Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset.

Objective: To date, no single scoring system for predicting 30-day mortality in patients with ruptured abdominal aortic aneurysms (rAAAs) has been endorsed by any vascular society or proven to definitively predict treatment futility. Three recently developed scoring systems for predicting 30-day mortality in patients with rAAA have been validated by their respective institutional data. The purpose of this study was to evaluate the accuracy of these rAAA mortality risk scores using an independent community hospital dataset.

Marijuana's Influence on Pain Scores, Initial Weight Loss, and Other Bariatric Surgical Outcomes.

Introduction: Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ.

Methods: Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015.

Giant Cardiac Lipoma: Refined Hypothesis Proposes Invagination from Extracardiac to Intracardiac Sites.

Cardiac lipomas are rare and usually present as benign, encapsulated masses outside the heart; however, they can also be found within the atria. No single theory-including molecular genetic mutation-adequately explains why this occurs. Extensive career experience and broadened knowledge in embryology and cardiac physiology have helped us to develop a hypothesis based on invagination of extracardiac tumors.

Amniotic Fluid Embolism: Using the Medical Staff Process to Facilitate Streamlined Care.

Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge.

Hyperthyroidism · myalgia · rapidly progressing paralysis · Dx?

A 26-year-old Hispanic woman presented to the emergency department (ED) with myalgia and weakness. There were no prior symptoms and family history was negative for endocrinopathies. She was admitted and started on methimazole 10 mg twice a day for thyroid suppression and given propranolol 10 mg twice a day for anticipated hyperadrenergic adverse effects.

Endovascular repair of ruptured and symptomatic abdominal aortic aneurysms using a structured protocol in a community teaching hospital.

Background: Open abdominal aortic aneurysm (AAA) repair has gradually been replaced by endovascular aneurysm repair (EVAR). The primary objective of this study is to establish baseline mortality data and compare our institutional mortality rates for ruptured AAA patients with published rates from institutions using similar approaches.

Methods: This study is a retrospective review of 49 patients treated using a structured ruptured AAA (rAAA) protocol in a community teaching hospital.

Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration.

Background: Post-esophagectomy patients who develop high-output chylous fistula and chylothorax can be successfully treated with percutaneous ablation thereby avoiding reoperation.

Methods: Five patients with refractory chylous fistula post-esophagectomy were treated with percutaneous embolization. Fistula outputs, evaluation of lymphatic access sites, agents used and additional procedures were analyzed.

Mycotic popliteal aneurysm rupture secondary to Campylobacter fetus.

Background: Mycotic aneurysms of the popliteal artery are uncommon. Popliteal aneurysms rarely rupture. The authors present the second reported case of popliteal artery rupture as a result of Campylobacter fetus infection.

A Clinician's Guide to the Diagnosis and Management of Gallbladder Volvulus.

Introduction: Gallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. We examine the history of gallbladder torsion and highlight the critical constellation of presenting signs and symptoms, which guide the acute care physician and surgeon to accurate and timely diagnosis of GV before surgical intervention.