A rare case of Gardner syndrome in an African adult male: A case report.

Gardner's syndrome with the complete manifestation of colonic and extracolonic features is uncommon. Therefore, every clinician should view extracolonic features with a high index of suspicion. This may be key to early diagnosis, definitive management in these patients and importantly, helps prevent malignant transformation of existing colonic polyps.

An Age-Based Analysis of Pediatric Melanoma: Staging, Surgery, and Mortality in the Surveillance, Epidemiology, and End Results Database.

The pediatric melanoma population is not well described, and current guidelines for their management are not well defined. Our study aims to identify this population, treatment modalities, and outcomes using a national population-based database. We reviewed the Surveillance, Epidemiology, and End Results database (2004-2008). Patients ≤21 years old with melanoma were included and grouped into ≤12 years of age, 13 to 18 years, and 19 to 21 years. Clinical characteristics were analyzed across the groups. A total of 1255 patients were included: 52.7 per cent were 19 to 21 years of age, 36.3 per cent were 13 to 18 years of age, and 11.0 per cent were ≤12 years of age. The 19- to 21-year-olds had the highest proportion of stage I (50.5%) versus ≤12 years of age (31.9%); the ≤12-year-olds had the highest proportion of stage IV (3.6%) versus 19 to 21 years of age (0.9%), P < 0.001. The 19- to 21-year-olds had the highest proportion receiving wide local excisions only (34.8%) versus ≤12 years of age (26.4%); the ≤12-year-olds had the highest proportion of patients without any surgeries (16.0%) versus 13 to 18 years of age (9.4%), P = 0.169. On adjusted analysis, the 19- to 21-year-olds had worse survival compared with ≤12 years of age (hazard ratio: 5.26, P = 0.017, 95% confidence interval 1.34-20.65). Disparities were found in the ≤12-year-old melanoma population, as they had later stage melanomas, less invasive surgery, and lower survival. Clearer prognostic factors are needed to better elucidate their management.

The impact of coagulopathy on traumatic splenic injuries.

BACKGROUND: Patients with pre-injury coagulopathy have worse outcomes than those without coagulopathy. This article investigated the risk-adjusted effect of pre-injury coagulopathy on outcomes after splenic injuries. METHODS: Review of the National Trauma Data Bank from 2007 to 2010 comparing mortality and complications between splenic injury patients with and without a pre-injury bleeding disorder. RESULTS: Of 58,896 patients, 2% had a bleeding disorder. Coagulopathic patients had higher odds of mortality (odds ratio, 1.3), sepsis (odds ratio, 2.0), acute respiratory distress syndrome (odds ratio, 2.6), acute renal failure (odds ratio, 1.5), cardiac arrest (odds ratio, 1.5), and overall complications (odds ratio, 2.4). The higher odds of myocardial infarction did not achieve statistical significance (odds ratio, 1.6). CONCLUSIONS: Pre-injury coagulopathy in patients with splenic injury has a negative impact on cardiac arrest, sepsis, acute respiratory distress syndrome, acute renal failure, and mortality. The higher likelihood of myocardial infarction did not reach statistical significance.

Predictors of postdischarge complications: role of in-hospital length of stay.

BACKGROUND: Surgical length of stay (LOS) has been correlated with quality of care, with shorter stays implying better care. The relationship between LOS and postdischarge complications (PDCs) has not been evaluated effectively. METHODS: The 2005 to 2007 National Surgical Quality Improvement Program data were queried for patients undergoing elective colectomies. The outcome of interest was the development of a PDC. Multivariate analysis was then performed adjusting for demographics, surgical approach, and comorbidities. RESULTS: A total of 12,956 colectomies were analyzed with an overall PDC of 8.7%. LOS was not associated with increased odds of developing a PDC. The laparoscopic approach reduced the risk of PDCs by 30% (odds ratio = .70, 95% confidence interval, 0.61-0.81). Body mass index, female sex, the presence of diabetes mellitus, and prolonged operative time increased the odds of developing a PDC. CONCLUSIONS: A shorter LOS did not correlate with a reduction in the likelihood of PDCs. Further investigation into the role of LOS as a measure of quality care is needed.

Multiple imputation in trauma disparity research.

BACKGROUND: Missing data has remained a major disparity in trauma outcomes research due to missing race and insurance data. Multiple imputation (M.IMP) has been recommended as a solution to deal with this major drawback. STUDY DESIGN: Using the National Data Trauma Bank (NTDB) as an example, a complete dataset was developed by deleting cases with missing data across variables of interest. An incomplete dataset was then created from the complete set using random deletion to simulate the original NTDB, followed by five M.IMP rounds to generate a final imputed dataset. Identical multivariate analyses were performed to investigate the effect of race and insurance on mortality in both datasets. RESULTS: Missing data proportions for known trauma mortality covariates were as follows: age-4%, gender-0.4%, race-8%, insurance-17%, injury severity score-6%, revised trauma score-20%, and trauma type-3%. The M.IMP dataset results were qualitatively similar to the original dataset. CONCLUSION: M.IMP is a feasible tool in NTDB for handling missing race and insurance data.

The effects of tobramycin on MG63 cell viability and function.

Management of bone infection and resulting bony defects is one of the major issues in Orthopaedic surgery. Systemic antibiotic therapy alone does not usually eradicate bacteria because of poor penetration into bone. Therefore, local application of aminoglycoside antibiotics at the site of infection can provide high drug concentrations to eradicate the bacteria. Aminoglycosides have been shown to be toxic to certain cells in the ears and in the kidneys. Approximately 5-10% of the people who are treated with aminoglycosides experience some side effect, affecting their hearing, sense of balance, or kidneys. Little information exists in the literature addressing the effects of the aminoglycoside, Tobramycin, on osteoblast cells. MG63 osteoblast-like cell line, were treated with varying concentrations of Tobramycin (0, 10, 50, 100microM) over a period of 24, 48 and 72 hours, harvesting them after each time period and performing assays to test their metabolic function (Glutathione assay) and cell membrane viability (MDA). The results show that Tobramycin at concentrations greater than the minimum inhibitory concentration (MIC) caused marked reductions in cell number with increased membrane damage as early as 48 hours. Glutathione levels within the cells were increased in the 50uM and 100uM treatments as early as 24 hours indicating impaired metabolic function. These results may have implications for using Tobramycin as antibacterial prophylaxis in Orthopaedic surgery, as its toxic effects may interfere with the osteoblasts ability to form bone, and delay healing.