1
|
Lagazzi E, Teodorescu DL, Argandykov D, Samotowka MA, King DR. Moving toward point-of-care surgery in Ukraine: testing an ultra-portable operating room in an active war zone. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02410-w. [PMID: 38175279 DOI: 10.1007/s00068-023-02410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE In conflict zones, providers may have to decide between delaying time-sensitive surgeries or performing operative interventions in the field, potentially subjecting patients to significant infection risks. We conducted a single-arm crossover study to assess the feasibility of using an ultraportable operating room (U-OR) for surgical procedures on a porcine cadaver abdominal traumatic injury model in an active war zone. METHODS We enrolled participants from an ASSET-type course designed to train Ukrainian surgeons before deployment to active conflict zones. They performed three standardized consecutive abdominal surgical procedures (liver, kidney, and small bowel injury repair) with and without the U-OR. Primary outcomes included surgical procedure completion rate, procedure time, and airborne particle count at the start of surgery. Secondary survey-based outcomes assessed surgery task load index (SURG-TLX) and perceived operative factors. RESULTS Fourteen surgeons performed 76 surgical procedures (38 with the U-OR, 38 without the U-OR). The completion rate for each surgical procedure was 100% in both groups. While the procedure time for the liver injury repair did not differ significantly between the two groups, the use of the U-OR was associated with a longer time for kidney (155 vs. 56 s, p = 0.002), and small bowel (220 vs. 103 s, p = 0.004) injury repair. The average airborne particle count within the U-OR was substantially lower compared to outside the U-OR (6,753,852 vs. 232,282 n/m3, p < 0.001). There was no statistically significant difference in SURG-TLX for procedures performed with and without the U-OR. CONCLUSION The use of the U-OR did not affect the procedure completion rate or SURG-TLX. However, there was a marked difference in airborne particle counts between inside and outside the U-OR during surgery. These preliminary findings indicate the potential feasibility of using a U-OR to perform abdominal damage-control surgical procedures in austere settings.
Collapse
Affiliation(s)
- Emanuele Lagazzi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
- Department of Surgery, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Debbie Lin Teodorescu
- SurgiBox Inc., Cambridge, MA, USA
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | | | - David Richard King
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| |
Collapse
|
2
|
Motamedi DS, Fitzgerald ZT, Schmit B, Mushtaq R. Spectrum of injuries with "less-lethal" beanbag weapons: pictorial essay. Emerg Radiol 2023; 30:119-126. [PMID: 36401711 DOI: 10.1007/s10140-022-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
Beanbag weapons are gaining popularity with increasing daily use as a non-lethal or less-lethal alternative to traditional firearms. While these are considered "less-lethal," these are associated with a spectrum of serious injuries. We present a pictorial essay of these injuries ranging from mild skin contusions to more severe solid organ injuries.
Collapse
Affiliation(s)
- Damon Salar Motamedi
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Berndt Schmit
- Department of Radiology, George Washington University, Washington, DC, USA
| | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
| |
Collapse
|
3
|
Muacevic A, Adler JR, Al Dhneem HN, AlZahid AA, Alfaraj D. Late Presentation of Peritonitis Post Jejunal Perforation Due to Flank Stab Wound. Cureus 2022; 14:e31351. [PMID: 36514649 PMCID: PMC9741703 DOI: 10.7759/cureus.31351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
Abdominal trauma injuries are caused by many mechanisms including blunt and penetrating trauma injuries. Penetrating injuries are far more common than blunt injuries. Subsequently, the most affected organ during such injuries is small intestine perforations. As far as we know, there were no cases reported before about jejunal injury due to penetrating trauma. We present a case of a 20-year-old male with a stab wound injury who was initially stable in the emergency department (ED). After a set of investigations were done, the patient was discharged home. Yet, the patient presented again with late signs of peritonitis. Imaging was done and showed pneumoperitoneum. Thereafter, the patient was rushed to the operation room (OR) where the jejunal repair was performed. ED physicians must be vigilant regarding any signs of deterioration in penetrating trauma patients and should provide clear instructions to patients regarding any symptoms of the acute abdomen before any discharge.
Collapse
|
4
|
Barsky D, Ben Ya’acov A, Avraham LW, Nachman D, Eisenkraft A, Mintz Y, Shteyer E. A feasibility study using sodium alginate injection for penetrating abdominal trauma in a swine model. Sci Rep 2022; 12:17132. [PMID: 36224357 PMCID: PMC9556518 DOI: 10.1038/s41598-022-22186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 10/11/2022] [Indexed: 01/04/2023] Open
Abstract
Penetrating abdominal injury is a major cause of death in trauma. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of Very Low Viscosity (high) G (VLVG) alginate following abdominal trauma in a swine model of penetrating abdominal injury. Seven anesthetized pigs were instrumented with invasive monitoring catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG alginate (study group) and four animals with saline (control group). During 8 h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. Hemodynamically, VLVG alginate-treated animals were more stable than controls, as reflected by their lower heart rate and higher blood pressure (p < 0.05 for both). They also had lower levels of liver enzymes and lactate, and less histopathological damage. We show that VLVG alginate might be a promising new agent for reducing penetrating intra-abdominal injury, with hemostatic and biocompatibility efficiency, and tissue preserving properties. Future effort of integrating it with a dispersal device may turn it into a valuable pre-hospital emergency tool to improve survival of trauma casualties.
