Hyperbilirubinemia as a Risk Factor for Mortality and Morbidity in Trauma Patients.

Hyperbilirubinemia is frequently reported in trauma patients. However, few studies have investigated the effects of hyperbilirubinemia on patients' clinical trajectories. This study aimed to evaluate the relationship between hyperbilirubinemia and patient outcomes following trauma. Our study included 387 patients who were admitted to the trauma bay with severe trauma between January 2017 and December 2021. We categorized patients into two groups based on their peak bilirubin levels: the low-bilirubin (LB) group, with levels below 3 mg/dL, and the high-bilirubin (HB) group, with levels above 3 mg/dL. We then compared the rates of complications and mortality between these two groups. The incidence of pneumonia (10.8% vs. 32.3%, p < 0.001), acute kidney injury (AKI) (2.8% vs. 19.2%, p < 0.001), sepsis (2.8% vs. 10.1%, p = 0.003), and wound infections (8.3% vs. 30.3%, p < 0.001) was significantly higher in the HB group. Additionally, the mortality rate was significantly higher (4.2% vs. 10.1%, p = 0.028) in the HB group. Multivariate analysis revealed that the higher the bilirubin level, the greater the risk of complications (pneumonia: odds ratio [OR] = 3.238; 95% confidence interval [CI] = 1.68-6.22; p < 0.001, AKI: OR = 4.718; 95% CI = 1.65-13.44; p = 0.004, sepsis: OR = 3.087; 95% CI = 1.00-9.52; p = 0.04, wound infection: OR = 3.995; 95% CI = 2.073-7.700; p < 0.001). In conclusion, hyperbilirubinemia was associated with poorer outcomes in trauma patients.

Outcomes of emergency endovascular versus open repair for abdominal aortic aneurysm rupture.

PURPOSE: Ruptured abdominal aortic aneurysm (rAAA) is one of the most common aortic emergencies in vascular surgery and is associated with high operative mortality and morbidity rates despite recent treatment advances. We evaluated operative mortality risks for the outcomes of emergency endovascular aneurysm repair (eEVAR) vs. open repair in rAAA. METHODS: Twenty patients underwent eEVAR (n = 12) or open repair (n = 8) for rAAA between 2016 and 2020. We adopted the EVAR first strategy since 2018. Primary endpoints included in-hospital mortality and 1-year survival. The outcome variables were analyzed with Fisher exact, Mann-Whitney test, and linear by linear association. The Kaplan-Meier method was used to estimate survival. RESULTS: There were 13 males (65.0%) and the median age of the study cohort was 78.0 years (range, 49-88 years). In-hospital mortality occurred in 7 patients (35.0%); 5 (50.0%) in the early period and 2 (20.0%) in the later period of this series. According to the procedure type, 4 (50.0%) and 3 (25.0%) in-hospital mortalities occurred in the open repair and eEVAR patients, respectively. In 6 patients (50.0%), eEVAR was performed on unfavorable anatomy. The 1-year survival of eEVAR vs. open repair group was 75% ± 12.5% and 50% ± 17.7%, respectively. On univariate analysis, preoperative high-risk indices, postoperative acute renal failure requiring dialysis, pulmonary complications, and prolonged mechanical ventilation were associated with higher operative mortality. CONCLUSION: The current data showed relatively superior outcomes with eEVAR vs. open repair for rAAA, even in some patients with unfavorable anatomy supporting the feasibility, efficacy, and safety of EVAR first strategy.

Fecopneumothoax: a rare case of delayed colon diaphragmatic herniation following esophagectomy.

Diaphragmatic hernia after esophagectomy and, particularly, eventual fecopneumothorax is a rare complication. Furthermore, a delayed manifestation 10 years after esophagectomy is an extremely rare situation. Herein, we report a surgical case of fecopneumothorax resulting from the perforation of intrathoracically herniated transverse colon 10 years after McKeown esophagectomy.

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava.

Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The non-pedunculated tumor involved most of the interatrial septum and extended from the orifice of the inferior vena cava to the displaced mitral annulus and the lower left pulmonary vein. The resected specimen weighed 76 gram and measured 80 × 40 × 30 mm. She did not complain of dyspnea or show any sign of recurrence by echocardiography during the 2-year follow-up period.

