Medicine and Health Sciences Commons^™

Renal Cell Carcinoma Metastatic To The Duodenum: Treatment By Classic Pancreaticoduodenectomy And Review Of The Literature, Robert Adamo, Patrick J. Greaney Jr., Agnieszka Witkiewicz, Eugene P. Kennedy, Charles J. Yeo

Department of Surgery Faculty Papers

Renal cell cancer (RCC) most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain, although metastases can occur elsewhere. RCC metastatic to the duodenum is especially rare, with only a small number of cases reported in the literature. Herein, we describe a case of an 86-year-old woman with a history of RCC treated by radical nephrectomy 13 years previously. The patient presented with duodenal obstruction and anemia from a solitary duodenal mass invading into the pancreas and was treated via classic pancreaticoduodenectomy. Preoperative imaging and intra-operative assessment showed no evidence of other disease. Pathology confirmed metastatic RCC without …

Comparison Of Eight Prosthetic Aortic Valves In A Cadaver Model., Benjamin A. Youdelman, Hitoshi Hirose, Harsh Jain, J Yasha Kresh, John W.C. Entwistle, Andrew S. Wechsler

Department of Surgery Faculty Papers

OBJECTIVES: Proper valve selection is critical to ensure appropriate valve replacement for patients, because implantation of a small valve might place the patient at risk for persistent gradients. Labeled valve size is not the same as millimeter measure of prosthetic valve diameters or the annulus into which it will fit. Studies that use the labeled valve size in lieu of actual measured diameter in millimeters to compare different valves might be misleading. Using human cadaver hearts, we sized the aortic annulus with 8 commonly used prosthetic aortic valve sizers and compared the valves using geometric orifice area. This novel method …

Comparison Of Eight Prosthetic Aortic Valves In A Cadaver Model, Benjamin A. Youdelman, Hitoshi Hirose, Harsh Jain, J. Yasha Kresh, John W.C. Entwhistle Iii, Andrew S. Wechsler

Department of Surgery Faculty Papers

OBJECTIVES: Proper valve selection is critical to ensure appropriate valve replacement for patients, because implantation of a small valve might place the patient at risk for persistent gradients. Labeled valve size is not the same as millimeter measure of prosthetic valve diameters or the annulus into which it will fit. Studies that use the labeled valve size in lieu of actual measured diameter in millimeters to compare different valves might be misleading. Using human cadaver hearts, we sized the aortic annulus with 8 commonly used prosthetic aortic valve sizers and compared the valves using geometric orifice area. This novel method …

Resected Serous Cystic Neoplasms Of The Pancreas: Locally Aggressive Behavior As A Predictor Of Malignant Disease? A Review Of 158 Patients With Recommendations For Treatment., Charles Galanis, Amir Zamani, John L. Cameron, Kurtis A. Campbell, Keith D. Lillemoe, David Caparrelli, David Chang, Ralph H. Hruban, Charles Yeo

Department of Surgery Faculty Papers

Background: Serous cystic neoplasms of the pancreas are regarded as a benign entity with rare malignant potential. Surgical resection is generally considered curative. Objective: To perform the largest single institution review of patients who underwent surgical resection for serous cystic neoplasms of the pancreas in the hopes of guiding future management. Methods: Between June 1988 and January 2005, 158 patients with serous cystic neoplasms of the pancreas underwent surgical resection. A retrospective analysis was performed. Univariate and multivariate models were used to determine factors influencing perioperative morbidity and mortality. Major complications were defined as pancreatic fistula or anastomotic leak, postoperative …

Gangliocytic Paraganglioma: Case Report And Review Of The Literature, Agnes Witkiewicz, Avi Galler, Charles Yeo

Department of Surgery Faculty Papers

Gangliocytic paraganglioma is a rare tumor, which occurs nearly exclusively in the second portion of the duodenum. Generally, this tumor has a benign clinical course, although rarely, it may recur or metastasize to regional lymph nodes. Only one case with distant metastasis has been reported. We present a case of duodenal gangliocytic paraganglioma treated first by local resection followed by pylorus-preserving pancreaticoduodenectomy. Examination of the first specimen revealed focal nuclear pleomorphism and mitotic activity, in addition to the presence of three characteristic histologic components: epithelioid, ganglion, and spindle cell. In the subsequent pancreaticoduodenectomy specimen, there was no residual tumor identified …

