Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted?

Objectives: In 2011, the Royal College of Surgeons published Emergency Surgery: Standards for Unscheduled Care in response to variable clinical outcomes for emergency surgery. The purpose of this study was to examine whether different treatment modalities would alter survival. Methods: All patients who underwent emergency laparotomy between April 2011 and December 2012 at Warwick Hospital (Warwick, UK) were included retrospectively....

Comorbidity Is a Competing Factor for Disease Recurrence Postnephrectomy

Objective: There is a relation between tumor stage and grade with the risk of cancer recurrence in patients undergoing surgical treatment for kidney cancer. The association of patient comorbidity with disease recurrence is less well characterized. The objective of this study was to explore the association between comorbidity and the recurrence of kidney cancer. Methods: We performed a retrospective analysis of 263 patients who received a...

Video-Assisted Thoracoscopic versus Open Lobectomy: Costs and Outcomes

Objectives: Video-assisted thoracoscopic (VATS) lobectomy is considered a promising surgical therapy for the diagnosis and treatment of non–small-cell lung carcinoma. The issue of whether VATS is superior to open thoracotomy remains controversial, however. We sought to determine whether the use of VATS lobectomy for diagnosing and treating non–small-cell lung carcinoma would improve patient outcomes at our institution. Methods: A...

PROMISE of Coronary CT Angiography: Precise and Accurate Diagnosis and Prognosis in Coronary Artery Disease

Coronary computed tomography angiography (CCTA) is a rapidly growing and powerful diagnostic test that offers a great deal of precision with respect to diagnosing coronary artery disease (CAD). Guideline statements for patients with stable ischemic heart disease have recommended CCTA for only a limited portion of intermediaterisk patients who have relative or absolute contraindications for exercise or vasodilator stress testing. The publication...

A Multidisciplinary Approach to Castleman Disease of the Neck

Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidiously and nonspecifically. A 21-year-old woman was referred to the otolaryngology service because of an asymptomatic neck mass...

Multidisciplinary Clinical Case Study

This issue of the Southern Medical Journal (SMJ) introduces a new format for case reports that emphasizes and requires multidisciplinary and interprofessional content. After a 5-year moratorium on unidimensional and single specialty case reports, we believe that the multidisciplinary clinical case study format will align with the Journal’s mission as a broad-based, interprofessional, clinically focused educational journal. Because the...

The View from Outside

More than a decade ago I retired from the active practice of medicine. I’d spent 26 years in solo private practice, then 10 as a professor at a well-known teaching medical center. Before that came 4 years in medical school, 4 years in specialty training, and almost 3 years as a medical officer in the US Air Force. Medicine had been my life for almost half a century. And now it wasn’t. Talk about culture...

Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome

Objectives: Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are...

Risk Factors for Complications during Outpatient Parenteral Antimicrobial Therapy for Adult Orthopedic and Neurosurgical Infections

Objectives: Outpatient parenteral antimicrobial therapy (OPAT) is an effective way of treating infections, but complications are common. We identified patient characteristics and OPAT treatment factors associated with increased risk of OPAT-related complications. Methods: We used a retrospective cohort design that assessed 337 adult patients treated with OPAT for orthopedic and neurosurgical infections between August 1, 2008 and May 30, 2010....

Commentary on “The View from Outside”

Many physicians are contemplating, or have already contemplated, their retirement from the active practice of medicine. Commensurate with this decision will be a decision regarding how to fill the time that was previously occupied by clinical medicine. Some may consider engaging in some aspect of their former career, such as volunteering to teach medical students or residents certain aspects of their experience garnered over decades of patient...

Enteral Nutrition Support Reduces the Necessity of Total Parenteral Nutrition to Reach Patient-Specific Caloric Goals Postpancreaticoduodenectomy

Objectives: Pancreaticoduodenectomy (PD) is associated with significant rates of postoperative complications. Although there is evidence that enteral nutrition support (ENS) may reduce postoperative sepsis, the true value of ENS in the abrogation of septic complications remains controversial. The aim of our study is to investigate the postoperative outcome of patients post-PD with and without ENS. Methods: Using our prospective institutional...

