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Stigall K, Blough PE, Rall JM, Kauvar DS. Conversion of the Abdominal Aortic and Junctional Tourniquet (AAJT) to Infrarenal Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Is Practical in a Swine Hemorrhage Model. J Spec Oper Med 2021; 21:30-36. [PMID: 33721303 DOI: 10.55460/v5ud-1svf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Two methods of controlling pelvic and inguinal hemorrhage are the Abdominal Aortic and Junctional Tourniquet (AAJT; Compression Works) and resuscitative endovascular balloon occlusion of the aorta (REBOA). The AAJT can be applied quickly, but prolonged use may damage the bowel, inhibit ventilation, and obstruct surgical access. REBOA requires technical proficiency but avoids many of the complications associated with the AAJT. Conversion of the AAJT to REBOA would allow for field hemorrhage control with mitigation of the morbidity associated with prolonged AAJT use. METHODS Yorkshire male swine (n = 17; 70-90kg) underwent controlled 40% hemorrhage. Subsequently, AAJT was placed on the abdomen, midline, 2cm superior to the ilium, and inflated. After 1 hour, the animals were allocated to an additional 30 minutes of AAJT inflation (continuous AAJT occlusion [CAO]), REBOA placement with the AAJT inflated (overlapping aortic occlusion [OAO]), or REBOA placement following AAJT removal (sequential aortic occlusion [SAO]). Following removal, animals were observed for 3.5 hours. RESULTS No statistically significant differences in survival, blood pressure, or laboratory values were found following intervention. Conversion to REBOA was successful in all animals but one in the OAO group. REBOA placement time was 4.3 ± 2.9 minutes for OAO and 4.1 ± 1.8 minutes for SAO (p = .909). No animal had observable intestinal injury. CONCLUSIONS Conversion of the AAJT to infrarenal REBOA is practical and effective, but access may be difficult while the AAJT is applied.
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Abstract
There is rising evidence of patients' use of alternative and complementary medicine. The percentage of the U.S. population who used at least one dietary supplement increased from 42% in 1988-1994 to 53% in 2003-2006. We present a case of an Asian female in her 40s, with no previous psychiatric illness, who presented to the emergency room following a brief psychotic episode, during which she self-amputated the tips of her fingers, after using multivitamins and herbal supplements including ginseng, gui yuan rou (Chinese herb), astaxanthin, goji (Chinese fruit), selenium, saw palmetto, grape seed extract, citrus bioflavanoid, lutein (zeaxantin), resvexatrol, sun chlorella, spirulina powder, phytoceramides, phytoestrogen, glucosatrin, bromelain plus, and American bee pollen. Comprehensive laboratory workup, drug screening, and diagnostic imaging were negative. Vital signs were stable. Other than the amputated finger tips, the remainder of her physical examination was unremarkable. Her mental status improved significantly after treatment with risperidone 1 mg twice daily, during a five-day psychiatric hospitalization. This case draws attention to the fact that supplements have the potential of producing frank psychosis and require close monitoring and study by physicians.
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Affiliation(s)
- Priyanka Yadav
- 1 Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Kyle Stigall
- 2 College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Hannah E Johnson
- 3 Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Abner O Rayapati
- 4 Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Nitin Chopra
- 5 Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Wennergren JE, Plymale M, Davenport D, Levy S, Hazey J, Perry KA, Stigall K, Roth JS. Quality-of-life scores in laparoscopic preperitoneal inguinal hernia repair. Surg Endosc 2015; 30:3467-73. [PMID: 26541729 DOI: 10.1007/s00464-015-4631-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Published support exists for using lightweight polypropylene mesh (PPM) to repair inguinal hernias with increased biocompatibility and decreased foreign body reaction and pain. However, quality of life (QOL) has not been assessed. We assess QOL in patients undergoing laparoscopic totally extraperitoneal hernia repair (TEP) with lightweight PPM. METHODS We performed an IRB-approved study of patients undergoing TEP hernia repair. Demographic information and hernia characteristics were collected perioperatively. Baseline Short Form-36 (SF-36), Carolinas Comfort Scale (CCS), and visual analog scale (VAS) for pain were performed preoperatively, and then after 1, 26, and 52 weeks. RESULTS Forty-eight patients undergoing TEP with mesh were selected. Average age was 43.2 years (SD = 13.2), and average BMI was 26.1 kg/m(2) (SD = 4.3). Procedures include bilateral hernia, right inguinal hernia, and left inguinal hernia repairs. Mean scores on the CCS(®) and VAS were low during the immediate post-op period and 1 year. SF-36 mean scores for body pain, physical function, and role physical showed decreases at the postoperative survey and then subsequent increases. Pain-associated scores increased during the immediate post-op period. CCS and SF-36 scores demonstrated improvement after 1 year. There was no significant difference in VAS. Bilateral repair patients reported more pain and reduced physical function versus unilateral repairs. Patients with larger mesh reported greater pain scores and reduced physical function scores. CONCLUSIONS Laparoscopic inguinal hernia repair is associated with initial declines in QOL in the postoperative period. Improvements appear in the long term. General health does not appear to be impacted by laparoscopic TEP. Smaller mesh and unilateral repairs are associated with improved QOL following laparoscopic TEP with PPM. Multiple metrics for QOL are required to reflect patient recovery.
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Affiliation(s)
- John E Wennergren
- Department of Surgery, University of Kentucky, Lexington, KY, 40536, USA
| | - Margaret Plymale
- Department of Surgery, University of Kentucky, Lexington, KY, 40536, USA
| | - Daniel Davenport
- Department of Surgery, University of Kentucky, Lexington, KY, 40536, USA.,University of Kentucky College of Medicine, MN273 Medical Science Building, 800 Rose Street, Lexington, KY, 40536-0298, USA
| | - Salomon Levy
- Department of Surgery, University of Kentucky, Lexington, KY, 40536, USA
| | - Jeffrey Hazey
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, 43210, USA
| | - Kyle A Perry
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, 43210, USA
| | - Kyle Stigall
- University of Kentucky College of Medicine, MN273 Medical Science Building, 800 Rose Street, Lexington, KY, 40536-0298, USA
| | - J Scott Roth
- Department of Surgery, University of Kentucky, Lexington, KY, 40536, USA. .,University of Kentucky College of Medicine, MN273 Medical Science Building, 800 Rose Street, Lexington, KY, 40536-0298, USA.
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