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Article ; Online: Rib Somatic Dysfunction Among General Surgical Patients.

Baltazar, Gerard A / Kolwitz, Christine E / Florek, Michael G

The Journal of the American Osteopathic Association

2020

Abstract: Context: Upper abdominal or chest pain, tenderness, or sensation of the presence of a mass may lead to general surgery (GS) service referral. These symptoms may be related to rib somatic dysfunction (SD).: Objective: To describe rib SD in the GS ... ...

Abstract	Context: Upper abdominal or chest pain, tenderness, or sensation of the presence of a mass may lead to general surgery (GS) service referral. These symptoms may be related to rib somatic dysfunction (SD). Objective: To describe rib SD in the GS setting and help build a foundation for additional osteopathic manipulative treatment (OMT) research in surgical care. Methods: The authors retrospectively reviewed and analyzed the electronic medical records of patient encounters in a GS outpatient clinic or private office in Bronx, New York. Included patients had emergency department or inpatient GS consultations with the diagnosis of rib SD (ICD-9 739.8 or ICD-10 M99.08) initially made by the GS service from February 1, 2016, to January 31, 2019. Six-month follow-up data were also reviewed. Results: Twelve patients had rib SD as the underlying cause of their chief concern upon presentation to the GS service. Only 1 also had an underlying operative GS disease. The GS service treated 11 patients (91.7%) with OMT; 1 patient refused OMT. Time spent on OMT ranged from 5 to 30 minutes, with a median of 10 minutes and a mean (SD) of 12.7 (9.05) minutes. The OMT techniques used included balanced ligamentous tension, counterstrain, muscle energy, myofascial release, rib-raising, and soft tissue. All patients who received OMT demonstrated improvement, and 3 patients required osteopathic manipulative medicine/neuromuscular medicine follow-up. Conclusions: Rib somatic dysfunction may contribute to patient referral to a GS service, and OMT performed by general surgeons may help provide optimal surgical care.
Language	English
Publishing date	2020-08-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	410350-6
ISSN	1945-1997 ; 0003-0287 ; 0098-6151
ISSN (online)	1945-1997
ISSN	0003-0287 ; 0098-6151
DOI	10.7556/jaoa.2020.097
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Article: Recurrent Cutaneous Rosai-Dorfman Disease.

Michaeli, Oren / Elassa, Mohammed / Williams, Richard / Baltazar, Gerard

Cureus

2019 Volume 11, Issue 12, Page(s) e6289

Abstract: Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder, most commonly presenting with cervical lymphadenopathy. When extranodal, a rare manifestation of the disease is the presence of cutaneous lesions. Surgical excision has shown ... ...

Abstract	Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder, most commonly presenting with cervical lymphadenopathy. When extranodal, a rare manifestation of the disease is the presence of cutaneous lesions. Surgical excision has shown promising results in patients with cutaneous RDD; however, no optimal management has been elucidated. We present a 60-year-old female with recurrence of left thigh cutaneous lesions consistent with extranodal RDD whose optimal management required combined used of excision and chemotherapy.
Language	English
Publishing date	2019-12-04
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.6289
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Article ; Online: Management of mass casualties due to COVID-19: handling the dead.

Petrone, Patrizio / Joseph, D'Andrea K / Jacquez, Ricardo A / Baltazar, Gerard A / Brathwaite, Collin E M

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2021 Volume 47, Issue 5, Page(s) 1343–1349

Abstract: A high number of fatalities can occur during major disasters or during events like the COVID-19 pandemic. In a natural disaster, the dead must be removed from disaster sites while rescue work is in progress; otherwise, the health and safety of the ... ...

Abstract	A high number of fatalities can occur during major disasters or during events like the COVID-19 pandemic. In a natural disaster, the dead must be removed from disaster sites while rescue work is in progress; otherwise, the health and safety of the community are threatened. The COVID-19 pandemic is analogous to a natural disaster with mass casualties where the disaster sites are hospitals with morgues that are overwhelmed. As the number of the deceased rise rapidly and hospital morgues are at their full capacity, hospitals use what is called a Body Collection Point (BCP). BCP is defined as a temporary refrigeration unit used to store decedents until transport is arranged. Decedents should always be handled in a manner denoting respect, and provisions and management of resources should be properly mobilized to ensure this. Contingency plans must be created to prepare for worsening of the disaster that further overwhelms the capacity of the health care systems.
MeSH term(s)	COVID-19 ; Disaster Planning ; Humans ; Mass Casualty Incidents ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2021-06-05
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-021-01717-w
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Article: Large Bowel Obstruction Subsequent to Resected Lobular Breast Carcinoma: An Unconventional Etiology of Malignant Obstruction.

