American Surgeon最新文献

{"title":"National Trends in the Creation of Diverting Ileostomy at the Time of Ileal Pouch-Anal Anastomosis in Adults With Ulcerative Colitis.","authors":"Ursula C Adams, Chris B Agala, Edward L Barnes, Jonathan M Stem, Anthony G Charles, Michael R Phillips","doi":"10.1177/00031348241295271","DOIUrl":"10.1177/00031348241295271","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of diverting ileostomy in adults with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) is unclear. This study uses a novel approach with population-level data to identify patients with diverting ileostomy at the time of IPAA and determine the impact of diverting ileostomy on postoperative outcomes.</p><p><strong>Methods: </strong>Using the International Business Machines (IBM) MarketScan® database, adults (18-64 years old) with a diagnosis of UC who underwent IPAA between 2000 and 2019 were examined. Patients were assigned to the diverting ileostomy (DI) cohort or no-DI cohort based on the presence of an ostomy closure code in the 1-year following their IPAA. Rates of ileostomy formation and readmissions were quantified and outcomes between cohorts compared.</p><p><strong>Results: </strong>There were 540 patients in the no-DI and 2494 in the DI cohort. There were regional differences in the rate of ostomy creation, but the overall rate of ostomy creation remained stable across years. Patients with no-DI vs DI had a longer index length of stay (LOS) (7 vs 6 days, <i>P</i> = .001). Adverse postoperative outcomes did not differ between cohorts. Diversion did not independently affect the likelihood of a 30-day readmission, and since 2000, readmission rates have declined for all IPAA patients.</p><p><strong>Discussion: </strong>This is the first study to capture population-level data on the effect of diversion at the time of IPAA for adult UC patients. This study demonstrates that the rate of fecal diversion at the time of IPAA has remained stable over time, but readmission rates have declined.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"273-280"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of <i>BRAF</i> Gene Mutation in Hashimoto's Thyroiditis With Multifocal Papillary Thyroid Carcinoma.","authors":"Feng Wang, Yanling Su, Xiyu Yao, Jie Liu, Qingxian Ke","doi":"10.1177/00031348241282710","DOIUrl":"10.1177/00031348241282710","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer (TC) is a highly prevalent malignant tumor of the head and neck. Papillary thyroid carcinoma (PTC) is the primary pathological type of TC, accounting for more than 80% of all TCs. <i>BRAF</i> mutations are closely associated with PTC. However, the relationship among HT, PTC, and <i>BRAF</i> mutations has not yet been clarified. We aimed to investigate the <i>BRAF</i> mutation in Hashimoto's thyroiditis (HT) with PTC.</p><p><strong>Methods: </strong>A total of 72 patients with multifocal PTC were included and grouped based on surgical pathology examination. Group A (n = 32) had pure multifocal PTC and Group B (n = 40) had HT with multifocal PTC. Various features were compared: <i>BRAF</i> mutation, multifactorial analysis of <i>BRAF</i> mutations, pathological features in patients with HT and multifocal PTC, and multifactorial analysis of factors affecting HT with multifocal PTC.</p><p><strong>Results: </strong>Significant differences were seen in thyroid peroxidase antibody levels, central lymph node metastasis, extra-thyroidal invasion, main and non-main lesion diameters, and <i>BRAF</i> mutation positivity (<i>P</i> < 0.05). Patients with the <i>BRAF</i> mutation had significantly higher rates of extra-thyroidal invasion and lymph node metastasis than those without the <i>BRAF</i> mutation (<i>P</i> < 0.05). Logistic regression analysis showed that <i>BRAF</i> mutation and main lesion nodule diameter were independent risk factors affecting extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC (<i>P</i> < 0.05).</p><p><strong>Discussion: </strong><i>BRAF</i> mutations were more prevalent and closely associated with extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"186-190"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Composition in Primary Hyperparathyroidism: A Potential Contributor to Weakness and Fatigue.","authors":"Paul M Bunch, Erik D Johansson, Joseph Rigdon, Josh Tan, Leon Lenchik, Reese W Randle","doi":"10.1177/00031348241281551","DOIUrl":"10.1177/00031348241281551","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism (PHPT) patients commonly report weakness and fatigue, though the underlying mechanisms are uncertain. Our purpose is to determine whether CT-derived muscle and adipose tissue metrics are associated with weakness and fatigue in PHPT patients.</p><p><strong>Methods: </strong>For this retrospective study, cross-sectional muscle and adipose tissue metrics were derived from CTs in PHPT patients undergoing preoperative imaging within 1 year of parathyroid surgery. Skeletal muscle index (SMI) and visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio were calculated based on a single CT image at the level of the L3 vertebra. Established sex-specific SMI thresholds were used to define sarcopenia. Demographic and clinical data were collected from the electronic health record. When available, postoperative CT images were analyzed to assess for changes in body composition pre- and post-parathyroidectomy.