Mirizzi syndrome: The Trojan horse of gallbladder disease.

Background: The incidence of Mirizzi Syndrome ranges from 0.05 to 5.7 % of patients who undergo cholecystectomy. The purpose of this study is to examine the preoperative workup and postoperative outcomes for patients diagnosed with Mirizzi Syndrome. Methods: Retrospective chart review was conducted between January 2018 and January 2022 at a single institution. All adult patients who underwent cholecystectomy were included. Results: 1628 patients underwent cholecystectomy of which 47 were diagnosed with Mirizzi Syndrome. The majority of patients had type 1 Mirizzi Syndrome. Preoperative studies were often nondiagnostic and 81 % of cases were diagnosed intraoperatively. 66 % of cases were performed laparoscopically, an open approach was required for type V Mirizzi Syndrome. The complication rate was 25 %; most commonly a bile leak requiring ERCP. Conclusion: Mirizzi syndrome is more common than previously expected and related to patient's ability to seek timely medical care. Most cases can be completed laparoscopically however there is a high rate of complications. Key message: This study presents an additional cohort of patients found to have Mirizzi syndrome and supports the hypothesis that it is difficult to diagnose preoperatively. Cases should be attempted laparoscopically but there remains a high complication rate.

Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model.

BACKGROUND: Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated. AIM: To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program. METHODS: Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. OUTCOMES: All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function. RESULTS: There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline. CLINICAL IMPLICATIONS: A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. STRENGTHS AND LIMITATIONS: This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center. CONCLUSION: These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck.

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

Alcohol decreases intestinal ratio of Lactobacillus to Enterobacteriaceae and induces hepatic immune tolerance in a murine model of DSS-colitis.

Alcohol can potentiate disease in a mouse model of dextran sodium sulfate (DSS) colitis; however, the underlying mechanism remains to be established. In this study, we assessed whether the potentiated disease could be related to Enterobacteriaceae and Lactobacillus, as changes in their relative abundance can impact intestinal health. We also assessed whether the intestinal barrier is compromised after alcohol and DSS as it may increase bacterial translocation and liver inflammation. Mice were administered DSS followed by binge ethanol or water vehicle, generating four experimental groups: (Control+Vehicle, Control+Ethanol, DSS+Vehicle, DSS+Ethanol). DNA was isolated from colon and cecal contents followed by qPCR for levels of Enterobacteriaceae and Lactobacillus. Colon and liver sections were taken for histology. Intestinal epithelial cells were isolated from the colon for RNA expression. DSS+Ethanol cecal contents exhibited a 1 log increase in Enterobacteriaceae (p < .05), a 0.5 log decrease in Lactobacillus, and a 1.5 log decrease (p < .05) in the Lactobacillus:Enterobacteriaceae ratio compared to DSS+Vehicle, with similar trends in colon contents. These changes correlated with shorter colons and more weight loss. Irrespective of ethanol administration, DSS compromised the mucosal barrier integrity, however only DSS+Ethanol exhibited significant increases in circulating endotoxin. Furthermore, the livers of DSS+Ethanol mice had significantly increased levels of triglycerides, mononuclear cells, yet exhibited significantly depressed expression of liver inflammatory pathways, suggestive of tolerance induction, compared to mice receiving DSS+Vehicle. Our results suggest that ethanol after DSS colitis increases the intestinal burden of Enterobacteriaceae which may contribute to intestinal and liver damage, and the induction of immune tolerance.

Cardiology Fellow Diagnostic Accuracy and Data Interpretation Outcomes: A Review of the Current Literature.

BACKGROUND: Cardiology fellows, in particular, are in a unique position to mold the new cardiovascular workforce, especially in terms of risk prevention. There is a growing need for the cardiovascular workforce. In the United States, one person dies every forty-two seconds due to a cardiovascular adverse event. METHODS: A PRISMA systematic review included comprehensive search of the MED-LINE database (PubMed) from 1927 to 2020 - the oldest to newest available literature on the subject available through PubMed. RESULTS: Fifty-seven cardiology fellows together interpreted a total of 1719 EKGs with a correct rate of 52%. Sixty-four fellows completed a total of 1363 echocardiography interpretations with an accuracy rate of nearly 75%. CONCLUSION: Based on the studies discussed, it is evident that a cardiology fellow, particularly in their early years of training, may be limited due to a lack of experience. With continued EKG and echocardiogram interpretation, as well as other clinical skills practice, fellows can improve their diagnostic accuracy and procedural efficiency.

Large extended abdominoplasty-dispelling the myths of prohibitively high BMI's: a case report.

