American Surgeon最新文献_第4页

Diagnosis and Management Gaps in Tertiary Hyperparathyroidism Following Renal Transplant. 肾移植后三期甲状旁腺功能亢进的诊断和治疗差距。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-29 DOI: 10.1177/00031348251363808

Julia Kasmirski, Christopher Wu, Zhixing Song, Rongzhi Wang, Mohammad A Murcy, Brenessa Lindeman, Jessica Fazendin, Herbert Chen, Andrea Gillis

{"title":"Diagnosis and Management Gaps in Tertiary Hyperparathyroidism Following Renal Transplant.","authors":"Julia Kasmirski, Christopher Wu, Zhixing Song, Rongzhi Wang, Mohammad A Murcy, Brenessa Lindeman, Jessica Fazendin, Herbert Chen, Andrea Gillis","doi":"10.1177/00031348251363808","DOIUrl":"https://doi.org/10.1177/00031348251363808","url":null,"abstract":"BackgroundTertiary hyperparathyroidism (3HPT) occurs when hypercalcemia and elevated parathyroid hormone (PTH) persist after renal transplantation. Our study aims to identify gaps in the diagnosis and treatment of patients with 3HPT.MethodsIn a single-center retrospective analysis, we identified renal transplant patients with 3HPT based on the history of secondary hyperparathyroidism, preserved renal allograft function, and persistent serum PTH elevations (12-88 pg/mL) during postoperative follow-up.ResultsA total of 1556 patients were biochemically diagnosed with 3HPT. Median age was 57 (IQR = 47-65). Most were male (n = 888, 61%), black (n = 801, 55%), and did not undergo parathyroidectomy (n = 1388, 95.4%). Of these, 29.4% (n = 429) of the patients were diagnosed and treated, 23.4% (n = 354) were diagnosed and not treated, and 46.2% (n = 672) remained undiagnosed. Predictive factors for diagnosis and treatment included elevated pre-kidney transplantation PTH levels ≥ 600 pg/mL, postoperative PTH levels ≥ 300 pg/mL, and elevated postoperative calcium (≥10.4 mg/dL).ConclusionMost patients with biochemical 3HPT remain undiagnosed. This highlights gaps in patient care and the need for clearer guidelines on timing for PTH assessment and surgical referral in patients with 3HPT.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363808"},"PeriodicalIF":0.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740974","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}

引用次数: 0

Prospective Evaluation of Chest Tube Thoracostomy Placement by General Surgery Residents at Two Level I Trauma Centers. 两个一级创伤中心普外科住院医师胸腔插管置入的前瞻性评价。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-29 DOI: 10.1177/00031348251363542

Zachary Shelton, Baytes Gabriel Regan-Jordan, Vinila Baljepally, Tyler Locke, Chase Hayman, Ethan Ward, Sarah King, Lou Smith

{"title":"Prospective Evaluation of Chest Tube Thoracostomy Placement by General Surgery Residents at Two Level I Trauma Centers.","authors":"Zachary Shelton, Baytes Gabriel Regan-Jordan, Vinila Baljepally, Tyler Locke, Chase Hayman, Ethan Ward, Sarah King, Lou Smith","doi":"10.1177/00031348251363542","DOIUrl":"https://doi.org/10.1177/00031348251363542","url":null,"abstract":"IntroductionOur study proposes to define accuracy of and identify areas in general surgery residents (GSR) chest tube thoracostomy (CTT) placement addressable by improved education and supervision.MethodsProspective study of resident-performed CTT from June-August 2023 and 2024 in two Level 1 trauma centers. Data collection/analysis included demographics, tube type, proceduralist PGY, placement accuracy, patient factors, and outcomes.ResultsSeventy-seven CTT were placed by GSR. Average patient age was 57 ± 16.8. 75% were male. Smokers, COPD diagnosis, and prior chest wall radiation patients experienced more resident-CTT placement errors. CTT were standard 28-32F tubes (58; 75%) and small-bore pleural catheters (19; 25%). CTT was adequate in 62 (80.5%), 19.5% were sub-optimal. Placement problems included sentinel hole outside the chest (7, 9.1%), extrapleural location (5, 6.5%), kinked tube (3, 3.9%), and ineffective fissural tube (1, 1.3%). Interns placed 41 CTT, 7 by PGY-2, 11 by PGY-3, 7 by PGY-4, and 10 PGY-5 surgery residents. PGY-1 residents had a higher incidence of CTT retraction (35%, P = 0.042). Retracted, poorly secured CTT had a longer duration compared to well-secured CTT (6 days [4-7] vs 3 [2-4], P = 0.019); but didn't affect hospital LOS (P = 0.651). No other differences based on PGY were noted.DiscussionGSR's CTT placement has an accuracy of 80%. Placement problems occur at all levels of residency training. Our findings highlight actionable training targets and recommend areas of enhanced supervision to improve GSR mastery of CTT.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363542"},"PeriodicalIF":0.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740975","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}

