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Surgical Procedures, Operative Commons

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Relapsed Ovarian High-Grade Serous Carcinoma With Long-Term Survival Associated With Synchronous Primary Squamous Cell Carcinoma Of The Colon, Karla Sladoljev, Ena Perin, Ani Mihaljević Ferrari, Marko Klarić, Alemka Brnčić-Fischer, Senija Eminović, Danijela Vrdoljak-Mozetič, Emina Babarovic 2018 School of Medicine University of Rijeka, University of Rijeka, Croatia

Relapsed Ovarian High-Grade Serous Carcinoma With Long-Term Survival Associated With Synchronous Primary Squamous Cell Carcinoma Of The Colon, Karla Sladoljev, Ena Perin, Ani Mihaljević Ferrari, Marko Klarić, Alemka Brnčić-Fischer, Senija Eminović, Danijela Vrdoljak-Mozetič, Emina Babarovic

Proceedings in Obstetrics and Gynecology

High-grade serous ovarian cancer (HGSOC) is the most common and also the most aggressive subtype of ovarian cancer while squamous cell carcinoma (SCC) of the colon is an extremely rare histologic subtype of all colonic malignancies with poor prognosis.

Here we report a unique case of synchronous primary SCC of the colon and second recurrence of HGSOC in a patient with 15-years survival. Our patient developed two recurrent HGSOCs with disease-free survival time of five and nine years, respectively. The second recurrence of HGSOC was associated with the synchronous primary SCC of the ascending colon and was further complicated with ...


Comparing Efficacy Of Lumen-Apposing Stents To Plastic Stents In The Endoscopic Management Of Mature Peripancreatic Fluid Collections: A Single-Center Experience, Matthew J. Fasullo, Yasir Al-Azzawai, Joan Kheder, Jeffrey Abergel, Wahid Y. Wassef 2018 University of Massachusetts Medical School

Comparing Efficacy Of Lumen-Apposing Stents To Plastic Stents In The Endoscopic Management Of Mature Peripancreatic Fluid Collections: A Single-Center Experience, Matthew J. Fasullo, Yasir Al-Azzawai, Joan Kheder, Jeffrey Abergel, Wahid Y. Wassef

Open Access Articles

Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the "step-up approach," which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution.

Methods: A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients ...


Unique Surgical Approach To A Twisted Ileal-Anal Pouch, Hannah Buettner, Maria X. Kiely, Mengdi Yao, James Yoo, Lilian Chen 2018 University of Massachusetts Medical School

Unique Surgical Approach To A Twisted Ileal-Anal Pouch, Hannah Buettner, Maria X. Kiely, Mengdi Yao, James Yoo, Lilian Chen

Open Access Articles

Total proctocolectomy with ileal pouch-anal anastomosis can restore gastrointestinal continuity in patients requiring colectomy for ulcerative colitis, however, it can be associated with high morbidity. Reoperation for pouch-related complications is technically challenging and often leads to deterioration of pouch function or need for permanent stoma. We report a case of acute on chronic small bowel obstruction secondary to a 360-degree twist in the small bowel introduced during creation of the ileal-anal pouch. Our novel approach at repair has not been reported in past literature which included resection and re-anastomosis of the small bowel proximal to the pouch allowing for pouch ...


Inertial Sensor-Based Variables Are Indicators Of Frailty And Adverse Post-Operative Outcomes In Cardiovascular Disease Patients, Rahul Soangra, Thurmon E. Lockhart 2018 Chapman University

Inertial Sensor-Based Variables Are Indicators Of Frailty And Adverse Post-Operative Outcomes In Cardiovascular Disease Patients, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Cardiovascular disease (CVD) patients with intrinsic cardiac cause for falling have been found to be frail and submissive to morbidity and mortality as post-operative outcomes. In these older CVD patients, gait speed is conjectured by the Society of Thoracic Surgeons (STS) as an independent predictor of post-operative morbidity and mortality. However, this guideline by STS has not been studied adequately with a large sample size; rather it is based largely on expert opinions of cardiac surgeons and researchers. Although one’s gait speed is not completely associated with one’s risk of falls, gait speed is a quick robust measure ...


