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Comparison Of Ct And Plain Film For The Postoperative Assessment Of Scaphoid Fracture Healing, Lauren Allyson Hackney
Comparison Of Ct And Plain Film For The Postoperative Assessment Of Scaphoid Fracture Healing, Lauren Allyson Hackney
Yale Medicine Thesis Digital Library
Our study is designed to investigate the question of whether plain film or CT is a more suitable imaging modality for use in the postoperative assessment of scaphoid fracture healing. We have retrospectively collected data on 16 scaphoid fracture patients who have undergone surgical intervention as part of their management, and who had both plain film and CT imaging conducted within a relatively short time frame of five weeks as part of their follow-up. These imaging studies were then assessed by two observers who are hand surgeons at our institution, and were graded as healed or not healed. Of the …
Supply Chain Management Models To Improve The Impact Of Orthopaedic Equipment Donations, Youssra Marjoua
Supply Chain Management Models To Improve The Impact Of Orthopaedic Equipment Donations, Youssra Marjoua
Yale Medicine Thesis Digital Library
More than any other surgical subspecialty, orthopaedic surgery relies heavily on the use of implants and instruments, particularly in the provision of trauma related orthopaedic injuries, which are increasingly prevalent in low-income countries (LICs). The current international response to improving musculoskeletal care in LICs, is primarily geared towards increasing the donation of supplies used in orthopaedic surgical procedures. This study outlines the current response, and assesses the supply chain component of international aid efforts to improve fracture care. It then explores this component with a goal of determining how a sustainable source of functional implants can be delivered to skilled …
Superior Patency Of Upper Arm Arteriovenous Fistulae In High Risk Patients, Larissa Catherine Chiulli
Superior Patency Of Upper Arm Arteriovenous Fistulae In High Risk Patients, Larissa Catherine Chiulli
Yale Medicine Thesis Digital Library
Background: Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods: The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival …
Role Of The Innate Immune Response In Tissue Engineered Vascular Graft Stenosis, Dane Mejias
Role Of The Innate Immune Response In Tissue Engineered Vascular Graft Stenosis, Dane Mejias
Yale Medicine Thesis Digital Library
Tissue Engineered Vascular Grafts (TEVGs) hold great promise in advancing the field of pediatric cardiac surgery and other applications in which a vascular conduit is required. The first human clinical trial of these grafts indicated that stenosis was the primary mode of graft failure. Here, we investigate the role of the immune response in stenosis through a CB17 murine inferior vena cava interposition model. We demonstrate that this mouse model undergoes a dramatic stenotic response, and that this is nearly completely abolished in a SCID/bg immunodeficient variant (average luminal diameter (LD) WT: 0.071+/-0.035mm, SCID/bg: 0.804+/-0.039mm; P<0.001). SCID-only mice, which lack T- cells and B-cells, undergo stenosis with luminal diameters approaching those of wild type mice. The bg mutation is characterized by defects in natural killer (NK) cell and platelet dysfunction, and treatment of wild-type mice with either anti-platelet therapy (aspirin/clopidogrel) or an anti- natural killer cell antibody (NK 1.1) results in patency that is half of that achieved in the SCID/bg mouse (WT: 0.071+/-0.035mm, SCID/bg: 0.804+/-0.039mm, SCID: 0.137+/-0.032mm, Asp/Pla: 0.452+/-0.130mm, NKab: 0.356+/-0.151mm; P<0.001). We additionally show that SCID/bg mice show a blunted immune response to scaffold implantation, wheras wild-type mice show a dramatic initial burst of activity as demonstrated by macrophage number, mRNA, and cytokine levels. Implicating the initial innate immune response to the scaffold as a critical contributing factor in graft stenosis may provide a strategy for prognosis and therapy of future TEVGs.
