Successful three stage repair of a large congenital abdominal region defect

We present two infants born with large, right upper quadrant defects which cannot be categorized as either a gastroschisis or omphalocele. We successfully managed one infant with a three stage repair using polytetrafluoroethylene (PTFE) patch, porcine urinary bladder matrix (UBM) and delayed surgical closure. The second infant passed away due to parental consent care withdrawal

Benign Fibroepithelial Polyps: A Rare Cause of Ureteropelvic Junction Obstruction in Children

FEPs are rare, benign mucosal growths that may cause urinary tract obstruction in both adults and children. We present the case of a ten year old Hispanic male with recurring urinary tract infections and hydronephrosis diagnosed with fibroepithelial polyps (FEPs). Despite multiple radiographic procedures, we were unable to accurately preoperatively diagnose FEPs. Here we demonstrate the difficulties in preoperative diagnosis and suggest that perhaps a combination of US and MRI in the setting of persistent urinary tract infections and flank pain may be the best approach for early diagnosis and conservative management, including less invasive treatment protocols

Geriatric traumatic brain injury – What we know and what we don’t

The issue of geriatric trauma is a significant and growing concern among trauma surgeons. The outcomes of geriatric patients with traumatic brain injury are worse than younger cohorts and the number of traumatic brain injury (TBI)-related hospitalizations and fatalities in elderly patients will continue to increase as the world’s population ages. Although guidelines for the treatment of TBI have been established, they do not address the challenges of managing TBI in older patients. Issues of anticoagulation reversal, confounding of clinical exam by premorbid conditions, and optimal timing and frequency of imaging remain poorly studied. Additionally, current guidelines for optimal management of blood pressure, intracranial monitoring, cerebral perfusion pressure and operative management fail to address the unique concerns in the geriatric patient. Prognostication of acceptable outcomes in older patients with TBI is more challenging compared to younger cohorts and require early palliative care approaches targeted to the geriatric patient. Geriatric-specific research is sorely needed in nearly all aspects of TBI care. Given the paucity of data available, this non-systematic review seeks to outline the unique considerations of the geriatric patient with TBI and highlight what is currently unknown about the best way to care for elderly patients with TBI

Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas

2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon\u27s rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = \u3c0.001) and in patients with surgical intervention (10% vs. 3%; p \u3c 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV

Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas

2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon\u27s rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = \u3c0.001) and in patients with surgical intervention (10% vs. 3%; p \u3c 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV