Lung Transplantation following Emergency Pneumonectomy in a Polytraumatized 18-Year-Old

Introduction. On rare occasions, a pneumonectomy needs to be performed after a severe polytrauma. Statistically, this procedure increases the mortality rate to 50%. One option to reduce this high rate could be an organ transplantation if a matching organ can be found. However, the current literature lacks any documentation of such a case. One reason for this stems from the fact that regulations for organ transplantation are very restricted and rarely allow exceptions. In addition, the chance for survival of polytraumatized patients in need of organs in the acute phase of the therapy is often quite unsure. Case Presentation. In this paper, we present the case of an 18-year-old patient who was involved in a serious motorcycle accident. His injury severity score was 29, but he suffered from severe bleeding in his lung which made a pneumonectomy necessary. The procedure led to a severe deterioration of his overall condition. An ECMO therapy was initiated, which effectively only slowed the aggravation. Therefore, he was transferred to our clinic where he was stabilized temporarily. A few days later, his situation turned worse. Since he had no other chance of survival, he was scheduled for a lung transplantation and was assigned an organ. After the transplantation, he stabilized quickly and recovered almost completely. Discussion. In this report, we want to show that an exception to the rules for organ transplantation might make sense on rare occasions. However, to increase the chance for any success, patients must be transferred to highly specialized clinics capable of treating patients with severe conditions. This might be the only chance for those patients to survive.

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Bowel necrosis in patient with severe case of COVID-19: a case report

BMC Surgery ◽

10.1186/s12893-021-01104-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Ardian Soeselo ◽

Wirawan Hambali ◽

Sandy Theresia

Keyword(s):

Case Report ◽

Mortality Rate ◽

Critically Ill ◽

High Mortality ◽

Severe Case ◽

Bowel Necrosis ◽

Case Presentation ◽

Gastrointestinal Manifestations ◽

Emergent Laparotomy

Abstract Background In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. Case presentation We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. Conclusions Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.

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Factors influencing the injury severity score and the probability of survival in patients who fell from height

Scientific Reports ◽

10.1038/s41598-021-95226-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Masashi Fujii ◽

Tsutomu Shirakawa ◽

Mami Nakamura ◽

Mineko Baba ◽

Masahito Hitosugi

Keyword(s):

Regression Analysis ◽

Mortality Rate ◽

Confidence Interval ◽

Injury Severity Score ◽

Survival Probability ◽

Severity Score ◽

Hospital Care ◽

Injury Severity ◽

Body Position ◽

Fall Height

AbstractIn Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014–March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2–3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02–0.55). Using ‘feet-first’ as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02–0.64) and 0.17 (0.03–0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.

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EN BLOC RESECTION OF BLADDER TUMOR(EBRT) USING MONOPOLAR CAUTERY; A TERTIARY HOSPITAL EXPERIENCE.

10.36106/ijar/8300518 ◽

2021 ◽

pp. 15-16

Author(s):

Neeraj Agarwal ◽

Bhuwan kumar ◽

Prashant Gupta ◽

Govind Sharma ◽

Shivam Priyadarshi

Keyword(s):

Bladder Cancer ◽

Correct Diagnosis ◽

En Bloc Resection ◽

Tertiary Hospital ◽

Complete Resection ◽

High Rate ◽

Severe Bleeding ◽

Detrusor Muscle ◽

Bladder Tumors ◽

En Bloc

Bladder cancer is a growing health problem with the second most common urological malignancy. It accounts for around 7% of a new cancer diagnosis. Tobacco smoking is the most important risk factor accounting for around 50% of cases. Tobacco smokes contain aromatic amines and polycyclic hydrocarbons which are excreted through kidneys. The goal of transurethral biopsy in NMIBC(non-muscle invasive bladder cancer) is to make the correct diagnosis and completely remove all visible lesions which can be either resected piecemeal or en bloc. The presence of detrusor muscle in the specimen is an important factor for planning treatment and prognosis. Here we share our experience of EBRT using monopolar cautery describing the feasibility, safety, and adequacy of the procedure in the management of small urinary bladder tumors. The study was conducted in the Department of Urology, SMS Medical College, and attached hospitals. All the patients with clinical NMIBC during study duration were admitted and a total of 25 patients above the age of 18yrs, having papillary bladder tumors less than 3 cm were included in the study. Complete resection by the en bloc technique was achieved in all 25 cases with no requirement of conversion to conventional TURBT. Our study also shows the presence of detrusor muscle in 22 specimens out of 25. And only two patients developed severe bleeding which needed a blood transfusion. Thus, ERBT using monopolar cautery is safe and feasible for the complete resection of NMIBCs with a high rate of detrusor-positive specimens in the selected patient population.

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Extramedullary Plasmacytoma of The Frontal Sinus: A Case Report

FACE ◽

10.1177/27325016211053640 ◽

2021 ◽

pp. 273250162110536

Author(s):

Joshua Harrison ◽

Samantha Marley ◽

Shawhin Shahriari ◽

Christian Bowers ◽

Anil Shetty

Keyword(s):

Frontal Sinus ◽

Surgical Excision ◽

Extramedullary Plasmacytoma ◽

High Rate ◽

Solitary Plasmacytoma ◽

Case Presentation ◽

Long Term Follow Up ◽

History Of

We report a rare case of an extramedullary plasmacytoma (EMP) in the frontal sinus with an indolent clinical presentation. Although a history of trauma was absent, the initial diagnosis was a mucocele, based on the radiological findings. Upon surgical excision, the patient was found to have an EMP. EMP, a form of solitary plasmacytoma, has a significantly high rate of conversion to multiple myeloma. This mandates long-term follow-up, even after successful radiotherapy and/or resection. While radiation therapy is generally considered a first line treatment for EMP, surgical intervention may provide optimal treatment in complicated cases. This case presentation highlights the prognosis of patients diagnosed with EMP.

