Evelio Velis

Treatment of suspected acute perforated appendicitis with antibiotics and interval appendectomy

BACKGROUND Initial antibiotics with planned interval appendectomy (interval AP) have been used to treat patients with complicated perforated appendicitis; however, little experience exists with this approach in children with suspected acute perforated appendicitis (SAPA). We sought to determine the outcome of initial antibiotics and interval AP in children with SAPA. METHODS Over an 18-month period, 751 consecutive patients underwent appendectomy including 105 patients with SAPA who were treated with initial intravenous antibiotics and planned interval AP ≥ 8 weeks after presentation. All SAPA patients had symptoms for ≤ 96 hours. Primary outcome variables were rates of readmission, abscess formation, and need for interval AP prior to the planned ≥ 8 weeks. RESULTS Intraabdominal abscess rate was 27%. Appendectomy prior to planned interval AP was 11% and readmission occurred in 34%. All patients underwent eventual appendectomy with pathologic confirmation confirming the previous appendiceal inflammation. White blood cell (WBC) count >15,000, WBC >15,000 plus fecalith on imaging, and WBC >15,000 plus duration of symptoms >48 hours were all significantly associated with higher rates of readmission (p=0.01, p=0.04, p=0.02) and need for interval AP prior to the planned ≥ 8 weeks (p=0.003, p=0.05, p=0.03). CONCLUSIONS Treatment of SAPA with antibiotics and planned interval AP is successful in the majority of patients; however, complications such as abscess formation and/or readmission prior to planned interval AP occur in up to one-third of patients. Certain clinical variables are associated with increased treatment complications.

Role of high definition colonoscopy in colorectal adenomatous polyp detection

AIM To investigate the rates of polyp detection in a mixed risk population using standard definition (SDC) vs high definition colonoscopes (HDC). METHODS This was a retrospective cohort comparative study of 3 colonoscopists who each consecutively performed 150 SDC (307, 200 pixel) and 150 HDC (792, 576 pixels) in a community teaching hospital. RESULTS A total of 900 colonoscopies were evaluated (mean age 56, 46.8% men), 450 with each resolution. Polyps of any type were detected in 46.0% of patients using SDC and 43.3% with HDC (P = 0.42). There was no significant difference between the overall number of polyps, HDC (397) and SDC (410), detected among all patients examined, (P = 0.73). One or more adenomatous polyps were detected in 24.2% of patients with HDC and 24.9% of patients with SDC colonoscopy (P = 0.82). There was no significant difference between HDC (M = 0.41) and SDC (M = 0.42) regarding adenomatous polyp (P = 0.88) or advanced adenoma (P = 0.56) detection rate among all patients examined. CONCLUSION HDC did not improve yield of adenomatous polyp, advanced adenoma or overall polyp detection in a population of individuals with mixed risk for colorectal cancer.

Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients

STUDY OBJECTIVE To validate a non-invasive cardiac output monitor in pediatric cardiac surgery patients. DESIGN Prospective trial. SETTING Operating room. PATIENTS 20 pediatric cardiac surgery patients ASA physical status 3 and 4. INTERVENTIONS Aesculon noninvasive cardiac output monitor was used and compared to the cardiac output derived from the Fick equation. Oxygen consumption was measured and blood samples were taken from the arterial line and from the superior and inferior vena cava. MEASUREMENTS Noninvasive cardiac output and cardiac index and Fick cardiac output and cardiac index. Oxygen consumption was measured by the TreyMed metabolic monitor. Blood samples were simultaneously drawn from the arterial line and from the superior and inferior vena cava purse string sites by the surgeon, prior to commencing cardiopulmonary bypass. Another data set was obtained right after termination of cardiopulmonary bypass. RESULTS There was a direct, significant relationship between Fick CO/CI and NICOM CO/CI measurements. More dispersion is detected when the magnitude of the measure increases, i.e., for older and larger patients. CONCLUSIONS There is a strong correlation between the cardiac output values derived from the Fick equation and the Aesculon non-invasive cardiac output monitor.

Dexmedetomidine use in patients undergoing electrophysiological study for supraventricular tachyarrhythmias

Dexmedetomidine is a selective alpha‐2 adrenergic agonist with sedative, analgesic, and anxiolytic properties. Dexmedetomidine has not been approved for use in pediatrics. Dexmedetomidine has been reported to depress sinus node and atrioventricular nodal function in pediatric patients; it has been suggested that the use of dexmedetomidine may not be desirable during electrophysiological studies.

Can we predict podiatric medical school grade point average using an admission screen

BACKGROUND Most medical school admission committees use cognitive and noncognitive measures to inform their final admission decisions. We evaluated using admission data to predict academic success for podiatric medical students using first-semester grade point average (GPA) and cumulative GPA at graduation as outcome measures. METHODS In this study, we used linear multiple regression to examine the predictive power of an admission screen. A cross-validation technique was used to assess how the results of the regression model would generalize to an independent data set. RESULTS Undergraduate GPA and Medical College Admission Test score accounted for only 22% of the variance in cumulative GPA at graduation. Undergraduate GPA, Medical College Admission Test score, and a time trend variable accounted for only 24% of the variance in first-semester GPA. CONCLUSIONS Seventy-five percent of the individual variation in cumulative GPA at graduation and first-semester GPA remains unaccounted for by admission screens that rely on only cognitive measures, such as undergraduate GPA and Medical College Admission Test score. A reevaluation of admission screens is warranted, and medical educators should consider broadening the criteria used to select the podiatric physicians of the future.

PD2.01 (also presented as P1.13): Lung Cancer Chromosomal Aberrations and Gene Expression Profiles of Hispanics Living in the US or Latin America are Similar

POSTER DISCUSSION SESSION 2 SATURDAY, AUGUST 27, 2016 e 08:00 e 09:15 PD2.01 (also presented as P1.13) Genes Evaluated by GEP # Tumors Tested Frequency % Hispanics % NHW % EGFR 380 22% 25% 21% ALK 339 5% 5% 5% Lung Cancer Chromosomal Aberrations and Gene Expression Profiles of Hispanics Living in the US or Latin America are Similar ROS-1 180 8% 3% 9% KRAS 258 30% 27% 31% c-MET 165 31% 27% 32%