BackgroundPenetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes.MethodsAll patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P<0.05 considered statistically significant.ResultsSternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285 mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240 mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group.ConclusionsHemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring.Level of evidenceTherapeutic study, level IV.
The ATP/ADP ratio reflects mitochondrial function and has been reported to be influenced by the size of the Huntington disease gene (HD) repeat. Impaired mitochondrial function has long been implicated in the pathogenesis of Parkinson’s disease (PD) and therefore, we evaluated the relationship of the HD CAG repeat size to PD onset age in a large sample of familial PD cases. PD affected siblings (n=495) with known onset ages from 248 families, were genotyped for the HD CAG repeat. Genotyping failed in 11 cases leaving 484 for analysis, including 35 LRRK2 carriers. All cases had HD CAG repeats (range 15 to 34) below the clinical range for HD, although 5.2 percent of the sample (n=25) had repeats in the intermediate range (the intermediate range lower limit=27; upper limit=35 repeats), suggesting that the prevalence of intermediate allele carriers in the general population is significant. No relation between the HD CAG repeat size and the age at onset for PD was found in this sample of familial PD.
Objective: Hepatocellular carcinoma (HCC) has an overall 5-year survival of 17.5%, and will lead to an estimated 27,170 deaths in the United States (US) in 2016. Previous evidence suggests that HCC outcomes are worse in Nevada (NV). This research investigated HCC inpatient outcomes, and examined putative HCC etiology and patient demographics for disparities. Methods: Adult inpatient hospitalizations from 2008 to 2012 in NV and the US were retrospectively reviewed using the Nationwide Inpatient Sample and NV State Inpatient Database of the Healthcare Cost and Utilization Project. We identified 60,220 US and 2107 NV hospitalizations with diagnosed HCC using ICD-9-CM codes. Metabolic syndrome (MetS), alcohol use, and viral hepatitis ICD-9-CM codes were used to create putative etiology subgroups (Viral-HCC, MetS-HCC, Alcohol-HCC), a multiple-cause subgroup (Multiple-HCC), and a cryptogenic subgroup (Other-HCC). Weighted logistic regression analyses were conducted using SAS/STAT Ò software version 9.4. Results: Overall-HCC, MetS-HCC, Alcohol-HCC, and Other-HCC accounted for significantly greater hospitalization charges in NV compared to the US (Table 1). Alcohol-HCC and Multiple-HCC had greater mean length of stay (LOS) in NV (Table 1). Other-HCC had lower inhospital mortality in NV (p = 0.045). The US mortality odds ratio was 1.31 for AfricaneAmerican (p < 0.001) and 1.58 for Native American (p = 0.021) compared to Caucasian patients, and 1.84 (p < 0.001) for self-pay compared to Medicare patients. Conclusion: Compared to the US, Nevadan HCC hospitalizations had increased LOS (Alcohol-HCC and Multiple-HCC) and increased total charges (MetS-HCC, Alcohol-HCC, Other-HCC, Overall-HCC). Confirming previous findings, disparities varied by ethnicity and insurance status, highlighting the need for further investigation and population health interventions.
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