Lombard Aorfix high angulation device, sac behavior following implantation.

Objective: Short neck length, and angulated infrarenal aortic necks, are historically associated with sac expansion following endovascular abdominal aortic aneurysm repair. Aorfix (Lombard Medical, Inc, Irvine, Calif), a conformable stent graft US Food and Drug Administration approved for highly angulated necks, was investigated in the US Pythagoras Trial. We investigated the incidence of, and factors related to, sac regression and expansion following implantation of the Aorfix device.

The impact of vascular surgery wound complications on quality of life.

Objective: In addition to traditional surgical outcomes, perioperative quality of life is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in context of postoperative wound complications (WCs). We hypothesized that WCs negatively affect quality of life.

Ruptured and unruptured mycotic superior mesenteric artery aneurysms.

Aneurysms of the superior mesenteric artery (SMA) and branches thereof are uncommon but have a high rate of rupture and mortality relative to other visceral artery aneurysms. Historically, the predominant etiology has been infectious; with a renewed rise in intravenous drug abuse rates in the last decade, we hypothesize a resurgence in septic embolic complications may occur in the coming years. Here, we describe the presentation and management of 2 cases of intravenous drug users presenting with infectious endocarditis and SMA main trunk and branch aneurysms, one of which was ruptured.

Predictive factors for failure of nonoperative management in perforated appendicitis.

Background: Identifying patients on admission with perforated appendicitis who have phlegmon or abscess initially selected for but likely to fail nonoperative management may avoid delays in definitive treatment.

Methods: Patients older than 15 years presenting to a university tertiary care hospital with perforated appendicitis and abscess or phlegmon and planned nonoperative management were reviewed. Comorbidities, clinical findings, laboratory markers, radiographic findings, and nonsurgical treatments associated with failure of nonoperative management were recorded.

Bleeding diatheses and preoperative screening.

Bleeding disorders pose a significant perioperative risk. Surgeons and surgical consultants should have a working knowledge of the cell-based coagulation model. Careful screening for bleeding diatheses begins with a careful history and physical examination.

Impact of adaptive statistical iterative reconstruction on radiation dose in evaluation of trauma patients.

Background: A recent study showed that computed tomographic (CT) scans contributed 93% of radiation exposure of 177 patients admitted to our Level I trauma center. Adaptive statistical iterative reconstruction (ASIR) is an algorithm that reduces the noise level in reconstructed images and therefore allows the use of less ionizing radiation during CT scans without significantly affecting image quality. ASIR was instituted on all CT scans performed on trauma patients in June 2009.

Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography.

Background: Elderly patients diagnosed with acute cholecystitis (AC) may undergo both ultrasonography (US) and computed tomography (CT).

Methods: A total of 475 patients (age, >64 y) with AC were included.

Results: Groups included US alone (n = 240), CT alone (n = 60), and CT + US (n = 168).

Can acute care surgeons perform emergency colorectal procedures with good outcomes?

Background: Acute care surgeons (ACS) perform emergency colorectal procedures but may have lower case volumes when compared with their general surgical and colorectal colleagues, which may compromise outcomes. In the acute populations, the elderly may be at particular risk.

Methods: Records of all elderly patients (age >65 years) presenting to a tertiary center with a colorectal emergency requiring operation over a 7-year period were reviewed.

Development of a computed tomography-based scoring system for necrotizing soft-tissue infections.

Background: Necrotizing soft-tissue infections (NSTIs) are associated with significant morbidity and mortality, but a definitive nonsurgical diagnostic test remains elusive. Despite the widespread use of computed tomography (CT) as a diagnostic adjunct, there is little data that definitively correlate CT findings with the presence of NSTI. Our goal was the development of a CT-based scoring system to discriminate non-NSTI from NSTI.

Ischemic colitis: risk factors for eventual surgery.

Background: Ischemic colitis is a common disorder often without clear indications for surgical management. The aim of this study was to identify risk factors that predict the need for surgery.

Methods: Patients were identified retrospectively based on International Classification of Disease codes and admission over an 8-year period.

Cologastric fistula with a foreign body in a patient with Crohn's disease.

Although the medical management of fistulizing Crohn's disease is improving, a subset of patients does not respond to maximal medical therapy and is referred for surgical consultation. We report a case of Crohn's colitis with an ingested foreign body resulting in a cologastric fistula. The patient underwent segmental colectomy and takedown of the cologastric fistula.

Contrast-induced nephropathy in elderly trauma patients.

Background: Computed tomography (CT) is the gold standard for the identification of occult injuries, but the intravenous (IV) contrast used in CT scans is potentially nephrotoxic. Because elderly patients have decreased renal function secondary to aging and chronic disease, we sought to determine the rate of acute kidney injury (AKI) in elderly trauma patients exposed to IV contrast.

Methods: Medical records of patients older than 55 years evaluated at a level-one trauma center between January 2003 and July 2008 were reviewed.

Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients.

Objective: To identify rapidly modifiable risk factors that would improve surgical outcomes in elderly patients undergoing emergent colorectal procedures who are at high risk for morbidity and mortality.

Design: Retrospective review. Patients were identified on the basis of Current Procedural Terminology codes and admission through the emergency department.