Abstract:
BACKGROUND:Management of patients with thoracic empyema ranges from tube thoracostomy drainage, with or without fibrinolytics, to operative intervention, with the optimal intervention remaining uncertain. Streptococcus milleri, typically a benign bacterium colonizing the oropharynx, has recently been reported as a potential pathogen in pneumonia and pleural space disease. Our initial experience indicated this infection, when in the pleural space, was particularly tenacious and often required major operative intervention to eradicate. Therefore, we hypothesized that patients with S milleri pleural space infections often require operative intervention as definitive treatment. METHODS:We reviewed all patients from June 17, 1999 to April 15, 2005 with S milleri infections at our level I academic trauma/acute care surgery department at a safety-net hospital. S milleri infections were diagnosed by thoracentesis, bronchoalveolar lavage, tube thoracostomy fluid, or intraoperative culture. RESULTS:Over the 70-month period evaluated, of 697 patients with S milleri infections, 39 patients had S milleri infections of the pleural space; 26 (67%) patients underwent operative intervention. The majority (72%) were men with a mean age of 46 (range 22 to 63); the underlying etiology in those patients requiring operation was pneumonia (26 patients; 67%), trauma (9 patients; 23%), postoperative infection (2 patients), foreign body ingestion (1 patient), and malignancy (1 patient). The vast majority of patients in the operative group were treated preoperatively with tube thoracostomy (88%) and antibiotics (96%). The average duration of chest tube drainage prior to operation was 4.4 days (95% confidence interval [CI] 2.6 to 6.2) and antibiotic treatment was 6.0 days (95% CI 3.8 to 8.2). Thirteen patients (50%) underwent video-assisted thoracoscopic surgery (VATS) and 13 patients required thoracotomy. VATS was performed more often when operative intervention occurred early (average hospital day 6.2) compared to initial thoracotomy or conversion from VATS to thoracotomy (average hospital day 9.8). Hospital length of stay was less in the operative group (average 24 days; 95% CI 17 to 31) than in the nonoperative group (34 days; 95% CI 19 to 49), discharge to home was greater in the operative group (77% vs. 16%), and mortality was less in operative group (0% vs. 23%). CONCLUSIONS:Despite attempts at nonoperative management, the majority of patients with a S milleri pleural space infection require operative intervention for definitive therapy. Patients diagnosed with S milleri empyema should be considered for early operative intervention due to the unrelenting nature of their infection. Operative treatment is associated with a shorter hospital length of stay, increased discharge to home, and decreased mortality.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Ripley RT,Cothren CC,Moore EE,Long J,Johnson JL,Haenel JBdoi
10.1016/j.amjsurg.2006.08.050subject
Has Abstractpub_date
2006-12-01 00:00:00pages
817-21issue
6eissn
0002-9610issn
1879-1883pii
S0002-9610(06)00604-0journal_volume
192pub_type
杂志文章abstract::Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of th...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80550-1
更新日期:1990-10-01 00:00:00
abstract:BACKGROUND:Extended release LCP-tacrolimus (LCPT) allows once-daily dosing in transplant recipients. The improved bioavailability may be beneficial for simultaneous pancreas-kidney recipients (SPK). METHODS:This is a study of 39 SPK recipients on standard immediate-release tacrolimus (IR-TAC, n = 21) or LCPT (n = 18)....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.02.027
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Post-traumatic splenic pseudocysts are uncommon. The optimal treatment is not well defined. METHODS:A retrospective chart review was conducted at the three adult hospitals in the Calgary Health Region. RESULTS:Six cases of splenic pseudocysts were found over a 6-year period. One splenic pseudocyst spontane...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2006.01.034
更新日期:2006-05-01 00:00:00
abstract::Static and dynamic forces exerted on 6-0 polypropylene suture material after carotid arteriotomy were measured in 22 adult mongrel dogs. Force was measured in 11 normotensive animals (Group I) before and 6 weeks after carotid artery repair. Force was measured in the remaining animals during normotension and induced hy...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90618-1
更新日期:1987-09-01 00:00:00
abstract:PURPOSE:To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years. METHOD:We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00611-0
