Surgical Procedures, Operative Commons^™

Improved Sensitivity To Fluorescence For Cancer Detection In Wide-Field Image-Guided Neurosurgery, Michael Jermyn, Yoann Gosselin, Pablo A. Valdes, Mira Sibai, Kolbein Kolste

Dartmouth Scholarship

In glioma surgery, Protoporphyrin IX (PpIX) fluorescence may identify residual tumor that could be resected while minimizing damage to normal brain. We demonstrate that improved sensitivity for wide-field spectroscopic fluorescence imaging is achieved with minimal disruption to the neurosurgical workflow using an electron-multiplying charge-coupled device (EMCCD) relative to a state-of-the-art CMOS system. In phantom experiments the EMCCD system can detect at least two orders-of-magnitude lower PpIX. Ex vivo tissue imaging on a rat glioma model demonstrates improved fluorescence contrast compared with neurosurgical fluorescence microscope technology, and the fluorescence detection is confirmed with measurements from a clinically-validated spectroscopic probe. Greater PpIX …

Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: Many patients undergoing open heart surgery have sinus node dysfunction and atrial fibrillation, leading to adverse outcomes. Mesenchymal stem cells (MSC) delivered at the time of surgery may have a reparative effect on atrial tissue, thereby improving sinus node function and reducing or preventing atrial fibrillation. Stem cell delivery to the atrium is entirely unstudied. This is a significant gap in medical research, as atrial disease contributes significantly to health care costs.

Purpose: The purpose of this pilot study is to establish a technique to deliver MSC to the atria through an open-chest model, to assess the safety of …

Initial Validation Of A Novel Method Of Presurgical Language Localization Through Functional Connectivity (Fcmri), Stephanie M. Noble, Dustin Scheinost, Susan Y. Bookheimer, Patricia Walshaw, R Todd Constable, Christopher F. Benjamin

Yale Day of Data

OBJECTIVE: Neurosurgery is potentially curative in chronic epilepsy but can only be offered to patients if the surgical risk to language is known. Clinical functional magnetic resonance imaging (fMRI) is an ideal, noninvasive method for localizing language cortex yet remains to be validated for this purpose. We have recently presented a novel method for localizing language cortex. Here we present a preliminary evaluation of this method’s validity. We hypothesized language regions identified using this novel method would demonstrate stronger functional connectivity than randomly generated set of proximal networks. METHOD: fMRI data were collected from sixteen temporal lobe patients …

Review Of Fluorescence Guided Surgery Visualization And Overlay Techniques, Jonathan T. Elliott, Alisha V. Dsouza, Scott C. Davis, Jonathan D. Olson, Keith Paulsen, David Roberts, Brian Pogue

Dartmouth Scholarship

In fluorescence guided surgery, data visualization represents a critical step between signal capture and display needed for clinical decisions informed by that signal. The diversity of methods for displaying surgical images are reviewed, and a particular focus is placed on electronically detected and visualized signals, as required for near-infrared or low concentration tracers. Factors driving the choices such as human perception, the need for rapid decision making in a surgical environment, and biases induced by display choices are outlined. Five practical suggestions are outlined for optimal display orientation, color map, transparency/alpha function, dynamic range compression, and color perception check.

Speckle-Tracking Echocardiographic Measures Of Right Ventricular Function Correlate With Improvement In Exercise Function After Percutaneous Pulmonary Valve Implantation., Shahryar M. Chowdhury, Ziyad M. Hijazi, John T. Fahey, John F. Rhodes, Saibal Kar, Raj Makkar, Michael Mullen, Qi-Ling Cao, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [VCO2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPVI.

METHODS: Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were …

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery In High Surgical Risk Patients With Left Main Or Three-Vessel Coronary Artery Disease, Tonga Nfor, Kambiz Shetabi, Wael Hassan, Quinta Nfor, Jayant Khitha, Anjan Gupta, Tanvir Bajwa, Suhail Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose

Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD.

Methods

Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality >5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study.

Results

Mean STS score was …

Characteristics Of A Novel Treatment System For Linear Accelerator–Based Stereotactic Radiosurgery, Ning Wen, Haisen Li, Kwang Song, Karen Chin-Snyder, Yujiao Qin, Jinkoo Kim, Maria Bellon, Misbah Gulam, Stephen Gardner, Anthony Doemer, Suneetha Devpura, James Gordon, Indrin Cherry, Farzan Siddiqui, Munther Ajlouni, Robert Pompa, Zane Hammoud, Michael Simoff, Steven Kalkanis, Benjamin Movsas, M. Salim Siddiqui

