Primary stenting of the SFA and PA provides durable results in patients with TASC A and B lesions and may be an effective treatment strategy. This approach is significantly less effective when used in treating those with TASC C and D disease. Based on the results in this series, the use of primary stenting does not extend the anatomic limits of the current treatment recommendations for catheter-based intervention in patients with infrainguinal occlusive disease.
The injection of liquid silicone for cosmetic augmentation has a history of both legal as well as illicit practice in the United States and worldwide. Recently, the American Society of Plastic Surgeons has launched a public awareness campaign through patient stories and various statements in response to the rise in deaths related to this illicit practice. A articular segment of the population that has become a target is the transgender patient group. A brief review is provided of the history of industrial liquid silicone injection, including the pathophysiology to fully describe and review silicone injection injury. Three cases of soft tissue cellulitis and wound necrosis treated at our institution are summarized and a treatment algorithm proposed based on literature review of treatment options and our own experience.
Vascular surgical site infections (VSSIs) result in significant patient morbidity and hospital cost. The objective of this study is to report a single hospital's experience using the National Surgical Quality Improvement Program (NSQIP) as an instrument to decrease VSSIs. After review of initial NSQIP data, changes in antibiotic dosage and timing, surgical preparation, patient warming, and oxygenation were put into practice. Records of all patients undergoing vascular surgical operations during a two-year period were reviewed and VSSIs were identified. Statistical comparisons were made between groups before and after implementation of these changes. A total of 478 cases met our criteria. Practice changes were introduced in October 2009 and fully implemented by January 2010. Two hundred forty-three cases were performed in 2009 and 235 in 2010. When operations during the two time periods were compared, significantly fewer VSSIs were identified in 2010 than in 2009 ( P = 0.036). NSQIP enabled our institution to identify an unacceptably high level of VSSIs. By implementing changes in our clinical practice, we were able to significantly lower our rate of VSSI.
The purpose of this study was to assess the incidence and clinical significance of famotidine-associated thrombocytopenia in the trauma patient population. A retrospective cohort study was performed between January 2003 and May 2009 comparing the consecutive platelet counts of trauma patients treated with intravenous famotidine with a similar group of trauma patients who were not. Patients were excluded if: 1) daily platelets counts for 48 hours were not drawn; 2) if platelet counts were less than 150 X 103/μL on admission or before initiation of famotidine treatment; 3) if patients received heparin or enoxaparin before or during the study period; and 4) if patients were taking famotidine before admission. Platelet counts were then recorded for the day of admission, the day famotidine was started if not on admission, and 24 hours and 48 hours during treatment. Seventy-two of 181 (39.8%) patients treated with famotidine developed thrombocytopenia compared with 23 of 126 (18.3%) untreated patients ( P < 0.001). Patients who developed thrombocytopenia were also more likely to have a longer length of stay and higher Injury Severity Scores. Intravenous famotidine therapy was the only variable found to be statistically significant after both univariate and multivariate analysis ( P < 0.001 and P = 0.003, respectively). Thrombocytopenia became clinically significant in eight of 181 (4.4%) famotidine-treated patients or 11.1 per cent of those who developed thrombocytopenia. Given these findings, we recommend the use of alternative medications for peptic ulcer prophylaxis in the critically ill trauma patient, especially those who are coagulopathic.
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