Biomedical subjects

W F Pizzi

Publications and source records attributed to W F Pizzi.

At least 19 recordsLinked to original sources

PubMed1999

The duration of antibiotic administration in penetrating abdominal trauma.

BACKGROUND: The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries. Not only do multiple injuries increase the risk of infection, a very high risk of serious infection is conferred by immunosuppression from hemorrhage and transfusion and the high likelihood of intestinal injury, especially to the colon. Optimal timing and choice of presumptive antibiotic therapy has been established for penetrating trauma, but duration has not been studied extensively in such seriously injured patients. The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of infection in penetrating abdominal trauma. METHODS: Three hundred fourteen consecutive patients with penetrating abdominal trauma were prospectively randomized into two groups: Group I received 24 hours of intravenous cefoxitin (1 g q6h) and group II received 5 days of intravenous cefoxitin. The development of a deep surgical site (intra-abdominal) infection as well as any type of nosocomial infection, as defined by the Centers for Disease Control and Prevention, (ie, surgical site infections, catheter-related infections, urinary tract, pneumonia), was recorded. Hospital length of stay was a secondary endpoint. Statistical analysis included chi-square tests for coordinate variables and two-tailed unpaired t tests for continuous variables. The independence of risk factors for the development of infection was assessed by multivariate analysis of variance. Significance was determined when P <0.05. RESULTS: Three hundred patients were evaluable. There was no postoperative mortality, and no differences in overall length of hospitalization between groups. The duration of antibiotic treatment had no influence on the development of any infection (P = 0.136) or an intraabdominal infection (P = 0.336). Only colon injury was an independent predictor of the development of an intraabdominal infection (P = 0.0031). However, the overall infection incidence was affected by preoperative shock (P = 0.003), colon (P = 0.0004), central nervous system (CNS) injuries (P = 0.031), and the number of injured organs (P = 0.026). Several factors, including intraoperative shock (P = 0.021) and injuries to the colon (P = 0.0008), CNS (P = 0.0001), and chest (P = 0.0006), were independent contributors to prolongation of the hospital stay. CONCLUSIONS: Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization. Infection was associated with shock on admission to the emergency department, the number of intra-abdominal organs injured, colon injury specifically, and injury to the central nervous system. Intra-abdominal infection was predicted only by colon injury. Prolonged hospitalization was associated with intraoperative shock and injuries to the chest, colon, or central nervous system.

Abdominal Injuries↗

PubMed1998

Inflammatory breast carcinoma: a community hospital experience.

BACKGROUND: Inflammatory breast cancer (IBC) is a rare form of rapidly progressive breast cancer. We reviewed the diagnosis, treatment, and outcome of IBC in our inner city community-based hospital and compared results with previous published reports. STUDY DESIGN: Twenty-five patients were diagnosed and treated for IBC at the Catholic Medical Center of Brooklyn and Queens during the 6-year period of January 1989 through December 1995. Criteria for inclusion in this study were clinical or histopathologic evidence, or both, of inflammatory carcinoma. RESULTS: IBC comprised 2.0% (25 of 1,257) of all breast cancer patients initially diagnosed during this study. All presented with clinical signs of IBC. Invasion of dermal lymphatics by neoplastic cells was demonstrated in 68% (17 of 25) of biopsy specimens. Sixty-eight percent (17 of 25) of patients presented with metastatic (ie, stage IV) disease and 28% (7 of 25) with stage IIIb; one patient (4%) died before staging. Estrogen and progesterone receptor studies were done on 72% (18 of 25) of all specimens. Of those patients who died, 85% were estrogen and progesterone receptor negative; of those surviving, 60% were estrogen receptor positive. Twenty (80%) of the 25 patients died, after a mean survival of 11.8 months and 5 (20%) remain alive, with a mean survival of 44.8 months. Of those who died, 85% were stage IV at presentation. All five survivors were stage IIIb at presentation. Patients underwent a variety of multimodal therapies. Survival was significantly associated with earlier stage at diagnosis and estrogen receptor positivity. CONCLUSIONS: IBC is characterized by rapid progression and dismal outcome. Earlier stage at diagnosis and positive estrogen receptor status suggest a more favorable prognosis. Neoadjuvant chemotherapy, as part of a multimodal approach, has significantly improved the outcome for IBC, but this is limited to patients with stage IIIb disease. Most of our patients presented with stage IV disease. If improvement is to be realized at the community level, limited health care resources must be directed toward aggressive physician and public education.

