Leo C . Mercer, MD, FACS (original) (raw)

Papers by Leo C . Mercer, MD, FACS

Research paper thumbnail of Early operation for acute biliary tract stone disease

PubMed, Oct 1, 1983

A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operati... more A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operation for biliary tract stone disease was performed. One hundred fifty-two consecutive patients with signs and symptoms compatible with biliary colic or acute cholecystitis were admitted to the hospital and promptly evaluated with ultrasonography and hepatobiliary (Pipida) scanning. Patients with demonstrable stones or a nonvisualized gallbladder underwent operation within 48 hours of admission. Of 75 patients who underwent operation, 64 had acute and/or severe chronic cholecystitis. Associated biliary pancreatitis was present in 14 of 75 patients. Cholecystectomy with intraoperative cholangiography was performed for 73 of the 75 patients. One patient underwent cholecystectomy only and one patient underwent cholecystostomy. There were 18 common duct explorations. No transfusions were required and there were no deaths. The average duration of hospital stay for all patients who underwent operation was 6.5 days. The results indicate that an accurate diagnosis of acute biliary tract stone disease can be made rapidly with use of sonography and hepatobiliary scanning, that cholecystectomy with intraoperative cholangiography and common duct exploration as necessary can be performed safely (including cases of biliary pancreatitis) in the acute setting, and that with early operation the duration of stay is decreased and morbidity and mortality rates compare favorably with those of elective cholecystectomy. It is concluded that operation performed within at least 48 hours of admission is the treatment of choice for acute biliary tract stone disease.

Research paper thumbnail of WITHDRAWN: Complexgenitourinary injury following gunshot in a 12 year old: A case report and systematic review

Trauma Case Reports, Feb 1, 2021

Research paper thumbnail of Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta™—A case report

International Journal of Surgery Case Reports, 2018

Research paper thumbnail of Early surgery for biliary pancreatitis

American Journal of Surgery, Dec 1, 1984

Research paper thumbnail of Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

Oxford University Press eBooks, Nov 18, 2021

This chapter reviews issues related to mortality in the intensive care setting. Relevant literatu... more This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Research paper thumbnail of 555: Novel Traumaguard Catheter to Measure Continuous Intra-Abdominal Pressure

Critical Care Medicine, Dec 16, 2021

Research paper thumbnail of Endo GIA stapler malfunction in a small bowel loop resection

Journal of surgical case reports, Oct 1, 2018

Research paper thumbnail of Immobilization of the plasminogen activator streptokinase and its fibrinolytic effects vivo

Thrombosis Research, Dec 1, 1978

... N o N wo OON nw of ... obs (ic(D m ~ mio !DC -5 r+ -h I mq / d 1 NW 4 T1 0 0 0 0 0 0 r, CONTR... more ... N o N wo OON nw of ... obs (ic(D m ~ mio !DC -5 r+ -h I mq / d 1 NW 4 T1 0 0 0 0 0 0 r, CONTROL a O 0~ IMM SK m GH CONCENTRATION GT (up) m N uu p 2 p td H aJ H IV '9 tc1 IMM SK m C9 cn H t SECONDS u oh r conrROL IMM SK u' tm SECONDS 'D CONTROL v to H o ~ H u ...

Research paper thumbnail of Pneumonectomy secondary to Mycobacterium fortuitum in infancy

The Annals of Thoracic Surgery, Jun 1, 1991

Research paper thumbnail of Perforated or Gangrenous Appendicitis Treated With Aminoglycosides

Archives of Surgery, Nov 1, 1989

To study the influence of bacterial culture data on the clinical management of gangrenous or perf... more To study the influence of bacterial culture data on the clinical management of gangrenous or perforated appendicitis, we reviewed records of 104 patients who had been treated empirically with aminoglycoside antibiotics. Culture results appeared to influence antibiotic therapy in only 7 patients (7%). The routine cultures obtained at appendectomy affected therapy in only 2 patients. Discriminant analysis identified postoperative infectious complications and related factors as the principal determinants of culture utility. We conclude that, in patients with perforated appendicitis treated empirically with aminoglycoside combination regimens, culture results were seldom used for clinical management except in instances of postoperative infectious complication. Routine cultures and Gram's stains of perforated appendicitis, however, should still be obtained (1) to allow epidemiologic tracking in the hospital; (2) to identify organisms that are recovered infrequently but may cause serious disease (eg, Clostridium); and (3) because newer antibiotics are replacing aminoglycosides in the treatment of perforated appendicitis.

