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acute Care/Trauma Surgeon＇s role in obstetrical/ gynecologic emergencies (The OBCAT Alert)

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World Journal of Emergency Medicine 2016年第4期7卷 274-277页

作者： Seong K. Lee Eddy H. Carrillo Andrew Rosenthal Rafael Sanchez Chauniqua Kiffin Dafney L. Davare Division of acute Care Surgery and Trauma Memorial Regional Hospital Hollywood FL 33021 USA

BACKGROUND:Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic(OB/GYN) procedures and may require the surgical training of an acute Care/Trauma *** OB Critical Assessment Team(OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN *** sought to review and characterize the acute Care/Trauma Surgeon's role in these ***:We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to *** OBCAT is a hospital based alert system designed to immediately notify OB/GYN,anesthesiology,acute Care/Trauma,the intensive care unit(ICU),and the blood bank of a potential emergency during an OB/GYN ***:There were 7±3 OBCAT alerts/*** patients required acute Care/Trauma surgery intervention for *** patients required damage control packing during their *** loss averaged 6.8±5.5 L and patients received a total of 21±14units during deliveries with *** were 17 other surgical interventions not related to hemorrhage;seven of these cases were related to adhesions or intestinal *** additional cases required evaluation post routine OB/GYN procedure;the most common reason was for severe wound *** were three deaths during this study ***:Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming *** Care/Trauma Surgeons have a key role in the treatment of these complex cases.

关键词： Obstetric hemorrhage Postpartum hemorrhage Damage control packing acute care surgery OBCAT

Pathophysiological consequences of obstructive jaundice and perioperative management

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 17-21页

作者： Efstathios T Pavlidis Theodoros E Pavlidis Aristotle University of Thessaloniki Medical School Second Surgical Propedeutic Department Hippocration Hospital

Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future *** sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were ***: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected ***: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.

关键词： Obstructive jaundice Perioperative management Preoperative biliary drainage Lactulose Endotoxin Biliary obstruction

acute liver failure:A systematic review and network meta-analysis of optimal type of stem cells in animal models

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World Journal of Stem Cells 2023年第1期15卷 1-15页

作者： Jun-Feng Ma Jian-Ping Gao Zi-Wei Shao Department of surgical Oncology Gansu Provincial HospitalLanzhou 730030Gansu ProvinceChina

BACKGROUND The therapeutic effects of various stem cells in acute liver failure(ALF)have been demonstrated in preclinical ***,the specific type of stem cells with the highest therapeutic potential has not been *** To validate the efficacy of stem cells in ALF model and to identify the most promising stem *** A search was conducted on the PubMed,Web of Science,Embase,Scopus,and Cochrane databases from inception to May 3,2022,and updated on November 16,2022 to identify relevant *** independent reviewers performed the literature search,identification,screening,quality assessment,and data *** A total of 89 animal studies were included in the *** results of traditional meta-analysis showed that stem cell therapy could significantly reduce the serum levels of alanine aminotransferase[weighted mean difference(WMD)=-181.05(-191.71,-170.39)],aspartate aminotransferase[WMD=-309.04(-328.45,-289.63)],tumor necrosis factor-alpha[WMD=-8.75(-9.93,-7.56)],and interleukin-6[WMD=-10.43(-12.11,-8.76)]in animal models of *** subgroup analysis and network meta-analysis showed that although mesenchymal stem cells are the current research hotspot,the effect of liver stem cells(LSCs)on improving liver function is significantly better than that of the other five types of stem *** addition,the ranking results showed that the possibility of LSCs improving liver function ranked *** fully proves the great therapeutic potential of LSCs,which needs to be paid more attention in the *** LSCs may have a higher therapeutic *** high-quality animal experiments are needed to explore the most effective stem cells for ALF.

关键词： acute liver failure Stem cells Animal model Systematic review Network meta-analysis

Bile duct injury repair --earlier is not better

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Frontiers of Medicine 2015年第4期9卷 508-511页

作者： Vinay K. Kapoor Department of surgical Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow 226014 India

Bile duct injury is a common complication of cholecystectomy. The timing of bile duct injury repair remains controversial. A recent review conducted in France reported 39% complications and 64% failure after immediate repair in 194 patients compared with 14% complications and 8% failure after late repair in 133 patients. A national review of 139 consecutive early repairs conducted at five hepatopancreaticobiliary centers in Denmark reported 4% mortality, 36% morbidity, and 42 restrictures （30%） at a median follow-up of 102 months, and only 64 patients （46%） demonstrated uneventful short-term and long-term outcomes. Most patients with bile duct injury present with bile leak and sepsis; thus, early repair is not recommended. Percutaneous drainage of bile and endoscopic stenting are the mainstays of treatment of bile leak because they convert acute bile duct injury into a controlled external biliary fistula. The ensuing benign biliary stricture should be repaired by a biliary surgeon after a delay of 4-6 weeks once the external biliary fistula has closed.