Abdominoplasty is one of the most highly requested cosmetic procedures in the USA. Although it is famed for its cosmetic value, there are few reports that discuss its therapeutic potential. Furthermore, few abdominoplasties are completed in patients over the body mass index (BMI) of 30 due to fears of increased complications. A 63-year-old male presented due to development of a large pannus following weight loss postgastric bypass. Unfortunately, because of this pannus, the patient began experiencing significant physical and emotional distress. The patient had difficult urinating, ambulating and could no longer engage in sexual activity. The patient underwent abdominoplasty for removal of the pannus. At the 5-month follow-up, patient exhibited resolution of his symptoms. Abdominoplasty should not be limited to cosmetic procedures. It holds therapeutic value, and the BMI should not be listed as a firm contraindication to the procedure.

Abdominoplasty for treatment of abdominal gun-shot wound sequalae - A case report.

BACKGROUND: Gun violence is a public health epidemic in the United States with 15,315 non-suicide related deaths reported in 2019 by the Gun Violence Archive. To date, abdominoplasty is primarily a cosmetic procedure, which involves low-lying incision, removal of excess skin, fat, and tissue, and strengthening of the abdominal wall musculature. There currently are limited reports in regard to abdominoplasty as a procedure for scar revision and abdominal deformity repair associated with gunshot related injuries. METHODS: An African American female patient, 38 years of age, presented for correction of a wide healed surgical incision and incisional hernia in the midline abdomen. This resulted from a trauma laparotomy in treatment of multiple gunshot wounds. RESULTS: Patient presented post-operatively with no complications. She had successful reduction of her incisional hernia using an anatomic repair. Her wide hypertrophic abdominal scar was excised and primarily closed. CONCLUSION: In the cases of abdominal hernia and scarring secondary to trauma laparotomies performed for gunshot wounds, abdominoplasty is an option for revision and repair.

Anatomic reconstruction for major tissue loss following abdominoplasty: A case report.

INTRODUCTION: Abdominoplasty is currently one of the most widely requested cosmetic procedures in the United States. There is limited literature describing the corrective measures following skin loss from a flap necrosis due to an abdominoplasty complication. METHODS: A 53-year-old female presented with a large split thickness skin graft due to skin loss as a necrotic complication from an abdominoplasty performed at our center. The patient suffered from emotional stress related to the abdominal deformity, which included a lack of an umbilicus. RESULTS: Patient recovered well post-operatively. She required two procedures - the initial procedure involved excision of the skin graft and closure with the patient's own full-thickness skin and tissue. The second procedure, which occurred six months later, involved the creation of an umbilical stalk from a small cuff of skin. CONCLUSION: Abdominoplasty, although sought for cosmetic purposes, is indeed a major procedure and can result in complications especially from aggressive liposculpture. When complications do occur, revisions are indeed possible with aesthetically pleasing results.

Does Formation of Multicellular Colonies by Choanoflagellates Affect Their Susceptibility to Capture by Passive Protozoan Predators?

Microbial eukaryotes, critical links in aquatic food webs, are unicellular, but some, such as choanoflagellates, form multicellular colonies. Are there consequences to predator avoidance of being unicellular vs. forming larger colonies? Choanoflagellates share a common ancestor with animals and are used as model organisms to study the evolution of multicellularity. Escape in size from protozoan predators is suggested as a selective factor favoring evolution of multicellularity. Heterotrophic protozoans are categorized as suspension feeders, motile raptors, or passive predators that eat swimming prey which bump into them. We focused on passive predation and measured the mechanisms responsible for the susceptibility of unicellular vs. multicellular choanoflagellates, Salpingoeca helianthica, to capture by passive heliozoan predators, Actinosphaerium nucleofilum, which trap prey on axopodia radiating from the cell body. Microvideography showed that unicellular and colonial choanoflagellates entered the predator's capture zone at similar frequencies, but a greater proportion of colonies contacted axopodia. However, more colonies than single cells were lost during transport by axopodia to the cell body. Thus, feeding efficiency (proportion of prey entering the capture zone that were engulfed in phagosomes) was the same for unicellular and multicellular prey, suggesting that colony formation is not an effective defense against such passive predators.

Cervical cord compression due to ossification of the ligamentum flavum - A case report and literature review.

BACKGROUND: Symptomatic compression of the cervical spinal cord by ossification of the ligamentum flavum (OLF) is rare. It typically involves the elderly and is particularly prominent in the Asian male population. Here, we present a 70-year-old Pakistani female who became quadriparetic due to OLF. CASE DESCRIPTION: A 70-year-old female became increasingly quadriparetic over 3 months duration, but exhibited preservation of vibration and proprioception. The cervical magnetic resonance/computed tomography revealed dorsal OLF measuring 7 mm × 25 mm × 14 mm. Two months following a decompressive laminectomy, her symptoms fully resolved. CONCLUSION: Although rare in older patients, cervical OLF may contribute to significant cervical myelopathy characterized by a progressive quadriparesis that can be readily resolved with a decompressive laminectomy.