Adenocarcinoma↗

PubMed1997

Management of penetrating juxtahepatic inferior vena cava injuries under total vascular occlusion.

BACKGROUND: Juxtahepatic inferior vena cava injuries are often lethal. Various operative strategies have been used to improve outcome, but the mortality rate reported in the literature is 80 percent or more. The atriocaval shunt has been advocated for isolation of bleeding retrohepatic vena cava, but recent reports suggest that mortality might be even higher in patients selected for shunting, perhaps owing to ongoing hemorrhage because of indecision and delay prior to insertion, or to technical difficulty with insertion. A series of patients with juxtahepatic inferior vena cava injuries treated successfully with total vascular isolation and occlusion were studied. STUDY DESIGN: Consecutive series of 10 patients with penetrating injuries to the juxtahepatic inferior vena cava were treated at an urban, university-affiliated Level I trauma center. A rapid and direct approach was used along with isolation techniques similar to those used in liver transplantation and elective resection for neoplasm. As resuscitation continued, repair of the inferior vena cava was accomplished in a bloodless field, created by manual compression of the liver, wide exposure, portal inflow occlusion, and proximal and distal control of the inferior vena cava. Aggressive fluid resuscitation and transient aortic cross-clamping controlled resulting systemic hypotension. RESULTS: Mean injury severity score was 26 and mean penetrating abdominal trauma index score was 28. After exposure, three patients had tangential injuries controlled by undersewing a partially occluding clamp. Subdiaphragmatic aortic cross-clamping was performed if total occlusion of the inferior vena cava reduced systolic blood pressure to 60 mm Hg, which was necessary in the remaining seven patients. Nine patients survived surgery, and seven of nine survived to hospital discharge. One postoperative death was a result of multiple organ dysfunction syndrome, and the other of necrotizing bacterial pneumonia. CONCLUSIONS: Total vascular occlusion with selective use of aortic cross-clamping yielded 70 percent survival in an injury that historically has been associated with survival of 20 percent or less. Minimization of visceral ischemia is accomplished by occluding the aorta only after complete isolation of the inferior vena cava.

Adolescent↗

PubMed1996

Perforated colorectal carcinomas.

BACKGROUND: Colorectal carcinomas that present with perforation are stated in the literature to carry a poor prognosis. This study is to verify or refute the dismal connotation associated with perforated colorectal carcinomas (PCCs). METHODS: A retrospective analysis of 1551 patients with colorectal carcinoma revealed that 51 (3.3%) patients presented with perforation. Mary Immaculate and St. John's Queens Hospital Divisions of the Catholic Medical Center of Brooklyn and Queens chart and tumor board data were retrieved for the period 1983 through 1993. RESULTS: Localized perforation with abscess formation occurred in 31 (61%) patients, and free perforation with generalized peritonitis in occurred 20 (39%) patients. Sixteen (31%) patients had distant metastasis at diagnosis with a mean survival of only 6 months. Overall operative mortality rate was 12%, and overall 5-year survival rate was 32%. By excluding 16 patients with documented Stage IV disease at diagnosis and 6 operative mortalities (3 of whom also had Stage IV disease at diagnosis), the remaining 32 patients had a mean survival of 59 months and a 5-year survival of 58%. CONCLUSION: In view of the 58% survival in our subset of patients, aggressive management is recommended. This includes management of sepsis and radical surgical resection of adjacent involved organs. A negative attitude associated with PCC is not substantiated in this retrospective 10-year study.