引用次数: 0

The Association of Social Vulnerability and Area Deprivation With Open Versus Laparoscopic Partial Colectomy for Colon Cancer. 社会脆弱性和区域剥夺与开放与腹腔镜部分结肠切除术结肠癌的关系。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-29 DOI: 10.1177/00031348251363498

John D Salvemini, Kelly Brister, Wayne Shannon Orr, Wade O Christopher

{"title":"The Association of Social Vulnerability and Area Deprivation With Open Versus Laparoscopic Partial Colectomy for Colon Cancer.","authors":"John D Salvemini, Kelly Brister, Wayne Shannon Orr, Wade O Christopher","doi":"10.1177/00031348251363498","DOIUrl":"https://doi.org/10.1177/00031348251363498","url":null,"abstract":"IntroductionComparisons between open and laparoscopic partial colectomy for colon cancer are well documented. Social vulnerability (SVI) and area deprivation (ADI) indices reflect social determinants of health, often associated with worse surgical outcomes. Here we examine the association of SVI and ADI with partial colectomy approach.MethodsData came from the Epic Cosmos database for patients with colon cancer who underwent partial colectomy between 2013 and 2022. Only patients with documented SVI were included. Descriptive statistics and binary logistic regression were performed.ResultsThis study included 41,158 patients with colon cancer, of which 18,446 patients underwent open and 22,712 patients underwent laparoscopic partial colectomy. White patients were more likely to undergo laparoscopic colectomy than Black patients (OR: 1.11, 95% CI 1.05-1.17, P < .001). Thirty-day and 12-month mortality were higher in the open (4.7% and 14.5%) than laparoscopic group (1.0% and 4.9%). Upper quartile SVI and ADI had higher odds of open surgery (OR: 1.24, 95% CI 1.18-1.30, P < .001; OR: 1.45, 95% CI 1.39-1.52, P < .001, respectively).ConclusionUpper quartile SVI and ADI had higher odds of open partial colectomy for colon cancer. Clinical presentation and stage at diagnosis largely dictate the approach. Increasing CRC awareness and screenings while promoting laparoscopic partial colectomy would benefit populations with high social vulnerability and area deprivation.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363498"},"PeriodicalIF":0.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740986","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}

引用次数: 0

Hepatic Portal Venous Gas and Pneumatosis Intestinalis Associated With Early Oral Feeding After Laparoscopic Total Gastrectomy. 腹腔镜全胃切除术后早期口服喂养与肝门静脉气体和肠气胸有关。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363540

Guanfu Cai, Weixian Hu

引用次数: 0

Technique for Consistent Selective Left Mainstem Intubation in Neonatal and Infantile Surgery. 在新生儿和婴儿手术中持续选择性左主干插管技术。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363506

Alexander Urevick, Camryn Coley, Haresh D Patel, Dave Bhattacharya, Curtis Koontz

