A Case Report of External Cardiac Pads Used for Internal Cardiac Defibrillation During Resuscitative Thoracotomy.

This is a case report regarding the use of non-conventional methods to perform internal cardiac defibrillation on a trauma patient in an austere environment. The patient was a polytrauma causality of an improvised explosive device who arrived to a far forward resuscitative surgical team during a recent armed conflict. After arrival, the patient lost pulses. An emergency resuscitative thoracotomy was performed, and the patient was noted to have ventricular fibrillation on direct cardiac visualization. In the absence of standard surgical defibrillation paddles, the team applied external defibrillator stickers directly to the patient's myocardium to deliver an electrical shock. The procedure successfully led to the return of spontaneous circulation. This report highlights a novel approach to resuscitation in resource-limited environments by a military surgical team.

Rectal Trauma: Evidence-Based Practices.

The management of rectal trauma has often been lumped in with colon trauma when, in fact, it is a unique entity. The anatomic nature of the rectum (with its intra- and extraperitoneal segments) lends itself to unique circumstances when it comes to management and treatment. From the four Ds (debridement, drainage, diversion, and distal irrigation), the management of rectal trauma has made some strides in light of the experiences coming out of the recent conflicts overseas as well as some rethinking of dogma. This article will serve to review the anatomy and types of injuries associated with rectal trauma. A treatment algorithm will also be presented based on our current literature review. We will also address controversial points and attempt to give our opinion in an effort to provide an update on an age-old problem.

Rare cause of colonic intussusception in an adult.

Colonic intussusception is an uncommon phenomenon in adults. Advanced imaging has facilitated the increase in awareness of this rare disease. When present, the lead point is most often secondary to a malignancy with primary adenocarcinoma being the most frequent cause. Current surgical management involves oncologic resections for this reason. This is a report of the third ever-reported case of colonic intussusception secondary to an angiolipoma and the first in the western hemisphere. We also demonstrate that these masses are amenable to minimally invasive resection for definitive management.

Cancer vaccines in colon and rectal cancer over the last decade: lessons learned and future directions.

INTRODUCTION: Great advances have been made in screening for and treatment of colorectal cancer (CRC), but recurrence rates remain high and additional therapies are needed. There is great excitement around the field of immunotherapy and many attempts have been made to bring immunotherapy to CRC through a cancer vaccine. Areas covered: This is a detailed review of the last decade's significant CRC vaccine trials. Expert commentary: Monotherapy with a CRC vaccine is likely best suited for adjuvant therapy in disease free patients. Vaccine therapy elicits crucial tumor infiltrating lymphocytes, which are lacking in microsatellite-stable tumors, and therefore may be better suited for these patients. The combination of CRC vaccines with checkpoint inhibitors may unlock the potential of immunotherapy for a much broader range of patients. Future studies should focus on vaccine monotherapy in correctly selected patients and combination therapy in more advanced disease.

Staying at the Cutting Edge: Partnership With a Level 1 Trauma Center Improves Clinical Currency and Wartime Readiness for Military Surgeons.

INTRODUCTION: Surgical currency is a critical component of medical corps readiness. We report a review of surgeons embedded into a civilian institution and analyze whether this improves surgical currency and wartime readiness. METHODS: Patient management and operative volume were acquired from four surgeons embedded at a civilian institution and compared to operative case loads of surgeons based at a military treatment facility (MTF). RESULTS: The surgeons embedded in the civilian institution had a mean of 49.3 cases compared to a mean of 8.3 cases for surgeons at the MTF over this 6-month period. In addition, the embedded surgeons obtained 44.4 to 94.7% of these cases during their civilian experience as opposed to cases done at the MTF. The cases performed by the embedded orthopedic surgeon (n = 247) was over 20 times the mean number of cases (mean = 12) performed at the MTF. Over a 6-month period, the trauma surgeon and general surgeon each evaluated 150 and 170 new trauma patients, respectively. In addition, the trauma/critical care surgeon cared for 250 critical care patients over this same 6-month period. CONCLUSION: This study demonstrates that embedding surgeons into a civilian institution allows them to maintain skill sets critical for currency and wartime readiness.

The future of quality measurement in the United States.

The need to practice cost efficient medicine and provide it in the safest way possible is paving the way for quality improvement (QI) programs to take off. American College of Surgeons National Surgical QI Project and Surgical Care and Outcomes Assessment Program are some of the leading examples and have provided useful data to evaluate our systems and decrease morbidity and mortality. With proven outcomes driving morbidity and mortality rates down, we have to wonder how to refine these measures to make them more relevant to specialty surgeries such as colorectal. On the contrary, participation in programs like these has placed extended requirements on hospitals and physicians. In addition, some of the quality measures may be inaccurately identifying low and high performing hospitals and individuals because of inherent flaws in the database. This could potentially be in conflict with the mission of these programs. What will be presented are some alternatives and different directions QI is moving toward.

Actinomycotic infection of the abdominal wall mimicking a malignant neoplasm.

BACKGROUND: Actinomyces infections can create diagnostic dilemmas and be mistaken for malignant tumors. METHODS: Case report and review of the pertinent English-language literature. RESULTS: A 44-year-old man who had undergone an appendectomy for perforated appendicitis presented three years later with an abdominal wall mass. He had been treated postoperatively for an abdominal wall infection with Actinomyces. Given his poor response to antibiotics and a diagnostic work-up that could not definitively rule out a malignant tumor, a wide local excision was performed. Microscopic examination revealed sulfur granules consistent with Actinomyces. CONCLUSIONS: Although the current recommendation is to treat Actinomyces infections with antibiotics, there may be a role for surgical intervention if the response to antibiotics has been suboptimal or a malignant process cannot be ruled out.