Research paper thumbnail of Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly

Case Reports, Jun 24, 2017

Research paper thumbnail of Use of an Electronic Referral Application to Address Post-Injury Needs of Victims of Firearm Injury in a Hospital-Based Violence Intervention Program

Violence and Victims

BackgroundWraparound referrals are a cornerstone of hospital-based violence intervention programs... more BackgroundWraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits.Study DesignThe population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention.ResultsPost-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance.ConclusionThis study demonstrated an increase in the ...

Research paper thumbnail of 555: Novel Traumaguard Catheter to Measure Continuous Intra-Abdominal Pressure

Critical Care Medicine, 2021

Research paper thumbnail of Ligate to Live: Stab Wound to the Neck with Major Vascular Injuries

Context: Penetrating neck injuries involving the major vasculature is associated with high morbid... more Context: Penetrating neck injuries involving the major vasculature is associated with high morbidity and mortality. This report describes a challenging case in which ligation of the left common carotid artery (CCA), left internal jugular (IJ) and direct tamponade of the left vertebral artery (LVA) was necessary after a patient sustained a stab wound to the left neck. Case Report: A 23 year old male sustained two stab wounds on the left side of the neck severing the CCA, LVA and both jugular veins. Patient arrived unconscious and with obvious signs of hemorrhagic shock. Neck exploration resulted in ligation of the left CCA, both jugular veins, and direct tamponade of the LVA within the vertebral canal. Post-injury day 2 patient required emergent craniectomy secondary to large left hemisphere infarct along the distribution of the left middle cerebral artery (MCA) with an associated large mass effect. Neurological sequelae included seizures, aphasia, and right sided hemiparesis through...

Research paper thumbnail of The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients

Journal of Burn Care & Research, 2021

Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a p... more Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in ol...

Research paper thumbnail of Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

Critical Care Psychology and Rehabilitation, 2021

This chapter reviews issues related to mortality in the intensive care setting. Relevant literatu... more This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Research paper thumbnail of A Single Center Review of the Dangers of Recreational Fires in the Pediatric Population

Journal of Burn Care & Research, 2020

The increasing trend of admissions due to recreational fires prompted a 5-year review. The retros... more The increasing trend of admissions due to recreational fires prompted a 5-year review. The retrospective chart review of pediatric burn injuries from campfires or bonfires treated at a single medical center’s burn unit. The study included children within the ages of 0 to 15 admitted or transferred from January 2012 to December 2016 with first, second, and/or third degree burns by bonfires. These patients accrued burns due to active fires as well as postfire ember contact. Two hundred-eighty nine (289) were pediatric admissions out of which 66 (22.8%) were pediatric admissions associated with recreational fires. The mean annual admission for campfire or bonfire burns was 13 ± .98. The mean age was 4 ± 2.47 years. Gender distribution revealed 21 female and 45 male pediatric patients under the age of 15. From the available data, 8 (12%) of these burns occurred at home in the backyard and 16 (24%) at a public camp or park. Injury mechanisms were more commonly a result of direct contact ...

Research paper thumbnail of A complex genitourinary injury following gunshot in a 12 Year old and systematic review

Urology Case Reports, 2021

Research paper thumbnail of Modification of Stryker T5TM and Stryker Flyte® Personal Protection Surgical Helmets to Function as Powered Air-Purifying Respirators

Surgical Innovation, 2020

Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal ... more Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal protective equipment (PPE) due to the worldwide demand and thus ensuing shortage. To address the dearth of available PPE, HCWs have quickly explored options to repurpose in-hospital equipment to provide alternative PPE to caregivers. We report the modification of a Stryker T5TM and Stryker Flyte® personal protection surgical helmets as a powered air-purifying respirator.

Research paper thumbnail of Endo GIA stapler malfunction in a small bowel loop resection

Journal of Surgical Case Reports, 2018

Endovascular gastrointestinal anastomosis (Endo-GIA) staplers are widely used in various surgical... more Endovascular gastrointestinal anastomosis (Endo-GIA) staplers are widely used in various surgical procedures despite difficulties in operating them and associated mechanical failures. We present a case of a patient whose post-operative recovery was complicated by intraoperative Endo-GIA stapler failure, which is rarely reported in literature. Our report describes the behavior and consequences of surgical stapler failure so surgeons can anticipate challenges of newer surgical devices while maintaining optimal patient outcomes.

