Cirrhosis Increases the Rate of Failure of Nonoperative Management in Blunt Liver Injuries.

Pre-existing cirrhosis is associated with increased mortality in blunt liver injury. Despite widespread use of nonoperative management (NOM) for blunt liver injury, there is a relative paucity of data regarding how pre-existing cirrhosis impacts the success of NOM. Herein, we perform a retrospective cohort study using ACS TQIP 2017-2020 data to assess the relationship between cirrhosis and failure of NOM for adult patients with blunt liver injury. 37,176 patients were included (342 cirrhosis and 36,834 without cirrhosis). After propensity-score matching, patients with pre-existing cirrhosis had higher rates of failure of NOM (32.2 vs 14.1%, p < 0.01) and in-hospital mortality (36.3 vs 10.8%, p < 0.01) than patients without cirrhosis. Hesitancy to operate on patients with pre-existing cirrhosis and trauma, as well as significant underlying coagulopathy, may explain these findings.

Patient outcomes and cost in robotic emergency general surgery.

The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of robotic emergency general surgery (REGS). The Florida Agency for Healthcare Administration database (2018-2020) was queried for adult patients undergoing intra-abdominal emergency general surgery within 24 h of admission and linked to CMS Cost Reports/Hospital Compare, American Hospital Association, and Rand Corporation Hospital datasets. Patients from the four most common REGS procedures were propensity matched to laparoscopic equivalents for hospital cost analysis. A telephone survey was performed with the top 10 REGS hospitals to identify key qualities for successful REGS programs. 181 hospitals (119 REGS, 62 non-REGS) performed 60,733 emergency surgeries. Six-percent were REGS. The most common REGS were cholecystectomy, appendectomy, inguinal and ventral hernia repairs. Before and after propensity matching, total cost for these four procedures were significantly higher than their laparoscopic equivalents, which was due to higher surgical cost as the non-operative costs did not differ. There were no differences in mortality, individual complications, or length of stay for most of the four procedures. REGS volume significantly increased each year. The survey found that 8/10 hospitals have robotic-trained staff available 24/7. Although REGS volume is increasing in Florida, cost remains significantly higher than laparoscopy. Given higher costs and lack of significantly improved outcomes, further study should be undertaken to better inform which specific patient populations would benefit from REGS.

Postoperative Capnocytophaga Sputigena Presenting as Diffuse Recalcitrant Intra-abdominal Abscesses.

Capnocytophaga sputigena is rarely implicated as the cause of postsurgical intra-abdominal abscess because it is almost exclusively found in oral flora. Despite its rarity in intra-abdominal infection, there are examples of this atypical presentation, and an awareness of this organism as a potential etiology of surgical infection is relevant for both obstetric and general surgeons. We report a case of a young female who presented just over a week after an uncomplicated C-section with complaint of abdominal discomfort and fevers. Imaging revealed multiple intra-abdominal fluid collections and cultures revealed the presence of C. sputigena. Percutaneous drainage and intravenous antibiotics were unable to provide significant source control, so she underwent surgical exploration with a multi-specialty team of obstetric and acute care surgeons. Although postsurgical pelvic abscesses are rarely due to C. sputigena, this organism has been documented to serve as a source of intra-abdominal infection.

Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population.

OBJECTIVE: We aimed to evaluate myocardial strain and strain rate (SR) by novel 2-dimensional speckle tracking echocardiography in a large pediatric cohort (1) to establish their normal values and (2) to discern the influence of maturation and cardiac growth on them. METHODS: Echocardiograms of 284 consecutive subjects of a healthy pediatric cohort aged between birth and 18 years were analyzed by vector velocity imaging software to measure longitudinal systolic strain (epsilon) and systolic and diastolic SR in left ventricular septal and lateral segments. Regression analysis was performed to determine the effect of aging and cardiac growth on epsilon and SR. RESULTS: Longitudinal epsilon (septal -18.30% +/- 6.67% and lateral -20.68% +/- 8.08%) did not change significantly with maturation and declining heart rate from birth to 18 years. Systolic and early diastolic SR declined until age 5 to 10 years. Longitudinal epsilon significantly (P < .05) correlated with left ventricular growth. CONCLUSION: This study establishes reference values for longitudinal epsilon and SR and reveals that epsilon is relatively independent of maturational changes, lending it as a tool for cardiac evaluation across differing ages in pediatric subjects.

Myocardial velocity, strain, and strain rate abnormalities in healthy obese children.

Childhood obesity is a major health care issue in the United States. This epidemic has important cardiovascular implications. Newer imaging modalities in obese adults have demonstrated abnormal systolic and diastolic cardiac function. The authors proposed to determine whether these abnormalities are present in obese children. A total of 168 children were identified from our echocardiographic database. Body mass index for age was calculated. Echocardiographic clips were analyzed using imaging technology to determine myocardial motion, strain, and strain rate. Patients at risk for obesity and those meeting criteria for obesity had increased late diastolic myocardial motion compared with normal-weight children. Obese patients had decreased systolic strain compared with normal-weight children. As with adults, obese children have significant differences in diastolic function and strain. These abnormalities may be subtle markers for the emergence of future cardiac disease.

Cantu syndrome in a woman and her two daughters: Further confirmation of autosomal dominant inheritance and review of the cardiac manifestations.

Cantu syndrome, or hypertrichosis-osteodysplasia-cardiomegaly syndrome, is a rare disorder of unknown etiology, associated with hypertrichosis, characteristic facial features, skeletal abnormalities, cardiomegaly, and occasional pericardial effusions. Although autosomal recessive inheritance was originally proposed, a man with three affected children has been reported, making autosomal dominant inheritance likely. We report on a woman and her two daughters with Cantu syndrome, further confirming dominant inheritance. All three of our patients have cardiac involvement, and symptomatic pericardial effusions requiring surgical intervention occurred in the mother and one of her daughters. Chromosome microarray analysis was normal in one of the girls. The etiology of the cardiomegaly and pericardial effusions in Cantu syndrome is unknown. We review all previously reported cases of Cantu syndrome and the associated cardiac manifestations.