Integration Of Complementary And Alternative Medicine Into The Healthcare System In The United States, Nikki Lu 2018 University of Washington – Tacoma

Integration Of Complementary And Alternative Medicine Into The Healthcare System In The United States, Nikki Lu

Global Honors Theses

Chronic diseases are a prevalent issue around the world and chronic diseases are hard to prevent due to various systemic factors in the healthcare system. This paper mainly focused on socioeconomic issues and highlighted a few systemic factors in the US healthcare system. These factors have created various health disparities, inequities among socially constructed groups, and financial expenditures in the US healthcare system. Socioeconomic factors significantly impact the health and healthcare among socially constructed groups. Additionally, in this paper there are current approaches in addressing these healthcare factors such as social determinants of health and precision medicine as well as ...


Failure Of Primary Total Knee Arthroplasty: Establishing A Baseline For Retrieval Analysis Using Well-Functioning Necropsy Specimens, Meredith Perkins 2018 University of Tennessee Health Science Center

Failure Of Primary Total Knee Arthroplasty: Establishing A Baseline For Retrieval Analysis Using Well-Functioning Necropsy Specimens, Meredith Perkins

Theses and Dissertations (ETD)

Introduction. Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis of the knee. While many patients have positive functional and pain outcomes following primary TKA, a subset of patients have suboptimal outcomes, such as unexplained pain or aseptic loosening of the implant components necessitating revision of the index procedure. The understanding of the exact etiology of these suboptimal outcomes of primary TKA is in its infancy. In order to elucidate the etiology of failure in primary TKAs, a baseline for the factors contributing to arthroplasty failure and dissatisfaction must first be established. The purpose of this study was ...


A Web-Based Treatment Decision Support Tool For Patients With Advanced Knee Arthritis: Evaluation Of User Interface And Content Design, Hua Zheng, Milagros C. Rosal, Wenjun Li, Amy Borg, Wenyun Yang, David C. Ayers, Patricia D. Franklin 2018 University of Massachusetts Medical School

A Web-Based Treatment Decision Support Tool For Patients With Advanced Knee Arthritis: Evaluation Of User Interface And Content Design, Hua Zheng, Milagros C. Rosal, Wenjun Li, Amy Borg, Wenyun Yang, David C. Ayers, Patricia D. Franklin

Open Access Articles

BACKGROUND: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery.

OBJECTIVE: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults.

METHODS: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information ...


Effects Of Psychiatric Comorbidities On The Perioperative Outcomes Following A Primary Total Arthroplasty, Taylor Smith 2018 Carroll College

Effects Of Psychiatric Comorbidities On The Perioperative Outcomes Following A Primary Total Arthroplasty, Taylor Smith

Carroll College Student Undergraduate Research Festival

This review was conducted to compare the perioperative outcomes following a total primary arthroplasty among patients with a psychiatric comorbidity versus those without a psychiatric comorbidity. Literature was reviewed from the database Pubmed. Seven cohort and case-control studies were reviewed, with the largest sample size of 8.4 million patients. Psychiatric comorbidities resulted in increased negative perioperative outcomes compared to patients without psychiatric comorbidities in six articles. These studies observed higher rates of revision, blood transfusion, mortality, non-traditional discharge, and increased length and cost of stay for patients with a diagnosed psychiatric condition. Therefore, it was concluded from most studies ...


The Morbidity And Mortality Of Laparoscopic Appendectomy In Patients With Cirrhosis, Yasir Al-Azzawai, Yasir Al-Abboodi, Matthew J. Fasullo, Tarek Najuib 2018 University of Massachusetts Medical School

The Morbidity And Mortality Of Laparoscopic Appendectomy In Patients With Cirrhosis, Yasir Al-Azzawai, Yasir Al-Abboodi, Matthew J. Fasullo, Tarek Najuib

Open Access Articles

Introduction: The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy.

Methods: We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control ...


