Medicine and Health Sciences Commons^™

Emergency Department Repair Of Blunt Right Atrial Rupture Utilizing Cardiopulmonary Bypass, Samuel P. Carmichael, Michael C. Bounds, Alexis E. Shafii, Phillip K. Chang

Internal Medicine Faculty Publications

Blunt cardiac injury (BCI) with free wall rupture carries a high risk of pre-hospital death. Cardiopulmonary bypass (CPB) has been utilized as a bridge to repair of cardiac lesions in select patients. We present an interesting case of emergency department repair of right atrial rupture with cardiopulmonary bypass.

Laparoscopic Harvest Of The Rectus Abdominis For Perineal Reconstruction, Nneamaka Agochukwu, Alisha Bonaroti, Sandra Beck, James Liau

Surgery Faculty Publications

The rectus abdominis is a workhorse flap for perineal reconstruction, in particular after abdominoperineal resection (APR). Laparoscopic and robotic techniques for abdominoperineal surgery are becoming more common. The open harvest of the rectus abdominis negates the advantages of these minimally invasive approaches. (Sentence relating to advantages of laparoscopic rectus deleted here.) We present our early experience with laparoscopic harvest of the rectus muscle for perineal reconstruction. Three laparoscopic unilateral rectus abdominis muscle harvests were performed for perineal reconstruction following minimally invasive colorectal and urological procedures. The 2 patients who underwent APR also had planned external perineal skin reconstruction with local …

Report Of The Ishlt Working Group On Primary Lung Graft Dysfunction Part Iii: Mechanisms: A 2016 Consensus Group Statement Of The International Society For Heart And Lung Transplantation, Andrew E. Gelman, Andrew J. Fisher, Howard J. Huang, Maher A. Baz, Ciara M. Shaver, Thomas M. Egan, Micheal S. Mulligan

Surgery Faculty Publications

No abstract provided.

Causes, Timing, And Impact Of Dual Antiplatelet Therapy Interruption For Surgery (From The Paris Registry), Mikkel Schoos, Jaya Chandrasekhar, Usman Baber, Aarti Bhasin, Samantha Sartori, Melissa Aquino, Birgit Vogel, Serdar Farhan, Sabato Sorrentino, Annapoorna Kini, Mitchell Kruckoff, David J. Moliterno, Timothy D. Henry, Giora Weisz, C. Michael Gibson, Ioannis Iakovou, Antonio Colombo, P. Gabriel Steg, Bernhard Witzenbichler, Alaide Chieffo, David Cohen, Thomas Stuckey, Cono Ariti, George Dangas, Stuart Pocock, Roxana Mehran

Internal Medicine Faculty Publications

Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation forcohort, 490 patients (9.8%) experienced 594 DAPT interruptions over 2 years following PCI. Only 1 antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT …

Ovarian Cysts, Vaginal Bleeding And Hypothyroidism In A 4-Year-Old Female With Down Syndrome: A Case Of Van Wyk-Grumbach Syndrome, Suniah S. Ayub, Ana Ruzic, Janice A. Taylor

Surgery Faculty Publications

Van Wyk-Grumbach Syndrome (VWGS) is a constellation of symptoms including precocious puberty without adrenarche, delayed bone age, ovarian cysts, and hypothyroidism. We report here a four-year-old Down Syndrome patient who presented for evaluation of abdominal distension, vaginal bleeding, and bilateral ovarian cysts. Her work-up and management demonstrates the importance of screening for hypothyroidism in Down Syndrome, as well as considering the diagnosis of VWGS when evaluating a patient with precocious puberty and an apparent intra-abdominal surgical process. Given the presence of ovarian masses, a surgical emergency such as ovarian torsion or rupture must be ruled out. Even when the diagnosis …

Open Vesicocalicostomy For The Management Of Transplant Ureteral Stricture, Margaret M. Higgins, Jonathan P. Walker, Michael F. Daily, Shubham Gupta

Urology Faculty Publications

A 59-year-old male developed a proximal stricture of his transplant ureter ten years after a living donor renal transplant. Endoscopic management was unsuccessful, and the patient was temporized with percutaneous nephrostomy tubes for months. Eventually, it became clear he would require surgical revision. Intraoperatively, complete fibrosis of the renal hilum, and intrarenal location of the pelvis precluded the planned pyelovesicostomy. A successful open vesicocalicostomy was performed, anastomosing a bladder flap to a lower pole calix. The patient remains recurrence free after 6 months of follow-up.

The Use Of Intraosseous Needles For Injection Of Contrast Media For Computed Tomographic Angiography Of The Thoracic Aorta, Michael A. Winkler, Cynthia Talley, Connor Woodward, Alexander Kingsbury, Frank Appiah, Hossam Elbelasi, Kevin P. Landwehr, Xingzhe Li, Dominik Fleischmann

Radiology Faculty Publications

Background

The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).

