Surgery Commons^™

A Retrospective Analysis Of Opioid Consumption Among Different Orthopedic Surgeons For Total Joint Replacement, Costas J. Gioules, Hayden B. Rockson, Russell M. Flatto, Arnel J. Almeda, Anthony L. Schwagerl

Senior Scholars Program

Background: Throughout the world, baby boomers reaching their sixth, seventh, and eighth decade of life are requiring a significant number of joint replacements—hips and knees. Due to the increasing number of joint replacements, it is important to find a multi-modal approach (MMA) to control pain, reduce the amount of opioid consumption, and improve patient satisfaction.

Purpose: The purpose of this study was to evaluate the intraoperative, postoperative, and total opioid consumption of patients undergoing total hip and knee replacements in an effort to develop a multi-modal approach to decrease opioid consumption, minimize adverse effects secondary to narcotic administration, and ...

The Association Between Preoperative Spinal Cord Rotation And Postoperative C5 Nerve Palsy, Mark S. Eskander, Steve Balsis, Chris Balinger, Caitlin M. Howard, Nicholas W. Lewing, Jonathan P. Eskander, Michelle E. Aubin, Jeffrey Lange, Jason C. Eck, Patrick J. Connolly, Louis G. Jenis

Orthopedics and Physical Rehabilitation Publications and Presentations

BACKGROUND: C5 nerve palsy is a known complication of cervical spine surgery. The development and etiology of this complication are not completely understood. The purpose of the present study was to determine whether rotation of the cervical spinal cord predicts the development of a C5 palsy.

METHODS: We performed a retrospective review of prospectively collected spine registry data as well as magnetic resonance images. We reviewed the records for 176 patients with degenerative disorders of the cervical spine who underwent anterior cervical decompression or corpectomy within the C4 to C6 levels. Our measurements included area for the spinal cord, space ...

Emotional Intelligence Assessment In A Graduate Entry Medical School Curriculum., Eva M. Doherty, Patricia A. Cronin, Gozie Offiah

Surgery (The Colles Institute) Articles

BACKGROUND: The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor's EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum.

METHODS: Fifty one graduate entry medical students completed an eight session course ...

Slow Birth Of New-Wave Medical Journalism, Vivian C. Mcalister

Vivian C. McAlister

Half a century has passed since Sir Theodore Fox reflected upon his recently completed 40-year tenure as editor of The Lancet. He titled his farewell lecture series “Crisis in communication: the functions and future of medical journals.”1 Even though the number of journals had dramatically increased by the 1960s, submissions had proliferated to such an extent that Fox’s principal regret was the increasing fraction he was forced to refuse. In the late 19th century, the surgeon general of the United States was able to catalogue the entire body of medical knowledge up to that time in a volume ...

De-Branching Of The Aortic Arch During Thoracic Endovascular Aortic Repair, James K. Wu Md, Caitlin O'Connor Bs, Tim S. Misselbeck Md, Theodore G. Phillips Md

Department of Surgery

No abstract provided.

Causes Of Death In Surgically Treated Patients With Type A Aortic Dissection - A Ten Year Review, James K. Wu Md, Eilizabeth Depaolo Bs, Theodore G. Phillips Md, Tim S. Misselbeck Md

Department of Surgery

No abstract provided.

The Perfect Fit

Colby Magazine

From the classrooms and laboratories of Mayflower Hill, they found their niche in science. Microbiologist Carrie Harwood ’73, transplant surgeon Patrick Wood ’75, and marine biologist Paul Wade ’80 have passion for their professions.

Laparoscopic Nissen Fundoplication Post-Oesophageal Stenting: An Unusual Case., Zubin J. Daruwalla, S Powles, Mayilone Arumugasamy, Stephen Patchett, Patrick Broe

Surgery Articles

Laparoscopic Nissen fundoplication post-oesophageal stenting is uncommon and yet to be reported. We report the case of a 57-year-old palliative lady who underwent surgery for symptomatic relief of severe gastrooesophageal reflux post-oesophageal stenting. Surgery was carried out successfully with no complications. On the evening post-surgery she was able to lie supine for the first time in months without symptoms of reflux. In conclusion, surgery is still valuable and may play an important role, even in a palliative setting.