Suspected Blood Indicator To Identify Active Gastrointestinal Bleeding: A Prospective Validation, Samuel Han, Julien Fahed, David R. Cave 2018 University of Massachusetts Medical School

Suspected Blood Indicator To Identify Active Gastrointestinal Bleeding: A Prospective Validation, Samuel Han, Julien Fahed, David R. Cave

Open Access Articles

Background: The suspected blood indicator (SBI) function in the RAPID Reader v8.3 program was designed to quickly identify the presence of blood in video capsule endoscopy. While previous retrospective studies have shown that the SBI function was accurate in detecting the presence of active bleeding in the small bowel, its specificity and sensitivity were poor.

Methods: An initial retrospective review (phase 1) compared 115 patients with active gastrointestinal bleeding seen on video capsule endoscopy (VCE) to 115 patients with no active bleeding seen on VCE to produce a highly accurate algorithm. A prospective study (phase 2) was then performed ...


Refrigerated Stability Of Diluted Cisatracurium, Rocuronium, And Vecuronium For Skin Testing After Perioperative Anaphylaxis, Kristen Dinsmore, Bethany Campbell, Timothy Archibald, Greg Mosier, Stacy Brown PhD, Alexei Gonzalez-Estrada MD 2018 East Tennessee State University

Refrigerated Stability Of Diluted Cisatracurium, Rocuronium, And Vecuronium For Skin Testing After Perioperative Anaphylaxis, Kristen Dinsmore, Bethany Campbell, Timothy Archibald, Greg Mosier, Stacy Brown Phd, Alexei Gonzalez-Estrada Md

Appalachian Student Research Forum

Rationale: The purpose of this study is to investigate the stored stability of dilutions of neuromuscular blocking agents (NMBAs), namely cisatracurium, rocuronium, and vecuronium, for skin prick/intradermal testing.

Methods: Concentrations of NMBAs were monitored by liquid chromatography-mass spectrometry (LC-MS/MS) for a period of 14 days. Dilutions of NMBAs were prepared in saline by factors of 10x, 100x, 1,000x, 10,000x, and 100,000x as sensitivity of the assay allowed. Diluted drug products were stored in a laboratory refrigerator until sampling. On sampling days, aliquots of each dilution were removed and compared to a freshly prepared set of ...


The Tempo Trial At 5 Years: Transoral Fundoplication (Tif 2.0) Is Safe, Durable, And Cost-Effective., Karim S Trad, William E Barnes, Elizabeth R Prevou, Gilbert Simoni, Jennifer A Steffen, Ahmad B Shughoury, Mamoon Raza, Jeffrey A Heise, Mark A Fox, Peter G Mavrelis 2018 George Washington University

The Tempo Trial At 5 Years: Transoral Fundoplication (Tif 2.0) Is Safe, Durable, And Cost-Effective., Karim S Trad, William E Barnes, Elizabeth R Prevou, Gilbert Simoni, Jennifer A Steffen, Ahmad B Shughoury, Mamoon Raza, Jeffrey A Heise, Mark A Fox, Peter G Mavrelis

Surgery Faculty Publications

BACKGROUND: Questions remain about the therapeutic durability of transoral incisionless fundoplication (TIF). In this study, clinical outcomes were evaluated at 5 years post-TIF 2.0.

METHODS: A total of 63 chronic gastroesophageal reflux disease (GERD) sufferers with troublesome symptoms refractory to proton pump inhibitor (PPI) therapy, absent or ≤2 cm hiatal hernia, and abnormal esophageal acid exposure were randomized to the TIF group or PPI group. Following the 6-month evaluation, all patients in the PPI group elected for crossover to TIF; therefore, all 63 patients underwent TIF 2.0 with EsophyX

RESULTS: Of 63 patients, 60 were available at 1 ...


