Surgical Procedures, Operative Commons^™

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

Open Dartmouth: Faculty Open Access Articles

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.

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 ...

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 ...

Absence Of Jc Viremia In A Case With Jc Virus Nephropathy: A Case Report And Literature Review, Samer Bani-Hani Md, Facp, Uma Gunasek Md

Tennessee Medicine E-Journal

BK virus associated nephropathy (BKVAN) is an important cause of graft dysfunction with a high rate of graft loss. Current literature describes the pathophysiology of Polyoma Virus Associated Nephropathy (PVAN) induced by BKV but it lacks detailed definition of allograft nephropathy induced by JC virus (JCV). BKVAN is typically associated with BK Viremia, and the latter is the most commonly used screening measure for BKVAN in most transplant centers [1]. We are reporting a case of JCV associated nephropathy in renal allograft recipient who did not have JC viremia during the entire course of his disease and did not respond ...

The End Of An Era: The Cancer Stem Cell Hypothesis And Its Therapeutic Implications, Emily Paton

Independent Study Project (ISP) Collection

Cancer, a leading cause of death in many developed countries, has become a global health burden. Much of the drain on healthcare systems has resulted from the high cost and ineffectiveness of conventional cancer treatments, which often lead to cancer relapse or metastasis. The failures of chemotherapy, radiation, and surgery have been elucidated by the cancer stem cell (CSC) hypothesis, which postulates that a small percentage of tumor cells drive tumorigenesis. These cells can sustain cancer through their capacity to self-renew and differentiate into specialized tumor cell types, similar to how healthy stem cells maintain healthy tissues. Conventional cancer treatments ...

A Prospective Randomized Comparison Of Patient Specific Instruments With Standard Tka Instrumentation, Christina Kane, Anthony Porter, Patricia D. Franklin, David C. Ayers

Patricia D. Franklin

Introduction: Patient specific instruments (PSI), an alternative to standard total knee arthroplasty (TKA) technology, have shown mixed results regarding effectiveness in previous studies. This study evaluated the accuracy of the predicted PSI plan, compared incremental cost savings with PSI, and compared outcomes of PSI and standard TKA patients.

Patients and Methods: This randomized, prospective feasibility study included 19 primary TKA patients receiving a cruciate-retaining cemented prosthesis from a single surgeon (DCA). 9 patients randomized to PSI received a pre-operative knee MRI for PSI fabrication using proprietary software.10 standard TKAs were completed. Operative data collected included operating times, implant details ...

Development Of A Fatal Noncompressible Truncal Hemorrhage Model With Combined Hepatic And Portal Venous Injury In Normothermic Normovolemic Swine, Ujwal R. Yanala, Jason M. Johanning, Iraklis I. Pipinos, Gustavo Larsen, William H. Velander, Mark A. Carlson

William H. Velander Publications

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury ...

Psychometric Evaluation Of Joint-Specific Patient-Reported Outcome Measures Before And After Total Knee Replacement: A Dissertation, Barbara L. Gandek

GSBS Dissertations and Theses

Background: Patient reports of pain and function are used to inform the need for and timing of total knee replacement (TKR) and evaluate TKR outcomes. This dissertation compared measurement properties of commonly-used patient surveys in TKR and explored ways to develop more efficient knee-specific function measures.

Methods: 1,179 FORCE-TJR patients (mean age=66.1, 61% female) completed questionnaires before and 6 months after TKR. Patient surveys included the knee-specific Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and generic SF-36 Health Survey. Tests of KOOS and WOMAC measurement properties included evaluations ...

Surgical Approach In Total Hip Arthroplasty: Patient Outcomes And Impact On Costs, Stephen M. Petis

Electronic Thesis and Dissertation Repository

Total hip arthroplasty is often renowned as one of the most important surgical advances of the past century. Orthopaedic surgeons must choose a surgical approach to gain access to the hip joint in order to perform the reconstruction. There is debate in the literature as to which surgical approach optimizes patient outcomes, minimizes complications, and reduces costs to hospitals as a high volume procedure.

In the current studies, patient reported outcomes were compared at short-term follow-up using a prospective study design across the anterior, posterior, and lateral approach. A micro-costing method was used to acquire costs related to each procedure ...