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Training and experience vary widely among surgeons performing laparoscopic surgery (LS). Visual perceptual demands are greater for LS than for traditional surgery, necessitating greater understanding of surgeon variables in skill acquisition and performance. METHODS:During an LS skills course incorporating ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00574-8
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND:Making a conflict of interest declaration is now mandatory at continuing medical education CME accredited events. However, these declarations tend to be largely perfunctory. This study sought to better understand physician perceptions surrounding conflict of interest. METHODS:The same PowerPoint (Microsoft,...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.01.012
更新日期:2013-05-01 00:00:00
abstract::Fourteen infants with intestinal stenosis as a late sequela of necrotizing enterocolitis were treated at Texas Children's and Ben Taub General Hospitals from 1972 to 1979. Barium enema studies are the keystone in making the diagnosis and should be performed in any infant with abdominal distention or poor feeding after...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(81)90320-2
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:We hypothesized that the method of breast cancer margin assessment may be associated with different rates of positive margins and residual carcinoma. METHODS:A total of 178 breast cancer specimens were divided into 2 groups (A and B) based on the margin assessment method used. Rates of positive margins, re-...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.06.009
更新日期:2006-10-01 00:00:00
abstract::A seven day old dehydrated male infant was found to have acute ischemia of the leg due to acute thrombotic occlusion of an external iliac, common and superficial femoral, and popliteal arteries. Early thrombectomy and arterioplasty resulted in complete remission of ischemia. Our success with direct vascular surgery pr...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90254-8
更新日期:1975-03-01 00:00:00
abstract:BACKGROUND:We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS:Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. St...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.10.014
更新日期:2019-06-01 00:00:00
abstract::Adult male rats underwent common bile duct ligation or sham celiotomy. At intervals of 7 and 14 days postoperatively, bacteremia was induced by intravenous injection of 10(9) Escherichia coli or intraperitoneal injection of 10(6) E. coli. Serial quantitative blood cultures and quantitative whole organ cultures were ob...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90530-8
更新日期:1989-02-01 00:00:00
abstract::An improved technic has been developed to predict rapidly the critical number of bacteria in tissues. This technic gave reliable and accurate measurements for wounds containing more than 2 X 10(5) organisms per gram of tissue. It is fortuitous that 10(6) bacteria is the critical number of bacteria that will induced cl...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90174-x
更新日期:1977-06-01 00:00:00
abstract:BACKGROUND:Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia in patients with appendicitis may have a predi...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.amjsurg.2008.08.026
更新日期:2009-08-01 00:00:00
abstract::Total pancreatectomy with islet autotransplantation is a promising treatment for refractory chronic pancreatitis. We analyzed postoperative complications in 83 TPIAT patients and their impact on islet graft function. We examined patient demographics, preoperative risk factors, intraoperative variables, and 30- and 90-...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.04.007
更新日期:2020-01-01 00:00:00
abstract:INTRODUCTION:Despite the use of radiologic, endoscopic, and laparoscopic staging techniques, the rate of nontherapeutic laparotomies in patients with hilar cholangiocarcinoma remains high. This study evaluated the accuracy of preoperative high-resolution computed tomography (HRCT) to determine resectability in this set...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.10.024
更新日期:2007-06-01 00:00:00
abstract::We tested the effectiveness of a single dose of prophylactic antibiotic (gentamicin) in elective cholecystectomy in a double-blind, controlled randomized study. All patients recognized preoperatively as being at risk were excluded. The treatment group comprised of 102 patients received a single dose of gentamicin and ...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9610(86)90218-7
更新日期:1986-11-01 00:00:00
abstract:BACKGROUND:The bispectral index (BIS) is a processed electroencephalographic value (awake = 100, isoelectric = 0). The relationship of BIS and brain death (BD) is assessed. METHODS:BIS was evaluated in GCS 3 head-injured patients with BD (no brain function including apnea) or near BD (no apnea or negative ancillary te...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.05.032
更新日期:2009-12-01 00:00:00