Carcinoma↗

PubMed1993

Hepatic duct transection during laparoscopic cholecystectomy.

A rare anatomical variation was encountered during a laparoscopic cholecystectomy. The right hepatic duct emptied into the infundibulum of the gallbladder. This confluence then joined the left hepatic duct to form the common bile duct. The right hepatic duct was transected between the gallbladder and the common bile duct as a normal cystic duct would have been isolated and divided laparoscopicaly. This anatomic variant was recognized after further mobilization of the gallbladder from the liver bed. A laparotomy was performed to create a right hepatic duct enteric anastomosis. The case illustrates one possible pitfall that may be encountered during laparoscopic cholecystectomy.

Adult↗

PubMed1993

Agenesis of the gallbladder revisited laparoscopically.

Gallbladder agenesis is an extremely rare disease. Necropsy incidence has been reported to be 0.016%. Failure to locate the gallbladder at the time of a planned cholecystectomy can be very challenging. We report such a case during a laparoscopic cholecystectomy. The indication for surgery in these patients are complaints of gallbladder symptoms along with a false-positive ultrasound study. During exploration, an abnormal location of the gallbladder has to be excluded. Ectopic gallbladder locations include intrahepatic, lesser omentum, retroperitoneal, retrohepatic, within the falciform ligament, retroduodenal, and retrohepatic areas. Thorough exploration and cholangiography are essential. Embryologically, the gallbladder and cystic duct arise from the caudal portion of the hepatic bud. All of the previously reported cases of gallbladder agenesis have shown an absence of both the gallbladder and cystic duct. We report an embryological oddity wherein a patent cystic duct was found along with an agenetic gallbladder. This is the first case report of this finding, along with this being the first absent gallbladder discovered laparoscopically.

Cholecystectomy, Laparoscopic↗

PubMed1993

Implications of risk factors in necrotizing fasciitis.

The following risk factors, previously associated with necrotizing fasciitis, were identified in 25 consecutive patients: diabetes mellitus, intravenous drug abuse, age greater than 50, hypertension, and malnutrition/obesity. Additional data recorded included the duration of illness to the time of the first operative procedure, the type of procedure performed, the anatomic location of the infection, the etiology, culture reports, and leukocyte counts. The goal of this study was to determine whether the number of risk factors present in a patient was predictive of mortality. Six patients (24%) died and 19 patients survived. The nonsurvivors exhibited a significantly higher percentage of diabetes mellitus, 83 per cent versus 37 per cent (P = 0.047). Fifteen of 19 survivors (79%) and only one of six nonsurvivors (17%) had fewer than three risk factors (P = 0.006). In conclusion, more than three previously identified risk factors present in patients with necrotizing fasciitis were found to be predictive of a mortality rate of 50 per cent. The mainstay of treatment remains aggressive surgical intervention, broad-spectrum antibiotics, and nutrition support.

Age Factors↗

PubMed1993

Body smuggling of illicit drugs: two cases requiring surgical intervention.

The smuggling of illicit drugs by concealing them within the human body has become a widespread practice. Those individuals who transport packaged drugs are commonly known as "body packers" or "mules". "Body stuffers," on the other hand, are individuals who emergently place the contraband in a body orifice when they sense apprehension is imminent. In the latter instance, the drugs are not well packaged for transportation by human "consumption," hence the high risk for leakage. These individuals require prompt surgical attention under two circumstances: when they are found to suffer from drug overdosage caused by inadvertent leakage or when obstruction in the body is caused by the drug-laden bags. Two such cases are reported. The first patient presented with acute drug overdose and required an emergency laparotomy. The second patient presented with pyloric obstruction and was treated by endoscopic removal of the bag. One must be aware that these patients are walking time bombs, carrying drugs that may be well packed but have the potential to deliver a lethal dose without warning. Knowledge of the type of drug and type of packaging are essential in managing these patients. The overall plan should be close observation, careful monitoring, conservative therapy, and expectant rapid surgical intervention as needed.

