Operative Management of Acute Appendicitis Was Safe During the COVID-19 Pandemic Shutdown.

Introduction: In the spring of 2020, New York City was one of the first epicenters of the COVID outbreak. In this study, we evaluate the incidence and treatment of appendicitis in two New York City community hospitals during the COVID pandemic.

Methods: This retrospective study focused on the incidence and outcome of acute appendicitis in the adult population (>18 y old) during peak-COVID periods (March 16, 2020,-June 15, 2020) compared to pre-COVID and post-COVID periods.

Blueprint for safe transition from a low- to high-volume pancreatic surgery center.

We describe a straightforward model to implement a high volume specialty surgery program at a community hospital. Using pancreatic surgery as an example, we employed published processes in three arenas. First, mandatory multidisciplinary tumor board presentations captured all the patients considered for surgery.

Over the hill and falling down: Can the NEXUS criteria be applied to the elderly?

Introduction: The National Emergency X-Radiography Utilization Study (NEXUS) criteria have been criticized due to the presumed unreliability of the clinical exam in elderly patients. The objective of this study was to determine if the NEXUS criteria can be safely applied to this vulnerable group of patients.

Methods: 596 trauma patients over the age of 65 were enrolled in a prospectively designed study between April 1, 2015 and October 1, 2016.

Distracting injury defined: does an isolated hip fracture constitute a distracting injury for clearance of the cervical spine?

Objectives: As the population within the USA ages, the number of hip fractures seen yearly in the emergency department is expected to rise. According to the NEXUS criteria, many of these patients receive computerized tomographic scan (CT) evaluation of the cervical spine because a hip fracture may constitute a distracting injury. The objective of this study is to determine if an isolated hip fracture constitutes a distracting injury which requires imaging of the cervical spine.

Use of High-Frequency Percussive Ventilation to Expand Organ Donor Pool.

A 34-year-old woman was brought in to the emergency department after a motor vehicle accident. She had signs of traumatic head injury with Glasgow Coma Scale score of 3, and her neurological examination was consistent with brain death. She was persistently hypoxic on conventional mechanical ventilation and high-frequency percussive ventilation was initiated.

Lactobacillus fermentum, a pathogen in documented cholecystitis.

Introduction: Lactobacillus species are probiotics proven to exhibit various preventative as well as therapeutic properties. While lactobacillus species have been implicated in the formation of dental caries, endocarditis and bacteremia, their role as pathogens in cholecystitis has not been reported. We present a rare case of Lactobacillus fermentum working as a pathogen in cholecystitis.

Aortic mural thrombus in the normal or minimally atherosclerotic aorta.

Background: Aortic mural thrombus in a nonaneurysmal minimally atherosclerotic or normal aorta is a rare clinical entity and an uncommon cause of peripheral arterial embolization. Both anticoagulation therapy and aortic surgery are commonly used as primary treatment, but there are no consensuses or clinical guidelines to outline the best management strategy for this unusual problem. This systematic review compares the outcomes of these different strategies for the treatment of aortic mural thrombus.

Blood transfusion and its effect on the clinical outcomes of patients undergoing major lower extremity amputation.

Background: Patients in need of lower extremity amputation are often debilitated and have coronary artery disease and underlying anemia. The transfusion of blood is a common practice in the perioperative management of these patients. However, blood transfusion has been reported to have a negative effect on the incidence of perioperative complications in other patient populations.

Selective nonoperative management of leaks after gastric bypass: lessons learned from 2675 consecutive patients.

Objective: To compare outcomes of patients with leaks after primary Roux-en-Y gastric bypass (GBP) managed operatively with those managed nonoperatively and subsequently derive indications for selective nonoperative management.

Summary Of Background Data: There is no consensus on the management of leaks complicating GBP, which remains the commonest cause of death.

Methods: We evaluated 2675 consecutive GBP procedures, determining incidence and outcomes of leaks in a program emphasizing early detection, routine drainage, and selective nonoperative management.

Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit.

Background: Central line-associated bloodstream infections occur commonly and are a potentially preventable source of morbidity in the critical care setting. The purpose of this study was to find a way to decrease central line-associated bloodstream infections.

Methods: Data were collected from February 1, 2005, to April 31, 2007, on all patients in the critical care unit who had a central venous catheter placed at New York Methodist Hospital in Brooklyn, which is a community teaching hospital with 628 beds.

Acute arterial occlusion after ultrasound-guided thrombin injection of a common femoral artery pseudoaneurysm with a wide, short neck.

Ultrasound-guided thrombin injection (UGTI) has emerged as the preferred treatment modality for pseudoaneurysms occurring as a result of percutaneous femoral arterial interventions. UGTI is safe and effective, with few complications. Native arterial thrombosis has been rarely reported in the literature following UGTI and has usually been attributed to excessive thrombin injection.

Delayed post-operative pneumoperitoneum.

We present a case of post-operative pneumoperitoneum (PP), which persisted for eight weeks. Postoperative retained air is the most common cause of PP. It does not require a surgical intervention and thus is defined as a 'non-surgical PP'.

Abdominal compartment syndrome in severe acute pancreatitis: an indication for a decompressing laparotomy?

Background: The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome (ACS), which is associated with the acute pancreatitis.

Methods: We present our recent experience with three patients suffering from severe acute pancreatitis.