Clinical surgery journal最新文献

{"title":"Cannabinoid Hyperemesis Syndrome Complicated by Pneumomediastinum: Implications for Pediatric Surgeons.","authors":"Gregory Klazura, Joseph R. Geraghty, M. Rojnica, T. Sims, Nathaniel Koo, Thom L. Lobe","doi":"10.25083/2559.5555/7.2.14","DOIUrl":"https://doi.org/10.25083/2559.5555/7.2.14","url":null,"abstract":"BACKGROUND\u0000Cannabinoid Hyperemesis Syndrome (CHS) is a form of cyclic vomiting syndrome characterized by episodic vomiting occurring every few weeks or months and is associated with prolonged and frequent use of high-dose cannabis. CHS in the pediatric population has been increasingly reported over the last decade and can lead to life-threatening complications such as pneumomediastinum, which warrant careful consideration for surgical intervention.\u0000\u0000\u0000CASE PRESENTATION\u0000A 17-year-old female with no significant past medical history presented to the emergency department with abdominal pain, nausea, and vomiting for 24 hours. She had four episodes of green-yellow emesis followed by dry heaves. She also complained of chest and back pain, worse with deep inspiration. Upon further history, the patient reported a similar episode of abdominal pain and repetitive vomiting six months prior to the current episode. She smoked cannabis at least once daily and has done so for the past two years. Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities. Follow-up chest computed tomography with contrast showed multiple foci of air within the anterior and posterior mediastinum tracking up to the thoracic inlet. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded. Given uncomplicated pneumomediastinum without frank contrast extravasation, the patient was treated medically with piperacillin-tazobactam, metronidazole, and micafungin for microbial prophylaxis; hydromorphone for pain control; as well as with pantoprazole, ondansetron, and promethazine. Nutrition was provided via total parenteral nutrition. The patient was intensely monitored for signs of occult esophageal perforation, but none were detected. She was advanced to a soft diet on hospital day eight, solid food diet on day nine, at which point antibiotics were discontinued, and the patient was subsequently discharged.\u0000\u0000\u0000CONCLUSION\u0000CHS in an increasingly common disorder encountered in the pediatric setting due to rising prevalence of cannabis use. The management of CHS and potentially life-threatening complications such as pneumomediastinum should be given careful consideration. Pneumomediastinum can be a harbinger of more sinister pathology such as esophageal perforation, which may warrant urgent surgical intervention.","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"29 1","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2022-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85427294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microglia and Post-Subarachnoid Hemorrhage Vasospasm: Review of Emerging Mechanisms and Treatment Modalities.","authors":"Coulter Small, Kyle Scott, Derek Smart, Michael Sun, Carlton Christie, Brandon Lucke-Wold","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Vasospasm is a potentially severe complication of subarachnoid hemorrhage. It can be attributed to neuroinflammation and the robust recruitment of microglia. Emerging evidence has linked this sustained inflammation to the development of delayed cerebral ischemia following subarachnoid hemorrhage. In this focused review, we provide an overview of the historical understanding of vasospasm. We then delve into the role of neuroinflammation and the activation of microglia. These activated microglia releases a host of inflammatory cytokines contributing to an influx of peripheral macrophages. This thereby opens a new and innovative treatment strategy to prevent vasospasm. Pre-clinical work has been promising, and the transition to clinical trials is warranted. Finally, some of the key mechanistic targets are outlined with emphasis on translation. This review will serve as a catalyst for researchers and clinicians alike in the quest to improve treatment options for vasospasm.</p>","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabinoid Hyperemesis Syndrome Complicated by Pneumomediastinum: Implications for Pediatric Surgeons.","authors":"Greg Klazura,&nbsp;Joseph R Geraghty,&nbsp;Marko Rojnica,&nbsp;Thomas Sims,&nbsp;Nathaniel Koo,&nbsp;Thom Lobe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cannabinoid Hyperemesis Syndrome (CHS) is a form of cyclic vomiting syndrome characterized by episodic vomiting occurring every few weeks or months and is associated with prolonged and frequent use of high-dose cannabis. CHS in the pediatric population has been increasingly reported over the last decade and can lead to life-threatening complications such as pneumomediastinum, which warrant careful consideration for surgical intervention.</p><p><strong>Case presentation: </strong>A 17-year-old female with no significant past medical history presented to the emergency department with abdominal pain, nausea, and vomiting for 24 hours. She had four episodes of green-yellow emesis followed by dry heaves. She also complained of chest and back pain, worse with deep inspiration. Upon further history, the patient reported a similar episode of abdominal pain and repetitive vomiting six months prior to the current episode. She smoked cannabis at least once daily and has done so for the past two years. Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities. Follow-up chest computed tomography with contrast showed multiple foci of air within the anterior and posterior mediastinum tracking up to the thoracic inlet. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded. Given uncomplicated pneumomediastinum without frank contrast extravasation, the patient was treated medically with piperacillin-tazobactam, metronidazole, and micafungin for microbial prophylaxis; hydromorphone for pain control; as well as with pantoprazole, ondansetron, and promethazine. Nutrition was provided via total parenteral nutrition. The patient was intensely monitored for signs of occult esophageal perforation, but none were detected. She was advanced to a soft diet on hospital day eight, solid food diet on day nine, at which point antibiotics were discontinued, and the patient was subsequently discharged.</p><p><strong>Conclusion: </strong>CHS in an increasingly common disorder encountered in the pediatric setting due to rising prevalence of cannabis use. The management of CHS and potentially life-threatening complications such as pneumomediastinum should be given careful consideration. Pneumomediastinum can be a harbinger of more sinister pathology such as esophageal perforation, which may warrant urgent surgical intervention.</p>","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"5 Suppl 13","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9696622/pdf/nihms-1825724.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Bowel Strangulation due to Right Para-Duodenal Hernia - A Case Report","authors":"R. Rajkumar, P. Beulah, R. Sundarapandiyan, S. Dash","doi":"10.46619/csj.2018.1-1001","DOIUrl":"https://doi.org/10.46619/csj.2018.1-1001","url":null,"abstract":"Para-duodenal hernias are rare causes of intestinal obstruction and strangulation, are difficult to diagnose preoperatively. It is a rare congenital anomaly which occurs due to defect in the rotation of gut. It is usually discovered incidentally at radiological study or at laparotomy. Here we report of right para-duodenal hernia presented in emergency with signs and symptoms of acute intestinal obstruction. Pre-operative Computer Tomography cuts show hernia sac, filled with loops of small bowel crowded in the right hypochondrium suggesting the rare diagnosis of Waldeyer’s hernia. He required resection of the gangrenous segment and primary anastomosis. The mouth of the sac was obliterated with suturing to the posterior abdominal wall. The patient was discharged uneventfully on 7th post-operative day.","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90202251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramyocardial LAD; Relevant Morphological/Anatomical Features and Stepwise Technique for Optimal Surgical Exposure","authors":"M. Sooknunden, P. Bonnet, R. Durieux, J. Defraigne, M. Radermecker","doi":"10.46619/csj.2018.1-1003","DOIUrl":"https://doi.org/10.46619/csj.2018.1-1003","url":null,"abstract":"Exposure of the embedded intra mural left anterior descending (LAD) coronary artery remains quite challenging especially for inexperienced surgeons. The main focus of this short review is thus to summarize both the relevant morphological characteristics and the already illustrated techniques for surgical exposure in English literature. We then propose a step by step rational and reproducible approach to successfully expose the intramural LAD artery for bypass and successfully tackle avoidable difficulties.","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80723157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reoperation and Postoperative Outcomes for Single-Stage versus Two-Stage Breast Reconstruction Following Mastectomy: A Meta-Analysis","authors":"Renee Aboushi, W. K. Childe, C. Hollenbeak, Harold C. Yang, Brynn S. Wolff","doi":"10.46619/csj.2018.1-1002","DOIUrl":"https://doi.org/10.46619/csj.2018.1-1002","url":null,"abstract":"Introduction Implant based breast reconstructions has become widely accepted as an appropriate reconstruction method following mastectomy for breast cancer. The two most common techniques include immediate reconstruction and implantation (single-stage procedure) or the use of a tissue expander with delayed insertion of implant and reconstruction (two-stage procedure). Using existing studies and available data, a meta-analysis was performed analyzing reoperation rates and postoperative complications between these two methods based upon available literature. Methods A literature search was performed by two individual investigators using the databases PubMed, Cochrane, and Medline. All articles comparing implant based single and two stage breast reconstructions outcomes between 2006 and 2016 were utilized. The primary endpoint of interest was reoperation rates. Secondary endpoints included postoperative complications such as infection, seroma, hematoma, and necrosis. Results A total of five studies met the inclusion criteria, for a total of 12,357 breast reconstructions. 2,281 breast reconstructions were singlestage and 10,076 were two-staged. The primary endpoint of reoperation was increased reoperation rate in the single-stage breast reconstruction (OR=0.78, CI 0.67-0.91; p<0.05). Secondary endpoints demonstrated no statistical significance in infections (OR 1.06, CI 0.84-1.34; p=0.40), hematoma (OR=1.66, CI 0.91-3.05; p=0.09) and necrosis (OR=1.13, CI 0.76-1.68; p=0.29). However, there was an increased incidence of seroma formation in two-stage reconstruction (OR=1.86, CI 1.05-3.28; p<0.005). Conclusions Single and two-staged implant breast reconstructions had similar infection, hematoma, and necrosis rates. Single-stage reconstructions resulted in a significant increase in reoperation/revision rates.","PeriodicalId":91009,"journal":{"name":"Clinical surgery journal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82091345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}