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Download Entire Issue: Gibbon Surgical Review, Volume 2, Issue 1, 2019

Gibbon Surgical Review

Table of Contents

4 - The Gibbon Surgical Externship: A Student’s Perspective

6 - Invited Article: The PCOM Wisely Surgical Association and the Philadelphia Surgery Conference

8 - Interview With Thomas Jefferson Cardiothoracic Surgeon, H. Todd Massey, MD

12 - The Life of a Rwandan Surgical Resident

14 - Role Of Technological Advancement In The Context Of Surgical Planning And Execution: Perspective Of Jefferson Surgical Faculty

16 - Interview with William B. Hughes, MD, Director of the Thomas Jefferson University Hospital Burn Center

19 - Women in Surgery: An Interview with Dr. Karen Chojnacki, Vice Chair of Surgical Education at …

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 2, 2018

Gibbon Surgical Review

Table of Contents

• Forward by Charles J. Yeo, MD, FACS
• PERSPECTIVE - An Interview with Dr. Theresa Yeo, Co-Director of the Jefferson Pancreas Tumor Registry (JPTR)
• A PGY-1's Perspective: Conducting Pancreatic Cancer Research as a Medical Student
• INTERVIEW - Jonathan Brody, PhD - Pancreatic Cancer Specialist
• RESEARCH SPOTLIGHT - The Journal of Pancreatic Cancer
• Pancreatic Cancer Research at Jefferson: The Mary Halinski Pancreatic Cancer Research Fund
• The Gibbon Surgical Society
• Contributors
• Samuel D. Gross Professor of Surgery: Charles J. Yeo, MD, FACS

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 1, 2018

Gibbon Surgical Review

Table of Contents

• A First Year's Perspective on JeffMD, Somnath Das, MS1
• Spotlight on TJUH's Quality and Safety Group, Samantha L. Savitch, MS1
• Medical Student Involvement in Quality Improvement Research, Tyler M. Bauer, MS3
• Global Surgery: A Shift in the Global Health Paradigm, Myles S. Dworkin, MS3
• Thomas Jefferson University Design Vault, Victor B. Hsue, MS2
• Physician Spotlight: Ernest (Gary) L. Rosato, MD, FACS, Carrie E. Andrews, MS3
• The SCALPELS Program, Emily Papai, MS1

Nuclear Factor Κb Inhibitors Alleviate And The Proteasome Inhibitor Ps-341 Exacerbates Radiation Toxicity In Zebrafish Embryos, Borbala Daroczi, Gabor Kari, Qing Ren, Adam Dicker Md, Phd, Ulrich Rodeck

Bodine Journal

Inflammatory changes are a major component of the normal tissue response to ionizing radiation, and increased nuclear factor κB (NF-κB) activity is an important mediator of inflammatory responses. Here, we used zebrafish embryos to assess the capacity of two different classes of pharmacologic agents known to target NF-κB to modify radiation toxicity in the vertebrate organism. These were proteasome inhibitors, including lactacystin, MG132, and PS-341 (Bortezomib/VELCADE), and direct inhibitors of NF-κB activity, including ethyl pyruvate (EP) and the synthetic triterpenoid CDDO-TFEA (RTA401), among others. The proteasome inhibitors either did not significantly affect radiation sensitivity of zebrafish embryos (MG132, lactacystin) or …

A Kidney For Christmas, Stephen Scholand

The Medicine Forum

When Asmar Lawrence first walked into the small examining room in the Jefferson Hospital Ambulatory Practice (JHAP) Clinic, we both had no idea what the future would hold. It was July, 1998 and I was fresh from medical school. Each week, I looked forward to the JHAP experience to develop my clinical skills and follow patients longitudinally. No longer was my learning prescribed from a textbook, this was the 'real world' of medicine where anything could happen and I was supposed to be in control of it. The long white coat probably helped perpetuate some of that illusion. Fortunately our …

