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Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini 2017 University of Southern Mississippi

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Nursing Capstone Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more common and may aid in reducing recovery and discharge times from the postoperative anesthesia care unit (PACU) as well as reducing overall costs. A retrospective chart review (N=176; 88 in propofol group and 88 in benzodiazepine and opioid group) was performed to determine if propofol sedation did reduce discharge times and decrease overall costs for the patient. Patients included in this study ...


Angiosarcoma Of The Lower Extremity Presenting As Bilateral Pneumothoraces, Mark H. Cooper 2017 Marshall University, Huntington, WV

Angiosarcoma Of The Lower Extremity Presenting As Bilateral Pneumothoraces, Mark H. Cooper

Marshall Journal of Medicine

Abstract

Spontaneous pneumothorax usually presents as unilateral disease. Bilateral spontaneous pneumothoraces are less common and are more likely to be secondary than primary. We describe a case of bilateral spontaneous pneumothoraces that were resistant to conventional treatment, and found ultimately to be secondary to angiosarcoma of the lower extremity. A previously well 49 year old white female was referred to our institution in London with bilateral pneumothoraces. A left video assisted thoracoscopic procedure was undertaken, and the wedge resection of the lung specimen contained an area of metastatic tumor. Talc was placed into the left pleural cavity; talc was also ...


Generation Of Crispr Knockout Of Idh1 In Pancreatic Ductal Adenocarcinoma Cell Line: An Optimal Model To Study Pancreatic Cancer Metabolic Reprogramming, Katerina Dukleska, MD, Mahsa Zarei, PhD, Ali Vaziri-Gohar, PhD, Charles J. Yeo, MD, Jonathan Brody, MD, Jordan M. Winter, MD 2017 Thomas Jefferson University

Generation Of Crispr Knockout Of Idh1 In Pancreatic Ductal Adenocarcinoma Cell Line: An Optimal Model To Study Pancreatic Cancer Metabolic Reprogramming, Katerina Dukleska, Md, Mahsa Zarei, Phd, Ali Vaziri-Gohar, Phd, Charles J. Yeo, Md, Jonathan Brody, Md, Jordan M. Winter, Md

Department of Surgery Posters

Introduction

• Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the US.

• PDA is resistant to conventional chemotherapy; however, mechanisms that contribute to this chemoresistance are not well-described.

• The tumor microenvironment in PDA has a dense stromal reaction, which is thought to result in low oxygen and low nutrient conditions (Feig, C., et al. 2012).

• Isocitrate Dehydrogenase 1 (IDH1) has been identified as an enzyme that plays an important role in chemoresistance in PDA (Zarei, M., et al. In progress).

• We sought to establish an IDH1 knockout cell line to further study its role in PDA ...


S100Β As A Serum Marker In Endocrine Resistant Breast Cancer., Sara Charmsaz, Éamon Hughes, Fiona T. Bane, Paul Tibbitts, Marie McIlroy, Christopher Byrne, Sinéad Cocchiglia, Jean McBryan, Bryan T Hennessy, Róisín M. Dwyer, Michael J. Kerin, Arnold DK Hill, Leonie S. Young 2017 Royal College of Surgeons in Ireland

S100Β As A Serum Marker In Endocrine Resistant Breast Cancer., Sara Charmsaz, Éamon Hughes, Fiona T. Bane, Paul Tibbitts, Marie Mcilroy, Christopher Byrne, Sinéad Cocchiglia, Jean Mcbryan, Bryan T Hennessy, Róisín M. Dwyer, Michael J. Kerin, Arnold Dk Hill, Leonie S. Young

Surgery Articles

BACKGROUND: Endocrine therapy is standard treatment for estrogen receptor (ER)-positive breast cancer. However, its efficacy is limited by intrinsic and acquired resistance. Here the potential of S100β as a biomarker and inhibition of its signaling network as a therapeutic strategy in endocrine treated patients was investigated.

METHODS: The expression of S100β in tissue and serum was assessed by immunohistochemistry and an enzyme-linked immunosorbent assay, respectively. The S100β signaling network was investigated in cell line models of endocrine resistance by western blot, PCR, immunoprecipitation, and chromatin-immunoprecipitation. Endocrine resistant xenografts and tumor explants from patients with resistant tumors were treated with ...


Therapeutic Application Of Carbon Monoxide In Acute Limb Compartment Syndrome, Aurelia Bihari 2017 The University of Western Ontario

Therapeutic Application Of Carbon Monoxide In Acute Limb Compartment Syndrome, Aurelia Bihari

Electronic Thesis and Dissertation Repository

Acute limb compartment syndrome (CS), a devastating complication of musculoskeletal trauma, develops in response to elevation of the pressure within a closed osseofascial compartment, producing muscle- and limb-threatening ischemia. Full decompression of all involved compartments by fasciotomy is the current gold-standard therapy, but it must be performed within a surgical window of 6-8 hours, before tissue damage becomes permanent.