Chronic Opioid Users Are More Difficult to Sedate than Alcoholics and Controls

Objectives: Diagnostic and therapeutic colonoscopy is performed using conscious sedation. Excessive alcohol users, chronic benzodiazepine and opioid users, and polysubstance users are commonly cited as difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups. Methods: The endoscopic database was searched for patients who underwent colonoscopy. A retrospective chart review was performed...

Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience

Objectives: To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Methods: Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures were compared in terms of diagnostic and therapeutic yield, adverse events, and procedural...

Is Early Reperfusion a Good Thing? Optimal Timing of CABG Surgery Postacute Myocardial Infarction

Objectives: The optimal timing of coronary artery bypass grafting (CABG) following an acute myocardial infarction (AMI) is a topic of debate. The present study was designed to evaluate patients undergoing CABG both early (5 days) after AMI in the era of percutaneous coronary intervention. Methods: The medical records at our institution from 2008 through 2012 were reviewed. A total of 128 patients underwent CABG after AMI during this time...

Outcomes of Lobar and Sublobar Resections for Non–Small-Cell Lung Cancer: A Single-Center Experience

Objectives: Lung cancer is the leading cause of cancer-related mortality in the United States. Kentucky has the highest age-adjusted lung cancer rate and has one of the highest death rates from lung cancer in the country. Lobectomy is considered the standard therapy for non–small-cell lung cancer (NSCLC), whereas sublobar resection remains an option for selected patients. We investigated outcomes in patients having standard resections for lung...

Uveal Melanoma in the First 4 Decades of Life

Objectives: According to reports in the clinical literature, metastatic uveal melanoma in young adults has not been well studied. This article describes the clinical characteristics and natural history of patients who were diagnosed as having uveal melanoma in the first 4 decades of life. Methods: This was a chart review of patients aged 40 years or younger who were treated for metastatic uveal melanoma. The eligibility criteria included an...

Early Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Safe for Patients?

To the Editor: There is still controversy in the literature about the best timing for surgery in treating acute cholecystitis. Proponents of early laparoscopic cholecystectomy argue that this technique may reduce morbidity, conversion rates, mortality, and hospital costs.1 Others favor delayed surgery (>7 days) because there is a belief that affected inflammatory tissue is more vulnerable to surgery and leads to an increased risk in...

Modern Management of Thoracic Empyema

Objectives: Historically, surgical management of empyema was performed predominantly via open thoracotomy; however, during the past decade the use of video-assisted thoracoscopic surgery (VATS) as an alternative has increased. This study retrospectively compared the outcomes and management of patients with empyema at the University of Kentucky Medical Center who had undergone VATS versus those receiving open thoracotomy to determine whether VATS...

CME Article: Airway Assessment of Patients Undergoing Endoscopic Procedures

Objectives: In advance of endoscopic procedures, an evaluation to assess the risk of sedation is performed by the gastroenterologist. Based on regulations, gastroenterologists are required to perform an airway assessment. At this time, data supporting this regulation are limited; therefore, we evaluated airway assessment accuracy by gastroenterologists before endoscopic procedures. Methods: A retrospective, single tertiary care center study...

Commentary on “Cholecystectomy for Biliary Dyskinesia in Gastroparesis: Mimic or Misfortune?”

Functional syndromes of the gastrointestinal tract can be challenging in both diagnosis and management. This is yet another example of the crossroads of art and science in medicine. Gastroparesis is a syndrome that can be objectively defined by delayed gastric emptying in the absence of mechanic obstruction.1 Gastroparesis also can be identified by a variety of clinical symptoms, including nausea, vomiting, bloating, early satiety, and upper...