A Pilot Study Of Diabetes Management In The Managed Care Setting, Rachel Wagman

The Medicine Forum

Diabetes mellitus represents a disease entity that primary care providers commonly encounter in the outpatient setting. Patient visits encompass a broad range of concerns, from optimizing management of hyperglycemia to the sequelae of chronic disease. The third National Health and Nutrition Exam Survey, (NHANES III) 1988-1994 has reported the prevalence of diabetes mellitus type 2 in the U.S. adult population at 12.3%. The cost of diabetes in 1998, estimated at $77 billion, is a formidable challenge to the health care community and third-party payers. Historically, Health Maintenance Organizations (HMOs) have encouraged more preventative tests, procedures, and exams to curtail the …

Brachytherapy: A New Weapon Against Coronary Restenosis, Rob Silver

The Medicine Forum

Since its introduction in the late 1970's, coronary angioplasty has become a common procedure for treating coronary atherosclerotic disease. It offers significant improvement in symptoms of coronary artery disease through a less invasive procedure than coronary artery bypass grafting (CABG). Each year, over 500,000 percutaneous transluminal coronary angioplasty (PTCA) procedures are performed in North America alone. In larger epicardial vessels that are 3 millimeters or greater in diameter, a metal stent can be placed during angioplasty to reduce the incidence of restenosis. In fact, stents are now deployed in approximately 80 percent of PTCA procedures. The success rate of PTCA …

Melena With Fever, Monica Patel, Jennifer Wilhelm

The Medicine Forum

The patient is a 62 year old Indian male with a past medical history significant for myasthenia gravis, hypertension, and diabetes mellitus, who presented to an outside hospital with fever, fecal incontinence, and melena. Work up at that hospital was remarkable for elevated liver function tests, heme-positive brown stool and a CT of the abdomen showing a thick ascending colon suggesting possible mass. The patient had an episode of desaturation and fever to 105 degrees Fahrenheit prior to transfer to Thomas Jefferson University Hospital for further evaluation. Upon arrival, the patient was in respiratory distress with oxygen saturation of 70% …

Severe Dyspnea And Cough, Traci Mellinger Kohl, Elizabeth Cartwright

The Medicine Forum

A 43 year-old white male with a history of hypertension and a smoking history of 30 pack-years presented to the emergency room coplaining of cough, severe dyspnea, nausea, and vomiting. Ten days prior to presentation, he experienced flu-like symptoms with a low-grade fever, myalgias, and malaise that lasted approximately four days but resolved spontaneously. He had a cough productive of white sputum and blood-tinged nasal drainage for one week. Three days prior to presentation he began to experience right upper quadrant abdominal pain and bilious vomiting. The patient worked as a bar inspector and had a routine PPD check 9 …

A Case Of Hypercalcemia, Daniel Lin

The Medicine Forum

A 79-year-old man with a past medical history of diet-controlled type 2 diabetes mellitus, hypertension, and chronic lower extremity venous stasis ulcers requiring two skin grafts was admitted to the hospital due to dehydration. He was in his usual state of health intermittently being wheelchair bound due to leg ulcers until four days earlier, when he accidentally spilled hot tea on his left arm while in the kitchen. In his attempt to maneuver the wheelchair away from the spill, the wheelchair turned over, pinning him on the floor and against the cabinets. He remained in that position for four days …

Hematuria Status Post Renal Biopsy, Bill Mcelhaugh

The Medicine Forum

This is a case of a 66 year old Caucasian woman admitted to the hospital following a ureteroscopic biopsy of the left renal pelvis. The biopsy was performed for asymptomatic hematuria, with a retrograde intravenous pyelogram revealing a mass in the left renal pelvis. The patient developed lightheadedness and left flank pain 12-24 hours following the procedure and was found to have a 3 gram drop in hemoglobin compared to blood work performed during the previous week.

Candidal Retinitis, Carl D. Mele

The Medicine Forum

Mr. R.T. was a 49 year old male with recurrent Hepatitis C infection after orthotopic liver transplant, who presented with complications related to hemorrhagic pancreatitis. While on long term total parenteral nutrition, he developed blurry vision and Candida albicans fungemia. A fundus photograph revealed fungal endopthalmitis with focal areas of chorioretinitis. His vision improved significantly with serial intravitreal antifungal injections.

