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Postoperative Outcomes In Oesophagectomy With Trainee Involvement., Oesophago-Gastric Anastomosis Study Group (Ogaa) On Behalf Of The West Midlands Research Collaborative
Postoperative Outcomes In Oesophagectomy With Trainee Involvement., Oesophago-Gastric Anastomosis Study Group (Ogaa) On Behalf Of The West Midlands Research Collaborative
Department of Surgery Faculty Papers
BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.
METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed …
International Evidence-Based Consensus Diagnostic And Treatment Guidelines For Unicentric Castleman Disease., Frits Van Rhee, Eric Oksenhendler, Gordan Srkalovic, Peter Voorhees, Megan Lim, Angela Dispenzieri, Makoto Ide, Sophia Parente, Stephen Schey, Matthew Streetly, Raymond Wong, David Wu, Ivan Maillard, Joshua Brandstadter, Nikhil Munshi, Wilbur Bowne, Kojo S Elenitoba-Johnson, Alexander Fössa, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Sheila K Pierson, Amy Greenway, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S Uldrick, Corey Casper, Amy Chadburn, David C Fajgenbaum
International Evidence-Based Consensus Diagnostic And Treatment Guidelines For Unicentric Castleman Disease., Frits Van Rhee, Eric Oksenhendler, Gordan Srkalovic, Peter Voorhees, Megan Lim, Angela Dispenzieri, Makoto Ide, Sophia Parente, Stephen Schey, Matthew Streetly, Raymond Wong, David Wu, Ivan Maillard, Joshua Brandstadter, Nikhil Munshi, Wilbur Bowne, Kojo S Elenitoba-Johnson, Alexander Fössa, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Sheila K Pierson, Amy Greenway, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S Uldrick, Corey Casper, Amy Chadburn, David C Fajgenbaum
Department of Surgery Faculty Papers
Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, …
Reply: There Are Limits To Autonomy., John W C Entwistle, Kathleen N Fenton
Reply: There Are Limits To Autonomy., John W C Entwistle, Kathleen N Fenton
Department of Surgery Faculty Papers
No abstract provided.
Transplantation Of Kidneys From Donors With Acute Renal Failure Five-Year Results From Double Center Experience, Ahmad Safra, Md, Ashesh P. Shah, Md, Cataldo Doria, Md, Phd, Warren R Maley, Md, Adam M. Frank, Md, Chad Gorn, Laurel Lerner, Rn, Marie Manley, Carlo B Ramirez, Md
Transplantation Of Kidneys From Donors With Acute Renal Failure Five-Year Results From Double Center Experience, Ahmad Safra, Md, Ashesh P. Shah, Md, Cataldo Doria, Md, Phd, Warren R Maley, Md, Adam M. Frank, Md, Chad Gorn, Laurel Lerner, Rn, Marie Manley, Carlo B Ramirez, Md
Department of Surgery Faculty Papers
Background:
Transplantation of kidneys from deceased donors with acute renal failure (ARF) has been described and represents an underutilized source of renal grafts. We reviewed retrospectively our double center experience with transplantation of ARF donor kidneys.
Methods:
Between January 2009 and June 2014, we performed a total of 397 kidney transplants at the two hospitals. Of which, 65 came from donors with ARF. The outcome was compared with 62 expanded criteria donor kidneys and 270 standard criteria donor kidneys. ARF was defined as donor terminal creatinine higher than 2. All kidneys from ARF donors had acceptable biopsies and were pumped. …
Declaring A Patient Brain Dead On Extracorporeal Membrane Oxygenation (Ecmo): Are There Guidelines Or Misconceptions, Kristin J. Kreitler, Nicholas C. Cavarocchi, Hitoshi Hirose, Sharon West, Richard Hasz, Michelle Ghobrial, Rodney D. Bell
Declaring A Patient Brain Dead On Extracorporeal Membrane Oxygenation (Ecmo): Are There Guidelines Or Misconceptions, Kristin J. Kreitler, Nicholas C. Cavarocchi, Hitoshi Hirose, Sharon West, Richard Hasz, Michelle Ghobrial, Rodney D. Bell
Department of Surgery Faculty Papers
Objectives:
- To review the clinical practice variations and trends with declaring patients brain dead on ECMO
- To highlight the need for the development of consensus guidelines to assist clinicians in the accurate diagnosis of brain death in this specific patient population
A Resource Planning Analysis Of District Hospital Surgical Services In The Democratic Republic Of The Congo., Melanie K. Sion, Md, Dheepa Rajan, Hyppolite Kalambay, Jean-Pierre Lokonga, Joseph Bulakali, Mathias Mossoko, Dieudonne Kwete, Gerard Schmets, Edward Kelley, Tarcisse Elongo, Luis Sambo, Meena Cherian
A Resource Planning Analysis Of District Hospital Surgical Services In The Democratic Republic Of The Congo., Melanie K. Sion, Md, Dheepa Rajan, Hyppolite Kalambay, Jean-Pierre Lokonga, Joseph Bulakali, Mathias Mossoko, Dieudonne Kwete, Gerard Schmets, Edward Kelley, Tarcisse Elongo, Luis Sambo, Meena Cherian
Department of Surgery Faculty Papers
BACKGROUND: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC).
