Besieged in the Bronx: Lessons from an in-hospital mass casualty.

Background: An active shooter in a hospital is an emergency extraordinaire. We report a single institution's response to the largest active shooter mass casualty event in American History.

Methods: Review of notification, flow of prioritized patients, and key elements of the day's dynamic after a hospital attack by a lone gunman were commenced.

Accuracy of MRI in Diagnosing Appendicitis during Pregnancy.

Appendectomy for presumed appendicitis is the most common surgical emergency during pregnancy. Delayed diagnosis and treatment of appendicitis carries risk for the fetus and mother. We sought to evaluate the accuracy of MRI in pregnant patients with suspected appendicitis.

Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass.

Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal-fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain.

Laparoscopic vs open partial colectomy in elderly patients: Insights from the American College of Surgeons - National Surgical Quality Improvement Program database.

Aim: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons - National Surgical Quality Improvement Program (ACS NSQIP) database.

Methods: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar pre-operative comorbidities.

Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice?

Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored.

Effect of Pain Medication Choice on Emergency Room Visits for Pain after Ambulatory Laparoscopic Cholecystectomy.

Inadequate pain control after ambulatory surgery can lead to unexpected return visits to the hospital. The purpose of this study was to compare patients based on which medications they were prescribed and to see whether this affected the rate of return to the hospital. A retrospective chart review of patients who underwent ambulatory laparoscopic cholecystectomy between January 2009 and December 2013 was performed.

Minimally invasive management of biliary tract injury following percutaneous nephrolithotomy.

Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy.

Independent risk factors for early urologic complications after kidney transplantation.

Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six-month follow-up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression.

Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video).

Background: The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC).

Aberrant cell adhesion molecule expression in human bronchopulmonary sequestration and congenital cystic adenomatoid malformation.

In many organs, integrins and cadherins are partly regulated by Hox genes, but their interactions in airway morphogenesis and congenital lung diseases are unknown. We previously showed that the Hox protein HoxB5 is abnormally increased in bronchopulmonary sequestration (BPS) and congenital cystic adenomatoid malformation (CCAM), congenital lung lesions with abnormal airway branching. We now report on alpha(2)-, alpha(3)-, and beta(1)-integrin and E-cadherin expression in normal human lung and in BPS and CCAM tissue previously shown to have abnormal HoxB5 expression and on the relationship of cell adhesion molecule expression to Hoxb5 regulation.

Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum.

This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future.

Cysts of serendipity.

Purpose: Primary intradiaphragmatic cysts are diagnostically challenging lesions. Often serendipitously discovered on radiological examination, intradiaphragmatic cysts are uncommon and require surgical resection for accurate identification.

Methods: Two children, aged 16 and 4 years, presented for surgical evaluation of what were believed to be asymptomatic cystic lesions of hepatic origin.

The growing teratoma syndrome.

Growing teratoma syndrome is defined as enlarging masses of mature teratoma following chemotherapy for malignant nonseminomatous germ-cell tumors. Typically, there is associated normalization of initially elevated serum tumor markers. We describe clinical and imaging findings in a case of growing teratoma syndrome originating from immature teratoma of the ovary in a 12-year-old girl.

Methylene blue: dangerous dye for neonates.

Methylene blue is a basic dye commonly used in histologic microbiologic, and tissue staining. This report describes an instance of methylene blue toxicity in a premature neonate.

The application of vascular technology to esophageal and airway strictures.

Background/purpose: Strictures of the esophagus and airway tract can be dilated if the strictures can be traversed and dilators passed. Unfortunately, using standard methods, not all strictures can be traversed. The authors set out to find a safe, expeditious, and reproducible way to traverse otherwise impassable strictures of the esophagus and airway.