Flushing Hospital Medical Center

Propofol is widely used for procedural sedation and anesthesia due to its rapid onset and recovery. Although regarded as safe, it can rarely provoke severe allergic reactions, including anaphylaxis. Because these events are infrequent, recognition may be delayed, particularly when clinical features are atypical. We described a case of propofol-induced anaphylaxis during outpatient colonoscopy in a 66-year-old man with no known allergies. The patient developed sudden desaturation, hypotension, and progressive facial and cervical angioedema, initially misinterpreted as bowel perforation due to associated abdominal distention. Multiple intubation attempts failed, necessitating an emergent tracheostomy. This case emphasizes the need for early suspicion of anaphylaxis in unexplained perioperative collapse, prompt administration of epinephrine, airway preparedness, and post-event allergy evaluation to confirm the diagnosis and prevent re-exposure.

BACKGROUNDPercutaneous cholecystostomy (PCT) is widely used for high-risk acute cholecystitis as an alternative to emergent cholecystectomy. Despite its effectiveness, the optimal timing, catheter management, and long-term outcomes remain to be elucidated.AIMTo characterize timing, catheter management, survival, and follow-up outcomes after PCT in a high-risk cohort.METHODSThis single center retrospective cohort study included consecutive adult patients undergoing PCT placement for acute cholecystitis at a community hospital setting in New York between January 2012 and December 2024. The study population was grouped according to type of acute cholecystitis (calculous vs acalculous), according to the timing of PCT placement since diagnosis [early (≤ 4 days) vs late (> 4 days)], and according to level of care [intensive care unit (ICU) vs non-ICU patients]. Cox proportional hazards models were used to examine effects of PCT placement interval on mortality rates, after accounting for potential confounding factors (age, Charlson Comorbidity Index, cholecystitis type, ICU status, bile culture and blood culture data).RESULTSThe population consisted of 174 patients who underwent PCT placement for acute cholecystitis between 2012 and 2024 at a community hospital in New York. Median time to PCT was 2 days (interquartile range 1-4). Overall, mortality was 21% (36/174) and was higher with delayed PCT (> 4 days) vs early PCT [35% (17/49) vs 15% (19/125), P = 0.001]. Catheter removal occurred in 13% (23/174), 55% (96/174) remained catheter-dependent, and 32% (56/174) had interval cholecystectomy. ICU admission was associated with prolonged catheter duration but was not associated with mortality. Kaplan-Meier analysis demonstrated a significantly higher survival rate in the early group compared with the late group (log-rank P = 0.006). In both unadjusted models and models adjusted for selected covariates, patients who had catheters placed late (> 4 days) had 2.5-fold higher risk of death than patients with early placement.CONCLUSIONEarly PCT was associated with higher survival in high-risk acute cholecystitis. High rates of catheter dependency highlight the need for standardized protocols and reassessment for definitive surgery.

The medical field is evolving rapidly, with an increasing focus on technology to address complex medical issues. In the traditional clinical encounter, the physician’s role is often seen as providing one-way technical expertise. However, every patient-physician interaction is a two-way relationship with the potential for reciprocal learning. In the relational model of patient-physician relationships, the patient is more than a passive bystander but also an integral participant and a teacher from whom physicians can learn invaluable insights, such as the interplay of emotional intelligence and the healing process. These insights can add to the heart of the profession beyond purely academic pursuits. From a senior surgical resident’s point of view, we explore the question: What do physicians learn from patients during the therapeutic relationship that extends beyond our technological tools?

Introduction: Peripheral Arterial Disease (PAD) is a prevalent condition associated with considerable morbidity and mortality, a burden that is further intensified by the frequent co-occurrence of hypertension. The coexistence of these conditions not only amplifies cardiovascular risks but also complicates clinical management, thereby contributing to elevated mortality rates. Although their correlation is well understood, mortality trends in United States have not been studied. Methods: This study utilized International Classification of Diseases, 10th Revision (ICD-10) codes to extract age-adjusted mortality data for individuals with PAD and hypertension from the CDC WONDER (Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) cohort. The overall sample and subgroups defined by demographics (age, sex, race/ethnicity) and region (state, census and urban-rural status) were analyzed. Trends in mortality were quantified by computing associated annual percentage changes (APC) using Joinpoint Regression Program Version 4.9.0.0 trend analysis software. Results: A total of 540954 deaths were observed, of which 260517 were men (48.2%). Overall, the age-adjusted mortality rates (AAMR) exhibited a sharp increase from 1999 to 2001 (APC:25.3; 95% CI: -0.36,56.2), followed by a sustained decrease until 2017 (APC: -2.16; 95% CI: -11.1, -1.52), after which a notable upward trend was observed (APC:9.38; 95% CI: -0.38,24.1). A similar AAMR trend was seen on gender-based subgroup analysis with male patients showing the highest AAMR 13.5 (95% CI: 13.1,13.7) in 2020. Amongst all racial groups, Black or African American showed the highest 14.9 (95% CI: 14.8-15) while Asian or Pacific Islander showed the lowest 5.8 (95% CI: 5.7-5.9) AAMR over 2 decades. The West region had the highest overall age-adjusted mortality rate (AAMR) of 10.2 (95% CI: 10.2-10.3). Among individual states, Vermont displayed the highest AAMR, reaching 15.8 (95% CI: 15.1-16.5). Conclusion: Healthcare disparities are evident. The unprecedented recent increase in mortality rates, following years of successful decline, necessitates a thorough evaluation of healthcare policies and PAD treatment advancements to identify the causative factors behind this trend reversal.

Endometrial carcinoma is one of the most common gynecologic cancers worldwide. The condition typically occurs after menopause; however, young women under the age of 40 years can also be diagnosed with the disease. Providers may delay diagnosis in young patients due to nonspecific presentation or low clinical suspicion. Standard treatment includes surgery, chemotherapy, and adjuvant radiotherapy. All these therapeutic interventions are determined by the patient's tumor stage and prognosis. However, in the case of a young patient, treatment options are determined by their desire to maintain fertility and ovarian function. We reported a case of a 26-year-old woman who presented to the gynecological office complaining of irregular menstrual cycles and oligomenorrhea. Endometrioid endometrial carcinoma was found after diagnostic hysteroscopy, followed by dilation and curettage (D&C) and a tissue examination. Our patient desired a surgical option as her family was complete. This case illustrates the importance of early diagnostic evaluation in young women with risk factors and highlights individualized decision-making in treatment planning.

Lipomyelomeningocele (LMMC) is an uncommon type of closed spinal defect that falls under the broader category of spine bifida. This congenital condition may present at birth as a lumbosacral mass or manifest later in life with neurologic symptoms. In this report, we describe a neonate who was diagnosed with LMMC at birth and underwent timely surgical intervention during the neonatal period. The procedure was successful and the patient experienced no adverse outcome. This case highlights the importance of early diagnosis and prompt surgical repair.

Adrenal hemorrhage in pregnancy, particularly of spontaneous origin, is an exceedingly rare phenomenon. We present the case of a 19-year-old primigravida, at 38 weeks gestation, afflicted by bilateral spontaneous adrenal hemorrhage. Initial presentation with severe abdominal pain posed diagnostic conundrums, necessitating a meticulous and multidisciplinary approach. Radiological evaluations revealed bilateral adrenal gland thickening, raising the suspicion of adrenal hemorrhage. The ensuing management included blood transfusion and steroid therapy, pivotal in stabilizing the patient's precarious clinical state. This case underscores the imperative of interdisciplinary collaboration and expeditious interventions in navigating medical complications during pregnancy as well as the importance of keeping in mind differential diagnoses such as adrenal insufficiency.