METHODS: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well …
Sphingosine-1-Phosphate Promotes The Differentiation Of Adipose-Derived Stem Cells Into Endothelial Nitric Oxide Synthase (Enos) Expressing Endothelial-Like Cells., Divya Arya, Shaohua Chang, Paul J Dimuzio, Jeffrey Carpenter, Thomas N Tulenko
Sphingosine-1-Phosphate Promotes The Differentiation Of Adipose-Derived Stem Cells Into Endothelial Nitric Oxide Synthase (Enos) Expressing Endothelial-Like Cells., Divya Arya, Shaohua Chang, Paul J Dimuzio, Jeffrey Carpenter, Thomas N Tulenko
Department of Surgery Faculty Papers
BACKGROUND: Adipose tissue provides a readily available source of autologous stem cells. Adipose-derived stem cells (ASCs) have been proposed as a source for endothelial cell substitutes for lining the luminal surface of tissue engineered bypass grafts. Endothelial nitric oxide synthase (eNOS) is a key protein in endothelial cell function. Currently, endothelial differentiation from ASCs is limited by poor eNOS expression. The goal of this study was to investigate the role of three molecules, sphingosine-1-phosphate (S1P), bradykinin, and prostaglandin-E1 (PGE1) in ASC endothelial differentiation. Endothelial differentiation markers (CD31, vWF and eNOS) were used to evaluate the level of ASCs differentiation capability. …
Comparison Of Sternal Pain And Narcotic Requirement After Cardiac Surgery Between New Rigid Closure And Conventional Wire Closure: Follow-Up Results Of 50 Randomizations., Jeevan Kuman, Bs, James T. Diehl, Md, Hitoshi Hirose, Md, Phd
Comparison Of Sternal Pain And Narcotic Requirement After Cardiac Surgery Between New Rigid Closure And Conventional Wire Closure: Follow-Up Results Of 50 Randomizations., Jeevan Kuman, Bs, James T. Diehl, Md, Hitoshi Hirose, Md, Phd
Department of Surgery Faculty Papers
To investigate if rigid closure reduces sternal pain.
Presented at Chest 2013.Chicago IL.October 26-31, 2013.
Two-Vessel Off-Pump Coronary Artery Bypass Grafting By Left Thoracotomy In A Complex Redo Case, Shinya Unai, Md, Hitoshi Hirose, Md, Phd, Gary A. Cook, Pa-C, Nicholas C. Cavarocchi, Md, John W..C. Entwistle Iii, Md, Phd
Two-Vessel Off-Pump Coronary Artery Bypass Grafting By Left Thoracotomy In A Complex Redo Case, Shinya Unai, Md, Hitoshi Hirose, Md, Phd, Gary A. Cook, Pa-C, Nicholas C. Cavarocchi, Md, John W..C. Entwistle Iii, Md, Phd
Department of Surgery Faculty Papers
Introduction:
The left thoracotomy approach is an alternative technique for coronary revascularization to avoid complications associated with re-sternotomy, such as injury to patent grafts, right ventricle, aorta, during re-sternotomy. Situations such as calcification of the ascending aorta and previous mediastinitis favor the use of the left thoracotomy approach. Revascularization of the circumflex territory via a lateral thoracotomy has been reported previously. However, reports of revascularization of the LAD combined with circumflex artery territory via left thoracotomy approach are rare. We successfully performed an off-pump CABG by left thoracotomy in a complex redo case to revascularize the LAD and obtuse marginal …
Case Series On Veno - Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo) As A Bridge To Complete Recovery In Influenza Type A Related Refractory Ards, Renganaden Sooppan, Md, Nicholas C. Cavarocchi, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Hitoshi Hirose, Md, Phd
Case Series On Veno - Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo) As A Bridge To Complete Recovery In Influenza Type A Related Refractory Ards, Renganaden Sooppan, Md, Nicholas C. Cavarocchi, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Hitoshi Hirose, Md, Phd
Department of Surgery Faculty Papers
Introduction:
Influenza A sequelae range from mild symptoms to acute respiratory distress syndrome (ARDS), which can be refractory to conventional ventilator therapy. We present a case series of three non-H1N1 Influenza patients with ARDS, who completely recovered after VV-ECMO.
