Salvatore Docimo

Emergency department visits by demented patients with malfunctioning feeding tubes

Background: Objective data indicate that feeding tubes in demented patients may not be efficacious and can have serious complications, but no study characterizes emergency department resource utilization for these patients. This study aimed to evaluate the incidence and resource utilization related to feeding tube malfunction in demented patients visiting the emergency department. Methods: A retrospective chart review for all demented patients visiting the emergency department with malfunctioning feeding tubes from September 1999 to May 2001 was conducted. Demographic data, diagnoses, type of tube, length of emergency department stay, method of transportation to the emergency department, consultations, laboratory evaluation, x-ray data, and total hospital and ambulance charges were determined. Results: A total of 138 emergency department visits by 33 patients occurred during this period (range of visits per patients, 1–21; mean, 4.1 ± 4.3). Malfunctions occurred in 61 percutaneous endoscopically placed gastric tubes, 37 jejunostomy tubes, 34 gastric tubes, 4 endoscopically placed gastrostomy and jejunostomy tubes, and 2 percutaneous endoscopically placed jejunostomy tubes. This required 108 ambulance round-trips to and from the emergency department. The most frequent complication was unintentional dislodgement (n = 125). The average length of stay was 2.6 ± 1.6 h. All the patients were seen by an emergency department physician. In addition, there were 99 surgical and 26 gastroenterology consultations about these patients. The total hospital charges, not including physician fees, were

Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome

86,234.48, and the total reimbursement (actual) from Medicare for ambulance charges was

Cardiovascular Disease and Its Association With Histological Changes of the Left Stellate Ganglion

57,664.00. During the same 21-month period, 42 feeding tubes were placed for dementia. Conclusions: The expense of emergency department visits for tube dislodgment or malfunction is a previously unreported issue involved in the tube feeding of demented patients. Extrapolation of our data yields an estimated health care charge of almost

Bartholin's abscess arising within hidradenoma papilliferum of the vulva: a case report

11 million for the country per year.

Single stage conversion from adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass: an analysis of 4875 patients

Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended prior to surgical interventions. Distal clavicle excision, the main surgical treatment option, can be performed by various surgical approaches, such as open procedures, direct arthroscopic, and indirect arthroscopic techniques. When choosing the best surgical option, factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain must be considered. This article examines patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthritis.

Incidence of cholecystectomy after bariatric surgery

Mounting evidence has demonstrated that the autonomic system plays a role in the morbidity and mortality of certain cardiovascular disease states. Ventricular arrhythmias have been associated with the level of sympathetic activation. We attempted to determine if the presence of fibrosis, a marker for previous ischemic events, correlates with an increase in the number of left stellate ganglion nerve cell bodies which is indicative of hypersympathetic stimulation to the myocardial tissue. Left stellate ganglia were removed, sectioned and prepared using hematoxylin and eosin and Massons trichrome stain. The interventricular septum of the heart corresponding to the stellate ganglion samples were removed, serially sectioned, and stained with hematoxylin and eosin and Massons trichrome stain. The samples were described using a grading scale to quantify the percentage of fibrosis. Ganglion nerve cell bodies were then individually counted in three separate high-powered fields. A students T-test was used to statistically evaluate the data. Stellate ganglions were sampled from 32 cadavers. Fibrosis was present within 72% (23/32) of the interventricular septums that were sampled. Nine interventricular septums were found to be free of fibrosis. For those interventricular septums that were positive for the presence of fibrosis, the mean left stellate ganglion nerve cell bodies was 39.8 (Range: 26-51). For those interventricular septums that were negative for the presence of fibrosis, the mean left stellate ganglion nerve cell bodies was 34.3 (Range: 27-46). The difference between the mean nerve cell bodies for interventricular septums with fibrosis and without fibrosis was found to be statistically significant (P = 0.048). Histological changes in terms of the number of left stellate ganglion nerve cell bodies seem to be dependent upon the presence of fibrosis within the interventricular septum. Considering fibrosis of the interventricular septum is a marker for previous ischemic events, an increase in the number of nerve cell bodies of the left stellate ganglion in the presence of fibrosis suggests an association does exist between hypersympathetic stimulation to the myocardial tissue and myocardial infarction. Further research into this association is warranted in order to determine if left stellate ganglion blockade is a viable treatment option for arrhythmias following myocardial infarctions.