{"title":"Technique for Consistent Selective Left Mainstem Intubation in Neonatal and Infantile Surgery.","authors":"Alexander Urevick, Camryn Coley, Haresh D Patel, Dave Bhattacharya, Curtis Koontz","doi":"10.1177/00031348251363506","DOIUrl":"https://doi.org/10.1177/00031348251363506","url":null,"abstract":"Selective left mainstem intubation can be challenging in neonates and infants due to airway fragility, limited device options, and the natural inclination toward right-sided placement. This paper describes a sample case series demonstrating a technique that combines patient positioning, a Seldinger-like approach using a soft stylet, and real-time fluoroscopic guidance for optimal left mainstem intubation. The method has become an institutional standard for procedures requiring single-lung ventilation, including esophageal atresia with tracheoesophageal fistula repair and congenital pulmonary airway malformation surgeries. Fluoroscopic imaging offers objective confirmation of tube placement, while reducing airway trauma and need for advanced bronchoscopy. Our experience indicates that reliance on auscultation alone can be minimized, leading to quicker, more precise verification of left mainstem intubation with minimal excess radiation. No technique-specific complications have been observed. Thus, this method provides a reliable alternative for achieving selective left mainstem intubation in pediatric populations, offering improved safety and procedural efficiency.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363506"},"PeriodicalIF":0.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726505","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}

引用次数: 0

Pushing the Tenets of REBOA: Leveraging Partial Endovascular Aortic Occlusion to Stabilize Blunt Cardiac Rupture. 推进REBOA的原则：利用部分血管内主动脉闭塞来稳定钝性心脏破裂。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363502

Will R Dunne, Zachary J Grady, Randi N Smith, Jonathan Nguyen

引用次数: 0

Results of Open and Endovascular Repair of Complex Aortic, Iliac, and Femoral Anastomotic Aneurysms. 血管内切开修复复杂的主动脉、髂、股吻合动脉瘤的结果。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363809

Shyamal Pansuriya, Sachinder Hans

{"title":"Results of Open and Endovascular Repair of Complex Aortic, Iliac, and Femoral Anastomotic Aneurysms.","authors":"Shyamal Pansuriya, Sachinder Hans","doi":"10.1177/00031348251363809","DOIUrl":"https://doi.org/10.1177/00031348251363809","url":null,"abstract":"Anastomotic aneurysms (AA) manifest as late complications of aortic-iliac-femoral reconstruction with a prosthetic graft. We studied open and endovascular repair of complex aortic iliac and femoral AA was performed for (A) Rupture, (B) Large symptomatic aneurysms, (C) Recurrent, (D) Femoral AA requiring simultaneous arterial reconstruction for critical limb ischemia in two teaching hospitals. Between 1990 and 2024, 100 aorto-femoral-iliac AA were repaired with 32 representing complex AA involving aorta (n = 6), iliac (n = 3), femoral (n = 23). Aortic and iliac anastomotic aneurysms underwent endovascular repairs in 5 patients and open repair in 4 patients with satisfactory outcomes in all. All 23 patients presenting with complex femoral anastomotic aneurysms were repaired via open technique, including five presenting with rupture with mortality in two, and one mortality among those presenting with large aneurysms. Complex femoral AA take longer to present after index operative, showed greater operative time, intra-operative blood loss but had similar mortality to patients with non-complex AAs. Most aortic and iliac AA can be repaired with endovascular and open techniques with satisfactory results, while complex femoral AA required open repair.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363809"},"PeriodicalIF":0.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726502","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}

引用次数: 0

Increasing Tube Thoracostomy Output Threshold to Less Than 300 mL Per Day is Not Associated With Increased Complications after Removal in Trauma Patients. 增加胸腔插管输出阈值至每天小于300 mL与创伤患者切除后并发症的增加无关。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363533

Lee C Givens, Chase A Jordan, James W Herrin, Yann-Leei L Lee, Steven G Miller, Thomas Capasso, Maryann Mbaka, Christopher M Kinnard, Andrew C Bright, Ashley Y Williams, Nathan M Polite, Jon D Simmons, Charles C Butts