Carbon monoxide (CO), a byproduct of heme metabolism, has been shown protective in ischemia. While inhalation of CO leads to elevation of carboxyhemoglobin (COHb), recent development of transitional metal carbonyls, CO-releasing molecules (CO-RMs), particularly the water-soluble CORM-3, delivers CO in a ...


A Review Of Pain Control In Pediatric Cardiac Bypass Surgery, Pranathi Ari, Andrew T. Waberski, Nina Deutsch 2017 George Washington University

A Review Of Pain Control In Pediatric Cardiac Bypass Surgery, Pranathi Ari, Andrew T. Waberski, Nina Deutsch

GW Research Days 2016 - Present

Background: Children undergoing cardiac surgery with cardiopulmonary bypass receive high dose opioids for analgesia and to reduce the neurohormonal stress response. While opioids have excellent pharmacodynamics profiles adverse effects include: respiratory depression, bradycardia, nausea, vomiting, and tolerance. Additionally, opioids with short half-lives like fentanyl require several boluses to be administered during surgery causing fluctuating levels analgesia. Several strategies to advance pain control incorporate regional and neuraxial anesthetic techniques, however anticoagulation preclude its routine use. Alternatively using opioids with longer half-lives for analgesia may improve pain control and reduce adverse effects.

Objective: The objective of this study is to quantify postoperative ...


Appendicular Mass – A Rare Form Of Tuberculosis, Petrisor Banu, Vlad D. Constantin, Florian Popa, Mircea Bratucu, Teodora Vladescu, Cristian Balalau 2017 Carol Davila University, Department of Surgery, Bucharest, Romania

Appendicular Mass – A Rare Form Of Tuberculosis, Petrisor Banu, Vlad D. Constantin, Florian Popa, Mircea Bratucu, Teodora Vladescu, Cristian Balalau

Journal of Mind and Medical Sciences

Tuberculosis is in the top 10 causes of death worldwide, being one of the most deadly infectious diseases. It is estimated that one of three people from the entire earth population has a latent infection with M tuberculosis. This aerobic bacterium possesses the ability to persist in host tissues for years and to begin replication once immunity declines.

The lungs are most frequent site of infection as the Mycobacterium tuberculosis is carried by aerosol droplets and is commonly transmitted by respiratory route. The second way of transmission is by contaminated food.

Intestinal contamination coexists with pulmonary tuberculosis and only 10 ...


The Prevalence Of High Dysplastic Colonic Adenomatous Polyps In A 3 Year Endoscopic Retrospective Study From A Single Clinical Center, Alexandru C. Septimiu, Cosmin A. Moldovan, Florin D. Ungureanu 2017 Witting Clinical Hospital of Bucharest, Department of surgery

The Prevalence Of High Dysplastic Colonic Adenomatous Polyps In A 3 Year Endoscopic Retrospective Study From A Single Clinical Center, Alexandru C. Septimiu, Cosmin A. Moldovan, Florin D. Ungureanu

Journal of Mind and Medical Sciences

Introduction: Many colon neoplastic tumors come from the malignancy of adenomatous polyps (70%-90%) that were not timely diagnosed in order to be resected. Materials and Methods: We conducted a retrospective study regarding the incidence of adenomatous polyps during 1.000 consecutive colonoscopies performed in our Upper and Lower Digestive Endoscopy Laboratory during a three-year period. Results: During these colonoscopies, some targeted polyps were biopsied or completely removed and the samples had been sent to a complete anatomopathological examination. Taking into consideration the results, the polyps were classified after the histological type and the form of dysplasia, in order to ...


An Evidence Based Guide To A Safe Intraoperative Approach Of Avoiding Iatrogenic Lesions During Difficult Laparoscopic Cholecystectomies, Cosmin Alec Moldovan, Roxana M. Duncea, Florin Dan Ungureanu, Vladimir Belis 2017 Titu Maiorescu University of Bucharest

An Evidence Based Guide To A Safe Intraoperative Approach Of Avoiding Iatrogenic Lesions During Difficult Laparoscopic Cholecystectomies, Cosmin Alec Moldovan, Roxana M. Duncea, Florin Dan Ungureanu, Vladimir Belis

Journal of Mind and Medical Sciences

Introduction: Although there are many sources for iatrogenic lesions during laparoscopic cholecystectomy, only a few stand out as being one of the most difficult to predict due to their nature of being very hard to diagnose before surgery. Materials and Methods: a short guide of cases with an evidence-based approach to avoid laparoscopic iatrogenic lesions. Results: these cases have been classified and presented into 3 main groups: cases with abnormal arterial layout, cases with heavy alteration of the normal anatomy, and cases with anomalies of the main biliary pathway. Conclusions: while not a complete guide covering all aspects of intraoperative ...