Research paper thumbnail of Early operation for acute biliary tract stone disease

PubMed, Oct 1, 1983

A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operati... more A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operation for biliary tract stone disease was performed. One hundred fifty-two consecutive patients with signs and symptoms compatible with biliary colic or acute cholecystitis were admitted to the hospital and promptly evaluated with ultrasonography and hepatobiliary (Pipida) scanning. Patients with demonstrable stones or a nonvisualized gallbladder underwent operation within 48 hours of admission. Of 75 patients who underwent operation, 64 had acute and/or severe chronic cholecystitis. Associated biliary pancreatitis was present in 14 of 75 patients. Cholecystectomy with intraoperative cholangiography was performed for 73 of the 75 patients. One patient underwent cholecystectomy only and one patient underwent cholecystostomy. There were 18 common duct explorations. No transfusions were required and there were no deaths. The average duration of hospital stay for all patients who underwent operation was 6.5 days. The results indicate that an accurate diagnosis of acute biliary tract stone disease can be made rapidly with use of sonography and hepatobiliary scanning, that cholecystectomy with intraoperative cholangiography and common duct exploration as necessary can be performed safely (including cases of biliary pancreatitis) in the acute setting, and that with early operation the duration of stay is decreased and morbidity and mortality rates compare favorably with those of elective cholecystectomy. It is concluded that operation performed within at least 48 hours of admission is the treatment of choice for acute biliary tract stone disease.

Research paper thumbnail of WITHDRAWN: Complexgenitourinary injury following gunshot in a 12 year old: A case report and systematic review

Trauma Case Reports, Feb 1, 2021

Research paper thumbnail of Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta™—A case report

International Journal of Surgery Case Reports, 2018

Research paper thumbnail of Early surgery for biliary pancreatitis

American Journal of Surgery, Dec 1, 1984

Research paper thumbnail of Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

Oxford University Press eBooks, Nov 18, 2021

This chapter reviews issues related to mortality in the intensive care setting. Relevant literatu... more This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Research paper thumbnail of 555: Novel Traumaguard Catheter to Measure Continuous Intra-Abdominal Pressure

Critical Care Medicine, Dec 16, 2021

Research paper thumbnail of Endo GIA stapler malfunction in a small bowel loop resection

Journal of surgical case reports, Oct 1, 2018

Research paper thumbnail of Immobilization of the plasminogen activator streptokinase and its fibrinolytic effects vivo

Thrombosis Research, Dec 1, 1978

... N o N wo OON nw of ... obs (ic(D m ~ mio !DC -5 r+ -h I mq / d 1 NW 4 T1 0 0 0 0 0 0 r, CONTR... more ... N o N wo OON nw of ... obs (ic(D m ~ mio !DC -5 r+ -h I mq / d 1 NW 4 T1 0 0 0 0 0 0 r, CONTROL a O 0~ IMM SK m GH CONCENTRATION GT (up) m N uu p 2 p td H aJ H IV '9 tc1 IMM SK m C9 cn H t SECONDS u oh r conrROL IMM SK u' tm SECONDS 'D CONTROL v to H o ~ H u ...

Research paper thumbnail of Pneumonectomy secondary to Mycobacterium fortuitum in infancy

The Annals of Thoracic Surgery, Jun 1, 1991

Research paper thumbnail of Perforated or Gangrenous Appendicitis Treated With Aminoglycosides

Archives of Surgery, Nov 1, 1989

To study the influence of bacterial culture data on the clinical management of gangrenous or perf... more To study the influence of bacterial culture data on the clinical management of gangrenous or perforated appendicitis, we reviewed records of 104 patients who had been treated empirically with aminoglycoside antibiotics. Culture results appeared to influence antibiotic therapy in only 7 patients (7%). The routine cultures obtained at appendectomy affected therapy in only 2 patients. Discriminant analysis identified postoperative infectious complications and related factors as the principal determinants of culture utility. We conclude that, in patients with perforated appendicitis treated empirically with aminoglycoside combination regimens, culture results were seldom used for clinical management except in instances of postoperative infectious complication. Routine cultures and Gram's stains of perforated appendicitis, however, should still be obtained (1) to allow epidemiologic tracking in the hospital; (2) to identify organisms that are recovered infrequently but may cause serious disease (eg, Clostridium); and (3) because newer antibiotics are replacing aminoglycosides in the treatment of perforated appendicitis.