</p><p><strong>Results: </strong>The cohort comprised 53 PHPT patients (38 females, 15 males, mean age 61.4 years), of whom 24 (45%) reported weakness, 43 (81%) reported fatigue, and 31 (58%) met CT-based criteria for sarcopenia. Lower SMI was significantly associated with preoperative weakness in females but not males. For both weakness and fatigue, VAT/SAT ratios were higher in symptomatic females and lower in symptomatic males than their asymptomatic counterparts, though these differences were not statistically significant. In patients with postoperative CTs (n = 23), no significant changes in CT metrics were observed after parathyroidectomy.</p><p><strong>Discussion: </strong>In females but not males with PHPT, subjective preoperative weakness was significantly associated with lower SMI. Effects of parathyroid hormone on skeletal muscle and visceral adiposity may differ by sex.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"178-185"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Disaster and Counterterrorism Medicine-An Introduction.","authors":"Joshua E Lane, Derrick Tin","doi":"10.1177/00031348241292729","DOIUrl":"10.1177/00031348241292729","url":null,"abstract":"<p><p>The specialties of disaster and counterterrorism medicine have continued to evolve based on the demand for medical responses to these unique and demanding environments. These medical responses are relevant to all medical specialties; however, surgeons play a particularly critical role. This is evidenced from decades of humanitarian and military surgical involvement. Numerous roles are present and include both administrative/leadership and active response.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"281-283"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Last Resort: Dacron Vascular Graft Prosthesis for Management of a Blowhole Colostomy.","authors":"Brittney A Ehrlich, Maria C Unuvar, Justin M Orenich, Rebecca L Hoffman","doi":"10.1177/00031348241290614","DOIUrl":"10.1177/00031348241290614","url":null,"abstract":"<p><p>The creation of a blowhole colostomy can be an effective option for patients with large bowel obstruction and severe abdominal disease. However, they are often difficult to manage secondary to poor appliance fitting, peristomal dermatitis, and pain. In 2021, a case series describing a novel technique using a Dacron Vascular Prosthesis (VUP medical, Brno, Czech Republic) sutured to the mucocutaneous junction to help with stoma management was described. In the following case study, we share our experience with placement of a Hemashield Gold Dacron Graft (Maquet Cardiovascular, LLC, Wayne, NJ, USA) as a last resort in the management of a blowhole colostomy in a patient with large bowel obstruction secondary to metastatic carcinoid tumor. Compared to the previously described technique, we used a shorter graft, non-absorbable suture (Nylon, Ethicon, Cincinnati, OH, USA) and took larger bites of the mucocutaneous junction to achieve improved quality of life.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"303-305"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Outcomes of Pregnant Trauma Patients With Positive Urine Toxicology: A Southern California Multicenter Study.","authors":"Isabel Clark, Jeffry Nahmias, Mallory Jebbia, Negaar Aryan, Alexa N Lucas, Nicole Fierro, Navpreet K Dhillon, Eric J Ley, Jennifer Smith, Sigrid Burruss, Alden Dahan, Arianne Johnson, William Ganske, Walter L Biffl, Dunya Bayat, Matthew Castelo, Diane Wintz, Kathryn B Schaffer, Dennis J Zheng, Areti Tillou, Raul Coimbra, Rahul Tuli, Jarrett E Santorelli, Brent Emigh, Morgan Schellenberg, Kenji Inaba, Thomas K Duncan, Graal Diaz, Erika Tay-Lasso, Danielle C Zezoff, Areg Grigorian","doi":"10.1177/00031348241290612","DOIUrl":"10.1177/00031348241290612","url":null,"abstract":"<p><p><b>Background:</b> The use of illicit substances during pregnancy has increased 4-fold in the past two decades, negatively impacting both mother and fetus. The rate and clinical outcomes of substance use in pregnant trauma patients (PTPs) are not well studied. We sought to evaluate clinical outcomes of PTPs with positive urine toxicology, hypothesizing a higher rate of in-hospital maternal complications for PTPs with a positive urine toxicology ((+)Utox) compared to those testing negative ((-)Utox). <b>Methods:</b> PTPs (≥18 years old) were included in this multicenter retrospective study between 2016 and 2021. We included patients with known urine toxicology results and compared (+)Utox vs (-)Utox PTPs. <b>Results:</b> From 852 PTPs, 84 (9.8%) had a (+)Utox with the most common illicit substance being THC (57%) followed by methamphetamine (44%). (+)Utox PTPs had higher rates of blunt head injury (9.5% vs 4.2%, <i>P</i> = .028), extremity injury (14.3% vs 6.5%, <i>P</i> = .009), domestic violence (21.4% vs 5.9%, <i>P</i> < .001), suicide attempt (3.6% vs 0.3%, <i>P</i> < .001), and uterine contractions (46% vs 23.5%, <i>P</i> < .001). Abnormal fetal heart tracing, premature rupture of membranes and placental injury were similar between groups (all <i>P</i> > .05). The rate of maternal complications was similar in both groups (all <i>P</i> > .05). <b>Conclusion:</b> In this study, the rate of (+)Utox in PTPs was 9.8%. The (+)Utox group had similar rates of maternal complications but more commonly experienced uterine contractions which may be related to the physiology of drugs such as methamphetamines. PTPs with (+)Utox also more commonly were victims of domestic violence and suicide attempt, which merits further prevention research efforts.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"259-265"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: ChatGPT-4o in Surgery: Comment.