关键词： bile duct injury cholecystectomy laparoscopic cholecystectomy

Gallbladder perforation:A single-center experience in north India and a step-up approach for management

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 168-174页

作者： Vivek Gupta Abhijit Chandra Vishal Gupta Ravi Patel Amit Dangi Ajay Pai Department of surgical Gastroenterology King George’s Medical UniversityLucknowUttar Pradesh 226003India

Background: Spontaneous gallbladder perforation(GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. Results: We identifed 151 patients(81 females and 70 males) with mean age of 53 years. Most common presenting features were pain(96.7%), fever(54.3%) and jaundice(31.1%). Most common cause was gallbladder stones(84.8%) followed by common bile duct stones(30.5%), xanthogranulomatous cholecystitis(17.9%) and malignancy(11.9%). As per Niemeier classifcation, 8.6% had type 1 GBP(free perforation in peritoneal cavity), 76.2% had type 2 GBP(localized perforation) and 13.2% had type 3 GBP(cholecystoenteric fstula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients(72.2%). Seven patients(4.6%) had a postoperative morbidity of Clavien-Dindo Ⅲ or higher. There were three mortalities in patients who underwent surgery. Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.

关键词： acute calculus cholecystitis Cholecystectomy Cholecysto-enteric fstula Niemeier classifcation

Advances in prognostic factors in acute pancreatitis:a mini-review

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 482-486页

作者： Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis surgical Propedeutical Department Medical SchoolAristotle University of ThessalonikiHippocration Hospital

BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the *** is dependent on the criteria of the Atlanta classification *** SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute ***:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning *** single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin 50 pg/ml with calcium acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.

关键词： acute pancreatitis severity prediction risk factor prognostic sign scoring system infected necrosis

Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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surgical Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews College of Medicine-Phoenix University of Arizona Phoenix AZ USA Creighton University Arizona Health Education Alliance Phoenix AZ USA Department of Surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery Tyler TX USA Trauma Wound Care UT Health East Tyler TX USA Department of Surgery University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of Medicine and Nursing University of Texas Arlington TX USA Past Commanding General TXSG Medical Brigade Austin TX USA surgical Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales manager Miach Orthopedics surgical acute account manager 3M Minneapolis MN USA Clinical Professor of Surgery Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

关键词： Emphysematous Cholecystitis Gangrenous Cholecystitis Cholecystocutaneous Fistula Necrotizing Fasciitis Sepsis

Post-cholecystectomy bile leak is not always synonymous with acute bile duct injury:Need for reclassification

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 492-494页

作者： Vishal Gupta Department of surgical Gastroenterology King George’s Medical UniversityLucknowUP 226003India

Bile leak after laparoscopic cholecystectomy remains a significant cause of postoperative *** duct stump is the most common site(~70%)of bile leak after cholecystectomy[1].Incidence of bile leak from the cystic duct stump is 0.5%−3%which is higher(4%−7%)in cases with complicated gallstone disease(*** cholecystitis)[2].Bile leak in postoperative period after cholecystectomy,manifesting as bile in intraoperatively placed drain or as an intrabdominal collection,localized or generalized,is considered a complication secondary to bile duct injury(BDI)that was sustained during the *** to the site of leak,such bile leak is classified as an iatrogenic BDI,and is subsequently categorised depending on the site of leak if that is localized on subsequent investigations.

关键词： bile cholecystectomy acute

Coronavirus disease 2019 and non-alcoholic fatty liver disease

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World Journal of Hepatology 2021年第9期13卷 969-978页

作者： Francesco Bellanti Gianluigi Vendemiale Department of Medical and surgical Sciences University of FoggiaFoggia 71122Italy

The coronavirus disease 2019(COVID-19)pandemic may present with a broad range of clinical manifestations,from no or mild symptoms to severe *** with specific pre-existing comorbidities,such as obesity and type 2 diabetes,are at high risk of coming out with a critical form of *** fatty liver disease(NAFLD)is the most common chronic liver disease,and,because of its frequent association with metabolic alterations including obesity and type 2 diabetes,it has recently been re-named as metabolic-associated fatty liver disease(MAFLD).Several studies and systematic reviews pointed out the increased risk of severe COVID-19 in NAFLD/MAFLD *** though dedicated mechanistic studies are missing,this higher probability may be justified by systemic low-grade chronic inflammation associated with immune dysregulation in NAFLD/MAFLD,which could trigger cytokine storm and hypercoagulable state after severe acute respiratory syndrome coronavirus 2 *** review focuses on the predisposing role of NAFLD/MAFLD in favoring severe COVID-19,discussing the available information on specific risk factors,clinical features,outcomes,and pathogenetic mechanisms.

关键词： Non-alcoholic fatty liver disease Metabolic-associated fatty liver disease COVID-19 SARS-CoV-2 Liver injury Immune dysregulation