academic surgeons, private practice surgeons were statistically less likely to have paid leave (p < 0.001) and were more likely to continue to pay benefits while on leave (p < 0.001). Private practitioners were more likely to return to work sooner than desired due to financial (p = 0.022) and supervisor (p = 0.004) pressures and were more likely to leave a job (p = 0.01). Academic surgeons were more likely to experience a delay in job advancement (p = 0.031). On multivariate analysis, more than two pregnancies were associated with an increased risk of perception of a bias and discrimination against pregnancy in the workplace. CONCLUSIONS: Parental leave policies and attitudes vary between academic and private practice, creating unique challenges for female surgeons and different issues for family planning depending on employment model.
Identifier
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<a href="http://doi.org/10.1007/s00268-020-05447-9" target="_blank" rel="noreferrer noopener">10.1007/s00268-020-05447-9</a>
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Journal Article
2020
Bingmer Katherine
Department of General Surgery
Gantt Nancy L
Mercy Health St Elizabeth Youngstown Hospital
NEOMED College of Medicine
Sanfey Hilary A
Stein Sharon L
Walsh Danielle S
World journal of surgery
-
Text
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URL Address
<a href="http://doi.org/10.1089/lap.2019.0750" target="_blank" rel="noreferrer noopener">http://doi.org/10.1089/lap.2019.0750</a>
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Update Year & Number
March 2020 Update
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery; NEOMED Student Publications
Affiliated Hospital
Summa Health System Akron City Hospital
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Operative Technique for Laparoscopic Placement of Continuous Ambulatory Peritoneal Dialysis Catheter.
Publisher
An entity responsible for making the resource available
Journal of laparoendoscopic & advanced surgical techniques. Part A
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
2020-02
Subject
The topic of the resource
peritoneal dialysis; CAPD catheter placement; laparoscopic catheter placement; PD catheter placement
Creator
An entity primarily responsible for making the resource
Smith Brandon M; Dan Adrian G
Description
An account of the resource
Background: Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. Objectives: To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Conclusion: Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.
Identifier
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<a href="http://doi.org/10.1089/lap.2019.0750" target="_blank" rel="noreferrer noopener">10.1089/lap.2019.0750</a>
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Journal Article
2020
CAPD catheter placement
Dan Adrian G
Department of General Surgery
Journal of laparoendoscopic & advanced surgical techniques. Part A
laparoscopic catheter placement
NEOMED College of Medicine
NEOMED College of Medicine Student
NEOMED Student Publications
PD catheter placement
Peritoneal Dialysis
Smith Brandon M
Summa Health System Akron City Hospital
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1093/asj/sjz358" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/asj/sjz358</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
ISSN
1527-330X
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Update Year & Number
January 2020 Update
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of General Surgery
Affiliated Hospital
Summa Health System; Summa Health System Akron City Hospital,
Dublin Core
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Title
A name given to the resource
Capsulectomy, Implant Exchange, and Placement of Acellular Dermal Matrix is Effective in Treating Capsular Contracture in Breast Augmentation Patients
Publisher
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Aesthetic Surgery Journal
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-12-12
Creator
An entity primarily responsible for making the resource
Wagner Douglas S; Mirhaidari Shayda
Description
An account of the resource
BACKGROUND: Capsular contracture is a common complication of breast augmentation surgery and many techniques to prevent and to treat capsular contracture have been suggested with inconsistent or variably effective results. OBJECTIVES: The authors describe a protocol for treating established capsular contracture after breast augmentation with a low recurrence rate. METHODS: From January 2009 to December 2012, 79 previous bilateral breast augmentation patients presented for treatment of established capsular contracture. There were 135 breasts with capsular contracture: 56 were bilateral and 23 were unilateral. Ten patients opted for no treatment; two patients opted for implant removal. Twenty-four were treated with the ICES (Implant exchange, Capsulectomy, and possible Exchange of Site) protocol and 43 were treated with the SPICES (Strattice Placement in the reconstructive position, Implant exchange, Capsulectomy, and possible Exchange of Site) protocol. RESULTS: The 24 patients treated with the ICES protocol had a recurrent capsular contracture rate of 15%. The 43 patients treated with the SPICES protocol had a 2.7% recurrent capsular contracture incidence and an 2.7% complication rate. CONCLUSIONS: Capsular contracture after breast augmentation, whether primary or recurrent, can be successfully treated with the SPICES protocol.