Extracorporeal Membranous Oxygenation Mimics Aortic Dissection On Cat Scan., Philip Batista, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers & Presentations

A 66 year-old female presented with refractory acute congestive heart failure, cardiogenic shock, and ventricular tachyarrhythmia. Veno-arterial extracorporeal membrane oxygenation (ECMO) was placed via femoral cannulation for salvage and stabilized. CAT scan of the chest performed as a part of heart transplant work-up, demonstrated an unequal distribution of intravenous contrast in the aortic arch (Figure 1). Radiologist’s preliminary reading was of “aortic dissection” while in fact this is truly “normal ECMO flow”.

Junctional Adhesion Molecule-A Is Co-Expressed With Her2 In Breast Tumors And Acts As A Novel Regulator Of Her2 Protein Degradation And Signaling., Kieran Brennan, Elaine A. Mcsherry, Lance Hudson, Elaine W. Kay, Arnold Ak Hill, Leonie S. Young, Ann M. Hopkins

Surgery Articles

Junctional adhesion molecule-A (JAM-A) is a membranous cell-cell adhesion protein involved in tight-junction formation in epithelial and endothelial cells. Its overexpression in breast tumors has recently been linked with increased risk of metastasis. We sought to identify if JAM-A overexpression was associated with specific subtypes of breast cancer as defined by the expression of human epidermal growth factor receptor-2 (HER2), estrogen receptor (ER) and progesterone receptor. To this end, JAM-A immunohistochemistry was performed in two breast cancer tissue microarrays. In parallel, cross-talk between JAM-A, HER2 and ER was examined in several breast cell lines, using complementary genetic and pharmacological approaches ...

Lipid Raft Association Restricts Cd44-Ezrin Interaction And Promotion Of Breast Cancer Cell Migration., Simona Donatello, Irina S. Babina, Lee D. Hazelwood, Arnold Dk Hill, Ivan R. Nabi, Ann M. Hopkins

Surgery Articles

Cancer cell migration is an early event in metastasis, the main cause of breast cancer-related deaths. Cholesterol-enriched membrane domains called lipid rafts influence the function of many molecules, including the raft-associated protein CD44. We describe a novel mechanism whereby rafts regulate interactions between CD44 and its binding partner ezrin in migrating breast cancer cells. Specifically, in nonmigrating cells, CD44 and ezrin localized to different membranous compartments: CD44 predominantly in rafts, and ezrin in nonraft compartments. After the induction of migration (either nonspecific or CD44-driven), CD44 affiliation with lipid rafts was decreased. This was accompanied by increased coprecipitation of CD44 and ...

Successful Management Of Severe Liver Failure On Venoarterial Extracorporeal Membrane Oxygenation Using Molecular Adsorbent Recirculating Systeme., Shigeki Tabata, Nicholas Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers & Presentations

A 49-year-old female with Adriamycin induced cardiomyopathy presented with decompensated biventricular congestive heart failure. Despite multiple Inotropes, the patient’s hemodynamics deteriorated and she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) placement as a bridge to decision. Pre-ECMO workup showed liver dysfunction with elevated total bilirubin of 5.9 mg/dl, normal liver enzymes and liver ultrasound image. Tentative diagnosis of “end-stage liver failure” was made without a biopsy.

Shortly after initiation of ECMO, the patient developed massive hemoptysis which was successfully managed with continuation of ECMO and ventilator management. [i] The patient’s total bilirubin continued to increase to peak ...

Prevention Of Infection In Pin Sites, Sarah Pelletier, Audrey Stearns, Victoria Smith

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

External fixation is a term describing skeletal apparatuses that attach to wire or pins that penetrate the bone, used for complex fractures and limb deformity. 11-100% of patients with external fixation develop some sort of infection. The purpose of this study is to determine whether the measures taken to prevent infection are effective.