Total Parenteral Nutrition In Patients Following Pancreaticoduodenectomy: Lessons From 1184 Patients, Cullen Worsh, Talar Tatarian, MD, PGY-4, Awinder Singh, Michael J. Pucci, MD, Jordan M Winter, MD, Charles J. Yeo, MD, Harish Lavu, MD 2017 Thomas Jefferson University

Total Parenteral Nutrition In Patients Following Pancreaticoduodenectomy: Lessons From 1184 Patients, Cullen Worsh, Talar Tatarian, Md, Pgy-4, Awinder Singh, Michael J. Pucci, Md, Jordan M Winter, Md, Charles J. Yeo, Md, Harish Lavu, Md

Department of Surgery Posters

Poster presented at Sigma XI Student Research Day at Thomas Jefferson University.

Background:

Total parenteral nutrition (TPN) has historically been used conservatively in the management of patients after pancreaticoduodenectomy (PD).

In this study, we evaluate the indications for and outcomes associated with TPN use in a high-volume pancreatic surgery center.


Can A Post-Discharge Telephone Call Reduce Hospital Readmission After Colorectal Surgery? A Prospective Study, Daniel Mandel, Karen Zaghiyan, Phillip Fleshner 2017 New York Medical College

Can A Post-Discharge Telephone Call Reduce Hospital Readmission After Colorectal Surgery? A Prospective Study, Daniel Mandel, Karen Zaghiyan, Phillip Fleshner

NYMC Student Posters

BACKGROUND: Hospital readmission after major colorectal surgery is a major economic burden and a benchmark of quality care by government agencies. We hypothesized that a post-discharge telephone follow-up (TFU) could reduce readmission after abdominal colorectal surgery.

METHODS: Consecutive patients undergoing abdominal colorectal surgery over the 4-month period ending Oct 2016 were prospectively evaluated. A structured TFU call during the 4-day period after hospital discharge evaluating the patient’s clinical status and possible interventions to avoid readmission was conducted by a second-year medical student, supervised by two board certified colorectal surgeons. Readmission rates were compared to a control group undergoing abdominal ...


An Irish Experience In Establishing And Evaluating An Intern Led Teaching Programme., Allan Jenkinson, Eoin Kelleher, Daragh Moneley, Gozie Offiah 2017 Royal College of Surgeons in Ireland

An Irish Experience In Establishing And Evaluating An Intern Led Teaching Programme., Allan Jenkinson, Eoin Kelleher, Daragh Moneley, Gozie Offiah

Surgery Articles

Near-Peer Teaching is a relatively new and expanding area of medical education. The benefit to medical students has been demonstrated in numerous contexts around the world. Our aim was to establish a structured Intern-Led Teaching (ILT) programme in the context of an Irish Intern Training Network affiliated to an Irish Medical School. We then sought to evaluate the success of this programme. Seventy interns were enrolled in the ILT programme and completed a Train the Trainer course involving teaching methods and skills of effective feedback. Following this, the intern tutors delivered several one-hour teaching sessions in small groups to final ...


Ipsilateral Lower Limb Weakness After Sarcoma Treatment: A Case Report, Jennifer Baima, Amanda Doodlesack, Jennifer LaFemina 2017 University of Massachusetts Medical School

Ipsilateral Lower Limb Weakness After Sarcoma Treatment: A Case Report, Jennifer Baima, Amanda Doodlesack, Jennifer Lafemina

Orthopedics and Physical Rehabilitation Publications and Presentations

Case Diagnosis: Our patient experienced worsening left foot neuropathy following chemotherapy and radiation treatment for sarcoma.

Case Description: A 24-year-old man underwent local resection of a 12cm x 8cm x 14.5cm rhabdomyosarcoma in the left vastus lateralis. Then, he was treated with vincristine for 40 weeks and radiation to the left lateral thigh with a maximum dose of 50.4 Gy. The sciatic nerve was outside the target area and received a lower dose. While undergoing chemotherapy, the patient experienced bilateral dysesthesias in his fingertips and feet. He had no history of neuropathy prior to treatment. After chemotherapy was ...


Frequent Mild Head Injury Promotes Trigeminal Sensitivity Concomitant With Microglial Proliferation, Astrocytosis, And Increased Neuropeptide Levels In The Trigeminal Pain System., Ashley L. Tyburski, Lan Cheng, Soroush Assari, Kurosh Darvish, Melanie B Elliott 2017 Thomas Jefferson University

Frequent Mild Head Injury Promotes Trigeminal Sensitivity Concomitant With Microglial Proliferation, Astrocytosis, And Increased Neuropeptide Levels In The Trigeminal Pain System., Ashley L. Tyburski, Lan Cheng, Soroush Assari, Kurosh Darvish, Melanie B Elliott

Department of Neurosurgery Faculty Papers

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms.

METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI ...


Prone Position: Does It Help With Acute Respiratory Distress Syndrome (Ards) Requiring Extracorporeal Membrane Oxygenation (Ecmo)?, Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose 2017 Thomas Jefferson University

Prone Position: Does It Help With Acute Respiratory Distress Syndrome (Ards) Requiring Extracorporeal Membrane Oxygenation (Ecmo)?, Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia ...


Prospects And Limitations Of Improving Skeletal Growth In A Mouse Model Of Spondyloepiphyseal Dysplasia Caused By R992c (P.R1192c) Substitution In Collagen Ii., Machiko Arita, Jolanta Fertala, Cheryl Hou, James Kostas, Andrzej Steplewski, Andrzej Fertala 2017 Thomas Jefferson University

Prospects And Limitations Of Improving Skeletal Growth In A Mouse Model Of Spondyloepiphyseal Dysplasia Caused By R992c (P.R1192c) Substitution In Collagen Ii., Machiko Arita, Jolanta Fertala, Cheryl Hou, James Kostas, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Skeletal dysplasias form a group of skeletal disorders caused by mutations in macromolecules of cartilage and bone. The severity of skeletal dysplasias ranges from precocious arthropathy to perinatal lethality. Although the pathomechanisms of these disorders are generally well defined, the feasibility of repairing established aberrant skeletal tissues that developed in the presence of mutant molecules is currently unknown. Here, we employed a validated mouse model of spondyloepiphyseal dysplasia (SED) that enables temporal control of the production of the R992C (p.R1192C) collagen II mutant that causes this disease. Although in our earlier studies we determined that blocking the expression of ...


Enhancement Of Fracture Healing In The Rat, Modulated By Compounds That Stimulate Inducible Nitric Oxide Synthase: Acceleration Of Fracture Healing Via Inducible Nitric Oxide Synthase., R A Rajfer, A Kilic, Andrew S Neviaser, L M Schulte, S M Hlaing, J Landeros, M G Ferrini, E Ebramzadeh, S-H Park 2017 George Washington University

Enhancement Of Fracture Healing In The Rat, Modulated By Compounds That Stimulate Inducible Nitric Oxide Synthase: Acceleration Of Fracture Healing Via Inducible Nitric Oxide Synthase., R A Rajfer, A Kilic, Andrew S Neviaser, L M Schulte, S M Hlaing, J Landeros, M G Ferrini, E Ebramzadeh, S-H Park

Orthopaedic Surgery Faculty Publications

OBJECTIVES: We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days.

MATERIALS AND METHODS: Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density ...


Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman III, Melissa D. Lester, Nepal C. Chowdhury 2017 Marshall University

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal ...


Hic1 (Hypermethylated In Cancer 1) Sumoylation Is Dispensable For Dna Repair But Is Essential For The Apoptotic Dna Damage Response (Ddr) To Irreparable Dna Double-Strand Breaks (Dsbs)., Sonia Paget, Marion Dubuissez, Vanessa Dehennaut, Joe Nassour, Brennan T Harmon, Nathalie Spruyt, Ingrid Loison, Corinne Abbadie, Brian R Rood, Dominique Leprince 2017 George Washington University

Hic1 (Hypermethylated In Cancer 1) Sumoylation Is Dispensable For Dna Repair But Is Essential For The Apoptotic Dna Damage Response (Ddr) To Irreparable Dna Double-Strand Breaks (Dsbs)., Sonia Paget, Marion Dubuissez, Vanessa Dehennaut, Joe Nassour, Brennan T Harmon, Nathalie Spruyt, Ingrid Loison, Corinne Abbadie, Brian R Rood, Dominique Leprince

Surgery Faculty Publications

The tumor suppressor gene HIC1 (Hypermethylated In Cancer 1) encodes a transcriptional repressor mediating the p53-dependent apoptotic response to irreparable DNA double-strand breaks (DSBs) through direct transcriptional repression of SIRT1. HIC1 is also essential for DSB repair as silencing of endogenous HIC1 in BJ-hTERT fibroblasts significantly delays DNA repair in functional Comet assays. HIC1 SUMOylation favours its interaction with MTA1, a component of NuRD complexes. In contrast with irreparable DSBs induced by 16-hours of etoposide treatment, we show that repairable DSBs induced by 1 h etoposide treatment do not increase HIC1 SUMOylation or its interaction with MTA1. Furthermore, HIC1 SUMOylation ...


Department Of Surgery Update, January 2017, Wright State University Department of Surgery 2017 Wright State University

Department Of Surgery Update, January 2017, Wright State University Department Of Surgery

Department of Surgery Updates

A one page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.


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