Case Presentation:
In January and February 2013, we experienced three cases of Influenza A induced ARDS that failed conventional ARDS ventilator therapy. All three patients presented with typical flu-like symptoms, which deteriorated over several days, requiring intubation. They were all treated with oseltamivir. They had bilateral chest infiltrates on chest x-rays. After a few days of failing conventional treatment these patients …
Does Skin Pigmentation Effect Readings Of Cerebral Oximeter Devices While On Cardiopulmonary Support?, Christine Feldmeier, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Does Skin Pigmentation Effect Readings Of Cerebral Oximeter Devices While On Cardiopulmonary Support?, Christine Feldmeier, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Department of Surgery Faculty Papers
Introduction:
Cerebral oximetry is utilized as a non-invasive method to ensure adequate cerebral perfusion. In a review of our clinical experience, it was noted that there were consistent inaccurate values from normal utilizing relative (INVOS, Covidien, Mansfield, MA) cerebral oximetry as opposed to absolute (FORESIGHT, CAS medical, Branford, CT) cerebral oximetry in darker skin patients.
Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.
A Cost Reducing Ecmo Model: A Single Institutional Experience., En Yaw Hong, Suzanne Wallace, Amy Tropea, Jaime Byrne, Msn, Rn, Hitoshi Hirose, Md, Phd, Harrsion Pitcher, Md, Nicholas C. Cavarocchi, Md
A Cost Reducing Ecmo Model: A Single Institutional Experience., En Yaw Hong, Suzanne Wallace, Amy Tropea, Jaime Byrne, Msn, Rn, Hitoshi Hirose, Md, Phd, Harrsion Pitcher, Md, Nicholas C. Cavarocchi, Md
Department of Surgery Faculty Papers
Background: The demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) which increase healthcare cost. Our goal was to assess if an ICU run ECMO model (without continuous bedside perfusion) would decrease costs while maintaining patient safety and outcomes.
Method: We performed a retrospective review that analyzed the cost and safety benefits of a newly implemented ICU-run ECMO unit from 2011-2012. The program consisted of a dedicated ICU involving multidisciplinary providers (ICU RN, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and …
The Impact Of A New Ecmo Program On Clinical Outcomes Of Patients With Acute Myocardial Infarction Complicated By Cardiogenic Shock., Shinya Unai, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas Ruggiero, Md, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md
The Impact Of A New Ecmo Program On Clinical Outcomes Of Patients With Acute Myocardial Infarction Complicated By Cardiogenic Shock., Shinya Unai, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas Ruggiero, Md, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md
Department of Surgery Faculty Papers
Objective:
To investigate if a new ECMO program will improve the outcome of patients who had acute myocardial infarction complicated with cardiogenic shock.
Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.
Mrsa Sepsis And Acute Respiratory Distress Syndrome During Veno-Arterial Extracorporeal Membrane Oxygenation (Ecmo)., Philip Hsiao, Bs, Joseph Miessau, Bs, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Mrsa Sepsis And Acute Respiratory Distress Syndrome During Veno-Arterial Extracorporeal Membrane Oxygenation (Ecmo)., Philip Hsiao, Bs, Joseph Miessau, Bs, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Department of Surgery Faculty Papers
Presentation:
A 39 year old female African American presented with respiratory distress two days after ERCP for pancreatitis.
The patient quickly deteriorated, required intubation, and developed severe hypotension requiring vasopressors.
VA-ECMO was initiated for ARDS and SIRS due to on-going pancreatitis.
Pre ECMO ABG: PH 7.01, PaCO2 70, PaO2 70 with FiO2 100% with PEEP 15
Profound hypotension, required 2 pressors
Preliminary results of cultures were negative at the time of ECMO placement.
Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.
Left Ventricular Thrombus Found In A Patient With Ards And Stress-Induced Cardiomyopathy Requiring Veno-Arterial Ecmo., Shreya Gupta, Bs, Joseph Miessau, Ms, Harrsion Pitcher, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Left Ventricular Thrombus Found In A Patient With Ards And Stress-Induced Cardiomyopathy Requiring Veno-Arterial Ecmo., Shreya Gupta, Bs, Joseph Miessau, Ms, Harrsion Pitcher, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd
Department of Surgery Faculty Papers
Presentation:
68 year-old male with a history of acute leukemia with complete remission after bone marrow transplant 4 months ago, coronary disease s/p LAD stents about 14 years ago with no chronic anti-platelet medication, and repeated episode of DVT despite appropriate anti-coagulation, presented with viral pneumonia (rhinovirus).
Antithrombin Iii Deficiency In A Patient Requiring Extracorporeal Membrane Oxygenation., Jonathan R. Sarik, Md, Shinya Unai, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md
Antithrombin Iii Deficiency In A Patient Requiring Extracorporeal Membrane Oxygenation., Jonathan R. Sarik, Md, Shinya Unai, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md
Department of Surgery Faculty Papers
Introduction:
Antithrombin or antithrombin III (ATIII) is a vitamin K-independent, natural anticoagulant that is the major inhibitor of thrombin. With the binding of heparin, a conformational change in antithrombin occurs that increases the inactivation of thrombin by antithrombin by 4000-fold. Antithrombin deficiency can be hereditary or acquired; the acquired form is frequently encountered in patients requiring mechanical circulatory support.
Formulation of clots within the circuit of extracorporeal membrane oxygenation (ECMO) is a life-threatening emergency and requires emergent intervention. Decreased ATIII is associated with a hypercoagulable state, which can lead to dangerous complications for patients requiring mechanical circulatory support.
We Came, We Saw, We Cannulated?, Hitoshi Hirose, Md, Phd, Kumar Gaurav, Md, Nicholas C. Cavarocchi, Md, Vanjul Agarwal, Md, Roselle Almeida, Md, Andrew Toscano, Md, Urvashi Vaid, Md, Ms, Bharat K. Awsare, M.D., Fccp, Michael Baram, Md
We Came, We Saw, We Cannulated?, Hitoshi Hirose, Md, Phd, Kumar Gaurav, Md, Nicholas C. Cavarocchi, Md, Vanjul Agarwal, Md, Roselle Almeida, Md, Andrew Toscano, Md, Urvashi Vaid, Md, Ms, Bharat K. Awsare, M.D., Fccp, Michael Baram, Md
Department of Surgery Faculty Papers
Introduction: Despite advances in management of patients with severe acute respiratory distress syndrome (ARDS), mortality due to ARDS still remains high. In patients with refractory gas-exchange abnormalities, extracorporeal membrane oxygenation (ECMO) is considered as salvage therapy that aims to decrease ventilator induced lung injury and provide lung rest. injury and provide lung rest.
Methods: We conducted a retrospective study of patients diagnosed with ARDS from October 2010 to September 2012. The aim of the study was to describe the population of patients placed on ECMO for ARDS in our institution. All patients placed on ARDSnet protocol were identified in the …
Assessment Of Nutritional Adequacy In Patients On Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Md, Phd, Joseph Miessau, Pa-C, Evanthia Foliou, Rd, Pawel Karbowski, Pa-C, Ms, Melanie K. Sion, Md, Christine Feldmeier, Md
Assessment Of Nutritional Adequacy In Patients On Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Md, Phd, Joseph Miessau, Pa-C, Evanthia Foliou, Rd, Pawel Karbowski, Pa-C, Ms, Melanie K. Sion, Md, Christine Feldmeier, Md
Department of Surgery Faculty Papers
Introduction: Nutrition is a key element of recovery from the state of critical illness. Little is known about nutritional adequacy in patients supported on extracorporeal membrane oxygenation (ECMO) for severe cardio-respiratory dysfunction. A study was performed whether or not early nutrition support improve outcomes of the patients on ECMO.