Adult↗

PubMed1992

Avoiding complications and decreasing costs of central venous catheter placement utilizing electrocardiographic guidance.

A technique for electrocardiographic (ECG) guided percutaneous placement of central venous catheters (CVC) was studied in a prospective, randomized manner. In 34 patients, 51 ECG guided percutaneous CVC were compared with 29 blind percutaneous CVC in 23 patients. Thirty-nine percent of CVC placements were changes over a guide wire. Ideal catheter tip location at the atriocaval junction was achieved in 96 percent of the patients in the study versus 59 percent of those in the control group (p less than 0.001). In addition, we report 25 patients with open placement of CVC using intraoperative ECG guidance and fluoroscopic confirmation. Ideal location of the catheter tip was achieved in 100 percent of these patients. ECG guided CVC placement using the technique described herein obviates the need for catheter repositioning, repeat roentgenographic studies and intraoperative fluoroscopic imaging, along with the attendant costs and radiation exposure to staff and patient. Aberrant catheter tip placement and the associated morbidity are also eliminated.

Arrhythmias, Cardiac↗

PubMed1990

Acute gastroduodenal perforations associated with use of crack.

Crack, the free-base form of cocaine, was introduced as an illicit street drug in 1986. Since then, we have noted a significant increase in acute gastroduodenal perforations. Between 1982 and 1986, we treated 11 patients with such perforations. This represents a constant occurrence rate of 6% of hospital admissions for peptic ulcer disease. Since 1986 we have treated 16 patients with gastroduodenal perforation, which yields an occurrence rate of 16%. Nine of the 16 patients had a close temporal relationship between the use of crack and the onset of their perforation. This group was younger and disproportionately comprised of male patients. These findings led us to believe that there may be a pathogenic relationship between the use of crack and acute gastroduodenal perforation, and the clinician should be aware of the various potential complications of this new drug. This relationship also raises questions about the exact pathophysiology of peptic ulcer disease.

Adult↗

PubMed1990

Adult foregut duplication.

We report a gastric duplication in a 23-year-old man. The case is unique because the stomach is the rarest location for enteric duplication, the duplication almost never occurs in adults, and the duplication consisted exclusively of pancreatic tissue. This extreme example illustrates the close embryologic and anatomic association between stomach and pancreas. A case is made for the use of the general term of foregut duplication to avoid confusing nomenclature.

Adult↗

PubMed1989

Small-bowel obstruction by an inflatable penile prosthesis reservoir.

Early experience with the inflatable penile prosthesis has been plagued with high failure rates. With improvements in design and surgical technique, the relative incidence of mechanical failures has decreased from 69.9% of all complications to 38.2%, increasing the relative importance of pathologic failures (from 27.3% to 56.4%). The overall complication rate has decreased from an initial 32.5% to 9.0% in recent series. A unique case of small-bowel obstruction caused by intraluminal migration of the reservoir of an inflatable penile prosthesis is described. It was successfully managed by resection of the affected bowel loop and extraperitoneal reimplantation of the reservoir. Although general surgeons are not involved in the placement of these devices, it is important for us to be aware of the possibility of erosion and migration of the component parts, which may result in potentially lethal gastrointestinal and other complications that we may be called on to assess.

Adult↗

PubMed1989

Electrocardiographic guidance for percutaneous placement of central venous catheters.

A new technique is described for the percutaneous insertion of central venous catheters under direct ECG guidance, using the intraluminal column of saline solution as a transvenous electrode. This method is safe and allows the correct placement of the catheter tip in the superior vena cava, regardless of anatomic variations in the length of the central veins. It also identifies the aberrantly located catheter, thus preventing potential complications, such as irritation of the right ventricle by the catheter tip and extravascular infusion of solutes.

Catheterization, Central Venous↗

PubMed1987

Jumping from the Brooklyn Bridge.