Methods

All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any …

Pharmacology, Pharmacokinetics, And Metabolism Of The Dna-Decoy Ayx1 For The Prevention Of Acute And Chronic Post-Surgical Pain, Julien Mamet, Scott Harris, Michael Klukinov, David C. Yeomans, Renee R. Donahue, Bradley K. Taylor, Kelly Eddinger, Tony Yaksh, Donald C. Manning

Physiology Faculty Publications

Background: AYX1 is an unmodified DNA-decoy designed to reduce acute post-surgical pain and its chronification with a single intrathecal dose at the time of surgery. AYX1 inhibits the transcription factor early growth response protein 1, which is transiently induced at the time of injury and triggers gene regulation in the dorsal root ganglia and spinal cord that leads to long-term sensitization and pain. This work characterizes the AYX1 dose-response profile in rats and the link to AYX1 pharmacokinetics and metabolism in the cerebrospinal fluid, dorsal root ganglia, and spinal cord.

Results: The effects of ascending dose-levels of AYX1 on mechanical …

Effect Of Social Support And Marital Status On Perceived Surgical Effectiveness And 30-Day Hospital Readmission, Owoicho Adogwa, Aladine A. Elsamadicy, Victoria D. Vuong, Ankit I. Mehta, Raul A. Vasquez, Joseph Cheng, Carlos A. Bagley, Isaac O. Karikari

Neurosurgery Faculty Publications

Study Design: Retrospective cohort review.

Objective: To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery.

Methods: The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form-36, and visual …

Anatomic Femoral And Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction: Anteromedial Portal All-Inside And Outside-In Techniques, Jeremy M. Burnham, Chaitu S. Malempati, Aaron Carpiaux, Mary Lloyd Ireland, Darren L. Johnson

Orthopaedic Surgery and Sports Medicine Faculty Publications

Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction failure. Small changes in tunnel placement can result in significant differences in outcome. More anatomic placement of the tunnels can lead to greater knee stability and a more accurate reproduction of native knee kinematics. This Technical Note describes 2 tibial tunnel–independent methods to obtain anatomic femoral tunnel placement. The all-inside anteromedial portal technique requires only minimal surgical incisions but allows precise femoral tunnel placement. However, hyperflexion of the knee is required, adequate surgical assistance is necessary, and this technique may be susceptible to graft-tunnel mismatch. …

Technical Considerations In Revision Anterior Cruciate Ligament Reconstruction For Operative Techniques In Orthopaedics, Jeremy M. Burnham, Elmar Herbst, Thierry Pauyo, Thomas Pfeiffer, Darren L. Johnson, Freddie H. Fu, Volker Musahl

Orthopaedic Surgery and Sports Medicine Faculty Publications

As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed to achieve successful results. The cause of the primary ACL reconstruction failure should be determined and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full-length alignment radiographs, lateral radiographs, 45° flexion weight-bearing posteroanterior radiographs, and patellofemoral radiographs. The 3-dimensional computed tomography scan should be performed to assess tunnel position and widening. Magnetic resonance …

Disparities In Stage-Appropriate Therapy For Resectable Non-Small Cell Lung Cancer In Kentucky, Jeremiah T. Martin

Theses and Dissertations--Clinical Research Design

Lung cancer (NSCLC) is the leading cause of cancer related mortality. Lung cancer screening aims to detect treatable cancers, however survival advantage will only be seen with early and appropriate stage-directed therapy. This study aims to understand recent rates of therapy for early-stage lung cancer in Kentucky, and to explore potential sources of disparities in treatment and outcomes. A Kentucky Cancer Registry query was performed of all NSCLC cases treated in the state from 2005-2014. Of 39,763 lung cancer patients, 10,622 were clinically operable. Of these, overall 40% did not receive surgery, while 16% did not receive any stage-appropriate local …

The Surgical Infection Society Revised Guidelines On The Management Of Intra-Abdominal Infection, John E. Mazuski, Jeffrey M. Tessier, Addison K. May, Robert G. Sawyer, Evan P. Nadler, Matthew R. Rosengart, Phillip K. Chang, Patrick J. O'Neill, Kevin P. Mollen, Jared M. Huston, Jose J. Diaz Jr., Jose M. Prince

Surgery Faculty Publications

Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations.

Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published …

Factors Influencing Preference For Surgical Choice Among Women With Early Stage Breast Cancer, Susan G. Yackzan

Theses and Dissertations--Nursing

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among …

Evaluation Of An Enhanced Recovery After Surgery (Eras) Pathway In Two Hospitals, Jennifer A. Janes

DNP Projects

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in …