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Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Hypocalcemia is cited as a complication of massive transfusion. However, this is not well studied as a primary outcome in trauma patients. Our primary outcome was to determine if transfusion of packed red blood cells (pRBC) was an independent predictor of severe hypocalcemia (ionized calcium ≤ 3.6 mg/dL). Methods: Retrospective, single-center study (01/2004–12/2014) including all trauma patients ≥ 18 yo presenting to the ED with an ionized calcium (iCa) level drawn. Variables extracted included demographics, interventions, outcomes, and iCa. Regression models identified independent risk factors for severe hypocalcemia (SH). Results: Seven thousand four hundred and thirty-one included subjects, 716 (9.8%) developed SH within 48 h of admission. Median age: 39 (Range: 18–102), systolic blood pressure: 131 (IQR: 114–150), median Glasgow Coma Scale (GCS): 15 (IQR: 10–15), Injury Severity Score (ISS): 14 (IQR: 9–24). SH patients were more likely to have depressed GCS (13 vs 15, p < 0.0001), hypotension (23.2% vs 5.1%, p < 0.0001) and tachycardia (57.0% vs 41.9%, p < 0.0001) compared to non-SH patients. They also had higher emergency operative rate (71.8% vs 29%, p < 0.0001) and higher blood administration prior to minimum iCa [pRBC: (8 vs 0, p < 0.0001), FFP: (4 vs 0, p < 0.0001), platelet: (1 vs 0, p < 0.0001)]. Multivariable analysis revealed penetrating mechanism (AOR: 1.706), increased ISS (AOR: 1.029), and higher pRBC (AOR: 1.343) or FFP administered (AOR: 1.097) were independent predictors of SH. SH was an independent predictor of mortality (AOR: 2.658). Regression analysis identified a significantly higher risk of SH at pRBC + FFP administration of 4 units (AOR: 18.706, AUC:. 897 (0.884–0.909). Conclusion: Transfusion of pRBC is an independent predictor of SH and is associated with increased mortality. The predicted probability of SH increases as pRBC + FFP administration increases. [ABSTRACT FROM AUTHOR]

To raise awareness for surgeons encountering bariatric patients with anatomy that deviates from the standard Roux-en-Y gastric bypass (RYGB). This is a single-institution retrospective case series over 12 years (2003-2014) involving patients who believed they received RYGBs, but actually did not. Data was obtained reviewing physician encounters, imaging, and operative reports. There were six cases with confusing clinical pictures, found to have aberrant RYGB anatomy: (1) gastric bypass with jejuno-jejunostomy only without gastrojejunostomy, (2) distal partial vertical gastrectomy without expected prosthetic band, (3) inverse vertical banded gastroplasty, (4) non-divided gastric bypass with no gastrojejunostomy, (5) 20-cm Roux limb, with gastro-gastric fistula, and (6) 200-cm bilio-pancreatic limb similar to the traditional Scopinaro procedure. There are cases of “Roux-en-Y gastric bypasses” that have no resemblance to the named procedure at all. Adjunctive upper gastrointestinal studies and upper endoscopies help surgeons make diagnoses that are incongruent with the surgical history. It is important to keep in mind that there could be anatomic or surgical variations which were born out of necessity or based on other surgeons’ creativities. [ABSTRACT FROM AUTHOR]

Credit value adjustment (CVA) is an adjustment to an existing trading price based on the counterparty-risk premium. Currently, CVA is computed with an implicit assumption that the replacement contract is default-free after the original counterparty defaults, with the assumption that those trades will not re-assigned. In the actual counterparty default settlement, it is the norm that trades will be re-assigned, especially on the buy side. Since the counterparty of the replacement contract could also default within the lifetime of an existing contract, ignoring the possibility of counterparty defaults of replacement contracts will either under or over estimate the cost of the risk. An important practical question is, therefore, how to estimate under/over pricing of CVA under current practice. In this paper, we considered the pricing of credit contingent interest rate swap (CCIRS) or credit contingent default swap (CCDS), which is considered the CVA hedge for interest rate swaps (IRS). We derived partial differential Eqs. (PDEs) satisfied by the approximated CVA with the assumption that the replacement contracts do not default. For comparison purposes, we also derived the PDEs for the cost of CVA by relaxing the assumption of default-free replacement contracts with a finite number of counterparty defaults. It shows that the no-default and two default cases can be derived within the same analytical solution framework, similar to the Funding Valuation Adjustment (FVA) problem where continuous funding is a reasonable assumption. The finite number of default case is non-trivial. The PDE for the two default case is derived in this paper. We calibrate our model based on market data and carry out extensive computations for the purpose of comparing these three CVAs. Our basic finding is that the values of the two CVAs are close for top rated counterparties. On the other hand, for counterparties with lower credit ratings, the difference among the two CVAs can be significant. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass is the gold standard for weight loss surgery. This procedure creates two to three mesenteric defects, depending on ante-colic versus retro-colic technique. Current literature supports mesenteric defect closure, but there is no consensus on how to best close these defects. Described options include running separate suture lines for each defect, or employing endoscopic staplers for defect closure.Methods: This is a video/dynamic manuscript on operative technique.Results: We describe an alternative technique that does not require an extra laparoscopic instrument and is more efficient than traditional suture lines due to less suturing.Conclusions: The technique maintains low gastric bypass complication rates by closing mesenteric defects, while keeping intra-operative costs low, and minimizing time spent on the defect closures. [ABSTRACT FROM AUTHOR]

Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc, cervical myofascial trigger points, as well as the cervical spinal nerves. Various interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat this disorder. And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition. [ABSTRACT FROM AUTHOR]

The present study investigated the characteristics of children who remain consistently peer victimized in comparison to those who transition out of victimization status. The relationships between victimization and the victim's level of overt aggression, relational aggression, impulsivity, and prosocial behaviors were examined from one year to the next. At Time 1, 1589 3rd, 4th, and 5th-grade children were administered a peer nomination instrument assessing victimization and standard sociometric variables. At Time 2 (1 year later), 1619 3rd, 4th, and 5th-grade children were administered the same measure. A mixed-design repeated measures MANOVA was conducted for boys and girls separately. Results indicated that in comparison to victims transitioning out of victimization status, consistently victimized boys were lower in prosocial behavior, and consistently victimized girls were higher in impulsivity. Results for girls also indicated that a reduction in victim's own level of relational aggression was associated with cessation of victimization. [ABSTRACT FROM AUTHOR]

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals. [ABSTRACT FROM AUTHOR]