Lumbar Decompression Surgery: Does Chronic Steroid Use Increase The Risk Of Postoperative Infectious Complications? – A Study Of The National Surgical Quality Improvement Program (Nsqip) Database, Shane Sobrio, Mikel Thista, Raj Rao, Alex Gu, Chapman Wei, Warren Yu 2018 George Washington University

Lumbar Decompression Surgery: Does Chronic Steroid Use Increase The Risk Of Postoperative Infectious Complications? – A Study Of The National Surgical Quality Improvement Program (Nsqip) Database, Shane Sobrio, Mikel Thista, Raj Rao, Alex Gu, Chapman Wei, Warren Yu

GW Research Days 2016 - Present

Intro: It has long been established that corticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Many past studies have shown that patient’s will have higher rates of infection if they are taking chronic steroids. What has yet to be established is just how much of an increased risk patients on chronic steroids have for infection after undergoing lumbar decompression surgeries, of which there are thousands per year. We hypothesize that patients on chronic steroids will have higher rates of surgical site infections and higher rates of other infections (UTI ...


Morphine Versus Fentanyl Patient-Controlled Analgesia For Postoperative Pain Control In Major Hepatic Resection Surgeries Including Living Liver Donors: A Retrospective Study, Eman M. Nada, Abdulmajeed Alabdulkareem 2018 University of Massachusetts Medical School

Morphine Versus Fentanyl Patient-Controlled Analgesia For Postoperative Pain Control In Major Hepatic Resection Surgeries Including Living Liver Donors: A Retrospective Study, Eman M. Nada, Abdulmajeed Alabdulkareem

Open Access Articles

Background: Liver resection surgery results in significant postoperative pain. However, it is still not clear which opioids used by patient-controlled analgesia (PCA) provides the best pain control and results in the least side effect in a patient with impaired liver function. Our hypothesis was that fentanyl is a better choice than morphine as it is a potent analgesic that its elimination half-life does not depend on the hepatic uptake and metabolism.

The Study Purpose: Is to compare morphine and fentanyl PCA in liver resection patients as regards the degree of pain control, the consumption of opioids, and the side effects ...


The Principles And Practice Of Open Fracture Care, 2018, Amna Diwan, Kyle R. Eberlin, Raymond Malcolm Smith 2018 University of Massachusetts Medical School

The Principles And Practice Of Open Fracture Care, 2018, Amna Diwan, Kyle R. Eberlin, Raymond Malcolm Smith

Open Access Articles

The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement and lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex ...


Mechanical Pleurodesis Is Not A Contraindication To Lung Transplantation, Alexa Thibodeau 2018 Wayne State University School of Medicine

Mechanical Pleurodesis Is Not A Contraindication To Lung Transplantation, Alexa Thibodeau

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Shigemura N, Bhama J, Gries CJ, et al. Lung transplantation in patients with prior cardiothoracic surgical procedures. American Journal of Transplantation. 2012;12(5):1249-1255. doi: 10.1111/j.1600-6143.2011.03946.x


Ischemia Augments Alloimmune Injury Through Il-6-Driven Cd4(+) Alloreactivity, Mayuko Uehara, Zhabiz Solhjou, Naima Banouni, Vivek Kasinath, Ye Xiaqun, Li Dai, Osman Yilmam, Mine Yilmaz, Takaharu Ichimura, Paolo Fiorina, Paulo N.A. Martins, Shunsuke Ohori, Indira Guleria, Omar H. Maarouf, Stefan G. Tullius, Martina M. McGrath, Reza Abdi 2018 Harvard Medical School

Ischemia Augments Alloimmune Injury Through Il-6-Driven Cd4(+) Alloreactivity, Mayuko Uehara, Zhabiz Solhjou, Naima Banouni, Vivek Kasinath, Ye Xiaqun, Li Dai, Osman Yilmam, Mine Yilmaz, Takaharu Ichimura, Paolo Fiorina, Paulo N.A. Martins, Shunsuke Ohori, Indira Guleria, Omar H. Maarouf, Stefan G. Tullius, Martina M. Mcgrath, Reza Abdi

Open Access Articles

Ischemia reperfusion injuries (IRI) are unavoidable in solid organ transplantation. IRI augments alloimmunity but the mechanisms involved are poorly understood. Herein, we examined the effect of IRI on antigen specific alloimmunity. We demonstrate that ischemia promotes alloimmune activation, leading to more severe histological features of rejection, and increased CD4(+) and CD8(+) T cell graft infiltration, with a predominantly CD8(+) IFNgamma(+) infiltrate. This process is dependent on the presence of alloreactive CD4(+) T cells, where depletion prevented infiltration of ischemic grafts by CD8(+) IFNgamma(+) T cells. IL-6 is a known driver of ischemia-induced rejection. Herein, depletion of donor antigen-presenting cells reduced ...


