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Article: Rare constellation of abdominal vascular injuries in blunt trauma: Left gastric artery pseudoaneurysms and dissection.

D'Souza, Karan / Bleszynski, Michael Sean / Hawes, Harvey George

International journal of surgery case reports

2019 Volume 60, Page(s) 30–33

Abstract: Introduction: Abdominal visceral artery pseudoaneurysms and dissections in blunt trauma are uncommon, however, solitary vascular injury of the left gastric artery and development of multifocal dissections are extremely rare with only 5 reported cases in ...

Abstract	Introduction: Abdominal visceral artery pseudoaneurysms and dissections in blunt trauma are uncommon, however, solitary vascular injury of the left gastric artery and development of multifocal dissections are extremely rare with only 5 reported cases in the literature. Presentation of case: A 79-year-old male presents two days after a motor boating incident in profound hemorrhagic shock. Subsequent CT imaging revealed moderate hemoperitoneum, two pseudoaneurysms of the left gastric artery measuring 6 mm and 9 mm, as well as attenuation of the artery in keeping with a focal dissection and intramural thrombus, and no active extravasation. After stabilization with blood product resuscitation, he was managed conservatively with administration of ASA and close monitoring. Conclusion: Abdominal visceral artery vascular injuries in blunt trauma can be managed safely with close monitoring, antithrombotic agent, and medical co-morbidity optimization. Instability or worsening/ persistent symptoms should be considered for endovascular treatment or surgical ligation Further research and reporting of management approaches are required.
Language	English
Publishing date	2019-05-24
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2019.05.028
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Article ; Online: Comparison of inflammatory cytokines in peritoneal fluid at source control surgery for abdominal sepsis.

Bleszynski, Michael S / Chan, Tiffany / Buczkowski, Andrzej K

American journal of surgery

2017 Volume 213, Issue 5, Page(s) 849–855

Abstract: Background: Open abdomen with vacuum assisted closure (VAC) is an alternate method to primary abdominal closure (PAC) in select situations for the management of severe surgical abdominal sepsis or septic shock. Peritoneal cytokines may potentially ... ...

Abstract	Background: Open abdomen with vacuum assisted closure (VAC) is an alternate method to primary abdominal closure (PAC) in select situations for the management of severe surgical abdominal sepsis or septic shock. Peritoneal cytokines may potentially correlate with deranged physiology and help stratify severity of sepsis. The primary objective of the study was to identify if cytokines can differentiate between patients who underwent PAC or VAC at primary source control laparotomy (SCL). Methods: Prospective case series including patients with severe abdominal sepsis/septic shock requiring urgent SCL. Peritoneal fluid (PF) was collected intra-operatively and blood samples were collected pre- and post SCL. Samples were analyzed with a Cytokine 30-plex Panel. APACHE-IV was used as a measure of disease severity between groups. Results: 4 PAC and 8 VAC patients were included. PF concentrations of IL 6, IL-17, IL-5 and HGF were significantly elevated in VAC compared to PAC. Serum RANTES was increased in survivors compared to non-survivors. Conclusions: Patients who received VAC management had a more severe degree of local abdominal sepsis based on significantly elevated peritoneal cytokines.
MeSH term(s)	APACHE ; Abdominal Wound Closure Techniques ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ascitic Fluid/metabolism ; Cytokines/metabolism ; Female ; Humans ; Laparotomy ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Prognosis ; Prospective Studies ; Sepsis/diagnosis ; Sepsis/metabolism ; Sepsis/mortality ; Sepsis/surgery ; Shock, Septic/diagnosis ; Shock, Septic/metabolism ; Shock, Septic/mortality ; Shock, Septic/surgery ; Young Adult
Chemical Substances	Cytokines
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2017.03.037
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Article ; Online: Liver Transplantation

Bleszynski, Michael Sean / Kim, Peter T. W.

The Critically Ill Cirrhotic Patient

Abstract: The field of liver transplantation has changed since the MELD scoring system became the most widely used donor allocation tool. Due to the MELD-based allocation system, sicker patients with higher MELD scores are being transplanted. Persistent organ ... ...

Abstract	The field of liver transplantation has changed since the MELD scoring system became the most widely used donor allocation tool. Due to the MELD-based allocation system, sicker patients with higher MELD scores are being transplanted. Persistent organ donor shortages remain a challenging issue, and as a result, the wait-list mortality is a persistent problem for most of the regions. This chapter focuses on deceased donor and live donor liver transplantation in patients with complications of portal hypertension. Special attention will also be placed on donor-recipient matching, perioperative management of transplant patients, and the impact of hepatic hemodynamics on transplantation.
Keywords	covid19
Publisher	PMC
Document type	Article ; Online
DOI	10.1007/978-3-030-24490-3_14
Database	COVID19

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Article: Evaluation of APACHE-IV Predictive Scoring in Surgical Abdominal Sepsis: A Retrospective Cohort Study.