Amberger, Melissa / Presnick, Nancy / Baltazar, Gerard

Case reports in surgery

2018 Volume 2018, Page(s) 6085730

Abstract: Introduction: Breast cancer metastasis to the gastrointestinal tract is rare and mostly limited to case reports which recommend consideration of metastasis when breast cancer patients particularly those with invasive lobular carcinoma present with new ... ...

Abstract	Introduction: Breast cancer metastasis to the gastrointestinal tract is rare and mostly limited to case reports which recommend consideration of metastasis when breast cancer patients particularly those with invasive lobular carcinoma present with new gastrointestinal complaints. Presentation of case: We report a 50-year-old female who presented with gastrointestinal symptoms of nausea and vomiting determined to be the result of large bowel obstruction secondary to rectosigmoid metastasis and carcinomatosis of breast invasive lobular carcinoma. She was treated with diverting loop sigmoid colostomy for her large bowel obstruction. Discussion: Our case reflects the importance of gastrointestinal surveillance of patients with a history of breast cancer. Current National Comprehensive Cancer Network (NCCN) guidelines for stage I-II breast cancer suggest posttreatment lab and imaging evaluation for metastasis only if new symptoms present. Conclusion: We observed an unusually rapid disease progression, requiring evaluation of new gastrointestinal symptoms. Assessment for GI tract metastatic involvement should be done as early as progression to symptomatic disease can result in need for further invasive surgery in advanced stages of cancer.
Language	English
Publishing date	2018-06-13
Publishing country	United States
Document type	Case Reports
ZDB-ID	2657697-1
ISSN	2090-6919 ; 2090-6900
ISSN (online)	2090-6919
ISSN	2090-6900
DOI	10.1155/2018/6085730
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Article ; Online: Stop the Bleed: A Prospective Evaluation and Comparison of Tourniquet Application in Security Personnel Versus Civilian Population.

Petrone, Patrizio / Baltazar, Gerard / Jacquez, Ricardo A / Akerman, Meredith / Brathwaite, Collin E M / Joseph, D'Andrea K

The American surgeon

2022 Volume 89, Issue 6, Page(s) 2481–2485

Abstract: Introduction: Stop the Bleed (STB) is a national training program aiming to decrease the mortality associated with life-threatening bleeding due to injury. The purpose of this study was to evaluate the efficacy and confidence level of security personnel ...

Abstract	Introduction: Stop the Bleed (STB) is a national training program aiming to decrease the mortality associated with life-threatening bleeding due to injury. The purpose of this study was to evaluate the efficacy and confidence level of security personnel placing a tourniquet (TQ) compared to civilians. Methods: Pre and post questionnaires were shared with security personnel (Group 1) and civilians (Group 2). Both groups were assessed to determine comfort level with TQ placement. Time and success rate for placement was recorded pre- and post-STB training. A generalized linear mixed model or generalized estimating equations was used to compare pre and post measurements. Results: There were 234 subjects enrolled. There was a statistically significant improvement between the pre- and post-training responses in both groups with respect to comfort level in placing a TQ. Participants also demonstrated increased familiarity with the anatomy and bleeding control after STB training. A higher successful TQ placement was obtained in both groups after STB training (Pre-training: Group 1 [17.4%], Group 2 [12.8%]; Post-training: Group 1 [94.8%], Group 2 [92.3%]). Both groups demonstrated improved time to TA placement with a longer mean time improvement achieved in Group 1. Although the time to TQ placement pre-and post-training was statistically significant, we found that the post-training times between Groups 1 and 2 were similar (P = .983). Conclusions: Participants improved their confidence level with the use of hemorrhage control techniques and dramatically increased the rate and time to successful placement of a TQ. While civilians had the greatest increase in comfort level, the security personnel group saw the most significant reduction in the time to successful TQ placement. These findings highlight the critical role of STB in educating and empowering both civilians and security personnel in bleeding control techniques.
MeSH term(s)	Humans ; Tourniquets ; Hemorrhage/etiology ; Hemorrhage/prevention & control ; Surveys and Questionnaires
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221101489
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Article ; Online: Outcomes in Obese vs Non-Obese Injured Patients at a Level 1 Trauma Center and Bariatric Surgery Center of Excellence.

