Assigning Level of Care in Blunt Chest Trauma Patients: Applying Objective Scoring Systems

25% of all traumatic deaths are related to blunt chest trauma and another 50% have in-hospital morbidity and mortality. Recognizing patients with high risk of mortality is just as important as recognizing the immediate severely injured patients. Atlanticare Regional Trauma Center developed a scoring system in an attempt to properly assign these patients to an appropriate level of care. The system was developed based on a literature review but has not yet been studied to review its effectiveness in improving outcomes in chest trauma patients. Therefore, the scoring system is used as a guideline and not an official document in the patients’ chart. The aim of this study is to examine outcomes in patients suffering blunt chest trauma and to determine if this scoring system has any significant impact

Brachial Artery Aneurysm after Arteriovenous Fistula Ligation Status Post-Kidney Transplant

Arteriovenous fistulas (AVF) are the most common and effective method of receiving hemodialysis; However, these access techniques do not come without consequence. Aneurysmal degeneration after creation and even years after ligation of such AVF can occur. This is still considered a rare complication. A true brachial artery aneurysm has an overall incidence of 0.17% among peripheral artery aneurysms. Factors that increase incidence of this complication include trauma, age and immunosuppression. Research on this topic is becoming more prevalent, but more answers are still needed. Below is a case of brachial artery aneurysm presenting years after AVF ligation in a patient with kidney transplant

Phyllodes Tumor Containing Invasive Ductal Carcinoma: A Rare Case Description & Review of Literature

Phyllodes tumors are uncommon, often benign, malignancies of the breast and account for approximately 0.5% of all breast malignancies. These tumors were first described in 1838 by Johannes Muller as cystosarcoma phyllodes and were later more aptly renamed phyllodes tumors (as they were neither cystic nor sarcomatous).(1) As a mixed connective tissue and epithelial tumor, these behave similar to benign fibroadenomas, though their growth is much more rapid and they tend to occur in older patients.(2) Hallmarked by their large size at presentation, these tumors average between 4 and 7 cm at the time of diagnosis. The only known risk factor for development of a phyllodes tumor is Li-Fraumeni syndrome.(1) Pathology of a phyllodes tumor is similar to that of a fibroadenoma though with increased cellularity and added whorled stroma which forms large clefts lined by epithelium resembling leaf-like clusters.(2) Mammography and ultrasound are unable to distinguish these tumors from a fibroadenoma as they show similar rounded borders. As a result, core needle biopsy is the preferred method of diagnosis, followed by complete wide excision with 1 cm margins to prevent local recurrence. Lymph node dissection is not required as lymph node metastasis is rare.(3) Review of SEER data showed only 8 of 498 women with phyllodes tumors had nodal involvement.(1) 50% of phyllodes tumors are entirely benign, however the remaining 50% are split between histologic designations of borderline (25%) and malignant (25%) after excision. Borderline and malignant histologies are characterized by increased stromal cellularity, atypia, mitotic rate, and presence of stromal overgrowth with infiltrative margins. These borderline and malignant tumors tend to have courses most similar to sarcoma of the trunk and spread hematogenously.(1) Only rarely in the literature have cases of invasive ductal cancer been reported in the background of a benign or borderline phyllodes histology

Amphotercin Washout of Fungal Peritonitis in Liver Transplant Recipient: A Novel Approach

Invasive fungal infection has a significant prevalence among organ transplant patients and is associated with high rates of morbidity and mortality. Fungal infection is difficult to identify early and subsequently difficult to effectively treat. In this case presentation we have a 45 y/o orthotopic liver transplant recipient who was profoundly sick from fungal peritonitis and due to the appearance of her abdomen and intestines, with the help of infectious disease, decided to proceed with direct amphotercin washout of the abdomen in the operating room. The patient had complete resolution of her fungal peritonitis and is doing well

A Case of Synchronous Colorectal Carcinoma Manifested as Three Separate Colon Masses

Colorectal cancer is the second leading cause of cancer-related deaths in the United States amongst cancers that affect both genders. Synchronous colorectal cancer is greater than one primary lesion detected on initial presentation and occurs about 5% of the time. This is a 78 year-old female with past medical history of left-sided breast cancer treated with neoadjuvant chemotherapy who presented with symptomatic anemia found to have a hemoglobin of five and positive fecal occult blood test. Patient was transfused and taken for EGD/colonoscopy, which showed three polypoid rectal lesions and three separate colon masses. Preliminary pathology showed high grade dysplasia in cecal mass and carcinoma in situ in rectal polyp. CT scan findings included 4.2 x 2.7 cm mass at cecum as well as areas of bowel wall thickening at proximal descending colon, proximal sigmoid colon, and distal rectosigmoid colon. Patient was taken to the operating room for rectal exam under anesthesia and laparoscopic subtotal colectomy. Post-operative pathology confirmed moderately-differentiated invasive adenocarcinoma arising from tubulovillous adenomas with lymph-vascular and perineural invasion. Five out of twelve lymph nodes sampled were involved. This patient never had a colonoscopy but was recommended to get one two years prior when some areas of her colon were found to be prominent on PET scan, however she did not follow up. The importance of screening for colorectal cancer has never been more apparent than it is today with its proven benefit to decrease mortality

Artificial Intelligence in Surgery, Surgical Subspecialties, and Related Disciplines

Artificial intelligence (AI) and machine learning (ML) algorithms show promise in revolutionizing many aspects of surgical care. ML algorithms may be used to improve radiologic diagnosis of disease and predict peri-, intra-, and postoperative complications in patients based on their vital signs and other clinical characteristics. Computer vision may improve laparoscopic and minimally invasive surgical education by identifying and tracking the surgeon’s movements and providing real-time performance feedback. Eventually, AI and ML may be used to perform operative interventions that were not previously possible (nanosurgery or endoluminal surgery) with the utilization of fully autonomous surgical robots. Overall, AI will impact every surgical subspecialty, and surgeons must be prepared to facilitate the use of this technology to optimize patient care. This chapter will review the applications of AI across different surgical disciplines, the risks and limitations associated with AI and ML, and the role surgeons will play in implementing this technology into their practice