IntroductionThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to imp... more IntroductionThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to implementing strict social distancing mandates nationwide. This study evaluates the trauma trends during the pandemic at a rural level II trauma center in Pennsylvania.MethodsA retrospective review of all trauma registries between 2018 and 2021 was performed overall and on a 6-month basis. Injury severity score, injury types–blunt versus penetrating, and mechanisms of injury were compared across the years.ResultsA total of 3056 patients in 2018-2019 and 2506 patients in 2020-2021 were evaluated as the historic control and study group, respectively. The median age of the patients was 63 and 62 years in the control and the study group, respectively (P = 0.616). There was an overall significant decline in blunt injuries and an increase in penetrating injuries (Blunt: 2945 versus 2329, Penetrating: 89 versus 159, P < 0.001). Injury severity score was not different across the eras. Falls, motorcycle accidents, motor vehicle accidents, and all-terrain vehicles comprised most of the blunt traumas. Penetrating injuries secondary to assault with firearms and sharp weapons had an increasing trend.ConclusionsThere was no association between trauma numbers and the beginning of the pandemic. Overall, there was a decline in trauma numbers during the second 6 mo of the pandemic. There was an increase in injuries involving firearms and stabbing. Rural trauma centers have a unique demographic and admission trend that should be considered while advising regulatory changes during pandemics.
To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and... more To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.
3763 Background: Synchronous liver metastasis (SLM), commonly defined as liver metastasis occurri... more 3763 Background: Synchronous liver metastasis (SLM), commonly defined as liver metastasis occurring within 12 months of the colon primary, represents 13-25% of the 90,000 newly diagnosed colorectal liver metastases. SLM have historically been found to have a worse overall survival when compared to metachronous lesions. The primary reason for this worse overall survival has been related to a majority of patients having unresectable disease because of multiple bilobar tumors or comorbid conditions. We hypothesized that patients with synchronous liver metastases would benefit from an aggressive ablation and resection to the same degree as patients with metachronous metastases. METHODS Review of our prospective database revealed 64 pts with unresectable colorectal liver metastases treated since 1998. The vast majority of patients underwent RFA as an open procedure. Survival was determined by the Kaplan-Meier. RESULTS Sixty-four pts underwent treatment for 200 liver metastases (38 resected, 162 RFA; mean 3.1 tumors/pt). Median age was 63 years (range 17-88). Median follow-up was 22 mo. The median size of the largest metastasis was 3 cm (range 1-10 cm). RFA was performed for 9 pts known to have minimal extrahepatic (EH) disease preoperatively, and 6 who were found to have EH disease at operation. Synchronous metastases were present in 38 pts. Eighteen pts (28%) experienced postoperative complications, usually minor and self-limited. Thirty-day mortality was 1.6%. Repeat RFA was performed in 11 pts for liver recurrence. Median disease-free and overall survival rates for the entire group were 12 and 31 mo, respectively. Median overall survival rates were 26 and 36 mo, respectively, for pts with or without EH metastasis (P=0.14). There were no differences in survival for pts with synchronous vs. metachronous liver metastases, or for pts who underwent RFA alone vs. RFA + resection. CONCLUSIONS RFA is as effective for patients with synchronous metastases as it is for those with metachronous metastases. Patients without EH disease appear to benefit the most, although further study is necessary to determine the potential benefit for patients with limited EH disease. No significant financial relationships to disclose.
Surgery for Obesity and Related Diseases, Volume 2, Issue 3, Pages 393-396, May 2006, Authors:Jef... more Surgery for Obesity and Related Diseases, Volume 2, Issue 3, Pages 393-396, May 2006, Authors:Jeff W. Allen, MD; Jorge Acosta, MD; Steven R. Casós, MD; Laura L. Baldwin, RN; Robert N. Cacchione, MD; Jorge L. Rodriguez, MD. Journal Home, ...
Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive proc... more Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive procedures such as angiography, ERCP, and percutaneous drainage. Although extensively discussed in the adult population, little has been reported on outcomes and management of pediatric liver injury. Retrospective review of all patients with blunt liver injuries admitted to an adult Level I trauma center and pediatric trauma center within the same community was performed from 2004 to 2006. The necessity for operation, adjuncts to nonoperative management, and outcome were collected and compared for the pediatric (PED) (<18 years of age) versus the adult (≥18 years of age) injured patients. There were 389 liver injuries identified (PED = 90, adult = 299); 25 per cent of adult injuries were greater than or equal to grade III, while 23 per cent of PED injuries were high-grade injuries. Each group of patients had similar rates of primary operative intervention: adult patients (18%) versus PED ...
To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and... more To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.
A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed accor... more A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant’s manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.
IntroductionThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to imp... more IntroductionThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to implementing strict social distancing mandates nationwide. This study evaluates the trauma trends during the pandemic at a rural level II trauma center in Pennsylvania.MethodsA retrospective review of all trauma registries between 2018 and 2021 was performed overall and on a 6-month basis. Injury severity score, injury types–blunt versus penetrating, and mechanisms of injury were compared across the years.ResultsA total of 3056 patients in 2018-2019 and 2506 patients in 2020-2021 were evaluated as the historic control and study group, respectively. The median age of the patients was 63 and 62 years in the control and the study group, respectively (P = 0.616). There was an overall significant decline in blunt injuries and an increase in penetrating injuries (Blunt: 2945 versus 2329, Penetrating: 89 versus 159, P < 0.001). Injury severity score was not different across the eras. Falls, motorcycle accidents, motor vehicle accidents, and all-terrain vehicles comprised most of the blunt traumas. Penetrating injuries secondary to assault with firearms and sharp weapons had an increasing trend.ConclusionsThere was no association between trauma numbers and the beginning of the pandemic. Overall, there was a decline in trauma numbers during the second 6 mo of the pandemic. There was an increase in injuries involving firearms and stabbing. Rural trauma centers have a unique demographic and admission trend that should be considered while advising regulatory changes during pandemics.
To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and... more To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.
3763 Background: Synchronous liver metastasis (SLM), commonly defined as liver metastasis occurri... more 3763 Background: Synchronous liver metastasis (SLM), commonly defined as liver metastasis occurring within 12 months of the colon primary, represents 13-25% of the 90,000 newly diagnosed colorectal liver metastases. SLM have historically been found to have a worse overall survival when compared to metachronous lesions. The primary reason for this worse overall survival has been related to a majority of patients having unresectable disease because of multiple bilobar tumors or comorbid conditions. We hypothesized that patients with synchronous liver metastases would benefit from an aggressive ablation and resection to the same degree as patients with metachronous metastases. METHODS Review of our prospective database revealed 64 pts with unresectable colorectal liver metastases treated since 1998. The vast majority of patients underwent RFA as an open procedure. Survival was determined by the Kaplan-Meier. RESULTS Sixty-four pts underwent treatment for 200 liver metastases (38 resected, 162 RFA; mean 3.1 tumors/pt). Median age was 63 years (range 17-88). Median follow-up was 22 mo. The median size of the largest metastasis was 3 cm (range 1-10 cm). RFA was performed for 9 pts known to have minimal extrahepatic (EH) disease preoperatively, and 6 who were found to have EH disease at operation. Synchronous metastases were present in 38 pts. Eighteen pts (28%) experienced postoperative complications, usually minor and self-limited. Thirty-day mortality was 1.6%. Repeat RFA was performed in 11 pts for liver recurrence. Median disease-free and overall survival rates for the entire group were 12 and 31 mo, respectively. Median overall survival rates were 26 and 36 mo, respectively, for pts with or without EH metastasis (P=0.14). There were no differences in survival for pts with synchronous vs. metachronous liver metastases, or for pts who underwent RFA alone vs. RFA + resection. CONCLUSIONS RFA is as effective for patients with synchronous metastases as it is for those with metachronous metastases. Patients without EH disease appear to benefit the most, although further study is necessary to determine the potential benefit for patients with limited EH disease. No significant financial relationships to disclose.
Surgery for Obesity and Related Diseases, Volume 2, Issue 3, Pages 393-396, May 2006, Authors:Jef... more Surgery for Obesity and Related Diseases, Volume 2, Issue 3, Pages 393-396, May 2006, Authors:Jeff W. Allen, MD; Jorge Acosta, MD; Steven R. Casós, MD; Laura L. Baldwin, RN; Robert N. Cacchione, MD; Jorge L. Rodriguez, MD. Journal Home, ...
Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive proc... more Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive procedures such as angiography, ERCP, and percutaneous drainage. Although extensively discussed in the adult population, little has been reported on outcomes and management of pediatric liver injury. Retrospective review of all patients with blunt liver injuries admitted to an adult Level I trauma center and pediatric trauma center within the same community was performed from 2004 to 2006. The necessity for operation, adjuncts to nonoperative management, and outcome were collected and compared for the pediatric (PED) (<18 years of age) versus the adult (≥18 years of age) injured patients. There were 389 liver injuries identified (PED = 90, adult = 299); 25 per cent of adult injuries were greater than or equal to grade III, while 23 per cent of PED injuries were high-grade injuries. Each group of patients had similar rates of primary operative intervention: adult patients (18%) versus PED ...
To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and... more To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.
A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed accor... more A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant’s manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.
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