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Hurley, MI, United States

Carr J.A.,Hurley Medical Center
World Journal of Surgery | Year: 2014

Purpose: To describe a novel technique using tissue expanders that allows skin coverage over large ventral hernia repairs after damage control laparotomy, including patients with stomas. Methods: A retrospective study of a single author's experience with the technique. Results: Tissue expanders were placed in the lateral abdominal wall skin adjacent to stomas and expanded over a short 6-week course. The expanders successfully stretched the skin to provide coverage over the large ventral hernia mesh repairs without infectious complications. Conclusions: The described technique is well tolerated by patients and very useful to provide skin coverage over large ventral hernia defects without infectious complications. © 2013 Société Internationale de Chirurgie. Source


Kaatz S.,Hurley Medical Center | Crowther M.,Hamilton Health Sciences | Crowther M.,McMaster University
Journal of Thrombosis and Thrombolysis | Year: 2013

The target-specific oral anticoagulants represent the first new oral anti-thrombotic therapy in over 50 years and have the potential to make therapy easier and hence more accessible to many patients. Like any new therapy, the potential benefits must be weighed against the potential challenges and one of the most concerning aspects of the new target-specific oral anticoagulants is the lack of a proven method to reverse their effect. Unlike the vitamin K antagonist, i.e. warfarin, there is no specific antidote for these medications. This paper will review the limited data on the use of non-specific therapies to reverse anticoagulation for the new agents. We hope to prepare clinicians who are faced with a patient who has serious bleeding or needs emergent surgery while taking dabigatran, rivaroxaban or apixaban. © 2013 Springer Science+Business Media New York. Source


Douketis J.D.,Duke University | Kaatz S.,Hurley Medical Center | Becker R.C.,University of Cincinnati | Caprini J.A.,NorthShore University HealthSystem | And 9 more authors.
New England Journal of Medicine | Year: 2015

Background It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecularweight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. Methods We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. Results In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI],-0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). Conclusions In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. Copyright © 2015 Massachusetts Medical Society. Source


Walton M.A.,University of Michigan | Chermack S.T.,University of Michigan | Chermack S.T.,Health Services Research and Development | Shope J.T.,University of Michigan | And 6 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Context: Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury. Objective: To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED. Design, Setting, and Participants: Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 PM and 11 PM 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). Intervention: All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. Main Outcome Measures: Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. Results: About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, -34.3%; control, -16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, -10.4%; control, +4.7%; RR, 0.70;95%CI, 0.52-0.95), and violence consequences (therapist, -30.4%; control, -13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, -32.2%; control, -17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, -29.1%; control, -17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95). Conclusion: Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences. Trial Registration: clinicaltrials.gov Identifier: NCT00251212. ©2010 American Medical Association. All rights reserved. Source


Carr J.A.,Hurley Medical Center
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: To describe the outcome of patients who had 2-octyl cyanoacrylate used as an adjunct to control air leaks after lung resection by application directly onto the visceral pleura. Methods: A retrospective review of these patients from 2007 to 2009 from a single surgeon's practice. Results: Seven challenging patients had 2-octyl cyanoacrylate used to control difficult air leaks after lung resection. The indications included lack of standard sealants in patients with emphysematous lung that would not hold suture and vast air leaks after decortications or extensive nonanatomic resections in patients that would not tolerate the loss of tidal volume. All air leaks sealed immediately and none of the patients left the operating theater with an air leak, including three patients who underwent difficult decortications for empyema. All patients recovered uneventfully, except one patient who died from acute respiratory distress syndrome. His postmortem examination revealed that the resin remained intact on the lung without signs of degradation after being in an intracorporeal environment for weeks. There were no complications nor toxicity directly related to the 2-octyl cyanoacrylate resin. Conclusions: 2-Octyl cyanoacrylate is extremely effective in immediately controlling air leaks, with the results being seen instantly. It dries quickly, does not wash off the lung, and remains intact on the visceral pleura for several weeks. 2-Octyl cyanoacrylate deserves additional testing as an adjunct to control air leaks after lung resection. © 2010 European Association for Cardio-Thoracic Surgery. Source

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