Methods: A retrospective IRB approved review was conducted of all patients supported on ECMO from 7/10 to 6/12. The patients were divided into 2 groups, survivors and non-survivors. Age, sex, preoperative comorbidities, type and duration of ECMO, day to initiation and goal feeding, caloric intake, weekly biomarkers (pre-albumin, albumin, …
Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi
Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi
Department of Surgery Faculty Papers
Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …
Parenthood With Exposure To Mycophenolic Acid Products, Sophia M. Termimi, Megan Clary, Lisa Coscia, Carolyn Mcgrory, Vincent T. Armenti
Parenthood With Exposure To Mycophenolic Acid Products, Sophia M. Termimi, Megan Clary, Lisa Coscia, Carolyn Mcgrory, Vincent T. Armenti
Department of Surgery Faculty Papers
Successful pregnancy outcomes have been reported in all solid-organ transplant recipients on a variety of immunosuppressive medication regimes. In October 2007, the FDA pregnancy category of mycophenolic acid products (MPA) was changed from category C to D, based on registry and post-marketing data which revealed a higher incidence of spontaneous abortions and structural birth defects. The purpose of this abstract is to describe pregnancy outcomes with exposure to MPA and pregnancies fathered by male transplant recipients conceived while taking MPA. Data were collected by the National Transportation Pregnancy Registry (NTPR) via questionnaires, telephone interview and medical records. There were 152 …
A Step Backward For Italy's Meritocracy., Ignazio Roberto Marino
A Step Backward For Italy's Meritocracy., Ignazio Roberto Marino
Department of Surgery Faculty Papers
Italian scientists have long lamented the lack of resources, political attention, and meritocracy in assigning taxpayers’ money.
Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas C. Cavarocchi, Paul Mather
Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas C. Cavarocchi, Paul Mather
Department of Surgery Faculty Papers
This is invited commentary to the following article:
Current Trend Of Off-Pump Coronary Artery Bypass Grafting., Hitoshi Hirose
Current Trend Of Off-Pump Coronary Artery Bypass Grafting., Hitoshi Hirose
Department of Surgery Faculty Papers
Published in "Front Lines of Thoracic Surgery", Edited by Stefano Nazari, ISBN 978-953-307-915-8, Published: February 3, 2012 under CC BY 3.0 license
Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) and
cardioplegic arrest has been performed safely over several decades. Cardiac surgery under
cardiac arrest provides a bloodless stable operative field, that can facilitate anastomosis. In
last decade, CABG without CPB, off-pump CABG (OPCAB) has become more common with
advances in surgical instruments and technique. This chapter summarizes the surgical
technique, risks and benefits of OPCAB.
Thoratec Heartmate Ii(®) Left Ventricular Assist Device Implantation In Patient With Patent Ventriculoperitoneal Shunt., Kentaro Yamane, Linda J Bogar, Shigeki Tabata, Hitoshi Hirose
Thoratec Heartmate Ii(®) Left Ventricular Assist Device Implantation In Patient With Patent Ventriculoperitoneal Shunt., Kentaro Yamane, Linda J Bogar, Shigeki Tabata, Hitoshi Hirose
Department of Surgery Faculty Papers
We report a case of HeartMate II® left ventricular assist device (LVAD) implantation as a destination therapy in a patient with a patent ventriculoperitoneal (VP) shunt after being suffered from subarachnoid hemorrhage. Because the patient's VP shunt was running through her right anterior chest and abdominal wall, a driveline exit site was selected in her left upper quadrant to avoid unnecessary perioperative complication in relation to the patent VP shunt tube. Tailored driveline placement was a key element of this LVAD implantation in this already sick patient with multiple comorbidities.
Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo
Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo
Department of Surgery Faculty Papers
INTRODUCTION: The incidence of melanoma is dramatically increasing worldwide. We hypothesized that the ratio of metastatic to examined lymph node ratio (LNR) would be the most important prognostic factor for stage III patients.
METHODS: We retrospectively reviewed our institutional database of melanoma patients and identified 168 patients who underwent lymph node dissection (LND) for stage III disease between 1993 and 2007. Patients were divided into three groups based on LNR (≤10%, n = 93; 10-≤25%, n = 45; and >25%, n = 30). Univariate and multivariate analysis was performed using Cox proportional hazards model.