Breast Specific Gamma Imaging: Role In Evaluation Of Breast Disease, Anne L. Rosenburg, Kristin L. Brill, R. A. Flynn, Lillian Stern, E. M. Ferguson

Department of Surgery Faculty Papers

Although mammography is the gold standard for screening for breast cancer, 10 to 15% of lesions are missed, and this is higher with dense breasts. Alternative diagnostic modalities are being developed. One of these, breast specific gamma imaging (BSGI), which is not effected by dense tissue, utilizes the increased metabolic activity of tumors to localize and distinguish benign from malignant processes in the breast. The test can be used for screening and diagnostic purposes.

Massive Retroperitoneal Hematoma Caused By Retroperitoneal Ectopic Pregnancy, Jay Goldberg, Michael Weinstein, Kris Kaulback, Aileen Gariepy, George Bega

Department of Surgery Faculty Papers

A massive retroperitoneal hematoma caused by a retroperitoneal ectopic pregnancy is managed successfully utilizing multidisciplinary cooperation and transfusion of blood products. The authors report an unusual case of a retroperitoneal ectopic pregnancy presenting as a massive retroperitoneal hematoma in a hemodynamically unstable patient.

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Role Of Immediate Reconstruction For Elderly Breast Cancer Patients, Anne L. Rosenburg, Kristin L. Brill, R. A. Flynn, Steven E. Copit

Department of Surgery Faculty Papers

With rising numbers of elderly women developing breast cancer, treatment options must evolve which take into consideration quality of life and functional status. Although fewer women at all ages are undergoing mastectomy, for those elderly women who undergo mastectomy, reconstruction options should be offered. Over the past 5 years, increasing numbers of elderly women are electing immediate reconstruction (IM).

Sentinel Node Staging For Breast Cancer: Intraoperative Molecular Pathology Overcomes Conventional Histologic Sampling Errors, Peter Blumencranz, Pat W. Whitworth, Kenneth Deck, Anne Rosenberg, Douglas Reintgen, Peter Beitsch, Anees Chagpar, Thomas Julian, Sukamal Saha, Eleftherios Mamounas, Armando Giuliano, Rache Simmons

Department of Surgery Faculty Papers

BACKGROUND:
When sentinel node dissection reveals breast cancer metastasis, completion axillary lymph node dissection is ideally performed during the same operation. Intraoperative histologic techniques have low and variable sensitivity. A new intraoperative molecular assay (GeneSearch BLN Assay; Veridex, LLC, Warren, NJ) was evaluated to determine its efficiency in identifying significant sentinel lymph node metastases (>.2 mm).

METHODS:
Positive or negative BLN Assay results generated from fresh 2-mm node slabs were compared with results from conventional histologic evaluation of adjacent fixed tissue slabs.

RESULTS:
In a prospective study of 416 patients at 11 clinical sites, the assay …

Initiation Of A Critical Pathway For Pancreaticoduodenectomy At An Academic Institution -- The First Step In Multi-Disciplinary Team Building, Eugene P. Kennedy, Ernest L. Rosato, Patricia K. Sauter, Laura M. Rosenberg, Cataldo Doria, Ignazio R. Marino, Karen A. Chojnacki, Adam C. Berger, Charles Yeo

Department of Surgery Faculty Papers

Objective: This study was designed to identify quantifiable parameters to track performance improvements brought about by the implementation of a critical pathway for complex alimentary tract surgery.

Background: Pancreaticoduodenectomy (PD) is a complex general surgical procedure performed in varying numbers at many academic institutions. Originally associated with significant perioperative morbidity and mortality, multiple studies have now shown that this operation can be performed quite safely at high volume institutions that develop a particular expertise. Critical pathways are one of the key tools used to achieve consistently excellent outcomes as these institutions. It remains to be determined if implementation …

Idiopathic Granulomatous Mastitis Masquerading As Carcinoma Of The Breast: A Case Report And Review Of The Literature., Richard Tuli, Brian J O'Hara, Janet Hines, Anne L Rosenberg

Department of Surgery Faculty Papers

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options …