Association of Long-term Anastomotic Ulceration After Roux-en-Y Gastric Bypass With Tobacco Smoking

BackgroundHidradenoma papilliferum is an uncommon, benign, cystic, papillary tumor that occurs almost exclusively in the female anogenital region. Bartholins abscess is also an anogenital cystic lesion caused by obstruction of Bartholins duct with an overlying infection. Concomitant presentation of Bartholins abscess and Hidradenoma papilliferum is unique.Case presentationA 43-year-old African American woman presented with a painful cystic mass on the left labia majora. A preoperative diagnosis of Bartholins abscess was made. During excision and draining, an additional tan-brown dermal nodule was removed which demonstrated histological features of Hidradenoma papilliferum.ConclusionWe present what we believe to be the first case of Bartholins abscess arising in hidradenoma papilliferum and its clinical significance.

Utilizing quantitative measures of visceral adiposity in evaluating trauma patient outcomes.

BACKGROUND The previous popularity of adjustable gastric banding (AGB), along with inconsistent long-term results, has resulted in the need for conversion to other procedures. The perioperative safety of laparoscopic sleeve gastrectomy (SG) and gastric bypass (RYGB) as single-stage conversion procedures is unclear. OBJECTIVES To compare the early safety of SG and RYGB when performed as single-stage conversion procedures at the time of AGB removal. SETTING Nationwide analysis of accredited centers. METHODS The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was queried for all patients who underwent single-stage conversion to SG or RYGB. Multivariable logistic regression was performed to control for baseline differences, and odds ratios (ORs) with 95% confidence intervals are reported. RESULTS There were 4865 patients who underwent a single-stage AGB conversion. SG was performed in 3364 (69.1%). The 30-day reoperation (1.6% versus 2.7%, P = .008), readmission (4% versus 5.7%, P = .006), reintervention (1.7% versus 2.7%, P = .024), and overall morbidity (2.9% versus 6.5%, P<.0001) were significantly less common in the SG group. After controlling for baseline characteristics, RYGB was independently associated with higher overall 30-day reoperation (OR 1.81, 1.19-2.75), readmission (OR 1.42, 1.07-1.88), reintervention (OR 1.59, 1.06-2.4), and overall morbidity (OR 2.17, 1.62-2.9). CONCLUSIONS AGB conversions are associated with low overall 30-day event rates. Patients undergoing RYGB as a single-stage conversion experience higher complication rates and the need for additional early procedures compared with SG.

Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures

BACKGROUND Bariatric surgery predisposes patients to development of cholelithiasis, and therefore the need of a subsequent cholecystectomy; however, the incidence of cholecystectomy after bariatric surgery is debated. OBJECTIVE The purpose of our study is to assess the incidence of cholecystectomy after 3 of the most common bariatric procedures. SETTING University Hospital, involving a large database in New York State. METHODS The Statewide Planning and Research Cooperative System administrative longitudinal database was used to identify all patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2004 and 2010. Through the use of a unique identifier patients were followed to evaluate for the need of a subsequent cholecystectomy over at least 5 years. Cox proportional hazard regression analysis was used to identify risk factors for subsequent cholecystectomy. RESULTS During this time period, there were 15,301 LAGB procedures, 19,996 RYGB, and 1650 SG. There were 989 (6.5%) patients who underwent cholecystectomy after LAGB, 1931 (9.7%) patients after RYGB, and 167 (10.1%) after SG. Approximately one quarter of follow-up cholecystectomies were performed at the same institutions. LAGB and RYGB were less likely to have a subsequent cholecystectomy compared with SG (hazard ratio .5, 95% confidence interval .4-.6 for LAGB; and hazard ratio .7, 95% confidence interval .6-.9 for RYGB). Risk factors for a subsequent cholecystectomy included age, sex, race, and some co-morbidities and complications (P<.05) based on a multivariable Cox proportional hazard model. CONCLUSION The rate of cholecystectomy after LAGB, RYGB, and SG was 6.5%, 9.7% and 10.1%, respectively. Patients should be counseled preoperatively about this risk and biliary prophylaxis should be contemplated.

Bariatric Procedures in Adolescents are Safe in Accredited Centers

Association of Long-term Anastomotic Ulceration After Roux-en-Y Gastric Bypass With Tobacco Smoking Bariatric surgery is the most effective treatment for obesity, leading to long-term weight loss, improvements in quality of life, and reduction of obesity-associated comorbidities.1 However, long-term complications are reported. Importantly, concerns about such complications represent a considerable barrier for eligible patients considering surgery.2 A common long-term postoperative complication for the Roux-en-Y gastric bypass (RYGB) procedure is anastomotic ulceration (AU). Although AU after RYGB is a well-recognized adverse event, its documented incidence varies widely.3 Additionally, tobacco-smoking has been implicated in the pathogenesis of AU.4 The aim of this study was to describe the epidemiology of AU after RYGB and measure the association of tobacco smoking with long-term AU incidence.