Validation Of A Novel, Non-Invasive System For Autonomic Profiling In Healthy Volunteers, Agostino Ingraldi, Behzad B. Pavri, Himanshu Patel, Sammy Zakaria, Reginald T. Ho, Arnold J. Greenspon

The Medicine Forum

Noninvasive profiling of the autonomic nervous system has been shown to have prognostic value in patients with myocardial infarction, CHF and diabetes. The ANSAR system (ANX 3.0, Philadelphia, PA) is a new commercially available system that utilizes respiratory rate, HR and BP to assess on-going sympathovagal modulation during various maneuvers known to evoke autonomic perturbations. Instead of using conventional Fast Fourier Transform for frequency domain analysis, a Continuous Wavelet Transform (CWT) is used to generate numerical and graphical data. The system calculates Low Frequency Area (LFA, analogous to LF Power) and Respiratory Frequency Area (RFA, analogous to High Frequency Power.) …

A Case Of Invasive Thymoma, Jon Geddes

The Medicine Forum

A 52 year-old man with a past medical history of an isolated seizure presented to the Veterans Affairs hospital complaining of weakness which was most prominent in the face and upper extremities. About 6 months prior to this admission he developed intermittent episodes of weakness when chewing and swallowing. He would often have to use his hands to close his jaw when eating or talking. He noticed that his voice had developed a nasal quality but he did not have slurred speech. He denied drooling, ptosis, cramping or muscle twitches. He was seen 6 months ago at another VA hospital …

A Case Of Thrombosis And Thromboembolic Events, Daniel Lin

The Medicine Forum

A 65 year old black woman with hypertension (HTN), gastroesophageal reflux disease (GERD), and anxiety had complained to her primary care physician of vague abdominal pain. Initial empiric treatment as an outpatient for worsening GERD was unsuccessful. The patient had insidious development of generalized fatigue, early satiety, nausea, vomiting, and weight loss. An ultrasound of the abdomen revealed multiple liver lesions, with the largest lesion being 2.5 cm x 2.5 cm. She subsequently underwent a CT scan of the abdomen and pelvis, which confirmed multiple hyperdense liver lesions. The remainder of the scan was unremarkable. Esophagogastroduodenoscopy (EGD) as well as …

A Case Of A Male With Fever And Fatigue, Steve Ting

The Medicine Forum

This is a case of a 78 year old Caucasian gentleman who presented to the hospital in the early summer with complaints of high fevers and progressive fatigue. The patient lives near Philadelphia and enjoys doing yard work. He reported finding a tick attached to the skin near his groin approximately 3 weeks prior to admission. The tick was removed; however the patient was unsure of the duration of the tick attachment. He also denied developing any significant rash in that area. He had no recent sick contacts and no recent history of travel. He began developing fever spikes up …

Nevirapine Hepatotoxicity: Case Report And Discussion, Matt Baichi

The Medicine Forum

Nevirapine (viramune) is a nonnucleoside reverse transcriptase inhibitor commonly used in combination with other antiretroviral medicines in the treatment of HIV/AIDS. The safety profile of nevirapine, as determined by review of prospective clinical trials, reports rash with an incidence of 16% as the most common side effect. Clinical hepatitis is reported to occur with an incidence of 1%. A review of the literature shows many case reports of nevirapine-induced hepatotoxicity in patients receiving both treatment and prophylaxis for HIV. The purpose of this case report is to stress the importance of early recognition and withdrawal of the offending drug.

A Case Of Facial Pain And Vesicular Rash, Matt Baichi

The Medicine Forum

The patient is an 81 year old male with a past medical history of non-insulin dependent diabetes mellitus, hypertension, and dyslipidemia who presents with a complaint of facial pain. The pain began 3-4 days before presentation to his primary care physician. It was constant and intense. There was no history of similar head or facial pain, visual changes, jaw claudication, rash, tearing, nasal discharge, photophobia, phonophobia, sinus congestion, tooth ache, nor neurologic complaints. There was no relief with over-the-counter analgesics. A rash subsequently developed over his left forehead and scalp. At presentation, vital signs were stable. Skin examination revealed an …