Pilot Study Of Delayed Icos/Icos-L Blockade With Alphacd40 To Modulate Pathogenic Alloimmunity In A Primate Cardiac Allograft Model, Natalie A. O'Neill, Tianshu Zhang, Gheorghe Braileanu, Xiangfei Cheng, Alena Hershfeld, Wenji Sun, Keith A. Reimann, Sia Dahi, Natalia Kubicki, Wessam Hassanein, Christopher Laird, Arielle Cimeno, Agnes M. Azimzadeh, Richard N. Pierson 2018 University of Maryland at Baltimore

Pilot Study Of Delayed Icos/Icos-L Blockade With Alphacd40 To Modulate Pathogenic Alloimmunity In A Primate Cardiac Allograft Model, Natalie A. O'Neill, Tianshu Zhang, Gheorghe Braileanu, Xiangfei Cheng, Alena Hershfeld, Wenji Sun, Keith A. Reimann, Sia Dahi, Natalia Kubicki, Wessam Hassanein, Christopher Laird, Arielle Cimeno, Agnes M. Azimzadeh, Richard N. Pierson

Open Access Articles

Background: Inducible costimulator (ICOS) is rapidly upregulated with T-cell stimulation and may represent an escape pathway for T-cell costimulation in the setting of CD40/CD154 costimulation blockade. Induction treatment exhibited no efficacy in a primate renal allograft model, but rodent transplant models suggest that the addition of delayed ICOS/ICOS-L blockade may prolong allograft survival and prevent chronic rejection. Here, we ask whether ICOS-Ig treatment, timed to anticipate ICOS upregulation, prolongs NHP cardiac allograft survival or attenuates pathogenic alloimmunity.

Methods: Cynomolgus monkey heterotopic cardiac allograft recipients were treated with alphaCD40 (2C10R4, d0-90) either alone or with the addition of delayed ...


Bow Hunter's Syndrome In A Patient With A Right Hypoplastic Vertebral Artery And A Dynamically Compressible Left Vertebral Artery, David Z. Cai, Ryan P. Roach, John P. Weaver, Gerald T. McGillicuddy, Zachary M. Mansell, Jonathan P. Eskander, Mark S. Eskander 2018 Tulane University

Bow Hunter's Syndrome In A Patient With A Right Hypoplastic Vertebral Artery And A Dynamically Compressible Left Vertebral Artery, David Z. Cai, Ryan P. Roach, John P. Weaver, Gerald T. Mcgillicuddy, Zachary M. Mansell, Jonathan P. Eskander, Mark S. Eskander

Open Access Articles

This is a case report of a 48-year-old man with multiple transient ischemic attacks and a known hypoplastic right vertebral artery (VA) who presented after a syncopal event while turning his head to the left. The objective of this study is to demonstrate the necessity of proper diagnosis and management of cerebrovascular pathology including imaging and surgical intervention in patients with known anatomical anomalies. This study was conducted at Massachusetts, United States of America. Our patient's history was significant for a hypoplastic right VA and a stenotic segment of the right VA at the C3-C4 junction. There was also ...


Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood 2017 The University of Southern Mississippi

Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood

Doctoral Projects

Post-operative pain creates burdens for the patient and their family members while also drastically increasing the price of cost to the healthcare system. The Institute of Medicine Committee on Advancing Pain Research, Care, and Education states that the annual economic cost of chronic pain in adults is $560-630 billion (IOM, 2011). Regional anesthesia has been shown to provide potent analgesia that often times leads to a reduction in systemic analgesic requirements, opioid related side effects, general anesthesia requirements, and possibly the incidence of chronic post-operative pain. There are several adjunct medications that can be combined with peripheral nerve blocks to ...


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