Emergent Management of a Tracheoinnominate Fistula in the Community Hospital Setting.

Tracheoinnominate fistula is a rare but highly lethal complication of tracheostomy. Early recognition and interventions are key to patient survival. A 63-year-old woman had undergone tracheostomy for respiratory failure secondary to disseminated histoplasmosis. She presented to the community hospital intensive care unit from a long-term acute care facility for presumed gastrointestinal bleeding. A tracheoinnominate fistula was suspected when there was bleeding around the tracheostomy. The patient underwent a median sternotomy with innominate artery ligation. The article will discuss the presentation, evaluation, and emergent management of this lethal complication of tracheostomies. The patient survival is dependent on high clinical suspicion, rapid diagnosis, and emergent surgical management.

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

OBJECTIVE: The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. METHODS: Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). RESULTS: The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. CONCLUSIONS: TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.

The effect of music therapy on the cardiac activity parameters of a fetus in a cardiotocographic examination.

OBJECTIVE: The assessment of cardiac parameters of the fetus in cardiotocographic record of pregnant women listening to classical music. STUDY DESIGN: Sixty NST records with no musical stimulation and 30 NST records during a 15-min auditive stimulation with Wolfgang Amadeus Mozart's "Turkish March" as well as 30 NST records during Johann Strauss's "Tritsch-Tratsch Polka" were performed for the study. The average stage of the responders' pregnancy was the 36rd week, the lowest - the 27th week, the highest - 41st. RESULTS: Following the listening to W.A. Mozart's composition, a significant increase was observed in values concerning: the number of fetal movements (p < 0.0001), accelerations >10 (p = 0.0063), accelerations >15 (p = 0.0011), high variability (p = 0.0019) and short-term variability (p < 0.0001). Meanwhile, parameters concerning baseline cardiac activity (p = 0.0003) and low variability (p = 0.0021) significantly decreased. The number of uterine contractions decreased insignificantly (p = 0.3718). Following listening to J. Strauss's composition, the following parameters underwent increase: fetal movements (p = 0.0021) and short-term variability (p = 0.0025). The remaining parameters of the cardiotocographic record: accelerations, uterine contractions - underwent an improvement, but the changes were not significant. CONCLUSION: Music therapy is a noninvasive and uncostly method, significantly improving wellbeing-indicative fetal parameters.