Internal Medicine Faculty Publications

The purpose of this study is to characterize the dosimetric properties and accuracy of a novel treatment platform (Edge radiosurgery system) for localizing and treating patients with frameless, image-guided stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Initial measurements of various components of the system, such as a comprehensive assessment of the dosimetric properties of the flattening filter-free (FFF) beams for both high definition (HD120) MLC and conical cone-based treatment, positioning accuracy and beam attenuation of a six degree of freedom (6DoF) couch, treatment head leakage test, and integrated end-to-end accuracy tests, have been performed. The end-to-end test of the …

Effects Of Pringle Maneuver And Partial Hepatectomy On The Pharmacokinetics And Blood–Brain Barrier Permeability Of Sodium Fluorescein In Rats, Mohammad K. Miah, Imam H. Shaik, Ulrich Bickel, Reza Mehvar

Pharmacy Faculty Articles and Research

Liver diseases are known to affect the function of remote organs. The aim of the present study was to investigate the effects of Pringle maneuver, which results in hepatic ischemia–reperfusion (IR) injury, and partial hepatectomy (Hx) on the pharmacokinetics and brain distribution of sodium fluorescein (FL), which is a widely used marker of blood–brain barrier (BBB) permeability. Rats were subjected to Pringle maneuver (total hepatic ischemia) for 20 min with (HxIR) or without (IR) 70% hepatectomy. Sham-operated animals underwent laparotomy only. After 15 min or 8 h of reperfusion, a single 25-mg/kg dose of FL was injected intravenously and serial …

Comparison Of Neutral Versus Extended Wrist Pushup For Patients With Wrist Injury, Emily Tucci

Renée Crown University Honors Thesis Projects - All

The scapholunate interosseous ligament (SLIL) is a crucial stabilizing structure of the wrist. Damage to this ligament often results from falling upon an outstretched hand, leading to carpal instability­.^1,2,3 Tears to the SLIL create a gap in the scapholunate joint and allow the scaphoid to flex and the lunate to extend, rather than moving with one another as they do in healthy physiologic motion.^4,5 The SLIL is normally repaired following injury in order to decrease the risk of arthritis and pain.^1,2,5,6,7 Patients will often begin rehabilitation exercises after SLIL repair in order to reduce recovery time.^{8,9 …}

Dynamic Simulation And Neuromuscular Control Of Movement: Applications For Predictive Simulations Of Balance Recovery, Misagh Mansouri Boroujeni

Doctoral Dissertations

Balance is among the most challenging tasks for patients with movement disorders. Study and treatment of these disorders could greatly benefit from combined software tools that offer better insights into neuromuscular biomechanics, and predictive capabilities for optimal surgical and rehabilitation treatment planning. A platform was created to combine musculoskeletal modeling, closed-loop forward dynamic simulation, optimization techniques, and neuromuscular control system design. Spinal (stretch-reflex) and supraspinal (operational space task-based) controllers were developed to test simulation-based hypotheses related to balance recovery and movement control. A corrective procedure (rectus femoris transfer surgery) was targeted for children experiencing stiff-knee gait and how this procedure …

Hydatid Cyst Of Thoracic Spine: A Rare Cause Of Paraplegia, Rahul Soangra, Mool Chand Soangra

Physical Therapy Faculty Articles and Research

Primary spinal hydatid cysts are uncommon and extradural involvement is rare. We report an unusual case of Paraplegia due to hydatid disease of primary site of infection extra spinal muscles in thoracic region from T5 to T8 level extending into a daughter cyst at T9 level, is main cause of acute Paraplegia. Magnetic resonance imaging (MRI) showed an extradural round cystic lesion in the spinal canal filling the posterior and left postero-lateral expect at T9 level, markedly compressing the cord. The cyst was removed after laminectomy and opening of the dural sac, with excision of extraspinal mass in left paravertebral …

Clinical Outcomes Of Splenectomy In Children: Report Of The Splenectomy In Congenital Hemolytic Anemia Registry., Henry E. Rice, Brian R. Englum, Jennifer Rothman, Sarah Leonard, Audra Reiter, Courtney Thornburg, Mary Brindle, Nicola Wright, Matthew M. Heeney, Charles Smithers, Rebeccah L. Brown, Theodosia Kalfa, Jacob C. Langer, Michaela Cada, Keith T. Oldham, J Paul Scott, Shawn D. St Peter, Mukta Sharma, Andrew M. Davidoff, Kerri Nottage, Kathryn Bernabe, David B. Wilson, Sanjeev Dutta, Bertil Glader, Shelley E. Crary, Melvin S. Dassinger, Levette Dunbar, Saleem Islam, Manjusha Kumar, Fred Rescorla, Steve Bruch, Andrew Campbell, Mary Austin, Robert Sidonio, Martin L Blakely, Splenectomy In Congenital Hemolytic Anemia (Sicha) Consortium

Manuscripts, Articles, Book Chapters and Other Papers

The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, …

Does Neuromuscular Electrical Stimulation As An Adjunct To Traditional Physical Therapy Improve Post-Operative Mobility After Total Knee Arthroplasty In Comparison To Traditional Pt Alone In Patients 50-85 Years Old?, Kelsey L. Welsh

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective Evidence Based Medicine (EBM) review is to determine whether or not neuromuscular electrical stimulation (NMES) as an adjunct to traditional physical therapy (PT) improves post-operative mobility including walking and stairclimbing ability following total knee arthroplasty (TKA) in comparison to traditional PT alone in patients 50-85 years old.

