Medicine and Health Sciences Commons^™

Combined Fluorescence And Reflectance Spectroscopy For In Vivo Quantification Of Cancer Biomarkers In Low- And High-Grade Glioma Surgery, Pablo A. ValdéS, Anthony Kim, Keith D. Paulsen, Frederic Leblond, Olga M. Conde, Brent T. Harris, David W. Roberts

Dartmouth Scholarship

Biomarkers are indicators of biological processes and hold promise for the diagnosis and treatment of disease. Gliomas represent a heterogeneous group of brain tumors with marked intra- and inter-tumor variability. The extent of surgical resection is a significant factor influencing post-surgical recurrence and prognosis. Here, we used fluorescence and reflectance spectral signatures for in vivo quantification of multiple biomarkers during glioma surgery, with fluorescence contrast provided by exogenously-induced protoporphyrin IX (PpIX) following administration of 5-aminolevulinic acid. We performed light-transport modeling to quantify multiple biomarkers indicative of tumor biological processes, including the local concentration of PpIX and associated photoproducts, total hemoglobin …

Principles Of Combat Surgical Care In A Staged Evacuation System, Vivian C. Mcalister, Rob Stiegelmar, Brian Church, Ray Kao

Vivian C. McAlister

Background: The NATO hospital classification of hospitals describes an orderly transfer of patients with severe injuries through a series of increasingly sophisticated hospitals as they are brought from the point of injury to their home hospital. Forward hospital surgery is restricted to damage control and resuscitation while definitive surgery is performed at home by the destination surgical team. In reality many patients enter the hospital chain higher up and some receive definitive surgery as they proceed through the chain of evacuation. The purpose of this paper is to determine if clear doctrine exists to guide the performance of surgery on …

Mesothelioma - Epidemiology And Management, Patricia Tai, Edward Yu, Avi Assouline, Kurian Joseph

Edward Yu

Mesothelioma is an uncommon tumor. It has a latency period of 20-40 years. The most important risk factor is asbestos exposure. Prognosis of mesothelioma is generally poor with high case-fatality rate, and research to improve the outcome of this disease is on-going worldwide. Due to its rarity, management by a multidisciplinary team with experience is recommended. Carefully selected patients may benefit from tri-modality (surgery, radiotherapy and chemotherapy) treatment. The management of pleural and peritoneal mesothelioma is summarized in this review. Recent advances in chemotherapy and biologic response modifiers are promising.

Lung Cancer Epidemiology – A Global View, Patricia Tai, Edward Yu, Rashmi Koul, Arbind Dubey

Edward Yu

Smoking, air pollution and radon exposure are causally related to lung cancer. This review analyzes trends of smoking habits by age, sex and ethnicity and their correlation with incidence and mortality of lung cancer. Unfortunately the use of tobacco by adolescents is on the rise. Most developed countries are still showing the rising trend of mortality in female smokers. In Asia, cigarette smoking has become a major health risk with one in three of all cigarettes in the world today are smoked in China. Estimated one hundred million young ( < 29 years old) Chinese smokers will eventually die from lung …

The Role Of Surgery In Building Resilience To Blast Attacks, Vivian C. Mcalister

Vivian C. McAlister

Blast attacks are the commonest form of terrorist attack on civilians. Blast often causes injury from industrial accidents. Blast injury is the most common cause of injury and death in modern combat. A recent review of Canadian fatal casualties in Afghanistan found 81% to have been caused by blast, almost four times the number killed by gun shot wounds. Improvised explosive devices (IED) caused 78% of the blasts with another 20% being due to rocket propelled grenades (RPG).1 The purpose of this review is to outline the mechanisms of injury, to define the surgical response and to understand the implications …

Exploring Obstacles To Proper Timing Of Prophylactic Antibiotics For Surgical Site Infections, J. Tan, V. Naik, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections. METHODS: 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the …

Evaluation Of The Use Of Patient-Focused Simulation For Student Assessment In A Surgery Clerkship., Gerald A Isenberg, Katherine W Berg, Judith A Veloski, Dale D Berg, J J. Veloski, Charles Yeo

Department of Surgery Faculty Papers

BACKGROUND: The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills.

