the purpose of this investigation was to identify the prevalence of hypoalbuminemia and obesity in orthopaedic trauma patients with high-energy injuries and to investigate their impact on the incidence of surgical site complications. Patients 18 years of age and older undergoing intramedullary nail fixation of their femoral shaft fractures at a university-based level-1 trauma centre were assessed. Malnutrition was measured using serum markers (albumin <3.5 g/dL) as well as body mass index (BMI) as a marker of obesity (BMi > 30 kg/m 2 ). The primary outcome measure was surgical wound complications. A total of 249 patients were included in this study. Ninety-eight patients (39.4%) presented with hypoalbuminaemia and 80 patients (32.1%) were obese. The overall incidence of wound complications in our study population was 9.65% (n = 25/259). A logistic regression model showed that non-obese patients (BMI < 30 kg/m 2 ) were at significantly reduced risk for perioperative wound complications (Odds Ratio 0.400 [95% confidence interval 0.168, 0.954], p = 0.039). This study demonstrated a substantial prevalence of hypoalbuminemia and obesity among orthopaedic trauma patients with high-energy injuries. obesity may increase the risk of surgical site complications. Future studies are required to further define malnutrition and its correlation with surgical site complications in orthopaedic trauma patients.
451 Background: Roughly 50,000 Americans are diagnosed with pancreatic cancer yearly (Howlader, N, Noone, A, Krapcho, M. Cancer Stat Facts: Pancreas Cancer. http://seer.cancer.gov/statfacts/html/pancreas ). High mortality rates following pancreatic cancer make surgical resection the primary curative method for treatment. Literature suggests significantly higher mortality rates (12.3%) in patients classified as government payers vs those with private insurance (7.3%) (Glasgow, RE, Mulvihill, SJ (1996)). Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. Western journal of medicine, 165(5),294). This study investigated disparities in use of resection as pancreatic cancer treatment, based on insurance status. Methods: A retrospective study was performed to evaluate use of pancreatic resection (ICD9: 52.51-52.53, 52.59, 52.6, 52.7) vs non-surgical options to treat patients with a principal diagnosis of pancreatic cancer (ICD9: 230.9, 157.1-157.4, 157.8, 157.9) from 2005-2014, using the Healthcare Cost and Utilization Project database. Rates of surgical resection were stratified based on insurance coverage status: private insurance, government insurance, or no insurance. Results: After adjusting for total discharges, we observed that percent pancreatic resections were highest for uninsured populations and lowest for Medicare. By 2014, the rate of surgical resections in uninsured patients decreased as a steady increase was observed for patients with Medicaid. Conclusions: Our preliminary findings suggest that the trends in rates of surgical resection as a treatment for pancreatic cancer vary by insurance status. Further research examining factors such as race, socioeconomic status, and comorbidities that increase the likelihood of uninsured patients receiving pancreatic resections vs other treatments are warranted. [Table: see text]
INTRODUCTION: Foreign bodies that are ingested may migrate from the gastrointestinal (GI) tract into different organs of the body and cause a variety of clinical manifestations including fever of unknown origin. In this vignette we describe the case of a transmural fish bone migration from the stomach to the liver causing a recurrent liver abscess. CASE DESCRIPTION/METHODS: A 76 year old Caucasian male with a past medical history of hypertension presented to the hospital with a left liver lobe abscess that was aspirated six years ago. All cultures at that time were negative and apparently resolved with antibiotics. About two months prior to his hospital admission, he started developing subjective fevers and malaise, with CT Scan of the abdomen showing a possible liver mass in the left lobe. He underwent a liver biopsy of this lesion that showed multiple caseating granulomas. Infectious work up was negative. Despite broad spectrum antibiotics, the patient continued with low grade fevers. Pancultures were negative and a left liver lobectomy and cholecystectomy was pefomed. CT imaging of the liver showed a multiloculated 7.2 cm lesion in the left lobe of the liver consistent with an abscess, with a linear foreign body which extended from the stomach into the left lobe liver lesion (Figure 1). During surgery, the foreign body was identified and removed. Surgical histology of the foreign body showed bone fragments lined by osteocytes and calcifications, which was identified as a “fish bone.” Furthermore, the left liver lobe showed prominent granulomatous inflammation with necrosis and microabscesses with no evidence of malignancy. Special stain GMS-F was positive for filamentous organisms that most closely resembled nocardia or streptomyces (Figure 2). DISCUSSION: This is the first case report showing filamentation of bacteria resembling a fungal infection causing a liver abscess due to a fish bone that penetrated the left lobe of the liver. Filamentation is a bacterial defense mechanism against eradication by antibiotics, which explains failure of resolution of the infection with antimicrobials. Studies have reported incomplete bacterial replication leading to the appearance of filamentation resembling fungal species. This phenomenon should be considered by clinicians when treating challenging liver foreign body abscesses.
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