Liposuction is one of the most commonly performed aesthetic plastic surgery procedures in the world. Although serious complications are rare, intra-abdominal complications such as bowel perforation are one of the most common causes of death after liposuction. We present a case series of six patients who sustained intra-abdominal injuries from liposuction. The acute care surgery (ACS) faculty at a single institution were surveyed for patients. Six patients were identified over a three-year period. The average age was 45 years, and all patients were female. All six underwent a cosmetic procedure in addition to their liposuction. Four (67%) had previous abdominal surgery, and five (83%) were overweight or obese. All patients presented with abdominal pain, tachycardia, and leukocytosis. All six underwent exploratory laparotomies: four patients had small bowel enterotomies, one had cecal volvulus and abdominal compartment syndrome, and one had fascial violation. They underwent an average of four ACS procedures (range 1 to 11) and had an average hospital LOS of 29 days (range 5 to 60) and an average ICU LOS of 11 days (range 1 to 39). Intra-abdominal injuries are a rare complication of liposuction; however, a high index of suspicion must be maintained to diagnose and treat these life-threatening injuries.
Introduction
Augmented renal clearance (ARC) has been reported to occur across many critical illnesses but has not been evaluated in critically ill burn patients. The impact of ARC on clinical outcomes within this population remains unknown. We hypothesize that ARC is prevalent in critically ill burn patients and is associated with improved survival.
Methods
We retrospectively reviewed a prospectively-maintained registry of Burn ICU patients from July 2021 – September 2022 at an academic burn center. We included patients in whom 24-hour urine creatinine collection was performed on admission and excluded patients in whom accurate collection was not performed within 48 hours of admission. Creatinine clearance was calculated for all patients who met inclusion criteria. ARC was determined to occur when creatine clearance exceeded 130 mL/min/1.73m2. Clinical outcomes were compared between patients with and without ARC.
Results
The analysis included 24 patients (67% male, median age 42 [31-55] years). The median percentage of total body surface area (TBSA) burned was 25 [10-38]. ARC was present in 17 patients (71%). Mean creatinine clearance was 162 ml/min/1.73m2 (range 37-313), and 7 patients (29%) had creatinine clearance greater than 200. Complication rates were low and were similar between patients with and without ARC (all p >0.05).
Conclusions
ARC appears to be a common phenomenon among critically injured burn patients. While the presence of ARC could be particularly meaningful in this population of patients that often receives massive volumes of resuscitative fluids, the sample size of our study did not permit the detection of statistically significant differences in outcomes between burn patients with and without ARC. Further work must be undertaken to assess the impact of ARC on fluid resuscitation strategies and medication dosing including that of antibiotics and thromboprophylaxis agents.
Applicability of Research to Practice
Augmented renal clearance (ARC) has never before been characterized in the population of critically injured burn patients. This topic merits further research, as it could have far-reaching clinical impact relating to fluid resuscitation practices and dosing of renally-cleared medications (antibiotics, thromboprophylaxis, etc.).
Introduction: The incidence of Hodgkin lymphoma (HL) shows a clear bimodal distribution with the first peak in young adults and the second peak in the elderly. Treatment-usually with combination chemotherapy (CT) and/or radiotherapy (RT)-has resulted in high survival rates compared to other cancers, even in patients with advanced disease.However, many patients experience long-term health problems due to therapy-related side effects, which may impact on their quality of life (QoL).
Methods
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