A Case Of Chronic Intestinal Pseudo-Obstruction, Matt Baichi

The Medicine Forum

Scleroderma is a systemic disease characterized by the deposition of excessive collagen and other matrix elements in the skin as well as in multiple internal organs. Scleroderma can be classified into diffuse cutaneous disease and limited cutaneous disease. Limited cutaneous disease is characterized by skin involvement limited to the hands, face, feet, and forearms; it includes the CREST variant (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, and telangiectasia). Diffuse cutaneous disease is characterized by skin involvement as well as early and diffuse visceral involvement. Clinically significant gastrointestinal involvement occurs in approximately 50% of all patients with scleroderma. The esophagus is the most …

Fractionated Stereotactic Radiosurgery Alone For The Treatment Of A Papillary Craniopharygioma, Tyler J. Kenning, Md, James J. Evans, Md

JHN Journal

The use of radiation treatment (RT) is usually reserved for residual or recurrent craniopharyngiomas, and the role of RT alone and not as an adjunctive therapy to surgery has not been clearly defined. The authors describe a case of a 50-year-old man presenting with a large suprasellar craniopharyngioma with extension into the third ventricle, producing acute hydrocephalus. A ventriculoperitoneal shunt was performed concurrently with an endoscopic biopsy. Treatment with fractionated stereotactic radiosurgery (FSR) resulted in near resolution of the lesion with no evidence of recurrence over six years. A review of RT for the treatment of craniopharyngiomas without surgical resection …

Neurosurgical Applications Of Magnetic Resonance Diffusion Tensor Imaging, Daniel D. Hirsch, Bs, Benjamin M. Zussman, Bs, Adam E. Flanders, Md, Ashwini D. Sharan, Md

JHN Journal

Magnetic Resonance (MR) Diffusion Tensor Imaging (DTI) is a rapidly evolving technology that enables the visualization of neural fiber bundles, or white matter (WM) tracts. There are numerous neurosurgical applications for MR DTI including: (1) Tumor grading and staging; (2) Pre-surgical planning (determination of resectability, determination of surgical approach, identification of WM tracts at risk); (3) Intraoperative navigation (tumor resection that spares WM damage, epilepsy resection that spares WM damage, accurate location of deep brain stimulation structures); (4) Post-operative assessment and monitoring (identification of WM damage, identification of tumor recurrence). Limitations of MR DTI include difficulty tracking small and crossing …

Complications Of Decompressive Craniectomy, Sandra Ho, Bs, Yinn C. Ooi, Md, Muhamad A. Sheikh, Mbbs, Mitchell Maltenfort, Phd, Jack Jallo, Md, Phd

JHN Journal

Introduction:

Persistent elevation of intracranial pressure (ICP), if untreated, may lead to brain ischemia or lack of brain oxygen and even brain death.1-6,10 When standard treatments for elevated ICP are exhausted without any signs of improvement, decompressive craniectomy can be an effective alternative solution.7,19 Decompressive craniectomies (DC) have been used as a method of controlling intracranial pressure in patients with cerebral edema secondary to cerebral ischemia, subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), among others. 8-10 Several studies over the years have demonstrated the efficacy of this procedure.7-9,11,35,36 However, consensus is still lacking in the utility of DC as …

Undergraduate Neurosurgical Learning Opportunities At Jefferson, Leadership Committee Neurosurgery Student Interest Group

JHN Journal

On the evening of November 29, 2011, Jefferson’s Neurosurgery Interest Group (NSIG) hosted fourteen Jefferson Medical College students for a technical course entitled “Foundations in Neurosurgery” taught by Dr. Ashwini Sharan, Associate Professor of Neurosurgery and Director of the Division of Functional Neurosurgery, and Dr. Joshua Heller, Assistant Professor of Neurosurgery at Thomas Jefferson University Hospital. Additional instructors included Jefferson neurosurgery residents Rohan Chitale (PGY5), Chengyuan Wu (PGY4), and Karl Balsara (PGY2). Stryker MedED provided equipment, models, and instructors Ryan Dugan and Devin Opdendyk (Figure 1).

