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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Pilonidal disease is a relatively common cause of morbidity and diminished quality of life in adolescents and young adults. Accumulation of debris and ingrowth of hair within the gluteal crease leads to the formation of pits that can become inflamed. Traditional treatment approaches have included improved hygiene, hair removal, and surgical excision of the pilonidal nidus. This study sought to determine the effectiveness of a dedicated pilonidal disease clinic that treated patients according to a specific protocol, including weekly visits as necessary, improved hygiene, hair removal, and excision of pilonidal pits under local anesthesia using a skin biopsy forceps.
Outcomes in consecutive patients (n=102) assigned to the treatment protocol over a 3-year interval were analyzed. Results were available for 78 patients. Complete resolution of mild pilonidal disease occurred in 77 of these patients, and the usual duration of treatment was 30 weeks. The authors noted that a previous study comparing the reported protocol with standard excisional treatment showed that the protocol was significantly less costly than the standard approach. Although limited (24% of patients were lost to follow-up and no effort to obtain follow-up in this patient group was reported), these results suggest that a dedicated protocol focused on interventions that can be accomplished in a purely outpatient setting may have potential value for management of mild pilonidal disease in adolescents and young adults.
Management of Decompensated Cirrhosis in the Surgical ICU
This article provided a summary of recommendations from an expert consensus group sponsored by the American Association for the Surgery of Trauma that was convened for the purpose of providing guidance for management of patients with decompensated cirrhosis who require surgical critical care. Recommendations for nine areas of care were provided.
The authors noted that assessment of intravascular volume is an especially challenging task in patients with decompensated cirrhosis. They recommended using data from pulmonary artery catheters, transthoracic echocardiography, and mean arterial pressures measured with indwelling arterial catheters to assess volume status. Balanced salt solution, albumin, and (if necessary) supplemental norepinephrine were recommended as important components of resuscitation. In preoperative patients, sodium restriction, diuretics, and large-volume paracentesis were the recommended interventions for refractory ascites. A transjugular intrahepatic portosystemic shunt (TIPS) can be considered for both preoperative and postoperative patients if standard approaches for ascites management do not provide adequate control. TIPS can also be a valuable intervention for patients with gastrointestinal bleeding. The authors recommended administration of ceftriaxone in combination with other interventions for patients with gastrointestinal hemorrhage. Enteral nutrition with aggressive management of hypoglycemia was also recommended.
Ventilator Associated Pneumonia and Intubation Location in Adults with Traumatic Injuries
The authors reported a systematic review of the literature that sought to determine whether prehospital endotracheal activation was associated with an increased risk for ventilator-associated pneumonia in patients who required ongoing ventilatory support. A total of 754 published articles were evaluated, and six of these met inclusion criteria; data on 2,990 patients were analyzed. A summary of relative risk was calculated across all study arms.
Although two of the six included studies that reported an increased risk of ventilator-associated pneumonia in patients undergoing endotracheal intubation in the prehospital phase of care, the overall statistical analysis did not demonstrate a significant increase in risk for this outcome. The authors noted that patients intubated in the prehospital phase of care were more likely to be severely injured and therefore were at increased risk of prolonged ventilation and associated complications. They concluded that prehospital intubation did not increase risk for ventilator-associated pneumonia.