STUDY DESIGN: Review of three English language primary studies published after 1999.

DATA SOURCES: Three randomized controlled trials comparing traditional PT with PT and adjuvant NMES following TKA in patients 50-85 years old found using PubMed and EBSCOhost Web.

OUTCOMES MEASURED: Clinical outcome was measured in each …

Femtosecond Laser Beam Propagation Through Corneal Tissue: Evaluation Of Therapeutic Laser-Stimulated Second And Third-Harmonic Generation, William R. Calhoun Iii

Theses and Dissertations

One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction.

The application of FSLs in medical therapeutics is a recent development, and although …

Quantitative Spatial Frequency Fluorescence Imaging In The Sub-Diffusive Domain For Image-Guided Glioma Resection, Mira Sibai, Israel Veilleux, Jonathan T. Elliott, Frederic Leblond, Brian Wilson

Dartmouth Scholarship

Intraoperative 5- aminolevulinic acid induced-Protoporphyrin IX (PpIX) fluorescence guidance enables maximum safe resection of glioblastomas by providing surgeons with real-time tumor optical contrast. However, visual assessment of PpIX fluorescence is subjective and limited by the distorting effects of light attenuation and tissue autofluorescence. We have previously shown that non-invasive point measurements of absolute PpIX concentration identifies residual tumor that is otherwise non-detectable. Here, we extend this approach to wide-field quantitative fluorescence imaging by implementing spatial frequency domain imaging to recover tissue optical properties across the field-of-view in phantoms and ex vivo tissue.

Can The Nintendo Wii Be Used As A More Effective Method Of Rehabilitation Than Traditional Physiotherapy Exercises For Patients With Knee Reconstruction Surgery?, Samantha Snyder

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not the Nintendo Wii can be used as a more effective method of rehabilitation than traditional physiotherapy exercises for patients with knee reconstruction surgery?

STUDY DESIGN: Review of three English language primary studies, published after 1999.

DATA SOURCES: Two randomized controlled trials (RCTs) and one case study with no comparison group were found using PubMed. These studies analyzed Nintendo Wii intervention in patients that underwent knee reconstructive surgery in need of rehabilitation.

OUTCOME MEASURED: The outcome measured was improvement in balance through use of the Activity-Specific Balance …

Use Of Swine Small Intestine Submucosa As A Dermal Suture, Paige E. Black

PCOM Biomedical Studies Student Scholarship

The purpose of this preliminary study is to determine if swine small intestine submucosa (SIS) can be used to create a suture that will perform comparably to commercially available chromic gut sutures when placed into a wound in rat dermis. This study is part of an ongoing collaboration that has explored SIS as a biologic scaffold in various tissues and surgical procedures. In this study, eight Sprague-dawley rats were divided into two groups, each receiving a full thickness skin wound between the scapula, made by a 5mm biopsy punch. The wound was then closed with commercially available chromic gut suture, …

Physiological And Psychological Changes Following Liposuction Of Large Volumes Of Fat In Overweight And Obese Women, Allan Geliebter, Emily Krawitz, Tatiana Ungredda, Ella Peresechenski, Sharon Y. Giese

Lander College of Arts and Sciences Publications and Research

Background: Liposuction can remove a substantial amount of body fat. We investigated the effects of liposuction of large volumes of fat on anthropometrics, body composition (BIA), metabolic hormones, and psychological measures in overweight/obese women. To our knowledge, this is the first study to examine both physiological and psychological changes following liposuction of large volumes of fat in humans.

Method: Nine premenopausal healthy overweight/obese women (age = 35.9 ± 7.1 SD, weight = 84.4 kg ± 13.6, BMI = 29.9 kg/m2 ± 2.9) underwent liposuction, removing 3.92 kg ± 1.04 SD of fat. Following an overnight fast, height, weight, …

Accurate Modelling And Positioning Of A Magnetically-Controlled Catheter Tip, Vi T. H. Le

Theses: Doctorates and Masters

This thesis represents the initial phase of a proposed operator and patient friendly method designed to semi-automate the positioning and directing of an intravascular catheter in the human heart using a variable electromagnetically induced field to control a catheter tip equipped with three tiny fixed magnets oriented in XYZ planes. Here we demonstrate a comprehensive mathematical model which accurately calculates the magnetic field generated by the electromagnet system, and the magnetic torques and forces exerted on a three-magnet tip catheter. From this we have developed an iterative predictive computer algorithm to show the displacement and deflection of the catheter tip. …