Chan, Tiffany / Bleszynski, Michael S / Buczkowski, Andrzej K

Journal of clinical and diagnostic research : JCDR

2016 Volume 10, Issue 3, Page(s) PC16–8

Abstract: Introduction: Evaluation of the effectiveness of care and clinical outcomes in critically ill patients is dependent on predictive scoring models that calculate measures of disease severity and an associated likelihood of mortality. The APACHE scoring ... ...

Abstract	Introduction: Evaluation of the effectiveness of care and clinical outcomes in critically ill patients is dependent on predictive scoring models that calculate measures of disease severity and an associated likelihood of mortality. The APACHE scoring system is a logistic regression model incorporating physiologic and laboratory parameters. APACHE-IV is the most updated scoring system for ICU mortality prediction. However, APACHE scores may not accurately predict mortality in patients who require surgery for abdominal sepsis, whose trajectory is modulated by source control procedures. Aim: To evaluate the accuracy of APACHE-IV mortality prediction in a cohort of ICU patients with surgical abdominal sepsis (SABS) requiring emergent laparotomy for source control. Materials and methods: The study was conducted in a combined medical and surgical intensive care unit in a large urban Canadian tertiary care hospital. Retrospective review of 211 consecutive adult ICU admissions that fulfilled the 2012 ACCP/SCCM criteria for severe sepsis/septic shock due to abdominal source was performed. APACHE-IV score and predicted mortality rate (PMR) were calculated and evaluated using area under the ROC curve (AUROC). Results: Overall in-hospital mortality was 28.4%. There was overestimation of PMR by the APACHE-IV model in the overall cohort with an absolute difference of 16.6% (relative difference 36.9%). APACHE-IV crudely distinguished between survivors and non-survivors, with a PMR of 40% vs. 59% (p<0.001). AUROC of the APACHE-IV score was 0.67, 95% CI (0.58, 0.76) while the AUROC for the PMR was 0.72, 95% CI (0.64, 0.80), indicating poor performance in this cohort. Conclusion: APACHE-IV has poor discrimination in SABS. Future research should explore disease-specific prediction models.
Language	English
Publishing date	2016-03-01
Publishing country	India
Document type	Journal Article
ZDB-ID	2775283-5
ISSN	0973-709X ; 2249-782X
ISSN (online)	0973-709X
ISSN	2249-782X
DOI	10.7860/JCDR/2016/17629.7326
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Article ; Online: Open abdomen with negative pressure device vs primary abdominal closure for the management of surgical abdominal sepsis: a retrospective review.

Bleszynski, Michael S / Chan, Tiffany / Buczkowski, Andrzej K

American journal of surgery

2016 Volume 211, Issue 5, Page(s) 926–932

Abstract: Background: Open abdomen with temporary abdominal closure remains a controversial management strategy for surgical abdominal sepsis compared with primary abdominal closure (PAC) and on-demand laparotomy. The primary objective was to compare mortality ... ...

Abstract	Background: Open abdomen with temporary abdominal closure remains a controversial management strategy for surgical abdominal sepsis compared with primary abdominal closure (PAC) and on-demand laparotomy. The primary objective was to compare mortality between PAC and open abdomen with vacuum assisted closure (VAC). Methods: Retrospective review of a tertiary center intensive care unit database (2006 to 2010) including suspected/diagnosed severe abdominal sepsis/septic shock requiring source control laparotomy. Groups were categorized according to closure method at index source control laparotomy. APACHE-IV was used as a measure of disease severity. Results: Of 211 patients, 75 PAC and 136 VAC cases were included. Controlling for disease severity, adjusted odds ratio of mortality for VAC was .41 95% confidence interval (.21, .81; P = .01) compared with PAC. PAC and VAC APACHE-1V predicted mortality rate were both 45%. VAC mortality was lower than PAC (22.8% vs 38.6%; P = .012). Conclusions: Open abdomen with VAC is associated with significantly improved survival compared with PAC in abdominal sepsis requiring laparotomy.
MeSH term(s)	APACHE ; Abdomen/surgery ; Adult ; Aged ; Databases, Factual ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Intensive Care Units ; Laparotomy/adverse effects ; Laparotomy/methods ; Male ; Middle Aged ; Negative-Pressure Wound Therapy/methods ; Retrospective Studies ; Risk Assessment ; Sepsis/diagnosis ; Sepsis/mortality ; Sepsis/surgery ; Surgical Wound Dehiscence/microbiology ; Surgical Wound Dehiscence/therapy ; Survival Rate ; Tertiary Care Centers ; Treatment Outcome ; Wound Closure Techniques ; Wound Healing/physiology
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2016.01.012
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Article ; Online: Fluorescent Cholangiography in Laparoscopic Cholecystectomy: An Updated Canadian Experience.

