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Initiation Of A Hyperthermic Intraperitoneal Chemotherapy Program At Aurora Health Care, Aaron H. Chevinsky, Wesley Papenfuss, Federico A. Sanchez, James L. Weese 2018 Aurora St. Luke’s Medical Center

Initiation Of A Hyperthermic Intraperitoneal Chemotherapy Program At Aurora Health Care, Aaron H. Chevinsky, Wesley Papenfuss, Federico A. Sanchez, James L. Weese

Journal of Patient-Centered Research and Reviews

Background: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) along with radical debulking has been the standard treatment for peritoneal-based malignancies, including appendiceal cancer (APPX), primary peritoneal cancer (PPC), peritoneal mesothelioma, and peritoneal spread from colorectal (CRC), gastric (GA), and gynecologic malignancies. At Aurora Health Care, a HIPEC program was initiated by our multidisciplinary gastrointestinal cancer group.

Purpose: To review the initiation and implementation of a HIPEC program started at Aurora.

Methods: Our protocol involves preoperative computed tomography scan, colonoscopy, upper endoscopy, and presentation at a multidisciplinary meeting. All patients received preoperative chemotherapy. All patients had diagnostic laparoscopy to determine resectability ...


Variability In Sentinel Lymph Node Biopsy Retrieval For Breast Cancer At Aurora Health Care, Aaron H. Chevinsky, Judy A. Tjoe, William L. Owens, James L. Weese 2018 Aurora St. Luke’s Medical Center

Variability In Sentinel Lymph Node Biopsy Retrieval For Breast Cancer At Aurora Health Care, Aaron H. Chevinsky, Judy A. Tjoe, William L. Owens, James L. Weese

Journal of Patient-Centered Research and Reviews

Background: Axillary lymph node involvement has always been one of the most important factors in determining treatment and prognosis for breast cancer. Routine axillary lymph node dissection (ALND) was the standard treatment for breast cancer until the mid-1990s, when sentinel lymph node biopsy (SLNB) became the standard.

Purpose: We undertook an evaluation of the SLNB procedure, comparing dedicated breast surgeons (4) with general surgeons who also perform breast procedures (25) to see if there were any differences and to standardize the approach throughout Aurora Health Care.

Methods: We performed a retrospective chart review at Aurora to evaluate patients undergoing surgical ...


Is Spontaneous Termination Of Atrial Fibrillation During Hybrid Ablation A Predictor Of Clinical Outcome In Patients With Persistent Atrial Fibrillation?, Lynn Erickson, David C. Kress, Firas Zahwe, Tadele Mengesha, David Krum, Jasbir S. Sra 2018 Aurora Research Institute

Is Spontaneous Termination Of Atrial Fibrillation During Hybrid Ablation A Predictor Of Clinical Outcome In Patients With Persistent Atrial Fibrillation?, Lynn Erickson, David C. Kress, Firas Zahwe, Tadele Mengesha, David Krum, Jasbir S. Sra

Journal of Patient-Centered Research and Reviews

Background: An epicardial/endocardial (hybrid) ablation approach has emerged as an option to treat a difficult population of patients with persistent atrial fibrillation (AF). Limited information exists on the importance of AF termination as a predictor of clinical outcome during hybrid ablation.

Purpose: This retrospective study aimed to demonstrate the significance of spontaneous AF termination during hybrid ablation of persistent AF.

Methods: We studied results from 63 consecutive hybrid ablations in patients with no prior ablation, a mean (± standard deviation) persistent AF duration of 19 ± 16 months and a mean follow-up of 27 ± 13 months. Patients received both epicardial ablation ...


The Canady Helios Cold Plasma Scalpel Significantly Decreases Viability In Malignant Solid Tumor Cells In A Dose-Dependent Manner, Warren Rowe, Xiaoqian Cheng, Lawan Ly, Taisen Zhuang, Giacomo Basadonna, Barry Trink, Michael Keidar, Jerome Canady 2018 Jerome Canady Research Institute for Advanced Biological and Technological Sciences

The Canady Helios Cold Plasma Scalpel Significantly Decreases Viability In Malignant Solid Tumor Cells In A Dose-Dependent Manner, Warren Rowe, Xiaoqian Cheng, Lawan Ly, Taisen Zhuang, Giacomo Basadonna, Barry Trink, Michael Keidar, Jerome Canady

Open Access Articles

To determine appropriate treatment doses of cold atmospheric plasma (CAP), the Canady Helios Cold Plasma Scalpel was tested across numerous cancer cell types including renal adenocarcinoma, colorectal carcinoma, pancreatic adenocarcinoma, ovarian adenocarcinoma, and esophageal adenocarcinoma. Various CAP doses were tested consisting of both high (3 L/min) and low (1 L/min) helium flow rates, several power settings, and a range of treatment times up to 5 min. The impact of cold plasma on the reduction of viability was consistently dose-dependent; however, the anti-cancer capability varied significantly between cell lines. While the lowest effective dose varied from cell line to ...


