UW Health University Hospital (UW Health, University of Wisconsin Hospital and Clinics or UWHC) is a 505-bed academic regional referral center with 125 outpatient clinics, located on the western edge of the University of Wisconsin–Madison's campus in Madison, Wisconsin. It is an American College of Surgeons designated Level I adult and pediatric trauma center, one of only two in Wisconsin. UW Health University Hospital has seven intensive care units (trauma and life support, pediatric, neonatal, cardiac, cardiothoracic, burn, neurosurgery). UW Health University Hospital was ranked by U.S. News & World Report as the 17th best hospital in the United States and the #1 hospital in Wisconsin in the publication's 2019-2020 Best Hospitals Honor Roll, earning national rankings in 12 adult and 4 pediatric specialties. Additionally, UW Health University Hospital was ranked as the 14th best hospital in the United States and among the top 100 hospitals in the world by Newsweek in 2019.UW Health describes itself as "the integrated health system of the University of Wisconsin–Madison." It is the primary teaching affiliate of the University of Wisconsin School of Medicine and Public Health (whose main building, the Health Sciences Learning Center, is connected to UW Health University Hospital). It is also the primary teaching affiliate of the University of Wisconsin–Madison's School of Nursing and School of Pharmacy, and is a teaching affiliate of Edgewood College's Henry Predolin School of Nursing.UW Health University Hospital is home to the University of Wisconsin Carbone Cancer Center, one of 41 National Cancer Institute-designated Comprehensive Cancer Centers. UW Health also operates the American Family Children's Hospital, a 110-bed pediatric hospital located adjacent to University Hospital, as well as UW Health at the American Center, a 56-bed hospital and emergency room located on the Northeast Side of Madison. Additionally, UW Health operates a network of outpatient clinics at over 80 sites throughout southern and central Wisconsin and northern Illinois, and has partnerships with UnityPoint Meriter Hospital in Madison, Beloit Hospital in Beloit, Wisconsin, and Swedish American Hospital in Rockford, Illinois. UW Health also has an affiliated insurance company, Quartz Health Solutions, Inc., operated in partnership with UnityPoint Health and Gundersen Health System.UW Health serves over 600,000 patients per year, and employs over 1,500 physicians and 16,500 staff across six hospitals, making it the second-largest employer in Madison (after UW–Madison) and in Wisconsin.UW Health University Hospital is home to a helipad that serves UW Med Flight, the hospital's air ambulance service.
BACKGROUND:Whether anticoagulation alone is an adequate treatment for acute, intermediate-risk pulmonary embolism is uncertain. METHODS:We conducted a multinational, adaptive-design trial with blinded outcome adjudication. Patients with intermediate-risk pulmonary embolism (with a ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter of ≥1.0 and an elevated troponin level) were eligible if they had at least two indicators of cardiorespiratory distress (systolic blood pressure of ≤110 mm Hg, a heart rate of ≥100 beats per minute, or a respiratory rate of >20 breaths per minute). Patients were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (the intervention group) or anticoagulation alone (the control group) according to prespecified treatment protocols. The primary outcome was a composite of pulmonary embolism-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days. RESULTS:The intention-to-treat population comprised 544 patients: 273 in the intervention group and 271 in the control group. The mean (±SD) age was 58.2±13.5 years, and 42.6% of the patients were women. A primary-outcome event occurred in 11 patients (4.0%; 95% confidence interval [CI], 2.3 to 7.1) in the intervention group and 28 (10.3%; 95% CI, 7.2 to 14.5) in the control group (relative risk, 0.39; 95% CI, 0.20 to 0.77; P = 0.005). The effect was driven primarily by a lower risk of cardiorespiratory decompensation or collapse in the intervention group. Major bleeding occurred within 7 days after randomization in 11 patients (4.1%) in the intervention group and 6 (2.2%) in the control group (P = 0.32); major bleeding occurred within 30 days in 11 patients (4.1%) and 8 patients (3.0%), respectively (P = 0.64). No substantial between-group differences in the incidence of other serious adverse events were observed up to 30 days after randomization; no intracranial hemorrhage occurred. CONCLUSIONS:In patients with acute, intermediate-risk pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation led to a lower risk of the composite of pulmonary embolism-related death, cardiopulmonary decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days than anticoagulation alone. (Funded by Boston Scientific; HI-PEITHO ClinicalTrials.gov number, NCT04790370.).
Background The USA is a low-incidence country for gastric cancer and screening is not performed. The use of diagnostic endoscopy (EGD) is not well standardized. As a result, patients most commonly have advanced-stage disease at diagnosis. Patients and Methods All patients with gastric cancer treated at a single center over the past 10 years were identified, and demographics, presenting symptoms, diagnostic evaluations, stage at diagnosis, and outcomes were analyzed. Results A total of 249 patients with gastroesophageal junction (GEJ) or gastric or GEJ adenocarcinoma were identified. The presence of gastrointestinal (GI)-related symptoms at diagnosis was associated with more advanced disease (p < 0.001), but 73% of stage I patients were symptomatic. The median self-reported duration of symptoms prior to first EGD was 2 months (range 0-35 months), but nearly 50% of patients with stage IV were diagnosed by cross-sectional imaging before performance of EGD. In addition, 182 patients (73%) were participating in colon cancer screening. The median overall survival (OS) of the entire cohort was 23.0 months (95% CI 14.4-31.6) and was not reached for stage I patients, 47 months (95% CI 24.3-69.7) for stage II, 23.0 months (95% CI 19.9-26.3) for stage III, and 11.0 months (95% CI 6.6-15.4) for stage IV (p < 0.001). Non-EGD method of original diagnosis was an independent predictor of poorer survival, regardless of stage (HR 1.46, 95% CI 1.03-2.09; p = 0.036). Conclusions Diagnostic EGD is underutilized in symptomatic patients, particularly those with dyspepsia, while most patients were participating in colon cancer screening. Novel protocols to standardize the use of diagnostic EGD should be investigated in the USA.
BACKGROUND:The "difficult gallbladder" in acute cholecystitis can preclude safe achievement of the critical view of safety, prompting subtotal cholecystectomy (STC) as a guideline-supported bailout. We performed a contemporary synthesis to clarify STC's safety effectiveness trade-offs vs total cholecystectomy (TC) and delineate technique-specific outcomes and patient factors that may influence risk. METHODS:We conducted a systematic review and meta-analysis of studies from 2010 to June 2025. Three comparisons were evaluated: (i) single-arm outcomes after STC, (ii) STC vs TC, and (iii) fenestrating STC (f-STC) vs reconstituting STC (r-STC). Random-effects models were applied, with prespecified subgroup analyses, leave-one-out sensitivity analyses, and exploratory meta-regression. RESULTS:In single-arm analysis, bile duct injury (BDI) occurred in 0.3%, bile leak in 13.5%, retained stones in 6.1%, and overall complications in 24.7% of patients. Readmission and reoperation occurred in 17.8% and 6.3%, whereas mortality was 0.8%. Postprocedural endoscopic retrograde cholangiopancreatography (ERCP) occurred in 16.2%, and percutaneous drainage in 5.7%. Compared with TC, STC had significantly higher bile leak, retained stones, overall complications, readmission, reoperation, and ERCP, with no significant difference in mortality, intensive care unit admission, or length of stay (LOS). Meta-regression linked diabetes with higher leak, complications, and ERCP, and male sex with higher surgical site infection. f-STC had significantly higher bile leak and longer LOS than r-STC, with ERCP trending higher. CONCLUSION:STC carries a very low BDI rate, but higher postoperative morbidity and secondary interventions than TC. r-STC demonstrated superior outcomes to f-STC. Diabetes and male sex were important risk modifiers. STC remains a rational bailout when the critical view cannot be achieved.
Decompressive craniectomy (DC) is a procedure commonly employed to relieve medically-refractory intracranial hypertension by removing a portion of the skull, thereby allowing for cerebral expansion and reducing the risk of internal herniation and secondary brain injury. This intervention is indicated in patients with severe traumatic brain injury, malignant middle cerebral artery infarction, or other pathologies resulting in elevated intracranial pressure. Although the procedure can be life-saving, it carries risks including hemorrhage, infection, and postoperative hydrocephalus. This review provides a detailed overview of the surgical techniques, intraoperative considerations, and complications associated with DC, with an emphasis on strategies to optimize outcomes and minimize morbidity. Although herein we review the unilateral frontotemporoparietal craniectomy, several of the principles are applicable to the bicoronal approach as well.