In an attempt to identify factors contributing to survival of free fall and impact, we evaluated the records of four patients who survived a jump from the Brooklyn Bridge into the East River in New York Harbor between 1977 and 1985. All four patients were male and ranged in age from 22 to 67 years. They had free falls of between 41.0 and 48.8 meters. All of the patients were brought to the hospital within 24 minutes of entering the water. Three of the four had emergency surgical treatment and the fourth patient had only minor injuries. All four patients survived the suicide attempts. The length of the hospital stay ranged from two to 26 days.

Adult↗

PubMed1986

Indications for intubation in blunt chest trauma.

The value of endotracheal intubation and internal stabilization in severe chest injuries is well known. Recent reports have proposed that many such patients can be managed without intubation. To determine which patients need intubation we reviewed 140 patients with three or more rib fractures who presented to our hospitals from 1 January 1979 through 31 December 1983: 119 nonintubated patients (Group A); 13 patients intubated on admission (Group B); five patients intubated after hospital day 1 (Group C); and three patients intubated questionably on admission (Group D). The purpose of this report was to identify the factors which indicated severe pulmonary injury necessitating intubation. The need for intubation was correlated with five risk factors: 1) initial respiratory rate of over 25 min; 2) pulse greater than 100 min; 3) systolic blood pressure less than 100 mm Hg; 4) poor initial arterial blood gas; 5) the presence of other injuries. There was no correlation between severity of pulmonary injury and number of fractures, bilateral and/or segmental fractures, flail chest, contusion of lung, or age of patient. There was a greater percentage of complications and deaths in intubated patients (Groups B, C, and D). Group C patients all had poor initial blood gases and were erroneously not intubated early, even though 60% of them had three or more risk factors, as did Group B patients. Only 4% of patients who did not need intubation (Group A) had three or more risk factors. Group D patients were intubated without apparent indication. They had good initial blood gas levels and only one risk factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1981

Bone scanning in the detection of occult fractures.

The potential role of bone scanning in the early detection of occult fractures following acute trauma was investigated. Technetium 99m pyrophosphate bone scans were obtained in patients with major clinical findings (e.g., pain, swelling, tenderness) and negative or equivocal roentgenograms following trauma. Bone scanning facilitated the prompt diagnosis of occult fractures in the hip, knee, wrist, ribs and costochondral junctions, sternum, vertebrae, sacrum, and coccyx. Several illustrative cases are presented. Roentgenographic confirmation occurred following a delay of days to weeks and, in some instances, the roentgenographic findings were subtle and could be easily overlooked. This study demonstrates bone scanning to be invaluable and definitive in the prompt detection of occult fractures.

Acetabulum↗

PubMed1981

Gastric lipomas: a rare cause of massive upper gastrointestinal bleeding.

Gastric lipomas are rare and most frequently present as upper gastrointestinal bleeding. Wide excision is advocated for small lesions and incisional biopsy followed by excision or shelling out of the tumor for large lesions. Histologic confirmation is essential so that a cancer operation, should it be necessary, will not be compromised. Concomitant lesions must be sought and treated appropriately.

Endoscopy↗

PubMed1978

Life-support training in high-density population centers.

Death and disability from ischemic heart disease, trauma, and other medical emergencies may be reduced significantly by developing an Emergency Medical Services system based on training for the nonmedical population in basic life-support skills; this is particularly appropriate in high-density population centers where professional response time is complicated by confestion and traffic. A pilot project in New York City, which designed and implemented a first-response capability for medical emergencies in corporations, using employees in a system congruent with the fire warden plans in effect, was completed in May 1977. To obtain an initial assessment of the medical impact of such training and the effectiveness of such a medical emergency response system during the pilot phase, The Regional Emergency Medical Services Council of New York City, Inc., obtained reports from the 24 participating corporations on all reported medical and surgical emergencies occurring in the working environment. The authors conclude that this approach to development of a first response-capability can provide an effective community base for an effective Emergency Medical Services system in urban areas.

Adult↗