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 ...


Ultrasound Guided Placement Of Single-Lumen Peripheral Intravenous Catheters In The Internal Jugular Vein, Tony Zitek, Elizabeth Busby, Heather Hudson, John D. McCourt, Jamie Baydoun, David E. Slattery 2018 University of Nevada, Las Vegas School; University Medical Center of Southern Nevada, Department of Emergency Medicine; Kendall Regional Medical Center

Ultrasound Guided Placement Of Single-Lumen Peripheral Intravenous Catheters In The Internal Jugular Vein, Tony Zitek, Elizabeth Busby, Heather Hudson, John D. Mccourt, Jamie Baydoun, David E. Slattery

School of Medicine Faculty Publications

Introduction: The peripheral internal jugular (IJ), also called the “easy IJ,” is an alternative to peripheral venous access reserved for patients with difficult intravenous (IV) access. The procedure involves placing a single-lumen catheter in the IJ vein under ultrasound (US) guidance. As this technique is relatively new, the details regarding the ease of the procedure, how exactly it should be performed, and the safety of the procedure are uncertain. Our primary objective was to determine the success rate for peripheral IJ placement. Secondarily, we evaluated the time needed to complete the procedure and assessed for complications. Methods: This was a ...


Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels, Paulo N.A. Martins, Amanda Rawson, Babak Movahedi, Isabel M. A. Bruggenwirth, Natasha H. Dolgin, Ann-Britt Martins, Paria Mahboub, Adel Bozorgzadeh 2018 University of Massachusetts Medical School

Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels, Paulo N.A. Martins, Amanda Rawson, Babak Movahedi, Isabel M. A. Bruggenwirth, Natasha H. Dolgin, Ann-Britt Martins, Paria Mahboub, Adel Bozorgzadeh

Open Access Articles

OBJECTIVES: Elevation of transaminases has been used as a marker of hepatic ischemic injury and as a crucial parameter for liver graft assessment. However, analysis of serum transaminases has limitations regarding the quantitative assessment of liver necrosis and is not a reliable predictor of outcomes.

MATERIALS AND METHODS: We retrospectively reviewed the medical records of all liver transplants (N = 238) performed at the UMass Memorial Medical Center from 2009 to 2013.

RESULTS: Fourteen liver grafts showed high peak aminotransferases alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at > 1000 U/L. This high aminotransferase group was compared with 224 donors with ...


Heat Stroke As A Cause Of Liver Failure And Evaluation Of Liver Transplant, Paulo N.A. Martins, Isabel M. A. Bruggenwirth, James McDaid, Martin Hertl, Tatsuo Kawai, Nahel Elias, Raymond T. Chung, James F. Markmann 2018 University of Massachusetts Medical School

Heat Stroke As A Cause Of Liver Failure And Evaluation Of Liver Transplant, Paulo N.A. Martins, Isabel M. A. Bruggenwirth, James Mcdaid, Martin Hertl, Tatsuo Kawai, Nahel Elias, Raymond T. Chung, James F. Markmann

Open Access Articles

Heat stroke is a multiple organ dysfunction syndrome of poorly understood pathogenesis. Exertional heat stroke with acute liver failure is a rarely reported condition. Liver transplant has been recommended as treatment in cases of severe liver dysfunction; however, there are only 5 described cases of long-term survival after this procedure in patients with heat stroke. Here, we present 2 cases of young athletes who developed heat stroke. Both patients developed acute liver failure and were listed for liver transplant. Liver function tests of one patient improved, and he was discharged on postoperative day 13. The other patient showed no signs ...


Video Capsule Endoscopy As A Tool For Evaluation Of Obscure Overt Gastrointestinal Bleeding In The Intensive Care Unit, Shahrad Hakimian, Salmaan Jawaid, Yurima Guilarte-Walker, Jomol Mathew, David R. Cave 2018 University of Massachusetts Medical School

Video Capsule Endoscopy As A Tool For Evaluation Of Obscure Overt Gastrointestinal Bleeding In The Intensive Care Unit, Shahrad Hakimian, Salmaan Jawaid, Yurima Guilarte-Walker, Jomol Mathew, David R. Cave

Open Access Articles

Background and study aims: Video capsule endoscopy (VCE) is a minimally invasive tool that helps visualize the gastrointestinal tract from the esophagus to the right colon without the need for sedation or preparation. VCE is safe with very few contraindications. However, its role and safety profile in the intensive care unit (ICU) population have not been reported. The aim of this study is to evaluate the safety, efficacy, and feasibility of VCE use in ICU patients. Patients and methods: We conducted a single-center retrospective observational study of patients who underwent VCE for evaluation of obscure overt gastrointestinal bleeding in the ...


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 ...


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