Journal of the American College of Surgeons
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Several thousand snakebites occur annually in the US, but fewer than 10 deaths occur. Most deaths are from envenomations by rattlesnakes (Crotalus species), but deaths from copperhead and water moccasin (Agkistrodon species) are rare. ⋯ Accurate identification of the pit viper species involved in snakebites is essential. Although envenomation by a rattlesnake (Crotalus species) may require antivenom and uncommonly surgery, a bite by a copperhead (Agkistrodon contortrix) rarely requires any intervention other than observation. The unnecessary use of antivenom should be discouraged.
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Posterior retroperitoneoscopic adrenalectomy (PRA) is an excellent surgical option for adrenal gland removal. The operation requires that surgeons learn a new approach with few similarities to anterior adrenalectomy. This study reports a large series of PRAs incorporated into surgical care using a team-model approach. ⋯ PRA is a technique safely performed for a variety of adrenal lesions, is ideal for patients who have undergone earlier abdominal surgery, and is feasible in obese patients. Proficiency can be obtained during a short period, leading to low conversion and complication rates. This technique should be incorporated into the armamentarium of the endocrine surgeon. A team approach to learning new surgical techniques is effective.
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Recent ventilator-associated pneumonia (VAP) guidelines recommend considering abbreviated therapy in patients with non-Pseudomonas aeruginosa VAP if clinical signs resolve. However, using an arbitrary day cutoff or clinical signs can be suboptimal for some, especially multiply injured patients, resulting in relapse and/or antibiotic resistance. Previously, we showed that repeat bronchoalveolar lavage (BAL) could guide antimicrobial duration for community-acquired VAP in trauma patients. The purpose of this study was to determine the appropriate duration of antimicrobial therapy for VAP in trauma patients secondary to hospital-acquired pathogens. ⋯ Repeat BAL provides objective evidence for VAP resolution in the face of potentially confounding clinical factors. Hospital-acquired VAP can be managed effectively by a defined course of therapy with a low recurrence. Duration of antimicrobial therapy for VAP in trauma patients should be dictated by the causative pathogen.
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Surgeon-performed cervical ultrasound (SUS) and 99Tc-sestamibi scanning (MIBI) are both useful in patients with primary hyperparathyroidism (PHPT). We sought to determine the relative contributions of SUS and MIBI to accurately predict adenoma location. ⋯ When performed by experienced surgeons, SUS is more accurate than MIBI for predicting the location of abnormal parathyroids in PHPT patients. For patients facing first-time surgery for PHPT, we now reserve MIBI for patients with unclear or negative SUS.
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Randomized Controlled Trial
The effects of an amino acid supplement on glucose homeostasis, inflammatory markers, and incretins after laparoscopic gastric bypass.
Protein supplements are routinely used after a laparoscopic gastric bypass (LGB). The aim of this study was to evaluate the impact of an amino acid supplement on glucose homeostasis and hormonal and inflammatory markers after LGB. ⋯ An amino acid supplement had no effect on the early postoperative incretins after LGB. It may have a negative influence on glucose kinetics and degree of inflammation. Future studies are needed to clarify these effects.