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1177/00031348241281844","DOIUrl":"10.1177/00031348241281844","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"306-307"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Firearm Homicide Mortality is Linked to Food Insecurity in Major US Metropolitan Cities.","authors":"Michael Ghio, Ayman Ali, John Tyler Simpson, Alexandra Campbell, Juan Duchesne, Danielle Tatum, M Pia Chaparro, Joseph Constans, Julia Fleckman, Katherine Theall, Sharven Taghavi","doi":"10.1177/00031348241281848","DOIUrl":"10.1177/00031348241281848","url":null,"abstract":"<p><strong>Background: </strong>Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM.</p><p><strong>Materials and methods: </strong>This was a cross-sectional analysis examining the largest 51 US major metropolitan statistical areas (MSAs) using data from 2018. Demographic data, markers of social inequities, and firearm homicide data were obtained from the US Census Bureau, US Department of Education, and the Frey and Brookings Institute. Food insecurity prevalence was obtained from Feeding America. Spearman ρ and linear regression were performed.</p><p><strong>Results: </strong>Using Spearman rho analysis, higher FI (r = 0.55, <i>P</i> < 0.001) was associated with FHM. Other variables associated with FHM included percent Black/African American (AA) (r = 0.77, <i>P</i> < 0.001), poverty rate (r = 0.53, <i>P</i> < 0.001), and percent of children living in single parent households (r = 0.58, <i>P</i> < 0.001). In linear regression analyses, FI was associated with increased FHM, with 1.3 additional FHM events for each unit increase in FI (β = 1.33, 95% CI 0.27-2.39, <i>P</i> = 0.02). The percent of a population that is Black/AA was also associated with FHM, with more than 4 additional cases for each 1% increase in the population (β = 4.32, 95% CI 3.26-5.38, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Food insecurity may influence FHM in major US metropolitan cities. Community- and hospital-based programs that target FI may help combat the gun violence epidemic and decrease gun violence.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"224-232"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Traumatic Stress Disorder (PTSD) in Trauma Patients.","authors":"Brandon Radow, Nathaniel Anderson, Bryan K Richmond","doi":"10.1177/00031348241290610","DOIUrl":"10.1177/00031348241290610","url":null,"abstract":"<p><p>Post-traumatic stress disorder (PTSD) was first introduced as a diagnosis by the American Psychiatric Association in 1980. This diagnosis, included in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III), was to be considered after someone was exposed to a traumatic event \"outside the range of usual human experience and would be markedly distressing to almost anyone.\" Since then, trauma survivors have been identified as being at risk for the development of post-traumatic stress symptom (PTSS) and post-traumatic stress disorder (PTSD). Despite the recognition of this fact, the screening, recognition, and diagnosis of PTSD in these at-risk populations are inconsistent. In the following review, which is designed for the clinician who is unfamiliar with PTSD and its recognition, diagnosis, and treatment, we introduce the problem in the trauma patient and define its scope. In addition, we discuss the diagnosis of PTSD in trauma patients, special considerations relating to these patient populations, treatment options, and explore future directions for how best to define, study, recognize, and treat this challenging and potentially devastating condition.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"292-299"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality Improvement Initiative to Implement Focused Family Meetings in the Surgical Intensive Care Unit: Does It Matter?","authors":"Yesha Maniar, Haarika Chalasani, Kenneth Messerole, Lindsay Beck, Adam Stright, Patrizio Petrone, Shahidul Islam, D'Andrea K Joseph","doi":"10.1177/00031348241285549","DOIUrl":"10.1177/00031348241285549","url":null,"abstract":"<p><p><b>Introduction:</b> Communication with families is essential to improve satisfaction, especially in the critical care setting. We sought to identify patients who were not recovering as expected and to improve communication with their families.<b>Methods:</b> We implemented a novel algorithm, incorporating clinical and social criteria, to determine which patients could benefit from additional communication. Patients who qualified were randomized to the intervention of a structured interdisciplinary family meeting or to standard communication in the Intensive Care Unit at the discretion of the attending. Surveys were administered to both groups to determine the primary outcome of satisfaction with communication. Wilcoxon rank-sum, chi-square, or Fisher's exact test as appropriate was used to compare baseline characteristics and survey items between groups.<b>Results:</b> There was no difference between the intervention (n = 25) and non-intervention groups (n = 33) in demographic or clinical characteristics (<i>P</i>-value >.05). Surveys were able to be completed for 76% of the intervention group and 51% in the non-intervention group. There was no difference in the responses to the survey between the groups (<i>P</i>-value >.05), signifying that families were satisfied with communication regardless of whether they had a structured interdisciplinary family meeting.<b>Conclusion:</b> Our results are contrary to the traditionally held belief that structured family meetings improve communication. A possible explanation is that implementing an algorithm to identify patients in need of additional communication predisposes providers to be more cognizant of family needs in the Surgical Intensive Care Unit. Future research should focus on qualitative research to elucidate what aspects of communication are most useful to families.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"208-216"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}