Bleszynski, Michael S / DeGirolamo, Kristin M / Meneghetti, Adam T / Chiu, C Jack / Panton, Ormond Neely

Surgical innovation

2019 Volume 27, Issue 1, Page(s) 38–43

Abstract: Background. ...

Abstract	Background.
MeSH term(s)	Adult ; Aged ; Canada ; Cholangiography ; Cholecystectomy, Laparoscopic ; Female ; Fluorescent Dyes/adverse effects ; Fluorescent Dyes/therapeutic use ; Humans ; Indocyanine Green/adverse effects ; Indocyanine Green/therapeutic use ; Liver/diagnostic imaging ; Liver/surgery ; Liver Diseases/diagnostic imaging ; Liver Diseases/surgery ; Male ; Middle Aged ; Optical Imaging ; Prospective Studies
Chemical Substances	Fluorescent Dyes ; Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2019-11-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2182571-3
ISSN	1553-3514 ; 1553-3506
ISSN (online)	1553-3514
ISSN	1553-3506
DOI	10.1177/1553350619885792
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Article ; Online: Outcomes of liver transplant recipients with high MELD scores: an experience from a Canadian centre.

Bleszynski, Michael S / Punnen, Subin / Desai, Sameer / Hussaini, Trana / Marquez, Vladimir / Yoshida, Eric M / Jayakumar, Saumya / Chartier-Plante, Stephanie / Segedi, Maja / Scudamore, Charles H / Chung, Stephen / Buczkowski, Andrzej K / Kim, Peter T W

Canadian journal of surgery. Journal canadien de chirurgie

2022 Volume 65, Issue 4, Page(s) E425–E439

Abstract: Background: The frequency with which patients with high Model for End-Stage Liver Disease (MELD) scores undergo liver transplantation has been increasing. Canadian literature regarding the outcomes of liver transplantation in recipients with high MELD ... ...

Abstract	Background: The frequency with which patients with high Model for End-Stage Liver Disease (MELD) scores undergo liver transplantation has been increasing. Canadian literature regarding the outcomes of liver transplantation in recipients with high MELD scores is limited. The primary objective of this study was to assess patient and graft survival among recipients with high (> 35) and low (≤ 35) MELD scores. Secondary objectives were to potentially identify independent predictors of graft failure and patient mortality. Methods: We conducted a retrospective chart review of patients undergoing liver transplantation at a single Canadian centre from 2012 to 2017. Results: A total of 332 patients were included in the study: 280 patients had a MELD score of 35 or lower, and 52 had a MELD score above 35. Patients with high MELD scores had higher rates of pretransplant acute kidney injury and dialysis ( Conclusion: No difference in patient mortality was found between MELD groups. Graft survival was significantly lower in recipients with MELD scores above 35. D-MELD may potentially be used as an adjunct in determining risk of graft failure in recipients with high MELD scores.
MeSH term(s)	Acute Kidney Injury ; Canada/epidemiology ; End Stage Liver Disease/surgery ; Humans ; Liver Transplantation ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
Language	English
Publishing date	2022-07-05
Publishing country	Canada
Document type	Journal Article
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
DOI	10.1503/cjs.025520
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Article ; Online: Determining when endoscopic ultrasound changes management for patients with pancreatic cystic neoplasms.

Sidhu, Hasrit / Maher, Safia / Bleszynski, Michael S / Chen, Leo / Farnell, Dave / Gan, Ian / Segedi, Maja

American journal of surgery

2020 Volume 221, Issue 4, Page(s) 813–818

Abstract: Introduction: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to increased CT and MRI usage. EUS is an emerging tool that can differentiate between benign and malignant features of pancreatic cysts. We hoped ... ...