Identifier
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<a href="http://doi.org/10.1093/asj/sjz358" target="_blank" rel="noreferrer noopener">10.1093/asj/sjz358</a>
PMID: 31826242
Format
The file format, physical medium, or dimensions of the resource
Journal Article
2019
Aesthetic Surgery Journal
Department of General Surgery
January 2020 Update
Journal Article
Mirhaidari Shayda
NEOMED College of Medicine
Summa Health System
Summa Health System Akron City Hospital
Wagner Douglas S
-
Text
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URL Address
<a href="http://doi.org/10.1016/j.ijscr.2019.04.011" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ijscr.2019.04.011</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Pages
48-49
Volume
58
ISSN
2210-2612
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<a href="http://ezproxy.neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.ijscr.2019.04.011" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.ijscr.2019.04.011</a>
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Title
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Pancreatoduodenectomy in patient with perforated duodenal diverticulum and peritonitis: Case report
Publisher
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International Journal Of Surgery Case Reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019
Creator
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Philip Justus; Cocieru Andrei
Description
An account of the resource
INTRODUCTION: Duodenal diverticula are quite prevalent in general population, seen on up to 5% of radiology studies and up to 22% of autopsy examinations. PRESENTATION OF THE CASE: 70 years old female was admitted to the hospital with epigastric pain, fevers and elevated white cell count. Abdominal CT scan demonstrated evidence of perforated duodenal diverticulitis which failed to improve with IV antibiotics. Emergent pancreatoduodenectomy was performed with full recovery and uncomplicated hospital stay. DISCUSSIONS: Conservative therapy with antibiotics and bowel rest is successful in majority cases of perforation. Failure of conservative therapy demands surgical management. Variety of surgical approaches ranging from simple diverticulectomy to segmental resection, duodenal exclusion/bypass to pancreatoduodenectomy are available. CONCLUSION: Pancreatoduodenectomy is an option when complicated duodenal diverticulum is not resolved with conservative or interventional therapy. This report has been written in concordance with the SCARE criteria Agha et al. [1]. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
Identifier
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<a href="http://doi.org/10.1016/j.ijscr.2019.04.011" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2019.04.011</a>
Format
The file format, physical medium, or dimensions of the resource
Journal Article
2019
Cocieru Andrei
Department of General Surgery
International Journal Of Surgery Case Reports
Journal Article
NEOMED College of Medicine
November 2019 Update
Philip Justus
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="https://iovs.arvojournals.org/article.aspx?articleid=2742298" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2742298</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Issue
9
Volume
60
ISSN
0146-0404
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Title
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Impact of the Optiwave Refractive Analysis in Post-LASIK Patients Undergoing Cataract Surgery
Publisher
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Investigative Ophthalmology & Visual Science
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-07
Creator
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Yalamanchili Siri; Parikh Ankur A; Gemmel David; Erzurum Sergul
Identifier
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<a href="https://iovs.arvojournals.org/article.aspx?articleid=2742298" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2742298</a>
Format
The file format, physical medium, or dimensions of the resource
Journal Article
2019
Department of General Surgery
Erzurum Sergul
Gemmel David
Investigative ophthalmology & visual science
Journal Article
Mercy Health St Elizabeth Youngstown Hospital
NEOMED College of Medicine
NEOMED College of Medicine Student
NEOMED Student Publications
November 2019 Update
Parikh Ankur A
Yalamanchili Siri