Author Archives: John

Noninvasive positive pressure ventilation for acute respiratory failure following upper abdominal surgery

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“More than four million abdominal surgeries are performed in the US every year and in England about 250,000 abdominal operations are performed per year. Adults undergoing upper abdominal surgery are at an increased risk of postoperative pulmonary complications.
Acute respiratory failure is a relatively common complication after abdominal surgery and is associated with significant morbidity and mortality. According to Michelet 2010, the development of respiratory complication may be explained by two pathological mechanisms.
The first is linked to surgical complications, notably with the occurrence of anastomotic leakage leading to mediastinitis, septic shock, and acute respiratory distress. The second is of medical origin, with multifactorial impairment of respiratory function.”

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Clinical characteristics and outcomes of patients with hepaticangiomyolipoma

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“Angiomyolipoma (AML) is a solid mesenchymal tumor, mainly described in the
kidney, and belongs to the group of perivascular epithelioid cell tumors
(PEComas). Hepatic localization of AML, described for the first time in 1976, is
rare, since only around 600 cases were reported after an exhaustive search of the
literature up to the year 2017. Hepatic AML (HAML) poses a veritable diagnostic
challenge in radiological terms, especially when fat content is low, because this type of
tumor may appear as a hypervascular tumor associated with a washout phase that
mimics other, more common hypervascular hepatic tumors, such as hepatocellular
carcinoma”

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Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications

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“It has been estimated that approximately 4.4% of the United States population has symptomatic hemorrhoids, contributing to as many as 2.5 million ambulatory visits annually. Excisional hemorrhoidectomy is the preferred treatment for grade 3-4 hemorrhoids and patients unresponsive to non-operative treatment. Despite being a relatively quick, outpatient procedure, one potential serious complication includes post-hemorrhoidectomy bleeding. Reported rates of this complication have varied. Studies suggest that .4-10% of hemorrhoidectomy cases will be complicated by bleeding and many requiring a second intervention. Among risk factors that have been associated with delayed bleeding are male sex, post-operative constipation, and the use of laxatives. Scarce data exist on the association of baseline oral anticoagulation or antiplatelet medications with delayed bleeding.”

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Postoperative CD4 counts predict anastomotic leaks in patients withpenetrating abdominal trauma

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“Survival following penetrating abdominal trauma has improved significantly, nonetheless despite enhanced resuscitation and surgical intervention strategies the immune mediated systemic inflammatory response syndrome (SIRS) continues to result in organ dysfunction and potential death. Posttraumatic lymphopenia or altered cell-mediated immunity as a result of decreased lymphocyte subsets may affect SIRS severity; however in penetrating trauma it is uncertain which factors may result in decreased CD4 counts and whether or not these changes affect postoperative outcomes, in particular anastomotic complications.”

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High ileostomy output: A practical review of pathophysiology, causes,and management

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“An estimated 100,000 surgical cases result in the creation of a stoma annually, of which approximately 40,000 are ileostomies. Given the truncation of the gastrointestinal (GI) tract and loss of the colon, ileocecal valve, and “ileal brake”, ileostomy patients are high risk for impaired sodium and water gastrointestinal absorption. Unsurprisingly, such alterations can lead to serious complications such as electrolyte derangements, dehydration, and acute kidney injury.”
“Though the definition of high-ileostomy output is debatable, it is typically recognized that a total ileostomy output exceeding 1.4 L per day has a potential of leading to such complications. An estimated 2030% of ileostomy patients experience high output in the early
postoperative period which imparts increases in morbidity, healthcare resource utilization, and length of inpatient stay.”

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Prevention and treatment of dilator injuries during central venous catheter placement

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“Accessing central veins is a common procedure that is performed in many clinical settings. Complications are not infrequent events. Local complications have been reduced by the utilization of ultrasound guidance; however, this practice does not prevent injuries to the deep, intrathoracic veins.
Major venous injuries that occur within the thorax secondary to misuse of the dilator have been reported. The majority of these reports have been anecdotal case reports. There is very little evidence to suggest that a flexible, spring-loaded guidewire could perforate a
major vein. The dilator is the only instrument that has the stiffness and point that is capable of perforating a central vein.”

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Post-pancreatectomy haemorrhage management stratified according to ISGPS grading

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“Despite improvements in the perioperative care of patients undergoing pancreatic surgery, the risk of major complications including anastomotic leak (6–24%), post-operative pancreatic fistula (POPF) (10–40%) and delayed gastric emptying (20–34%) persist. Post-pancreatectomy haemorrhage (PPH) is a less common, but particularly hazardous complication with mortality rates of up to 40%. However, varying definitions and incidences of PPH have been previously reported, which have hindered comparison of optimal treatment modalities.”

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