Is Aggressive Mediastinal Control Needed After Neoadjuvant Therapy For Distal Esophagus Carcinomas?, Chantae Sullivan
Is Aggressive Mediastinal Control Needed After Neoadjuvant Therapy For Distal Esophagus Carcinomas?, Chantae Sullivan
Yale Medicine Thesis Digital Library
The pattern of recurrence after neoadjuvant chemoradiotherapy followed by transhiatal esophagectomy with limited mediastinal lymphadenectomy among 73 patients with carcinoma of the distal esophagus, gastroesophageal junction (GEJ) and/or gastric cardia, was investigated in this retrospective study. Results indicate that among the 30 patients with recurrence, distant sites (n = 24) were more common than local sites (n = 6) and this difference was statistically significant (P = 0.001). Lungs and liver were the most common sites of first recurrence, 51%, while mediastinal nodes were the sites of first recurrence in 6% of cases. Twenty patients (27.4%) had pathologic complete response, …
Aesthetics Of The Female Breast: Correlation Of Pluralistic Evaluations With Volume And Surface Area, Yuen-Jong Liu
Aesthetics Of The Female Breast: Correlation Of Pluralistic Evaluations With Volume And Surface Area, Yuen-Jong Liu
Yale Medicine Thesis Digital Library
The goal of cosmetic and reconstructive breast surgery is to fashion symmetric breasts with aesthetically acceptable shapes. Breast shape is largely determined by volume of tissue and surface area of the skin envelope. Values for breast surface area have never been published in the literature. The investigators developed an inexpensive, non-invasive optical method to objectively measure breast volume and surface area. The aims were to validate the method, to assess the accuracy of visual inspection by plastic surgeons, to determine ideal anthropomorphic measurements, and to derive a mathematical relationship between volume and surface area for an aesthetically acceptable shape. In …
Diminished Circulating Monocytes After Peripheral Bypass Surgery For Critical Limb Ischemia, Dania Magri
Diminished Circulating Monocytes After Peripheral Bypass Surgery For Critical Limb Ischemia, Dania Magri
Yale Medicine Thesis Digital Library
Introduction: Mononuclear cells (MNCs) have been shown to increase neovascularization and ulcer healing after direct injection into the ischemic limbs of patients with unreconstructable peripheral vascular disease (PVD). Circulating MNCs are composed of lymphocytes (85%), monocytes (15%) and endothelial progenitor cells (EPCs; 0.03%). It is thought that MNCs may be effective in ameliorating ischemia since EPCs are a component of the monocyte fraction, and EPCs have been shown to participate in vascular healing. We hypothesized that ischemic areas secrete paracrine signals such as cytokines and growth factors that recruit bone marrow-derived monocytes into the circulation in order to augment vascular …
Clinical And Demographic Predictors Of Short-Term Recovery From Arthroscopic Partial Meniscectomy, Peter Fabricant
Clinical And Demographic Predictors Of Short-Term Recovery From Arthroscopic Partial Meniscectomy, Peter Fabricant
Yale Medicine Thesis Digital Library
Patients undergoing orthopaedic surgery are concerned with returning to activities of daily living (recovery) in addition to the long-term result of their surgery (end result). As evidence of predictors of rate of short-term recovery is limited to date, this study seeks to determine which patient clinical and demographic factors can serve as prognostic indicators for rate of short-term recovery from arthroscopic partial meniscectomy in the year following surgery and how they may differ from previously published associations with long-term outcome. Clinical (depth of meniscal excision, involvement of one or both menisci, extent of meniscal tear, extent of osteoarthritis) and demographic …
Evolution Of The Surgeon Volume / Patient Outcome Relationship, Leon Dimitrios Boudourakis
Evolution Of The Surgeon Volume / Patient Outcome Relationship, Leon Dimitrios Boudourakis
Yale Medicine Thesis Digital Library
Adams et al. was the first to demonstrate an association between improved outcomes and provider experience in a 1973 study examining complication rates from coronary arteriograms.[1] In this study, a questionnaire was mailed to the directors of coronary arteriography laboratories throughout the US. They found that mortality was eight times higher in institutions performing fewer than 200 examinations per two-year period compared to institutions performing more than 800 examinations per two-year period. It was not until 1979, however, that efforts to systematically study outcomes in surgery were made by Luft and colleagues.[2] They demonstrated lower mortality rates at high-volume centers …
Biomechanical Testing Of Charité Disc Replacements Versus Fusion Using Hybrid Testing Protocol And Follower Load, Edward Teng
Biomechanical Testing Of Charité Disc Replacements Versus Fusion Using Hybrid Testing Protocol And Follower Load, Edward Teng
Yale Medicine Thesis Digital Library