Design And Development Of A Miniature In Vivo Surgical Robot With Distributed Motor Control For Laparoendoscopic Single-Site Surgery, Eric J. Markvicka

Mechanical (and Materials) Engineering -- Dissertations, Theses, and Student Research

Paradigm shifts in invasiveness, recovery time, cosmesis, and cost have been seen within the field of general surgery through major advances in surgical technology. Some of the most advanced types of general surgery now include Minimally Invasive Surgery (MIS), LaparoEndoscopic Single-Site (LESS) surgery, and Natural Orifice Translumenal Endoscopic Surgery (NOTES). One of the newest and rapidly developing catalysts is robotic platforms. Such platforms have improved ergonomics and control, increased workspace and dexterity, and have surpassed the efficacy of many non-robotic platforms such as traditional laparoscopic surgical tools. This thesis presents the design and development of a four-degree-of-freedom (4- DOF) miniature ...

Evaluating Human Performance For Image-Guided Surgical Tasks, Matthew Kenneth Kramers

Electronic Thesis and Dissertation Repository

The following work focuses on the objective evaluation of human performance for two different interventional tasks; targeted prostate biopsy tasks using a tracked biopsy device, and external ventricular drain placement tasks using a mobile-based augmented reality device for visualization and guidance. In both tasks, a human performance methodology was utilized which respects the trade-off between speed and accuracy for users conducting a series of targeting tasks using each device. This work outlines the development and application of performance evaluation methods using these devices, as well as details regarding the implementation of the mobile AR application. It was determined that the ...

Towards Highly-Integrated Stereovideoscopy For In Vivo Surgical Robots, Jay Carlson

Theses, Dissertations, and Student Research from Electrical & Computer Engineering

When compared to traditional surgery, laparoscopic procedures result in better patient outcomes: shorter recovery, reduced post-operative pain, and less trauma to incisioned tissue. Unfortunately, laparoscopic procedures require specialized training for surgeons, as these minimally-invasive procedures provide an operating environment that has limited dexterity and limited vision. Advanced surgical robotics platforms can make minimally-invasive techniques safer and easier for the surgeon to complete successfully. The most common type of surgical robotics platforms -- the laparoscopic robots -- accomplish this with multi-degree-of-freedom manipulators that are capable of a diversified set of movements when compared to traditional laparoscopic instruments. Also, these laparoscopic robots allow for ...

Determination Of The Functional Relationship Between Lumbar Lordosis And Pelvic Tilt, Casey Tyler Hebert

Theses and Dissertations (ETD)

Americans are undergoing spinal fusion surgery (SFS) at an ever increasing rate; in 2008 over 400,000 Americans underwent SFS with a national cost of approximately $33.9 billion. During SFS it is difficult for the surgeon to properly align the spine’s s-shape, as viewed from the patient’s side. Abnormal alignment of the spine then alters the position of the pelvis and hip joints, which may impact the function and hip contact patterns. Several studies have shown that patients with spinal pathology, such as arthritis, often have a coexisting hip pathology or subsequently develop hip pathology, and it ...

Joint Reaction Force And Contributions Of Surrounding Muscles To Knee Joint Load During Stair Ascent In Total Knee Replacement Patients And Healthy Individuals, Robert Jacob Rasnick

Masters Theses

Total knee replacement (TKR) is commonly used to correct end stage knee osteoarthritis (OA) of the knee joint. Unfortunately, difficulty with stair climbing has been seen to exist, prolonging the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future research. The outcome of a TKR is intended to reestablish normal motion and loading of the knee. Musculoskeletal modeling provides a means to accurately approximate joint loading and the corresponding muscle contributions during a movement.

The purpose of the present study was to examine ...

Fluid Powered Miniature In-Vivo Robots For Minimally Invasive Surgery (Mis), Abolfazl Pourghodrat

Mechanical (and Materials) Engineering -- Dissertations, Theses, and Student Research

Minimizing the invasiveness of surgery is believed to improve patient outcomes. Bleeding, infection, and pain are major concerns in surgery afflicting patients for decades. Minimally invasive techniques have come into play to reduce these concerns and smooth the evolution of abdominal surgery to a scarless process where nearly all surgeries can be performed without a skin incision. Technology continually advances the frontier of development of novel surgical devices to implement less invasive surgical techniques.

Fusion of robotics and Minimally Invasive Surgery (MIS) has created new opportunities to develop diagnostic and therapeutic tools. Surgical robotics is advancing from externally actuated systems ...

