, especially in elderly patients with morbidity and mortality rates of 11-35% and 9-22%, respectively. Age, comorbidities, American Society of Anesthesiologists (ASA) score, among other factors, have been reported as significant risk factors. However, age alone predicts poor tolerance of cancer treatment and the heterogeneity of the older cancer population requires a tailored approach that considers individual frailty, especially in the emergency setting [ 5 ]. In the present study, we aimed to compare the clinical findings and perioperative outcomes after emergencysurgery
Cardiol. 2013;29:S34-44. 4. Pernod G, Albaladejo P, Godier A, Samama CM, Susen S, Gruel Y, et al. Management of major bleeding complications and emergencysurgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors: proposals of the working group on perioperative haemostasis (GIHP). Arch Cardiovasc Dis. 2013;106:382-93. 5. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology
We describe the case of a 68-year-old patient who was admitted to the trauma unit with anisocoria after pre-hospital resuscitation upon loss of consciousness. An intracranial bleeding was ruled out. The patient was admitted to the cardiology ward with the initial diagnosis of a syncope due to myocarditis, as myocardial necrosis markers were slightly elevated. The suspicion of an acute aortic dissection (AAD) was raised when the patient developed kidney failure and a progressive aortic regurgitation. He underwent emergency surgery for an acute type A AAD. Renal function recovered completely and, fortunately, the patient was discharged 10 days later.
Confounding by indication is a critical challenge in evaluating the effectiveness of surgical interventions using observational data. The threat from confounding is compounded when using medical claims data due to the inability to measure risk severity. If there are unobserved differences in risk severity across patients, treatment effect estimates based on methods such a multivariate regression may be biased in an unknown direction. A research design based on instrumental variables offers one possibility for reducing bias from unobserved confounding compared to risk adjustment with observed confounders. This study investigates whether a physician’s preference for operative care is a valid instrumental variable for studying the effect of emergency surgery. We review the plausibility of the necessary causal assumptions in an investigation of the effect of emergency general surgery (EGS) on inpatient mortality among adults using medical claims data from Florida, Pennsylvania, and New York in 2012–2013. In a departure from the extant literature, we use the framework of stochastic monotonicity which is more plausible in the context of a preference-based instrument. We compare estimates from an instrumental variables design to estimates from a design based on matching that assumes all confounders are observed. Estimates from matching show lower mortality rates for patients that undergo EGS compared to estimates based in the instrumental variables framework. Results vary substantially by condition type. We also present sensitivity analyses as well as bounds for the population level average treatment effect. We conclude with a discussion of the interpretation of estimates from both approaches.
A hypercalcaemic crisis, also called para thyrotoxicosis, hyper parathyroid crisis or parathyroid storm, is a complication of primary hyperparathyroidism (PHPT) and an endocrinology emergency that can have dramatic or even fatal consequences if it is not recognised and treated in time.
Two cases presented in the emergency department with critical hypercalcaemic symptoms and severe elevation of serum calcium and parathyroid hormone levels, consistent with a hypercalcaemic crisis. The first case, a 16-year-old female patient, had imaging data that highlighted a single right inferior parathyroid adenoma and a targeted surgical approach was used. The second case, a 35-year-old man was admitted for abdominal pain, poor appetite, nausea and vomiting. Laboratory tests revealed severe hypercalcaemia, hypophosphatemia and an increased serum iPth level. There was no correlation between scintigraphy and ultrasonography, and a bilateral exploration of the neck was preferred, resulting in the exposure of two parathyroid adenomas. The patients were referred for surgery and recovery in both cases was uneventful
These cases support the evidence that surgery remains the best approach for patients with a hypercalcaemic crisis of hyperparathyroidism origin, ensuring the rapid improvement of both the symptomatology and biochemical alterations of this critical disease.
differentiation of cerebral cortex, uneven distribution of neurons, immature neurons with vesicular nuclei and reduced cytoplasm, triangular-shaped neurons, and proliferative glial cells. All six patients in the control group had emergencysurgery due to brain trauma, of which four were male and two were female, giving a male to female ratio of 2:1. The age of patients in the control group ranged from 17 to 55 years old (average: 36.5±16.8) and these patients had no previous history of seizures or epilepsy. Clinical data are summarized in Table 1 . Control samples represent
, emergencysurgery, renal deficiency, pulmonary hypertension,
and endocarditis were considered. The postoperative
mortality of patients with erythroblasts in peripheral
blood (n=57) was 45.6% (n=26), being significantly
higher (p<0.001) than the mortality of patients without
erythroblasts (3.0%). None of six patients with more
than 2000 erythroblasts x 106/l survived. The postop-
erative detection of erythroblasts is highly predictive
of death, the odds ratio after adjustment for the other
known prognostic factors being 7.2 (95% confidence
interval 3.4–15.1). Erythroblasts
the hernia sac and stranding of nearby fat on CT has been reported to have 98% sensitivity and specificity for the diagnosis of appendicitis inside a hernia sac [ 46 ]. The treatment of this disease is emergencysurgery. Due to the rarity of the condition there is no standard procedure. The options available include laparoscopic or open approaches either with a mesh or simple herniorrhaphy, with or without appendectomy. In our review, most cases were performed via an open approach. Appendectomy via the hernial sac is considered appropriate; in case of perforation