Statement of Purpose: To quantify adjacent level effects following Charité disc replacement compared to fusion, using the follower load and the new standard hybrid testing method in flexion, extension, and torsion. Summary of Background Data: As opposed to fusion, artificial discs not only preserve motion, but may diminish adjacent level effects and thus slow adjacent disc degeneration. This study aims to use hybrid test protocol and follower load to perform in vitro multidirectional testing and quantify adjacent- and other- level (AOL) effects following one- and two-level disc implants compared to fusion. Methods: Five intact human cadaveric lumbar specimens underwent multidirectional …
Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez
Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez
Yale Medicine Thesis Digital Library
Purpose: The purpose of this study was to examine the associations between pre-operative weight loss, weight loss programs, and clinic attendance relative to the success of gastric bypass in class II and III obese patients. Background: The increasing number of obese children and adults in the United States poses an extensive social problem in the era of managed care. Notwithstanding the stigmatization associated with obesity, the considerable health implications along with the financial burden it imposes create a formidable adversary. Surgical procedures have proved to be superior to conservative and pharmacotherapeutic interventions in the morbidly obese. Despite the overall success …
The Use And Safety Of Vascular Occlusion Techniques: A Survey Of Practicing Surgeons, Ryan Kelly
The Use And Safety Of Vascular Occlusion Techniques: A Survey Of Practicing Surgeons, Ryan Kelly
Yale Medicine Thesis Digital Library
Vascular occlusion techniques can be divided into two categories ¡V transfixion and non-transfixion. Transfixion techniques are defined by the passage of suture material or staples through the vascular tissue. Non-transfixion techniques are defined as suture, metal, or polymer material placed solely around the vascular tissue. The purpose of this study was to survey surgeons in various specialties to determine which vascular control technique they believe is safest and most appropriate to manage medium-sized arteries 6-10mm in diameter. A survey was distributed to surgeons in the following specialties: general surgery, urology, thoracic surgery, vascular surgery, obstetrics and gynecology, and colon and …
Ct Scan Natural History Of Post-Operative Thoracic Aortic Surgery Patients, Jessica Kirk
Ct Scan Natural History Of Post-Operative Thoracic Aortic Surgery Patients, Jessica Kirk
Yale Medicine Thesis Digital Library
This study evaluated post-operative CT scans to determine the normal postoperative appearance following thoracic aorta surgery. The 188 CT studies in 102 patients were analyzed for presence of perigraft fluid collections and pleural effusions. Fifty-seven of 102 patients (56%) had perigraft fluid at the time of their first postoperative CT scan. The majority of collections disappeared over time but some persisted with 22% scans showing fluid at greater than 24 months post-operatively. Pleural effusions were present on 86% of scans in the first post-operative month and only 9% of scans after 1 year. Pseudoaneurysms occurred in 3 of 48 ascending …
Differentiation Of Appendiceal Carcinoids By Marker Gene Expression, Igor Latic
Differentiation Of Appendiceal Carcinoids By Marker Gene Expression, Igor Latic
Yale Medicine Thesis Digital Library
Objective: To utilize differential gene expression of candidate markers to discriminate benign APCs (APCs) from malignant and mixed cell APCs. Background Data: Considerable controversy exists in regard to the appropriate surgical management of APCs since standard clinical and immunohistochemical methods cannot reliably determine whether an APC is indolent or aggressive. We have identified five differentially expressed genes: nucleosome assembly protein 1-like 1 [NAP1L1]; melanoma antigen D2 [MAGE-D2]; metastasis-associated protein 1 [MTA1]; NAcht Leucine-rich-repeat Protein 1 [NALP1] and Chromogranin A [CgA] that define gut neuroendocrine (NE) Enterochromaffin (EC) cell behavior. We hypothesized that APC (APC) malignancy, also derived from EC cells, …
Size Matters: Gastric Pouch Size As A Predictor Of Weight Loss Following Laparoscopic Roux-Y Gastric Bypass, Joyce I. Kaufman
Size Matters: Gastric Pouch Size As A Predictor Of Weight Loss Following Laparoscopic Roux-Y Gastric Bypass, Joyce I. Kaufman
Yale Medicine Thesis Digital Library
Introduction: The identification of relevant components of successful weight reduction surgery is the most important endeavor in the latest research aiming to increase excess weight loss. Over the past twenty years there has been ongoing discussion about the importance of gastric pouch size as one of the key factors influencing weight loss after restrictive weight reduction surgery. The goal of our analysis is to determine the relationship between pouch size and weight reduction following laparoscopic Roux-Y gastric bypass (LRYGB). Methods: Between August 2002 and March 2005, 321 LRYGB procedures were performed at the same institution. Patient demographics were entered into …