{"title":"Increasing Tube Thoracostomy Output Threshold to Less Than 300 mL Per Day is Not Associated With Increased Complications after Removal in Trauma Patients.","authors":"Lee C Givens, Chase A Jordan, James W Herrin, Yann-Leei L Lee, Steven G Miller, Thomas Capasso, Maryann Mbaka, Christopher M Kinnard, Andrew C Bright, Ashley Y Williams, Nathan M Polite, Jon D Simmons, Charles C Butts","doi":"10.1177/00031348251363533","DOIUrl":"https://doi.org/10.1177/00031348251363533","url":null,"abstract":"BackgroundTube thoracostomy (TT) is a life-saving intervention that has a high complication rate. While many institutions continue drainage until <200 mL/day, there is little data on removal with higher output. This study aimed to determine whether TT removal with higher output on the day of removal is associated with complication of tube thoracostomy (CTT).Materials and MethodsThis was a retrospective study of patients who underwent TT due to traumatic hemothorax/pneumothorax. Data on demographics, admission vital signs, injury details, treatment course, and output on day of removal was collected. Output was classified as HIGH (200-299 mL at removal) or LOW (<200 mL). The primary outcome variable was development of CTT, which was defined as re-accumulation of HTX/PTX, development of an empyema, subsequent TT, or need for thoracic surgery following tube removal.ResultsAfter applying exclusion criteria, we identified 315 patients for analysis. The average age was 41 years old, and 74% (233) were male. The mean duration of treatment with TT was 5 days. The mean output on the day of removal was 80 mL, with 10% having a volume between 200-299 mL on day of removal. Overall, 16% developed CTT. There was no difference in the rate of CTT after removal between HIGH and LOW groups. Multiple variable logistic regression showed only chest AIS was statistically significantly associated with CTT.DiscussionComplications after tube thoracostomy are common (16%), but patients with higher output were not more likely to develop a complication. Chest tubes can be safely removed with an output <300 mL/day.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363533"},"PeriodicalIF":0.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726497","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}

引用次数: 0

Statewide Discharge Data Supports Development of Inclusive Trauma System. 全州范围的出院数据支持包容性创伤系统的发展。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363513

Pascal Osita Udekwu, William Luo, Anquonette Stiles, Sharon Schiro

{"title":"Statewide Discharge Data Supports Development of Inclusive Trauma System.","authors":"Pascal Osita Udekwu, William Luo, Anquonette Stiles, Sharon Schiro","doi":"10.1177/00031348251363513","DOIUrl":"https://doi.org/10.1177/00031348251363513","url":null,"abstract":"IntroductionVerification by the American College of Surgeons and state designation of trauma centers improve outcomes in trauma care. In regions where participation in trauma systems is optional, legislation requiring inclusion may need evidence of outcome differences. Given the distinct populations treated at trauma centers vs non-trauma centers, validated risk adjustment is essential for fair comparison. The International Classification of Diseases, 10th Revision injury severity score (ICISS) has been validated for such assessments.MethodsWith institutional review board approval, data from the state Healthcare Cost and Utilization Project from 2018 to 2020 was analyzed. Using ICISS for risk adjustment, outcomes were compared across overall, age-specific, and diagnosis-specific groups.ResultsAmong 3,316,016 discharges, 245,404 (7.4 percent) included at least one injury diagnosis. After excluding transfers out, 151,855 cases remained. Patients at trauma centers had lower risk-adjusted mortality and fewer occurrences of acute kidney injury and pulmonary embolism but higher rates of ventilator-associated pneumonia and surgical site infections. Subgroup analyses revealed that pediatric patients and those with traumatic brain injuries or shock were predominantly treated at trauma centers. Increased age, higher injury severity, male gender, and non-trauma center treatment were associated with lower survival rates. Among geriatric patients with proximal femur fractures, 63 percent were treated at non-trauma centers, with no observed mortality benefit from trauma center care.ConclusionsTrauma center care is associated with improved outcomes supporting the development of more inclusive trauma systems.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251363513"},"PeriodicalIF":0.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726503","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}

引用次数: 0

The Last Scalpel: Ghosts in the Operating Room. 《最后的手术刀：手术室里的鬼魂》

IF 0.9 4区医学

American Surgeon Pub Date : 2025-07-28 DOI: 10.1177/00031348251363545

Amir Farah

引用次数: 0