Massage Therapy May be Safe and Reduce Pain in Critically Ill Patients with Acute Neurological Injury: a Case Control Study.

Purpose: Massage therapy is an important adjunctive treatment for physiologic and psychologic symptoms and has been shown to benefit patients among a wide variety of patient populations.

Setting: Few studies have investigated the utility of massage therapy in the general ICU setting, and even fewer have done so in the neurological ICU (NeuroICU).

Research Design: If massage therapy was determined to improve objective outcomes-or even subjective outcomes in the absence of harm-massage may be more readily employed as a complementary therapy, particularly in the ICU setting or in patients with acute neurological injury.

Well Differentiated Liposarcoma Presenting as a Duodenal Polyp: A Case Report and Review of the Literature.

Liposarcoma is the most common malignant soft tissue tumour in adults occurring predominantly in the retroperitoneum and extremities but very rarely within the gastrointestinal tract. We report on a 77-year-old gentleman who presented with a history of melaena and anaemia. On oesophagogastric duodenoscopy a duodenal polyp was identified.

Perceptions Regarding the SARS-CoV-2 Pandemic's Impact on Neurocritical Care Delivery: Results From a Global Survey.

Background: The SARS-CoV-2 (COVID-19) pandemic has impacted many facets of critical care delivery.

Methods: An electronic survey was distributed to explore the pandemic's perceived impact on neurocritical care delivery between June 2020 and March 2021. Variables were stratified by World Bank country income level, presence of a dedicated neurocritical care unit (NCCU) and experiencing a COVID-19 patient surge.

Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in all patients suffering from obstructive jaundice before pancreatic surgery. The severity of jaundice that mandates PBD has yet to be defined. The evaluated paper examines the impact of PBD on intra-operative, and post-operative outcomes in patients initially presenting with severe obstructive jaundice (bilirubin ≥250 μmol/L).

Hospital Costs and Long-term Survival of Patients Enrolled in an Enhanced Recovery Program for Open Liver Resection: Prospective Randomized Controlled Trial.

Background: The clinical benefits of enhanced recovery programs (ERPs) have been extensively researched, but few studies have evaluated their cost-effectiveness. Our ERP for open liver resection is based closely on the guidelines produced by the Enhanced Recovery After Surgery Society (2016). This study follows on from a previous randomized controlled trial.

Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California.

Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources.

Left hepatic trisectionectomy for hepatobiliary malignancies: Its' role and outcomes. A retrospective cohort study.

Background: Left hepatic trisectionectomy (LHT) is a complex hepatic resection; its' role and outcomes in hepatobiliary malignancies remains unclear.

Materials And Methods: All patients undergoing LHT at the tertiary HPB referral unit at RSCH, Guildford, UK from September 1996 to October 2015 were included. Data were collected from a prospectively maintained database.

Hepatopancreatoduodenectomy -a controversial treatment for bile duct and gallbladder cancer from a European perspective.

Background: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers.

Use of Accelerometry for Long Term Monitoring of Stroke Patients.

Stroke patients are monitored hourly by physicians and nurses in an attempt to better understand their physical state. To quantify the patients' level of mobility, hourly movement (i.e.

Acute necrotising pancreatitis - early management in the district general hospital and tertiary hepato-pancreatico-biliary unit.

Acute pancreatitis is a common general surgical emergency presentation. Up to 20% of cases are severe and can involve necrosis with high associated morbidity and mortality. It is most commonly due to gallstones and excess alcohol consumption.

Surgical management of spontaneous intracerebral hemorrhage: insights from randomized controlled trials.

Spontaneous intracerebral hemorrhages (ICH) are a major cause of neurologic morbidity and mortality. The optimal management strategy of ICH remains controversial. We examine the available randomized controlled trial (RCT) data regarding neurosurgical evacuation of ICHs.

Correction to: Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society.

The authors note that there is a discrepancy between the text of the paper and Table 2 regarding physician subspecialty certification requirements in neurocritical care for Level II centers.

Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society.

Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS).

Centralisation for resection of the pancreatic head: A comparison of operative factors and early outcomes during the evolving unit and tertiary unit phases at a UK institution.

Aims: To assess impact of centralisation on patients undergoing pancreatic head resections at a tertiary hepatobiliary (HPB) centre in the UK.

Methods: Data were analysed from a prospectively maintained database from 1998 to 2014 on all patients undergoing pancreatic head resections. Two specific time periods were defined; these were the evolving unit phase (EU) from 1998 to 2009 and finally the established tertiary unit phase (TU) from 2010 to 2014.

ICP management in patients suffering from traumatic brain injury: a systematic review of randomized controlled trials.

Background: Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI.

Brunner's gland hamartoma: a cause of the double-duct sign.

Introduction Brunner's glands are submucosal glands found in the duodenum. Proliferation of these glands can lead to the formation of Brunner's gland hamartomas (BGHs), which are uncommon, asymptomatic and usually found incidentally. They are predominantly benign lesions, but instances of malignant transformation have been reported.

Primary hepatic solitary fibrous tumor with histologically benign and malignant areas.

Extrapleural solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm, presenting most commonly in the intrathoracic sites but which has been reported at numerous extrathoracic locations. The majority of intra-thoracic SFTs are benign, but 10%-15% behave aggressively. We report a case of primary hepatic SFT with histologically benign and malignant areas.

Accuracy of First Recorded "Last Known Normal" Times of Stroke Code Patients.

Background: Given the time sensitivity of thrombolytic therapy, the accurate documentation of last known normal (LKN) time is crucial to ensure optimal management of stroke patients. This study investigates whether a difference exists between preliminary LKN times (first responders and emergency department practitioners) and revised LKN times (neurology/stroke practitioners), and what potential impact on emergent management of acute stroke this discrepancy may pose.

Methods: All stroke code patients from UC San Diego hospitals from October 2008 to July 2013 with treatment time data were included and grouped based on the disparity between preliminary LKN time and revised LKN time: preliminary earlier than revised, 2 times equal, and preliminary later than revised.

The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy.

Introduction: Despite advances in surgery and critical care, severe pancreatitis continues to be associated with a high rate of mortality, which is increased significantly in the presence of infected pancreatic necrosis. Controversy persists around the optimal treatment for such cases, with specialist units variously advocating open necrosectomy, simple percutaneous drainage or one of several minimal access approaches. We describe our technique and outcomes with a two-port laparoscopic retroperitoneal necrosectomy (2P-LRN).

Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy.

Introduction: Afferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week.

Liver metastases from esophageal carcinoma: is there a role for surgical resection?

Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer.

An unusual complication of PEG feeding after pancreatico-gastrostomy.

Context: We describe a late complication of the pancreatico-gastrostomy (PG) anastomosis following pancreatico-duodenectomy (PD).

Case Report: A percutaneous endoscopic gastrostomy (PEG) feeding tube was inserted many months post-operatively. In this patient activated pancreatic enzymes eroded the gastrostomy tract, resulting in pain, recurrent infection and eventual removal of the gastrostomy tube.

Randomized clinical trial on enhanced recovery versus standard care following open liver resection.

Background: Enhanced recovery programmes (ERPs) have been shown to reduce length of hospital stay (LOS) and complications in colorectal surgery. Whether ERPs have the same benefits in open liver resection surgery is unclear, and randomized clinical trials are lacking.

Methods: Consecutive patients scheduled for open liver resection were randomized to an ERP group or standard care.

The usefulness of P-POSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.

Background/aims: P-POSSUM predicts operative risk and mortality, although few reports describe its use in elective liver resection. We analysed P-POSSUM scores in patients undergoing resection for colorectal liver metastases, non-colorectal cancer and benign liver dis-ease.

Methodology: Data for 664 elective liver resections were included between 1998 and 2009; 480 for colorectal metastases; 96 for benign and 88 for non-colorectal disease.