Abstract	Introduction: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to increased CT and MRI usage. EUS is an emerging tool that can differentiate between benign and malignant features of pancreatic cysts. We hoped to identify the specific cross-sectional imaging findings and patient characteristics that warrant EUS referral. Methods: We conducted a retrospective case-control chart review, evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS between January 1, 2010 and December 31, 2017. Results: EUS was found to change management when CT imaging found cyst size > 4 cm (OR = 4.07, p < 0.01), cyst size > 3 cm (OR = 3.79, p < 0.001) and associated solid component to the cyst (OR = 5.95, p < 0.01). Additionally, patient characteristics, including age less than 50 years, male sex and 10-pack year smoking history were significantly associated with EUS change in management. Discussion: Our findings suggest that EUS referral should be coordinated based on the findings of specific HRFs, with support from high risk patient characteristics, rather than the accumulation of multiple HRFs, as suggested by existing guidelines.
MeSH term(s)	Age Factors ; Case-Control Studies ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Cyst/diagnostic imaging ; Pancreatic Cyst/therapy ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/therapy ; Retrospective Studies ; Sex Factors ; Smoking
Language	English
Publishing date	2020-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2020.03.036
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Article ; Online: Acute care and emergency general surgery in patients with chronic liver disease: how can we optimize perioperative care? A review of the literature.

Bleszynski, Michael S / Bressan, Alexsander K / Joos, Emilie / Morad Hameed, S / Ball, Chad G

World journal of emergency surgery : WJES

2018 Volume 13, Page(s) 32

Abstract: The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction, degree of portal hypertension, emergency of surgery, and severity of patients' ... ...

Abstract	The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction, degree of portal hypertension, emergency of surgery, and severity of patients' comorbidities constitute predictors of postoperative mortality. Comprehensive history taking, physical examination, and thorough review of laboratory and imaging examinations typically elucidate clinical evidence of hepatic dysfunction, portal hypertension, and/or their complications. Utilization of specific scoring systems (Child-Pugh and MELD) adds objectivity to stratifying the severity of hepatic dysfunction. Hypovolemia and coagulopathy often represent major preoperative concerns. Resuscitation mandates judicious use of intravenous fluids and blood products. As a general rule, the most expeditious and least invasive operative procedure should be planned. Laparoscopic approaches, advanced energy devices, mechanical staplers, and topical hemostatics should be considered whenever applicable to improve safety. Precise operative technique must acknowledge common distortions in hepatic anatomy, as well as the risk of massive hemorrhage from porto-systemic collaterals. Preventive measures, as well as both clinical and laboratory vigilance, for postoperative hepatic and renal decompensation are essential.
MeSH term(s)	Emergency Medical Services/methods ; Emergency Medical Services/standards ; End Stage Liver Disease/physiopathology ; End Stage Liver Disease/surgery ; General Surgery/methods ; General Surgery/standards ; Humans ; Hypertension, Portal/physiopathology ; Hypertension, Portal/surgery ; Perioperative Care/methods ; Quality of Health Care/trends ; Severity of Illness Index ; Ultrasonography/methods
Language	English
Publishing date	2018-07-18
Publishing country	England
Document type	Journal Article ; Review
ISSN	1749-7922
ISSN (online)	1749-7922
DOI	10.1186/s13017-018-0194-1
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Article ; Online: Incisional wound VAC and risk-adjusted SSI rates in colorectal surgery: A tertiary centre experience.

Webb, Mitchell A / Bleszynski, Michael S / Chen, Leo / Chiu, Jack / Meneghetti, Adam / Panton, Ormond N

American journal of surgery

2018 Volume 217, Issue 5, Page(s) 948–953

Abstract: Background: In colorectal surgery, indications for incisional negative pressure wound therapy (iVAC) remain unclear. We sought to compare rates of surgical site infection (SSI) in patients who received iVAC or standard sterile dressing (SSD).: Methods! ...

Abstract	Background: In colorectal surgery, indications for incisional negative pressure wound therapy (iVAC) remain unclear. We sought to compare rates of surgical site infection (SSI) in patients who received iVAC or standard sterile dressing (SSD). Methods: Institutional colorectal NSQIP data between 2014 and 2018 was reviewed. SSI rates were compared between iVAC and SSD cohorts using the NSQIP surgical risk calculator (NSQIP SRC) for risk-adjusted analysis. Secondary outcomes included other wound complications, morbidity, mortality, disposition destination and overall length of stay. Results: 145 patients received iVAC while 544 received SSD. SSI was greater in iVAC than SSD (17% vs 9%, p = 0.009). iVAC was independently associated with SSI (OR 2.3, 95% CI 1.3-3.9). The presence of a colostomy strengthened this relationship. There was no difference in secondary outcomes. Conclusion: iVAC was independently associated with SSI with risk-adjusted analysis. This relationship was stronger in patients with a colostomy.
MeSH term(s)	Aged ; Colectomy/adverse effects ; Female ; Humans ; Male ; Negative-Pressure Wound Therapy/statistics & numerical data ; Occlusive Dressings/statistics & numerical data ; Proctectomy/adverse effects ; Risk Assessment ; Surgical Wound Infection/epidemiology ; Tertiary Care Centers
Language	English
Publishing date	2018-12-15
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.12.019
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