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1.
Thorac Cardiovasc Surg Rep ; 13(1): e1-e3, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38264199

RESUMO

Background Patients with primary cardiac tumors may present with symptoms based on the size and location of the tumor. Symptoms may include congestive heart failure secondary to intracardiac obstruction, systemic embolization, arrhythmias, and constitutional symptoms. Case Description A patient presented with new onset atrial fibrillation and heart failure. Workup including open surgery revealed a primary cardiac lymphoma. Conclusion Cardiac tumors present with a variety of symptoms and are best evaluated by echocardiogram, computed tomography angiography, and magnetic resonance imaging. Tissue diagnosis is necessary. Although primary cardiac lymphoma is rare, long-term survival after chemotherapy and rituximab is superior to other cardiac malignancies.

2.
Am Surg ; 89(8): 3605-3608, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36959693

RESUMO

Bilioenteric fistulae are rare and difficult to manage complications of chronic cholecystitis. While cholecystoduodenal and cholecystocolic fistulae are more common, a cholecystoappendiceal fistula is an extremely rare finding. We report the presentation and operative management of a 59-year-old male with cholecystoappendiceal fistula and associated abscess in the gallbladder fossa. The patient was appropriately resuscitated, the abscess drained by interventional radiology, and after a complete workup, underwent a laparoscopic appendectomy and cholecystectomy. Pathology revealed moderately differentiated appendiceal adenocarcinoma requiring a right hemicolectomy with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). He has recovered well postoperatively with no complications. This case highlights the importance of having a very high index of suspicion for underlying malignancy when managing a fistula of any kind. To the best of our understanding, this is only the second reported case of a cholecystoappendiceal fistula.


Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Fístula , Hipertermia Induzida , Neoplasias Peritoneais , Masculino , Humanos , Pessoa de Meia-Idade , Quimioterapia Intraperitoneal Hipertérmica , Procedimentos Cirúrgicos de Citorredução , Abscesso/cirurgia , Neoplasias Peritoneais/patologia , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/terapia , Neoplasias do Apêndice/patologia , Adenocarcinoma/terapia , Adenocarcinoma/cirurgia , Fístula/cirurgia , Colectomia
3.
Am Surg ; 89(11): 4992-4995, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36571144

RESUMO

Structural cardiac injury after blunt trauma is uncommon but usually life-threatening. While tricuspid injury is very rare and potentially lethal, the right heart can accommodate larger volumes and higher pressures in acute tricuspid insufficiency and facilitate initial stabilization prior to definitive valvular repair. ECMO may be used to ameliorate resulting right heart failure. The traumatic force required to cause cardiac structural injury is also associated with pulmonary complications related to pneumothorax, hemothorax, effusion, acute pain secondary to rib fractures, and pulmonary contusions causing hypoxia. We present an unusual case of hypoxia in a trauma patient caused by acute tricuspid regurgitation with pre-existing patent foramen ovale.


Assuntos
Forame Oval Patente , Traumatismos Cardíacos , Insuficiência da Valva Tricúspide , Ferimentos não Penetrantes , Humanos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico por imagem , Hipóxia/complicações , Ferimentos não Penetrantes/complicações
5.
Surgery ; 171(3): 785-792, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35034795

RESUMO

BACKGROUND: Accountable care organizations through the Affordable Care Act are to improve Medicare beneficiaries' health while reducing costs. We hypothesize that this model may shift care, disease burden, and costs to nonaffiliated hospital facilities in patients with acute cholecystitis. METHODS: A retrospective difference-in-differences analysis was performed to compare severity, postoperative complications, diagnostic modality, length of stay, and costs in patients with acute cholecystitis from a post-accountable care organization implementation period (January 2014 through December 2015) to a pre-accountable care organization period (January 2011 through December 2012). RESULTS: Analysis of 400 patients with acute cholecystitis revealed the post-accountable care organization patients had significantly (P < .0001) higher disease severity (14.4% vs 8.4%), emergency admissions (90.1 vs 74.2%), computed tomography scans (55.5% vs 27.8%), prolonged length of stay (5.2 vs 3.9 days), and a 30% (P < .0003) increase in total costs. CONCLUSION: These data are consistent with the hypothesis that the introduction of accountable care organizations resulted in a higher morbidity, more emergency admissions, more extensive management, a prolonged length of stay, and increased cost in patients with acute cholecystitis. These data support the position that accountable care organizations may shift costs from the primary care setting to nonaffiliated accountable care organization hospitals, provide a lesser level of care, and thus potentially failing their primary mandates.


Assuntos
Organizações de Assistência Responsáveis , Colecistite Aguda/terapia , Adulto , Idoso , Colecistite Aguda/diagnóstico , Colecistite Aguda/economia , Efeitos Psicossociais da Doença , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Texas , Tomografia Computadorizada por Raios X/estatística & dados numéricos
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