abstract::The effects of epinephrine on the vascular perfusion of solitary Walker tumors implanted in the liver were studied in Sprague-Dawley rats. Colored silicone rubber (Microfil) solutions were injected into the arterial and portal circulations in each animal, and specimens were studied under a stereomicroscope. Internal v...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90044-6
更新日期:1980-11-01 00:00:00
abstract:BACKGROUND:Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated. METHODS:A retrospective review was conducted of patients who underwent m...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.10.014
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Using an original model, the Donor Rat Model, we showed that bile-pancreatic juice (BPJ) exclusion from gut exacerbates ligation-induced acute pancreatitis in rats. We also showed that muscarinic cholinergic M3 and CCK-A receptor expression is induced following duct ligation. Increased receptor number potent...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.07.008
更新日期:2004-11-01 00:00:00
abstract::The nephrocholedochoscope designed for inspection of the ductal system of the urinary and bladder tracts has proved to be a useful method for examining the denuded vessel wall after limited blind endarterectomy. This technic is especially helpful in endarterectomy of the common iliac arteries and also has application ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90375-5
更新日期:1976-11-01 00:00:00
abstract::The following report illustrates a rare case of small bowel obstruction which occurred when a large phytobezoar, which had formed in a proximal jejunal diverticulum, dislodged and migrated distally. Obstruction and subsequent perforation resulted when the phytobezoar passed into the narrow terminal ileum and lodged ju...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.02.018
更新日期:2008-01-01 00:00:00
abstract::Allergy to metal implants is under study at the Dartmouth-Hitchcock Medical Center using in vitro examination of white blood cell migration. Retrospective data from 121 patients confirm that allergic responses do occur. Prospective data are being gathered to investigate the incidence, prevalence and relation to morbid...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90323-2
更新日期:1980-04-01 00:00:00
abstract::We performed a 1 year review of mammographic interpretations and breast biopsy experiences at Madigan Army Medical Center, correlating biopsy results with mammographic interpretations when possible. Fibrocystic mammary dysplasia was reported in two thirds of our patients, with interpretations heavily weighted toward f...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90130-2
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:Antiphospholipid (APL) antibodies are a heterogenous group of antibodies that have been associated with an increase in bleeding complications and a marked increase in thrombotic events, both of which result in significant patient morbidity and mortality. PATIENTS AND METHODS:A retrospective analysis of pati...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(99)80285-2
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:Capsule endoscopy (CE) is a new device that enables visualization of areas of the small bowel that were previously inaccessible through other noninvasive procedures. The purpose of this study is to evaluate this new diagnostic tool and its efficacy in finding occult GI tract pathology. METHODS:A single-inst...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.08.015
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Spigelian hernias are rare defects of the abdominal wall usually appearing between the abdominal muscles, lateral to the rectus abdominis and through a debilitated Spigelian aponeurosis. Recently, mesh repair has been introduced for the treatment of these types of hernias and different approaches have been p...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.04.016
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:A review of 1993 data on length of stay (LOS) and charges for diagnosis-related group (DRG) 195 (complicated cholecystectomies) showed that Maricopa Medical Center charged more and had longer LOS than all other area hospitals. METHODS:Twenty DRG 195 charts were analyzed for the causes of the inefficiencies....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(99)80035-x
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:Burnout affects surgical residents' well-being. OBJECTIVE:We sought to identify factors associated with burnout among surgery residents. METHODS:An electronic/anonymous survey was sent to surgical residents at 18 programs, consisting of demographic/programmatic questions and validated scales for burnout, d...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.07.004
更新日期:2020-06-01 00:00:00