Faculty Bibliography

Arcuate line hernias are a rare type of hernia with limited publications regarding their successful repair. The arcuate line is the inferior limit of the posterior leaf of the rectus sheath. An arcuate line hernia is a type of intraparietal hernia, meaning it is not a truly complete fascial defect of the abdominal and, therefore, may present with atypical symptoms. Although published data on arcuate line hernia repairs are limited to a handful of case reports and one literature review, reports regarding robotic repair are exceptionally rare. This case report is the second documented robotic approach to arcuate line hernias known to these authors.
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Introduction. Complete or incomplete intestinal obstruction is one of the most frequent acute abdomen conditions. It constitutes between 20% and 35% of the urgent admissions of hospital surgical areas. Clinical case. We present a case of a patient with a history of prostate carcinoma, who began with clinical symptoms of intestinal obstruction and acute abdomen. He was diagnosed with volvulus of the cecum, intestinal malrotation, and situs ambiguous. Surgical treatment of the patient was successful. Conclusion. Knowledge of these pathological conditions is essential to be able to provide correct surgical treatment and reduce the mortality that these can lead to.

BACKGROUND:This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support. METHODS:An anonymous online 31-question survey was distributed to medical students and postgraduate year residents. Topics included were demographics, clinical responsibilities, educational/curricula changes, and trainee wellness. Descriptive analysis was performed for each set of demographic groupings as well as 2 and 3 group comparisons. RESULTS:< .0001). CONCLUSION/CONCLUSIONS:We aim to provide continued educational support for our trainees' clinical development and well-being during the COVID-19 pandemic.

INTRODUCTION/BACKGROUND:Coronavirus disease 2019 (COVID-19) has been shown to affect outcomes among surgical patients. We hypothesized that COVID-19 would be linked to higher mortality and longer length of stay of trauma patients regardless of the injury severity score (ISS). METHODS:We performed a retrospective analysis of trauma registries from two level 1 trauma centers (suburban and urban) from March 1, 2019, to June 30, 2019, and March 1, 2020, to June 30, 2020, comparing baseline characteristics and cumulative adverse events. Data collected included ISS, demographics, and comorbidities. The primary outcome was time from hospitalization to in-hospital death. Outcomes during the height of the first New York COVID-19 wave were also compared with the same time frame in the prior year. Kaplan-Meier method with log-rank test and Cox proportional hazard models were used to compare outcomes. RESULTS:There were 1180 trauma patients admitted during the study period from March 2020 to June 2020. Of these, 596 were never tested for COVID-19 and were excluded from the analysis. A total of 148 COVID+ patients and 436 COVID- patients composed the 2020 cohort for analysis. Compared with the 2019 cohort, the 2020 cohort was older with more associated comorbidities, more adverse events, but lower ISS. Higher rates of historical hypertension, diabetes, neurologic events, and coagulopathy were found among COVID+ patients compared with COVID- patients. D-dimer and ferritin were unreliable indicators of COVID-19 severity; however, C-reactive protein levels were higher in COVID+ relative to COVID- patients. Patients who were COVID+ had a lower median ISS compared with COVID- patients, and COVID+ patients had higher rates of mortality and longer length of stay. CONCLUSIONS:COVID+ trauma patients admitted to our two level 1 trauma centers had increased morbidity and mortality compared with admitted COVID- trauma patients despite age and lower ISS. C-reactive protein may play a role in monitoring COVID-19 activity in trauma patients. A better understanding of the physiological impact of COVID-19 on injured patients warrants further investigation.

BACKGROUND:Deep vein thrombosis (DVT) has been reported to occur at varying rates in patients with COVID-19. Limited data exist regarding comparison with non-Covid-19 patients with similar characteristics. The objective was to compare the rates of DVT in patients with and without COVID-19 and to determine the impact of DVT on outcome. METHODS:Retrospective, observational cohort study. Single institution, level 1 Trauma Center. COVID-19 patients compared with a group of non-COVID-19. Patients included a non-COVID-19 group from March 20, 2019 to June 30, 2019 and a COVID-19 group from the same interval in 2020. Standard prophylactic anticoagulation with heparin 5,000 units three times daily or enoxaparin 40 mg daily not weight adjusted (n=573) and enoxaparin 40 mg daily not weight adjusted (n=213). Two primary outcomes included the rate of DVT in the COVID-19 group compared to the historic control, and the impact of DVT on mortality. Subgroup analysis included patients with adult respiratory distress syndrome (ARDS), pulmonary embolism (PE), and intensive care unit patients (ICU). RESULTS:The rate of DVT and PE in the 573 patients, age 61 ± 17 years, male 44.9%, was 71/573 (12.4%) and 19/573 (3.3%) compared to 72/213 (33.8%) and 15.213 (7.0%) in COVID-19 patients, age 61 ± 16 years, male 61.0%. Unprovoked PE occurred in 10/15 (66.7%) in COVID-19 patients compared to 8/497 (1.6%) in non-COVID-19. Patients with ARDS (n=60) had an incidence of DVT 28/60 (46.7%) versus 44/153 (28.8%), p=0.01. ICU patients had an increased rate of DVT in COVID-19 patients: 39/90 (43.3%) versus 33/123 (33.3%), p=0.01. Risk factors for mortality included age, DVT, multiple organ failure syndrome, and prolonged ventilatory support with the following odd ratios: 1.030, 95% CI 1.002 - 1.058, 2.847, 95% CI 1.356-5.5979, 4.438, 95% CI 1.973-9.985, and 5.321, 95% CI 1.973-14.082. CONCLUSIONS:The incidence of DVT in COVID-19 patients receiving standard dose not weight-adjusted prophylactic anticoagulation is high, particularly in ICU patients. DVT is one of the contributing factors to increased mortality. These results suggest re-evaluation of the present standard dose thromboprophylaxis in patients with COVID-19.

INTRODUCTION/BACKGROUND:Stop the Bleed (STB) is a national training program aiming to decrease the mortality associated with life-threatening bleeding due to injury. The purpose of this study was to evaluate the efficacy and confidence level of security personnel placing a tourniquet (TQ) compared to civilians. METHODS:Pre and post questionnaires were shared with security personnel (Group 1) and civilians (Group 2). Both groups were assessed to determine comfort level with TQ placement. Time and success rate for placement was recorded pre- and post-STB training. A generalized linear mixed model or generalized estimating equations was used to compare pre and post measurements. RESULTS:There were 234 subjects enrolled. There was a statistically significant improvement between the pre- and post-training responses in both groups with respect to comfort level in placing a TQ. Participants also demonstrated increased familiarity with the anatomy and bleeding control after STB training. A higher successful TQ placement was obtained in both groups after STB training (Pre-training: Group 1 [17.4%], Group 2 [12.8%]; Post-training: Group 1 [94.8%], Group 2 [92.3%]). Both groups demonstrated improved time to TA placement with a longer mean time improvement achieved in Group 1. Although the time to TQ placement pre-and post-training was statistically significant, we found that the post-training times between Groups 1 and 2 were similar (P = .983). CONCLUSIONS:Participants improved their confidence level with the use of hemorrhage control techniques and dramatically increased the rate and time to successful placement of a TQ. While civilians had the greatest increase in comfort level, the security personnel group saw the most significant reduction in the time to successful TQ placement. These findings highlight the critical role of STB in educating and empowering both civilians and security personnel in bleeding control techniques.