Clinical And Financial Impact Of Hospital Readmissions Following Colorectal Resection: Predictors, Outcomes, And Costs: A Thesis, Rachelle N. Damle

GSBS Dissertations and Theses

Background: Following passage of the Affordable Care Act in 2010, 30-day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements. We examined the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery (CRS).

Methods: The University HealthSystem Consortium database was queried for adults (≥ 18 years) who underwent colorectal resection for cancer, diverticular disease, inflammatory bowel disease, or benign tumors between January 2008 and December 2011. Our outcomes of interest were readmission within 30-days of the patient’s index discharge, hospital readmission outcomes, and total ...

Stability Of A Tapered Femoral Stem In Total Hip Arthroplasty Using Radiostereometric Analysis, Christina Kane, Audrey Nebergall, Meridith Greene, Anthony Porter, Benjamin Snyder, Marie Walcott, Michelle E. Aubin, Jacob M. Drew, Peyton L. Hays, Mark S. Eskander, Henrik Malchau, Charles R. Bragdon, David Ayers

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Early femoral implant stability is essential to long-term success in total hip replacement (THR). Radiostereometric analysis (RSA) provides highly precise measurements of stem micromotion relative to the femur that are otherwise not detectable by routine radiographs. This study characterized micromotion of a tapered, cementless femoral stem using RSA up to 5 years following THR.

Methods: This IRB-approved, prospective, randomized, blinded study, involved 46 patients with a mean age of 58 and BMI of 30. All patients received a cementless, porous-coated titanium double tapered stem (M/L Taper, Zimmer) manufactured with 3 tantalum RSA beads and underwent primary THR by ...

Use Of The Spine Adverse Events Severity (Saves) System To Categorize And Report Adverse Events In Spine Surgery., P. J. Wagner, T. Ailon, H. Zhou, Scott Pascal, M. B. Harrigan, Michael Stauff, Anthony Lapinsky, Patrick J. Connolly, Christian P. Dipaola

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Analysis of adverse events (AEs) in spine surgery has historically been retrospective, utilizing hospital administrative data. Our objective was to determine the incidence, severity and effect on hospital length of stay (LOS) for AEs in spine surgery using the Spine AdVerse Events Severity (SAVES V2) system.

Methods: AEs for all surgical spine patients at our institution were prospectively collected for 18 months and correlated with retrospective data from operative reports and H&Ps. Statistical analyses compared patient demographics, diagnoses, and surgical characteristics to hospital length of stay and likelihood of adverse events.

Results: This system captured 75% (765/977 ...

A Prospective Randomized Comparison Of Patient Specific Instruments With Standard Tka Instrumentation, Christina Kane, Anthony Porter, Patricia D. Franklin, David C. Ayers

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Patient specific instruments (PSI), an alternative to standard total knee arthroplasty (TKA) technology, have shown mixed results regarding effectiveness in previous studies. This study evaluated the accuracy of the predicted PSI plan, compared incremental cost savings with PSI, and compared outcomes of PSI and standard TKA patients.

Patients and Methods: This randomized, prospective feasibility study included 19 primary TKA patients receiving a cruciate-retaining cemented prosthesis from a single surgeon (DCA). 9 patients randomized to PSI received a pre-operative knee MRI for PSI fabrication using proprietary software.10 standard TKAs were completed. Operative data collected included operating times, implant details ...

Radiostereometric Analysis Of Tantalum Vs. Titanium Acetabular Shells In Young Thr Patients, Christina Kane, Anthony Porter, Benjamin Snyder, Marie Walcott, Michelle E. Aubin, Jacob M. Drew, Meridith Greene, Henrik Malchau, Charles R. Bragdon, David Ayers

UMass Center for Clinical and Translational Science Research Retreat

Introduction: In the active total hip replacement (THR) population, maintaining acetabular component stability and limiting polyethylene wear are crucial components to preventing premature implant failure. Titanium with Co/Cr/Mo fiber metal coating is among the most common materials used in cementless THR. Trabecular metal, composed of porous tantalum, has a metallic strut design resembling trabecular bone, designed to improve tissue infiltration and limit migration. This study assesses the stability and clinical outcomes of tantalum versus titanium acetabular shells using radiostereometric analysis (RSA) technology.

Methods: In this IRB approved, prospective, randomized, blinded study, 46 patients received a primary THR by ...