Stroke And Left Atrial Appendage Occlusion In Cardiac Surgery, Richard P. Whitlock

Open Access Dissertations and Theses

Stroke is a devastating event for a patient. Patients undergoing cardiac surgery are at risk of both peri-operative and delayed stroke. This thesis comprises 8 chapters that highlight the rate of stroke in cardiac surgery patients and its risk predictors. It justifies the need for a randomized controlled trial of left atrial appendage (LAA) occlusion on top of usual antithrombotic therapy for stoke prevention in patients with atrial fibrillation or flutter.

Chapter 1 is a preface that provides the rationale for undertaking each of the studies included within this thesis.

Chapter 2 presents a large cohort study that examines the ...

Tension Pneumothorax On Extracorporeal Membrane Oxygenation Leading To Significant Pneumoperitoneum., Hitoshi Hirose, Nicholas C. Cavarocchi, Kathleen Holoyda

Department of Surgery Faculty Papers & Presentations

Veno-venous and veno-arterial extracorporeal membrane oxygenation (ECMO) therapy is used to support the cardiac and pulmonary systems in the setting of acute failure. Maintaining adequate ECMO flow is crucial for the success of the therapy. Sudden decrease in venous return on ECMO has multiple etiologies, such as intravascular hypovolemia, malposition or kink of the venous cannula, suction occlusion of a cannula, and venous or arterial thrombi. Pathology within the chest, including pneumothorax, tension hemothorax and pericardial tamponade, may also decrease the ECMO flow because of compression of the cannula and decreased atrial volume. Air from a tension pneumothorax may be ...

Venoarterial Extracorporeal Membrane Oxygenation (Ecmo) For Support During Whole Lung Lavage For Pulmonary Alveolar Proteinosis., Hitoshi Hirose, Julie Monteagudo, Nicholas C. Cavarocchi, Boyd Hehn, Naveed Hasan

Department of Surgery Faculty Papers & Presentations

INTRODUCTION ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support. CASE PRESENTATION We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea ...

Novel Approach To Monitoring Renal Perfusion With The Use Of Continuous Renal Oximetery In The Setting Of Aortic Dissection, Hitoshi Hirose, Philip Batista, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers & Presentations

INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function. CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to ...

Sternal Pain After Rigid Fixation: A Pilot Study Of Randomization Rigid Vs Conventional Wire Closure., Hitoshi Hirose, Hong Mun Kong, Shigeki Tabata, Kentaro Yamane, Margaret Lusardi, Linda J. Bogar, James Diehl

Department of Surgery Faculty Papers & Presentations

Objective: Rigid sternal fixation may provide better sternal closure than conventional sternal wire closure. We performed a prospective randomized study to investigate if rigid closure reduces postoperative sternal pain. Methods: Patients undergoing CABG ± valve surgery between July 2011 and January 2012 were prospectively randomized into conventional wire closure (group C) or rigid fixation using sternal plates (group R). Pain scores were determined at 6 AM using a numeric rating scale (0 no pain, 5 moderate pain, 10 worst possible pain). Narcotic pain medication requirement from day 1 to 5 was collected and converted into intravenous morphine equivalent. Results: Among the ...

Fate Of The Lower Extremity In Patients With Va-Ecmo Via Femoral Cannulation, Hitoshi Hirose, Kathleen Lamb, Neil Moudgill, Paul Dimuzio, Megan Mccullough, Pawel Karbowski, Atul Rao, Nicholas Cavarocchi, Joshua Eisenberg

Department of Surgery Faculty Papers & Presentations

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of ...

Percutaneous Gastrostomy (Peg) Tube Placement In Patients With Continuous Flow Left Ventricular Assist Device. (Lvad)., Hitoshi Hirose, Chris Rizzi, Linda Bogar, Jay S. Jenoff, Nicholas Cavarocchi

Department of Surgery Faculty Papers & Presentations

Percutaneous gastrostomy (PEG) tube placement in patients with continuous flow left ventricular assist device. (LVAD). CHRIS RIZZI, BS, Linda Bogar, MD, Jay Jenoff, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. The LVAD patients with complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 ...