RESULTS: The median survival time of …
A Novel Survival-Based Tissue Microarray Of Pancreatic Cancer Validates Muc1 And Mesothelin As Biomarkers., Jordan M Winter, Laura H Tang, David S Klimstra, Murray F Brennan, Jonathan R Brody, Flavio G Rocha, Xiaoyu Jia, Li-Xuan Qin, Michael I D'Angelica, Ronald P Dematteo, Yuman Fong, William R Jarnagin, Eileen M O'Reilly, Peter J Allen
A Novel Survival-Based Tissue Microarray Of Pancreatic Cancer Validates Muc1 And Mesothelin As Biomarkers., Jordan M Winter, Laura H Tang, David S Klimstra, Murray F Brennan, Jonathan R Brody, Flavio G Rocha, Xiaoyu Jia, Li-Xuan Qin, Michael I D'Angelica, Ronald P Dematteo, Yuman Fong, William R Jarnagin, Eileen M O'Reilly, Peter J Allen
Department of Surgery Faculty Papers
BACKGROUND: One-fifth of patients with seemingly 'curable' pancreatic ductal adenocarcinoma (PDA) experience an early recurrence and death, receiving no definable benefit from a major operation. Some patients with advanced stage tumors are deemed 'unresectable' by conventional staging criteria (e.g. liver metastasis), yet progress slowly. Effective biomarkers that stratify PDA based on biologic behavior are needed. To help researchers sort through the maze of biomarker data, a compendium of ∼2500 published candidate biomarkers in PDA was compiled (PLoS Med, 2009. 6(4) p. e1000046).
METHODS AND FINDINGS: Building on this compendium, we constructed a survival tissue microarray (termed s-TMA) comprised of short-term …
Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C Berger, Jeffrey M Farma
Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C Berger, Jeffrey M Farma
Department of Surgery Faculty Papers
The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …
Growth Inhibition Of Human Hepatocellular Carcinoma Cells By Overexpression Of G Protein-Coupled Receptor Kinase 2, Zhengyu Wei, Reginald Hurtt, Cataldo Doria
Growth Inhibition Of Human Hepatocellular Carcinoma Cells By Overexpression Of G Protein-Coupled Receptor Kinase 2, Zhengyu Wei, Reginald Hurtt, Cataldo Doria
Department of Surgery Faculty Papers
Summary:
In this study, we investigated a novel approach for HCC treatment by inducing overexpression of GRK2 in human HCC cells. We found that overexpression of GRK2 through recombinant adenovirus transduction inhibits the growth of human HCC cells. BrdU incorporation assay showed that the growth inhibition caused by elevated GRK2 level was due tot he reduced cell proliferation but not apoptosis. To examine the anti-proliferative function of increased GRK2 level, we performed cell cycle analysis using propidium iodide staining. We found that the proliferation suppression was associated with G2/M phase cell cycle arrest by the wild type GRK2 but not …
Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez
Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez
Department of Surgery Faculty Papers
Conclusions:
Use of liver grafts from older donors presents similar survival outcomes as grafts from younger donor age. Therefore, it offers a viable option to expand the donor pool and increase number of OLTs.
However, there is higher incidence of retransplantation due to primary graft non-function, and longer hospital length of stay observed in the older donor age group.
Further studies using larger patient populations are needed to validate our results.
Endothelial Differentiation Of Adipose-Derived Stem Cells From Elderly Patients With Cardiovascular Disease., Ping Zhang, Neil Moudgill, Eric Hager, Nicolas Tarola, Christopher Dimatteo, Stephen Mcilhenny, Thomas Tulenko, Paul J Dimuzio
Endothelial Differentiation Of Adipose-Derived Stem Cells From Elderly Patients With Cardiovascular Disease., Ping Zhang, Neil Moudgill, Eric Hager, Nicolas Tarola, Christopher Dimatteo, Stephen Mcilhenny, Thomas Tulenko, Paul J Dimuzio
Department of Surgery Faculty Papers
Adipose-derived stem cells (ASCs) possess significant therapeutic potential for tissue engineering and regeneration. This study investigates the endothelial differentiation and functional capacity of ASCs isolated from elderly patients. Isolation of ASCs from 53 patients (50-89 years) revealed that advanced age or comorbidity did not negatively impact stem cell harvest; rather, higher numbers were observed in older donors (>70 years) than in younger. ASCs cultured in endothelial growth medium-2 for up to 3 weeks formed cords upon Matrigel and demonstrated acetylated-low-density lipoprotein and lectin uptake. Further stimulation with vascular endothelial growth factor and shear stress upregulated endothelial cell-specific markers (CD31, …