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Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽

10.1161/circ.142.suppl_3.13317 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hai Xu ◽

Angel Martin ◽

Avneet SINGH ◽

Mangala Narasimhan ◽

Joe Lau ◽

...

Keyword(s):

Pulmonary Embolism ◽

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Risk Stratification ◽

Clinical Outcomes ◽

Acute Pulmonary Embolism ◽

Severe Bleeding ◽

Study Cohort ◽

D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

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All-Cause Mortality of Hospital-Treated Borderline Personality Disorder: A Nationwide Cohort Study

Journal of Personality Disorders ◽

10.1521/pedi_2018_32_403 ◽

2020 ◽

Vol 34 (6) ◽

pp. 723-735 ◽

Cited By ~ 8

Author(s):

Jesper N⊘rgaard Kjær ◽

Robert Biskin ◽

Claus Vestergaard ◽

Povl Munk-J⊘rgensen

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Mortality Rate ◽

Borderline Personality ◽

High Rate ◽

Standardized Mortality Ratio ◽

Central Research ◽

Emergency Rooms ◽

Icd 10 ◽

Mortality Ratio

Patients with borderline personality disorder (BPD) are known to present frequently in emergency rooms, and they have a high rate of suicide. The mortality rate of patients with BPD is still unclear. The Danish Psychiatric Central Research Register and The Danish Register for Causes of Death were used to identify patients with a first-ever diagnosis of BPD (ICD-10: F60.31) from 1995 through 2011 together with time and cause of death. A total of 10,545 patients with a BPD diagnosis were followed for a mean time of 7.98 years. A total of 547 deaths were registered. The standardized mortality ratio of patients with BPD compared to the general population was 8.3 (95% CI [7.6, 9.1]). More than three inpatient admissions per year or a comorbid diagnosis of substance use disorder correlated with a higher mortality rate. The increased mortality rate in patients with BPD treated in secondary care emphasizes that it is a severe mental disorder.

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Cesarean Hysterectomy in Abnormally Invasive Placenta: The Role of Prenatal Diagnosis

Diseases ◽

10.3390/diseases9030056 ◽

2021 ◽

Vol 9 (3) ◽

pp. 56

Author(s):

Ana Maria Cubo ◽

Ana Villalba Yarza ◽

Irene Gastaca ◽

María Victoria Lapresa-Alcalde ◽

Maria José Doyague ◽

...

Keyword(s):

Decisive Role ◽

Massive Bleeding ◽

High Rate ◽

Severe Bleeding ◽

Cesarean Hysterectomy ◽

Invasive Placenta ◽

Postsurgical Recovery ◽

Dangerous Condition ◽

Abnormally Invasive Placenta

An abnormally invasive placenta (AIP) is a placenta that cannot be removed spontaneously or manually without causing severe bleeding. It is a dangerous condition associated with a high rate of maternal and perinatal morbidity and mortality due to the high rate of massive bleeding and visceral injuries. The standardized ultrasound diagnostic criteria have helped improve its early diagnosis, which is essential to plan coordinated actions to reduce associated morbimortality. We present a case report in which ultrasound diagnosis played a decisive role, enabling the coordination of a multidisciplinary team and improving the immediate care of both mother and newborn. Cesarean hysterectomy was performed with minimal blood loss and a good postsurgical recovery.

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Perioperative complications of esophagectomy - prevention, diagnosis and management

Acta chirurgica iugoslavica ◽

10.2298/aci1701027s ◽

2017 ◽

Vol 64 (1) ◽

pp. 27-38

Author(s):

Dejan Stojakov ◽

Predrag Sabljak ◽

Bratislav Spica ◽

Dejan Velickovic ◽

Vladimir Sljukic ◽

...

Keyword(s):

Mortality Rate ◽

Perioperative Complications ◽

Rapid Development ◽

Postoperative Mortality ◽

High Volume ◽

Esophageal Resection ◽

Vocal Cord Palsy ◽

Pulmonary Complications ◽

High Rate ◽

Septic Complications

Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset of arrhythmia could be associate with other surgical complications. Postesophagectomy chylothorax is life-threatening complication due to rapid development of immunosuppression and septic complications, and early ligation of thoracic duct is often mandatory. Intrathoracic herniation of intrabdominal viscera is rare, and ischemic spinal cord lesions are very rare after esophagectomy. Majority of perioperative complications could be prevented or solved, decreasing mortality rate of esophagectomy.

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Vasopressor Use during Emergency Trauma Surgery

The American Surgeon ◽

10.1177/000313481408000518 ◽

2014 ◽

Vol 80 (5) ◽

pp. 472-478 ◽

Cited By ~ 5

Author(s):

Robert M. Van Haren ◽

Chad M. Thorson ◽

Evan J. Valle ◽

Gerardo A. Guarch ◽

Jassin M. Jouria ◽

...

Keyword(s):

Cardiac Arrest ◽

Mortality Rate ◽

Odds Ratio ◽

Injury Severity ◽

Trauma Surgery ◽

Vital Signs ◽

Severely Injured ◽

Severely Injured Patients ◽

Vasopressor Use ◽

Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

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