Research paper thumbnail of Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly

Case Reports, Jun 24, 2017

Research paper thumbnail of Use of an Electronic Referral Application to Address Post-Injury Needs of Victims of Firearm Injury in a Hospital-Based Violence Intervention Program

Violence and Victims

BackgroundWraparound referrals are a cornerstone of hospital-based violence intervention programs... more BackgroundWraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits.Study DesignThe population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention.ResultsPost-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance.ConclusionThis study demonstrated an increase in the ...

Research paper thumbnail of 555: Novel Traumaguard Catheter to Measure Continuous Intra-Abdominal Pressure

Critical Care Medicine, 2021

Research paper thumbnail of Ligate to Live: Stab Wound to the Neck with Major Vascular Injuries

Context: Penetrating neck injuries involving the major vasculature is associated with high morbid... more Context: Penetrating neck injuries involving the major vasculature is associated with high morbidity and mortality. This report describes a challenging case in which ligation of the left common carotid artery (CCA), left internal jugular (IJ) and direct tamponade of the left vertebral artery (LVA) was necessary after a patient sustained a stab wound to the left neck. Case Report: A 23 year old male sustained two stab wounds on the left side of the neck severing the CCA, LVA and both jugular veins. Patient arrived unconscious and with obvious signs of hemorrhagic shock. Neck exploration resulted in ligation of the left CCA, both jugular veins, and direct tamponade of the LVA within the vertebral canal. Post-injury day 2 patient required emergent craniectomy secondary to large left hemisphere infarct along the distribution of the left middle cerebral artery (MCA) with an associated large mass effect. Neurological sequelae included seizures, aphasia, and right sided hemiparesis through...

Research paper thumbnail of The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients

Journal of Burn Care & Research, 2021

Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a p... more Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in ol...

Research paper thumbnail of Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

Critical Care Psychology and Rehabilitation, 2021

This chapter reviews issues related to mortality in the intensive care setting. Relevant literatu... more This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Research paper thumbnail of A Single Center Review of the Dangers of Recreational Fires in the Pediatric Population

Journal of Burn Care & Research, 2020

The increasing trend of admissions due to recreational fires prompted a 5-year review. The retros... more The increasing trend of admissions due to recreational fires prompted a 5-year review. The retrospective chart review of pediatric burn injuries from campfires or bonfires treated at a single medical center’s burn unit. The study included children within the ages of 0 to 15 admitted or transferred from January 2012 to December 2016 with first, second, and/or third degree burns by bonfires. These patients accrued burns due to active fires as well as postfire ember contact. Two hundred-eighty nine (289) were pediatric admissions out of which 66 (22.8%) were pediatric admissions associated with recreational fires. The mean annual admission for campfire or bonfire burns was 13 ± .98. The mean age was 4 ± 2.47 years. Gender distribution revealed 21 female and 45 male pediatric patients under the age of 15. From the available data, 8 (12%) of these burns occurred at home in the backyard and 16 (24%) at a public camp or park. Injury mechanisms were more commonly a result of direct contact ...

Research paper thumbnail of A complex genitourinary injury following gunshot in a 12 Year old and systematic review

Urology Case Reports, 2021

Research paper thumbnail of Modification of Stryker T5TM and Stryker Flyte® Personal Protection Surgical Helmets to Function as Powered Air-Purifying Respirators

Surgical Innovation, 2020

Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal ... more Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal protective equipment (PPE) due to the worldwide demand and thus ensuing shortage. To address the dearth of available PPE, HCWs have quickly explored options to repurpose in-hospital equipment to provide alternative PPE to caregivers. We report the modification of a Stryker T5TM and Stryker Flyte® personal protection surgical helmets as a powered air-purifying respirator.

Research paper thumbnail of Endo GIA stapler malfunction in a small bowel loop resection

Journal of Surgical Case Reports, 2018

Endovascular gastrointestinal anastomosis (Endo-GIA) staplers are widely used in various surgical... more Endovascular gastrointestinal anastomosis (Endo-GIA) staplers are widely used in various surgical procedures despite difficulties in operating them and associated mechanical failures. We present a case of a patient whose post-operative recovery was complicated by intraoperative Endo-GIA stapler failure, which is rarely reported in literature. Our report describes the behavior and consequences of surgical stapler failure so surgeons can anticipate challenges of newer surgical devices while maintaining optimal patient outcomes.