Co-existence of acute appendicitis and inflammatory myofibroblastic tumor of the small intestine: A case report

Inflammatory myofibroblastic tumor as a rare neoplastic lesion is seen most commonly in the pulmonary system. Beside the presence of limited number of inflammatory myofibroblastic tumors of the gastrointestinal tract in the literature, co-existence with acute appendicitis has not been reported before.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Incarceration of the hepatic lobe in incisional hernia: A case report

Incisional hernias are abnormal peritoneal outward pouch-like protrusions that develop due to defects that arise as a result of the disruption of the fascia's continuity after abdominal surgery. Incisional hernias are one of the common problems seen after the abdominal surgery with incidence rates ranging from 2 to 11% according to different sources(3). Abdominal surgery related incisional hernias leads to significant job loss and morbidity, as well as negatively affecting quality of life. Therefore, due to high prevalence and morbidity, incisional hernias continue to be one of the most important complications of abdominal surgery. Subcutaneous herniation of the left lobe of the liver passing through the abdominal wall is a very rare condition and there is only one case in the literature [1]. In this case report, we present a case of incarcerated incisional hernia that involves the left liver lobe and associated acute liver failure. The aim of this study is to show that hernia sac may contain solid organs.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Efficiency of herbal medicine Dai-kenchu-to on portal blood flow in rat models

Normal liver rats were divided into a DKT 90 mg/kg, DKT 270 mg/kg administered group, and control, while cirrhotic liver rats were divided into a DKT-LC 90 mg/kg administered group and Control-LC. The PBF was measured after the administration of either DKT or water for 60 min by laser Doppler flowmetry system.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Medical Publishing Triage - Chronicling Predatory Open Access Publishers

This editorial examines the problem of predatory publishers and how they have negatively affected scholarly communication. Society relies on high-quality, peer-reviewed articles for public policy, legal cases, and improving the public health. Researchers need to be aware of how predatory publishers operate and need to avoid falling into their traps. The editorial examines the recent history of predatory publishers and how they have become prominent in the world of scholarly journals. © 2013 Surgical Associates Ltd.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Annals of Medicine and Surgery - Educating and Developing Leading Physicians and Surgeons

Clinical ethics and medical law; Clinical evidence into practice; Evidence based medicine; Healthcare policy, delivery and commissioning; Human factors, teamwork and communication; Implementation science; Leadership and management; Medical education, teaching and training; Patient safety; Professionalism; Public and global health; Quality improvement science and practice; Research and innovation; Resource management; Use of technology and health informatics

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

Bariatric surgery aims to provide long-term WEIGHT LOSS AND improvement in weight-related comorbidities.

Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery.

A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss.

Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis

·         National estimates for EGS procedures were abstracted from the National Inpatient Sample database.

·         Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, as well as small and large bowel resections) were included.

·         TCs were identified based on American College of Surgeons’ verification.

·         ACS-TC programs were recorded from the American Association for the Surgery of Trauma.

·         Outcome measures were hospital length of stay, complications, and mortality.

·         Regression analysis was performed after adjusting for age, sex, race, Charlson comorbidity index, and type of procedure.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Hepatic resection for disappearing liver metastasis: a cost-utility analysis

The authors sought to estimate the cost–effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM). This study suggests that surveillance of DLM after sCT was more beneficial and cost–effective among patients >60 years with multiple factors predictive of true complete pathological response, such as normalization of CEA, HAI therapy, BMI ≤30 kg/m2, and diagnosis of DLM made through MRI.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Dacron Graft Axillary Infection after Aortic Dissection Surgery

Peripheral cannulation is required to have an adequate perfusion in patients undergoing cardiac surgery due to an aortic dissection. Many surgeons use the axillary artery to perfuse the patient using a tube graft sutured to the axillary artery. The purpose of this technique is to have more control of the surgical field. We described the case of a patient who developed a decubitus of the axillary Dacron graft six month after surgery.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

On the Ratio between Static Pressure and Thickness of Growing AAAs

A representative FE model was created in order to simulate the historical evolution of the AAA. CFD analyses were performed to obtain data of the static pressure aging on the model. Patient informed consent and IRB approval were obtained. A linear law was speculated to understand thickness thinning in function of aneurysm’s growth. The obtained pressure maps were used as input to perform elastic linear analyses on the five different FE wrappings.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Numerical Simulation for Design Evaluation of Thoracic Stent Graft to Investigate the Migration Phenomena and Type 1a Endoleak of Thoracic Aneurysm