Fate of newly detected lesions during postoperative surveillance for non-small cell lung cancer.

BACKGROUND: Chest computed tomography (CT) is the mainstay of postoperative surveillance for non-small cell lung cancer (NSCLC). However, there is no clear consensus about the optimal management of newly detected lesions on follow-up CT. Our goals were (1) to determine the eventual outcome of newly detected lesions on follow-up CT in patients with previously resected NSCLC and (2) to determine the characteristics of the detected lesions that suggest recurrence. METHODS: In this retrospective study, we investigated 116 patients with NSCLC who underwent operations between February 2004 and December 2011 and had newly detected lesions on postoperative surveillance CT at least once during the follow-up period (median, 29 months). We investigated lesion size, growth, laterality, multiplicity, and recurrence patterns, as well as demographic data. RESULTS: One hundred fifty-seven new lesions were detected during the follow-up period. Of the 157 lesions, 139 were intrathoracic (lung, 83; lymph node, 34; pleura, 14; others, 8) and 18 were extrathoracic. Further investigation or follow-up confirmed that 78 lesions (49.7% [78 of 157]) were recurrences. Extrathoracic lesions showed a higher correlation with recurrence compared with intrathoracic ones (83.3% versus 45.3%; p = 0.002). Regarding lung lesions, solid nodules (p = 0.003; hazard ratio, 13.190) and lesions in patients with stage III disease (p = 0.043; hazard ratio, 6.464), were much more likely to reflect recurrence. CONCLUSIONS: In patients with newly detected lesions on follow-up chest CT after resection of NSCLC, special attention should be paid to lesions with the following characteristics: extrathoracic lesions, solid lung nodules, and lung lesions in patients with stage III disease. It is necessary to investigate these lesions more aggressively because they suggest the presence of recurrent disease.

[Students' perceptions of team-based learning by individual characteristics in a medical school].

PURPOSE: The purpose of this study was to examine medical students' perceptions of team-based learning (TBL) according to their individual characteristics: gender, team efficacy, interpersonal understanding, proactivity in problem solving, and academic ability. METHODS: Thirty-eight second-year medical students who took an integrated cardiology course participated in this study; 28 were male and 10 were female. A questionnaire on individual characteristics and a questionnaire on the perception of TBL were administered, and the scores of individual characteristics were grouped into three: high, middle, and low. The data were analyzed by t-test, analysis of variance, and multiple regression analysis. RESULTS: The TBL efficacy perception scale consisted of 3 factors: team skill, learning ability, and team learning. The group of male students and the group of students with high academic ability recognized the effect of TBL on improvements in learning ability more than females and those with low academic ability. The group of students with high team efficacy reported that TBL was effective with regard to team skill improvement. The group of students with high scores on interpersonal understanding and high proactive problem solving tended to perceive the TBL's effect on team skill improvement. Team efficacy and proactivity in problem solving had a positive effect on the perception of TBL. CONCLUSION: Medical students' perceptions of the effectiveness of TBL differ according to individual characteristics. The results of this study suggest that these individual characteristics should be considered in planning of team learning, such as TBL, to have a positive impact and stronger effects.

Staged repair of a chronic dissecting aneurysm with the two elephant trunks technique.

The elephant trunk technique is a novel staged procedure for the treatment of an extensive thoracic aortic aneurysm. Occasionally, entrapment or obstruction in the smaller lumen occurs with the use of the elephant trunk technique in aortic dissection. The general procedure is to excise a generous portion of the dissecting septum distally for a chronic dissecting aneurysm of the descending thoracic aorta. We present the "two elephant trunks" technique. In this procedure, a single side-branched graft is placed in the descending aorta without excising the dissecting septum during a first-stage operation. This modification is simple to perform and has the possibility to prevent interval rupture for a chronic dissecting aneurysm.

Severe pulmonary artery stenosis by a calcified pericardial ring.

We present a rare case of a 44-year-old man with acquired pulmonary stenosis caused by a calcified pericardial ring. Chest computer tomography and cardiac angiography showed external compression of the main pulmonary artery by a calcified pericardial ring. A calcified pericardial ring was removed and the pulmonary artery angioplasty was performed for the stenotic pulmonary artery. The patient's condition improved dramatically thereafter.