Antidepressant Pharmacotherapy: Prescription Practices In Psychiatric Resident Care, Rachel Dew, W. Vaughn Mccall

Jefferson Journal of Psychiatry

Background: Research on treatment of depression has raised concerns regarding adequacy of medication trials and rationality of drug choice. Little data exists regarding pharmacotherapy by psychiatric residents. As practice habits begun in training will likely persist after graduation, examination of residents' antidepressant use may ultimately improve treatment by psychiatrists.

Methods: Charts of new patients presenting to the Wake Forest University Psychiatry Resident Clinic were reviewed. Survey was made of medications prescribed to 112 patients diagnosed with major depression, dysthymia, depressive disorder NOS, adjustment disorder with depressed mood, or bipolar disorder with a documented depression during the studied period. Drug choice …

The Duty To Warn/Protect Doctrine And Its Application In Pennsylvania, Clarence Watson

Jefferson Journal of Psychiatry

Despite the almost universal familiarity of mental health professionals with the Tarasoff case, many questions regarding its associated legal requirements often arise when evaluating potentially dangerous patients. The principles of the duty to warn/protect, while appearing nebulous at times, contain key concepts that the clinician must consider in the face of potential danger to third parties. This article reviews the landmark decision of the Tarasoff case and outlines its key concepts. In addition, given that state jurisdictions vary in treatment of Tarasoff-like cases, this article explores the Pennsylvania Supreme Court decision, Emerich v. Philadelphia Center for Human Development, Inc.

Editor's Note, Anika Vaughn-Cooke

Jefferson Journal of Psychiatry

No abstract provided.

Electroconvulsive Therapy: A Review Of Its Current Status, Tyler Kenning, Ranjnish Mago, Steven Huege, Kenneth Certa, Rodney Pelchat

Jefferson Journal of Psychiatry

This article presents an overview of the current knowledge and practice of ECT. It provides a brief history of the development of ECT followed by a discussion of the accepted indications for ECT in psychiatric practice, including major depression, bipolar disorder (mania and depression), and schizophrenia. Moreover, a description of the technique of performing ECT is given. Also examined are the use of ECT in medically ill patients and the risks associated with ECT. In conclusion, with the aid of advances in anesthesia and the delivery of ECT, electroconvulsive therapy is a safe and effective treatment of mood and psychotic …

Lilliputian Hallucinations And Marijuana Dependence In A Bipolar Patient, Matthew L. Bush M.S. Iv, Saurabh Gupta M.D.

Jefferson Journal of Psychiatry

Lilluputian hallucinations are rarely seen in manic patients. Here we present a case of isolated lilluputian hallucinations against a backdrop of psychosis and marijuana use. The phenomenon is interesting and worth following up with. The patient recovered and a brief literature search is included.

Current Methodological Issues In Candidate Gene Association Studies In Psychiatric Disorders, Leo Sher M.D.

Jefferson Journal of Psychiatry

One of the most rapidly emerging areas of neuroscience research is the study of genetic approaches to complex psychiatric disorders. The author discusses potential benefits and pitfalls of candidate gene association studies. Association studies search for correlations in the population between a DNA marker and a disorder. The so-called candidate gene approach is frequently used in association studies. Candidate gene studies are usually based on hypotheses about relationships between specific known loci and particular phenotypes. The aim of molecular genetic studies of behavioral disorders includes the development of predictive and diagnostic testing for psychiatric disorders that can help to establish …

Psychosis In Azheimer's Disease, George M. Strickland M.D., Thomas F. Ditzler Ph.D.

Jefferson Journal of Psychiatry

Much of the basic science literature on Alzheimer's Disease (AD) reflects ongoing research into pathophysiology and neuropathology. Yet, despite reports of the association between psychotic symptoms and Alzheimer's disease, relatively little is known about why such symptoms develop in certain patients and not in others. Neuroimaging and genetic studies may provide greater understanding of this association and allow clinicians and researchers to prevent, predict and treat the onset of psychotic symptoms in the future. This paper will review the current literature on the topic of psychosis in Alzheimer's disease and focus on current recommendations for interventions by clinicians and caregivers.