Collapse
Affiliation(s)
- Daniel Barsky
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, Israel
| | - Ami Ben Ya’acov
- grid.9619.70000 0004 1937 0538Juliet Keidan Pediatric Gastroenterology Institute, Shaare Zedek Medical Center and the Hebrew University of Jerusalem, Shmuel Bait St 12, Jerusalem, Israel
| | - Linn Wagnert Avraham
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel
| | - Dean Nachman
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,grid.17788.310000 0001 2221 2926Department of Internal Medicine, Hadassah Medical Center, Ein Kerem, P.O. Box 91120, Jerusalem, Israel
| | - Arik Eisenkraft
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,Faculty of Medicine, Institute for Research in Military Medicine, POB 12272, 91120 Jerusalem, Israel
| | - Yoav Mintz
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,grid.17788.310000 0001 2221 2926Department of General Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, P.O. Box 91120, Jerusalem, Israel
| | - Eyal Shteyer
- grid.9619.70000 0004 1937 0538Juliet Keidan Pediatric Gastroenterology Institute, Shaare Zedek Medical Center and the Hebrew University of Jerusalem, Shmuel Bait St 12, Jerusalem, Israel
| |
Collapse
|
5
|
Santamaria-Alza Y, Vasquez G. Are chimeric antigen receptor T cells (CAR-T cells) the future in immunotherapy for autoimmune diseases? Inflamm Res 2021; 70:651-663. [PMID: 34018005 DOI: 10.1007/s00011-021-01470-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE CAR-T cell therapy has revolutionized the treatment of oncological diseases, and potential uses in autoimmune diseases have recently been described. The review aims to integrate the available data on treatment with CAR-T cells, emphasizing autoimmune diseases, to determine therapeutic advances and their possible future clinical applicability in autoimmunity. MATERIALS AND METHODS A search was performed in PubMed with the keywords "Chimeric Antigen Receptor" and "CART cell". The documents of interest were selected, and a critical review of the information was carried out. RESULTS In the treatment of autoimmune diseases, in preclinical models, three different cellular strategies have been used, which include Chimeric antigen receptor T cells, Chimeric autoantibody receptor T cells, and Chimeric antigen receptor in regulatory T lymphocytes. All three types of therapy have been effective. The potential adverse effects within them, cytokine release syndrome, cellular toxicity and neurotoxicity must always be kept in mind. CONCLUSIONS Although information in humans is not yet available, preclinical models of CAR-T cells in the treatment of autoimmune diseases show promising results, so that in the future, they may become a useful and effective therapy in the treatment of these pathologies.
Collapse
Affiliation(s)
- Yeison Santamaria-Alza
- Rheumatology Section, Facultad de Medicina, Universidad de Antioquia, Street 52 number 61-30 lab 510, Medellín, Colombia.
| | - Gloria Vasquez
- Rheumatology Section, Facultad de Medicina, Universidad de Antioquia, Street 52 number 61-30 lab 510, Medellín, Colombia
| |
Collapse
|
6
|
Karachentsev S. Blunt trauma to abdominal solid organs: an experience of non-operative management at a rural hospital in Zambia. Pan Afr Med J 2021; 38:89. [PMID: 33889255 PMCID: PMC8033190 DOI: 10.11604/pamj.2021.38.89.20061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction although non-operative management of patients with blunt trauma to abdominal solid organs has become standard care, the role of peripheral hospitals remains poorly defined. This study reviews treatment and outcomes in patients with liver and spleen injuries at a regional hospital over a 10-year period. Methods a retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. All patients with solid visceral injuries managed between 2009 and 2019 at a rural surgical hospital in Zambia were included. On admission, the patients were offered either urgent laparotomy or non-operative management (NOM) depending on their haemodynamic status. Continuous variables were expressed as median and mean ± standard deviation; categorical data were expressed as percentages. Statistical evaluation of data was performed by two-sample t-test. Statistical significance was assigned at p<0.05. Results fourty-three patients were included. The majority of victims sustained isolated spleen or liver injury. Twenty-three patients were urgently operated due to haemodynamic instability. Splenectomy performed in 17 patients, liver laceration sutured in 5 patients. One patient underwent concomitant splenectomy and liver repair. Conservative management was attempted in 20 (47%) patients and was successful in 18 (42%). In two patients NOM failed and splenectomy was performed urgently. Two patients died postoperatively. There were no deaths in NOM group. Conclusion NOM of patients with injury to solid abdominal organs could be safely initiated in rural hospitals provided there is uninterrupted monitoring of patients' condition, well-trained staff and unrestricted access to the operating theatre (OT).
Collapse
|