Petrone, Patrizio / Joseph, D'Andrea K / Baltazar, Gerard / Akerman, Meredith / Howell, Raelina S / Brathwaite, Collin E M

The American surgeon

2022 Volume 89, Issue 5, Page(s) 1899–1905

Abstract: Background: We hypothesized that the outcomes of trauma patients with a body mass index (BMI) equal to or greater than 30 compared to patients with BMI less than 30 would not differ at a level 1 trauma center that is also a Metabolic and Bariatric ... ...

Abstract	Background: We hypothesized that the outcomes of trauma patients with a body mass index (BMI) equal to or greater than 30 compared to patients with BMI less than 30 would not differ at a level 1 trauma center that is also a Metabolic and Bariatric Surgery Center of Excellence in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). Study design: Patients equal to and greater than 18 years old treated between 1/1/2018 and 12/31/2020 were included. Demographics, BMI, comorbidities, and outcomes (hospital-LOS, ICU-LOS, blood products used, and mortality) were compared between 2 groups: obese (BMI ≥30) vs non-obese (BMI <30). Results: Of the 4192 patients identified, 3821 met the inclusion criteria; 3019 patients had a BMI <30, and 802 had a BMI ≥30. There was a statistically significant difference between the 2 groups with respect to gender (females: 57% vs 47%, Conclusions: Obesity did not correlate with poorer outcomes at an ACS-verified level 1 Trauma Center and Bariatric Surgery Center of Excellence. Further studies are needed to determine whether outcomes vary at hospitals without both designations.
MeSH term(s)	Female ; Humans ; Adolescent ; Trauma Centers ; Obesity/complications ; Obesity/surgery ; Obesity/epidemiology ; Bariatric Surgery ; Body Mass Index ; Comorbidity ; Retrospective Studies ; Obesity, Morbid/complications ; Obesity, Morbid/surgery
Language	English
Publishing date	2022-03-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221083954
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Article: Osteopathic Manipulative Treatment Relieves Post-concussion Symptoms in a Case of Polytrauma.

Baltazar, Gerard A / Kolwitz, Christine / Petrone, Patrizio / Stright, Adam / Joseph, D'Andrea

Cureus

2020 Volume 12, Issue 3, Page(s) e7317

Abstract: Optimal management of post-concussion symptoms (PCS) remains ill-defined but includes multimodal, symptom-guided plans of care. Osteopathic manipulative treatment (OMT) may be used as an adjunct treatment for PCS. We present a case of a motor vehicle ... ...

Abstract	Optimal management of post-concussion symptoms (PCS) remains ill-defined but includes multimodal, symptom-guided plans of care. Osteopathic manipulative treatment (OMT) may be used as an adjunct treatment for PCS. We present a case of a motor vehicle collision victim whose PCS improved directly and progressively after OMT. To our knowledge, this is the first report of OMT utilized for PCS management after polytrauma and as part of an organized trauma system. Previous studies discuss potential benefits of OMT for patients with PCS after sports-related injuries, and none account for management of multiply injured patients as part of an organized trauma system. Further study of OMT for PCS is warranted and would benefit by recruiting patients from trauma centers in order to observe a range of mechanisms of injury that result in concussion.
Language	English
Publishing date	2020-03-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.7317
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Article: Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy.

Hakmi, Hazim / Joseph, D'Andrea K / Sohail, Amir / Tessler, Lee / Baltazar, Gerard / Stright, Adam

Journal of surgical case reports

2020 Volume 2020, Issue 6, Page(s) rjaa172

Abstract: Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we ... ...