Migration and endoleak phenomena are considered to be the principal reasons for Endovascular Aneurysm Repair failure. Wide differences of opinion exist regarding the nature of these critical complications. They occur when there is non-complete and ineffective contact between the endograft ends and the wall of the blood vessel. A major goal of present work is to investigate, using the Finite Element Method, the effect of nitinol stent design on the overall effectiveness of contact and radial force. The specific-patient aneurysmal thoracic aorta are challenging. The optimized stent results show better contact stability to resist the migration. They also show a good compromise of stent design requirements (flexibility and stiffness). Moreover, the new design can also prevent the risk of folding or the collapse of stent struts by mitigating the energy of eccentric deformation caused by high angulation and oversizing.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Characterization of the Mechanical Properties of the Human Aortic Arch Using an Expansion Method

Analyzing cardiovascular diseases leads to multidisciplinary problems which require transversal and complementary approaches. This study focuses on the identification of the mechanical properties of the aortic arch. Stereo-correlation technique is used to measure the strain field in the aortic arch during its expansion. The aorta is immersed in water which allows better results in terms of measurement method and to take into account the residual stress and strain effects. Results are obtained at different values of expansion: 9 samples are collected, 7 of them are frozen before the experiment and 2 are fresh. The mean age is 76 years old at the volunteers� time of death. 4 samples did not lead to conclusive results because of the quality of the arterial wall and leaks that happened during the experiment preventing a proper expansion. The horizontal and vertical displacements are relatively homogeneous for all the samples: two preferred radial and longitudinal directions are observed. The strain fields associated with these directions show heterogeneities and have significant differences between fresh and frozen specimen. The final objective is to perform virtual surgical simulation of the whole endovascular stent graft procedure for an aortic aneurysm. This procedure has a high rate of short-term success and its indication compared to open surgery is increasing but it needs to be more reliable and secure. In this context, it is important to identify the mechanical properties of the aorta for further numerical simulations.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Controversies in the Anesthetic Management of Lumbar Drains for Aortic Surgery

Lumbar drain insertion is an integral aspect of perioperative care for patients undergoing thoracoabodminal aortic aneurysm (TAA) repair. It has been shown to reduce incidence of paraplegia when both open and endovascular technique is used. Controversy exists in terms of optimal management of these catheters. This commentary will present current guidelines as well as experienced recommendations for their use.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

New Methods of Diagnosis and Treatment of Ophthalmic Artery Stenosis in Patients with Ischemic Central Retinal Vein Occlusions

The purpose of this report was to examine if correlations exist in patients with Ischemic Central Retinal Vein Occlusion syndromes and significant narrowing’s of the ophthalmic arteries. Further, we wanted to see if a minimally invasive technique could accurately indicate low orbital arterial perfusion and predict which patients may benefit from cerebral angiography. By identifying proximal ophthalmic artery lesions which may contribute to retinal hypo perfusion and severe visual loss, ophthalmic artery revascularization may be a reasonable recommendation in selected cases. One patient who underwent revascularization experienced dramatic improvement in visual function and retinal morphology. If ophthalmic artery disease proves to be a relatively consistent finding in Ischemic Central Retinal Vein occlusive disease, techniques for intervention could be offered.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Non-Hodgkins Lymphoma Involving Multiple Cardiac Chambers with Skeletal Muscle Involvement in a Hepatitis C Positive Patient

Primary cardiac lymphomas are rare and involvement of multiple cardiac chambers is not common. It usually invades primarily the right atrium, followed by the right ventricle, the left ventricle, and finally the atrial septum. Skeletal muscle involvement is also rare. FDG PET Scan is useful in diagnosis and in determining the disease extent, site for biopsy and its response to treatment.

We present a rare case of a Primary Cardiac Lymphoma in a Hepatitis C positive male which developed 3 years after he underwent CABG Surgery, which involved the right atrium, inter-atrial septum and left atrium and prolapsed across the tricuspid valve into the right ventricle. Additionally there was involvement of the Internal Oblique muscle that was proven on biopsy. FDG PET CT Scan was a useful guide to determine the extent of involvement, select the site of biopsy and evaluate the response to chemotherapy.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-medicine-and-surgery/

Comparison of short- and mid-term efficacy and the mechanisms of gastric bypass surgeries on managing obese and nonobese type 2 diabetes mellitus

Seven nonobese T2DM patients with gastric cancer submitted to Billroth II gastrojejunostomy were compared with nine obese T2DM patients undergoing RYGB about their baseline characteristics, weight loss and glycemic control, 3 months and 2 years after surgery.

Meanwhile, β-cell function, glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and gastric inhibitory polypeptide (GIP) levels were also investigated.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Bariatric surgery prior to total knee arthroplasty is associated with fewer postoperative complications

This study used a national database to compare 90 day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA):

1.non-obese patients (n = 66,523),morbidly obese patients who did not have bariatric surgery (n = 11,294)morbidly obese patients who underwent bariatric surgery prior to TKA (n = 219).

2.Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P = 0.001) and minor (OR 0.61, P = 0.01) complications compared to morbidly obese patients who did not have bariatric surgery.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Preoperative prediction of conversion from laparoscopic rectal resection to open surgery: a clinical study of conversion scoring of laparoscopic rectal resection to open surgery

·         The clinical data of 602 cases of laparoscopic rectal resection were retrospectively assessed.

·         Risk factors associated with conversion of laparoscopic rectal resection to open rectal surgery were identified by logistic regression analysis.

·         Also, a scoring system was created to calculate a score for the conversion of laparoscopic rectal resection to predict possible conversion for patients who underwent laparoscopic rectal resection before surgery.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Sarcomas of the spermatic cord and para-testicular tissues: Our experience and review of current literature

FDG-PET, fluorodeoxyglucose positron emission tomography; FNCLCC, French Fédération Nationale des Centres de Lutte Contre le Cancer; Gy, Centigray; HPF, High Power Fields; MARSU, Midlands Abdominal and Retroperitoneal Sarcoma Unit; MFH, malignant fibrous histiocytomas; NCI, United States National Cancer Institute; PET, fluorodeoxyglucose positron emission tomography; RLND, retroperitoneal lymph node dissection; TRAM, transverse rectus abdominis muscle

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Pembrolizumab versus Ipilimumab in Advanced Melanoma

In this randomized, controlled, phase 3 study, we assigned 834 patients with advanced melanoma in a 1:1:1 ratio to receive pembrolizumab (at a dose of 10 mg per kilogram of body weight) every 2 weeks or every 3 weeks or four doses of ipilimumab (at 3 mg per kilogram) every 3 weeks. Primary end points were progression-free and overall survival.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease

In this single-blind, randomized trial conducted at 54 sites, we assigned, in a 2:1 ratio, 476 patients with symptomatic intermittent claudication or ischemic pain while at rest and angiographically significant atherosclerotic lesions to angioplasty with a paclitaxel-coated balloon or to standard angioplasty. The primary efficacy end point was primary patency of the target lesion at 12 months (defined as freedom from binary restenosis or from the need for target-lesion revascularization). The primary safety end point was a composite of freedom from perioperative death from any cause and freedom at 12 months from limb-related death (i.e., death from a medical complication related to a limb), amputation, and reintervention.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Screening for Occult Cancer in Unprovoked Venous Thromboembolism

We conducted a multicenter, open-label, randomized, controlled trial in Canada. Patients were randomly assigned to undergo limited occult-cancer screening (basic blood testing, chest radiography, and screening for breast, cervical, and prostate cancer) or limited occult-cancer screening in combination with CT. The primary outcome measure was confirmed cancer that was missed by the screening strategy and detected by the end of the 1-year follow-up period.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes

We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin–ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. The median follow-up was 6 years.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Inherited DOCK2 Deficiency in Patients with Early-Onset Invasive Infections

We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)–cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure

We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

A Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer

Current or former smokers undergoing bronchoscopy for suspected lung cancer were enrolled at 28 centers in two multicenter prospective studies (AEGIS-1 and AEGIS-2). A gene-expression classifier was measured in epithelial cells collected from the normal-appearing mainstem bronchus to assess the probability of lung cancer.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/