Outcomes After Duodenoduodenostomy for Superior Mesenteric Artery Syndrome.

Background: Superior Mesenteric Artery Syndrome (SMAS) is a very rare disease that causes starvation and malnutrition secondary to a mechanical obstruction of the 3 portion of the duodenum between the superior mesenteric artery and aorta. Long-term outcomes following surgery for SMAS by current methods have a high failure rate of 21%-67%. We report the 3-year outcomes of a novel operation for SMAS described as the duodenoduodenostomy (DD).

Undertriage of Geriatric Trauma Patients in Florida.

Introduction: Elderly undertriage rates are estimated up to 55% in the United States. This study examined risk factors for undertriage among hospitalized trauma patients in a state with high volumes of geriatric trauma patients.

Materials And Methods: This is a population-based retrospective cohort study of 62,557 patients admitted to Florida hospitals between 2016 and 2018 from the Agency for Healthcare Administration database.

Frailty Score as a Predictor of Outcomes in Geriatric Patients with Isolated Hip Fractures.

Background: Isolated hip fractures (IHFs) are a cause of morbidity and mortality in the geriatric population aged >65 years. Frailty has been identified as a determinant for patient outcomes in other surgical specialties. The purpose of this study is to determine if frailty severity is a predictor of outcomes in IHF in the geriatric population.

Increased Mortality in Hip Fracture Patients With Aortic Stenosis and Pulmonary Hypertension Compared to Aortic Stenosis Alone.

Introduction: Hip fractures are one of the most common traumatic injuries in the United States, secondary to an aging population. Multiple comorbidities are found in patients who present to trauma centers (TCs) with isolated hip fractures (IHFs) including significant cardiac disease. Aortic stenosis (AS) among these patients has been recently shown to increase mortality.

Hospital Volume of Emergency General Surgery and its Impact on Inpatient Mortality for Geriatric Patients: Analysis From 3994 Hospitals.

Background: Previous investigations have shown a positive association between hospital volume of operations and clinical outcomes. However, it is unclear whether such relationships also apply to emergency surgery. We sought to examine the association between hospital case volume and inpatient mortality for 7 common emergency general surgery (EGS) operations among geriatric patients.

The Statewide Epidemiology of Mucormycosis Among Trauma Patients in Florida.

Objectives: Mucormycosis is a rare angioinvasive infection caused by filamentous fungi with a high lethality among the immunocompromised. In healthy people, the innate immune system is sufficient to prevent infection. The exception to this is deep tissue exposure seen during trauma.

Statewide Seasonal Variations of Infections Within the Intensive Care Unit Among the Trauma Population.

Background: Infections within intensive care unit (ICU) are a persistent problem among the critically ill. Viral pneumonias have already been established as having a season variations. We attempt to evaluate the seasonal variations of pneumonia among the traumatically injured and the critically ill.

An Early Case of Fat Embolism Syndrome Occurring Following Polytrauma.

Fat embolism syndrome (FES) is a clinical entity occurring due to the presence of fat particles in the microcirculation, typically manifesting 12-72 hours after long bone trauma with respiratory distress, altered mental status, and petechial rash. Our case is that of a 17-year-old girl who suffered multiple orthopedic injuries without intracranial trauma after being a pedestrian struck by a vehicle. Despite presenting with a normal Glasgow Coma Score (GCS), within 4 hours of presentation, she was noted to have an acute mental status change to a GCS 7 with a normal computed tomography brain.

Optimizing energy expenditure and oxygenation toward ventilator tolerance is associated with lower ventilator and intensive care unit days.

Background: We hypothesize that if both energy expenditure and oxygenation are optimized (EEOO) toward ventilator tolerance, this would provide patients with the best condition to be liberated from the ventilator. We defined ventilator tolerance as having a respiratory quotient value between 0.7 and 1.

Merkel Cell Carcinoma of the Hand: A Case Report and Review of the Literature.

Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy characterized by high incidence of local recurrence, distant metastases, regional nodal metastases, and high mortality. Clinically, MCC presents as a persistent asymptomatic red/pink shaped nodule, usually smaller than 2 cm with nontender intracutaneous swelling, with rapidly growing localized disease with lymph node metastases preceding distant metastases. Because of its rare nature and the lack of comprehensive understanding of the disease, management of MCC has been controversial.

A protocol for the management of adhesive small bowel obstruction.

Background: Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively.

Methods: Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours.

Hospital-acquired infections and thermally injured patients: chlorhexidine gluconate baths work.

Background: Thermally injured patients are at high risk for infections, including hospital acquired infections (HAIs). We modeled a twice-daily chlorhexidine gluconate (CHG) bath protocol aimed at decreasing HAIs.

Methods: Bathing with a 0.

Vascularized plantar myocutaneous free flap transfer for amputee stump preparation: a proof of concept cadaver study.

Lower extremity amputee stump ulceration, irritation, and pain have been a deterrent to consistent long-term or continuous use of lower extremity prosthetics. This study is the first in a series that hypothesizes that these complications can be minimized through the insetting of a vascularized plantar free flap (VPFF) on the amputee stump. Using three hip disarticulated cadaver specimens, a VPFF was designed, dissected, and implanted on one transfemoral and two transtibial stumps.

Predicting resource utilization of elderly burn patients in the baby boomer era.

Background: Census predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group.

Methods: Using the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors.

Bacillus cereus necrotizing fasciitis in a patient with end-stage liver disease.

Background: Bacillus cereus has been increasingly recognized as a virulent pathogen, particularly in immunocompromised patients.

Methods: Presented is a case report of a 24-year-old man with end-stage liver disease secondary to primary sclerosing cholangitis, who developed necrotizing fasciitis of the right lower leg due to B. cereus.

All-terrain vehicle safety in Florida: is legislation really the answer?

Florida is among the nation's leaders in all-terrain vehicle (ATV)-related injuries and fatalities. We hypothesized that patients sustaining injuries while in compliance with ATV laws would demonstrate less severe injury patterns and improved outcomes when compared with noncompliant patients. We reviewed patients treated for ATV-related injuries over a 36-month period.

Hand injuries in the state of Florida, are centers of excellence needed?

Introduction: Hand injuries are common and costly. The need for hand surgery specialists is undeniable. In the state of Florida, the availability of specialty services in hand surgery is limited.

Aberrant course of a communicating branch of the ulnar nerve to the median nerve contributing to hypothenar Hammer syndrome.

This presentation represents a unique anatomic predisposition to the development of hypothenar hammer syndrome (HHS). In this case, a communicating branch of the ulnar nerve to the median common digital nerve of the ring finger was identified crossing volar to the superficial palmar arch. This relationship caused thrombosis of the superficial palmar arch proximal to this crossing nerve branch.

Rational treatment for multiple digit congenital absence: case report of nonvascularized toe phalangeal transfers and distraction lengthening for symbrachydactyly.

A case is discussed in which a young male was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits when he was an infant. This initial surgical procedure was later followed by webspace deepening and ultimately by distraction lengthening of the digits. At 8 years of age, he has a very functional hand with mobile metacarpophalangeal joints in all reconstructed fingers.