Abstract	Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients' head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.
Language	English
Publishing date	2020-06-19
Publishing country	England
Document type	Case Reports
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjaa172
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Article ; Online: Management of adult renal trauma: a practice management guideline from the eastern association for the surgery of trauma.

Aziz, Hiba Abdel / Bugaev, Nikolay / Baltazar, Gerard / Brown, Zachary / Haines, Krista / Gupta, Sameer / Yeung, Lawrence / Posluszny, Joseph / Como, John / Freeman, Jennifer / Kasotakis, George

BMC surgery

2023 Volume 23, Issue 1, Page(s) 22

Abstract: Background: The kidney is the most frequently injured component of the genitourinary system, accounting for 5% of all trauma cases. Several guidelines by different societies address the management of urological trauma. However, unanswered questions ... ...

Abstract	Background: The kidney is the most frequently injured component of the genitourinary system, accounting for 5% of all trauma cases. Several guidelines by different societies address the management of urological trauma. However, unanswered questions remain regarding optimal use of angioembolization in hemodynamically stable patients, indications for operative exploration of stable retroperitoneal hematomas and renal salvage techniques in the setting of hemodynamic instability, and imaging practices for patients undergoing non-operative management. We performed a systematic review, meta-analysis, and developed evidence-based recommendations to answer these questions in both blunt and penetrating renal trauma. Methods: The working group formulated four population, intervention, comparator, outcome (PICO) questions regarding the following topics: (1) angioembolization (AE) usage in hemodynamically stable patients with evidence of ongoing bleeding; (2) surgical approach to stable zone II hematomas (exploration vs. no exploration) in hemodynamically unstable patients and (3) surgical technique (nephrectomy vs. kidney preservation) for expanding zone II hematomas in hemodynamically unstable patients; (4) frequency of repeat imaging (routine or symptom based) in high-grade traumatic renal injuries. A systematic review and meta-analysis of currently available evidence was performed. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were used. Recommendations were voted on by working group members and concurrence was obtained for each final recommendation. Results: A total of 20 articles were identified and analyzed. Two prospective studies were encountered; the majority were retrospective, single-institution studies. Not all outcomes projected by PICO questions were reported in all studies. Meta-analysis was performed for all PICO questions except PICO 3 secondary to the discrepant patient populations included in those studies. PICO 1 had the greatest number of articles included in the meta-analysis with nine studies; yet, due to differences in study design, no critical outcomes emerged; similar differences among a smaller set of articles prevented observation of critical outcomes for PICO 4. Analyses of PICOs 2 and 3 favored a non-invasive or minimally invasive approach in-line with current international practice trends. Conclusion: In hemodynamically stable adult patients with clinical or radiographic evidence of ongoing bleeding, no recommendation could be made regarding the role of AE vs. observation. In hemodynamically unstable adult patients, we conditionally recommend no renal exploration vs. renal exploration in stable zone II hematomas. In hemodynamically unstable adult patients, we conditionally recommend kidney preserving techniques vs. nephrectomy in expanding zone II hematomas. No recommendation could be made for the optimal timing of repeat imaging in high grade renal injury. Level of evidence: Guideline; systematic review, level III.
MeSH term(s)	Humans ; Adult ; Retrospective Studies ; Prospective Studies ; Wounds, Nonpenetrating/complications ; Kidney/diagnostic imaging ; Kidney/surgery ; Wounds, Penetrating/surgery ; Hemorrhage ; Hematoma/etiology ; Hematoma/surgery
Language	English
Publishing date	2023-01-27
Publishing country	England
Document type	Systematic Review ; Meta-Analysis ; Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-023-01914-x
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Article ; Online: Response to letter to the editor regarding article: Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma.

Mahoney, Eric J / Bugaev, Nikolay / Appelbaum, Rachel / Goldenberg-Sandau, Anna / Baltazar, Gerard A / Posluszny, Joseph / Dultz, Linda / Kartiko, Susan / Kasotakis, George / Como, John / Klein, Eric

The journal of trauma and acute care surgery

2023 Volume 95, Issue 6, Page(s) e62–e63

MeSH term(s)	Abdomen ; Abdominal Cavity/surgery ; Practice Guidelines as Topic
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004111
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