METHODS: Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models.

RESULTS: A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for …

Thomas Dent Mütter: The Humble Narrative Of A Surgeon, Teacher, And Curious Collector., Jennifer A. Baker, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Thomas Dent Mutter, a beloved teacher, respected colleague, devoted husband, surgical pioneer, and legendary collector, emerged from a tragic childhood as an ambitious young physician who would leave a permanent imprint on medical education (Fig. 1). Dr. Mutter is best known in the Philadelphia area for the museum of medical curiosities, which bears his name. Overflowing with various medical memorabilia, anatomical and pathological specimens, casts, models, watercolors, and historical instruments, the Mutter Museum often overshadows the numerous other contributions Dr. Mutter made during his shortened life.1 A quote from Henry Brooks Adams is quite apropos, ‘‘A teacher affects eternity; he …

Leveraging Complex Event Processing For Smart Hospitals Using Rfid, Wen Yao, Chao-Hsien Chu, Zang Li

Research Collection School Of Computing and Information Systems

RFID technology has been examined in healthcare to support a variety of applications such as patient identification and monitoring, asset tracking, and patient–drug compliance. However, managing the large volume of RFID data and understanding them in the medical context present new challenges. One effective solution for dealing with these challenges is complex event processing (CEP), which can extract meaningful events for context-aware applications. In this paper, we propose a CEP framework to model surgical events and critical situations in an RFID-enabled hospital. We have implemented a prototype system with the proposed approach for surgical management and conducted performance evaluations to …

Tyrie, Betsy (Fa 22), Manuscripts & Folklife Archives

Folklife Archives Finding Aids

Finding aid only for Folklife Archives Project 22. "The Life of Dr. C. C. Howard," an oral history project conducted by Betsy Tyrie about Dr. Carl Clifford Howard, the outstanding Glasgow, Kentucky, physician who was instrumental in the fight against tuberculosis and in founding hospitals in Glasgow. Project contains interviews with Dr. Howard's family, friends, and colleagues as well as archived autobiographical information about Howard.

Role Of Multidetector Computed Tomography (Mdct) In Patients With Ovarian Masses., Fatima Mubarak, Muhammad Shahbaz Alam, Waseem Akhtar, Saima Hafeez, Noureen Nizamuddin

Department of Radiology

Objective:To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT) in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard. Material And

Methods:

This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred Patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these Patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. …

Safety And Tolerability Of An Ovine-Derived Polyclonal Anti-Tnfα Fab Fragment (Azd9773) In Patients With Severe Sepsis, Peter E. Morris, Brian Zeno, Andrew C. Bernard, Xiangning Huang, Steven G. Simonson, Gordon R. Bernard

Surgery Presentations

Sepsis remains a significant medical problem. TNFα is a central cytokine in sepsis pathophysiology. We conducted a phase IIa trial in patients with severe sepsis to assess the safety and tolerability of an intravenously infused ovine-derived polyclonal anti-TNFα Fab fragment (AZD9773).

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …

Thoracolumbar Tuberculosis: Implications For Appropriate Management Based On Disease Location And Proposal Of A Novel Scoring System, Shahryar Noordin, Salim Allana, Tashfeen Ahmad, Zafar Sajjad, Khabir Ahmad, Ather Enam, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention.
Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids.
Results: Ninety-three patients aged 7-77 years (mean age 40 years) were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C) was present in 68% of patients with thoracic disease, as …

Robotic Cardiac Surgery By 2031, W Randolph Chitwood

The Texas Heart Institute Journal

No abstract provided.

Comparison Of The Open Primary Repair With Augmentation And Without Augmentation In Acute Achilles Tendon Rupture, Durmuş Ali̇ Öçgüder, Meti̇n Doğan, Süleyman Bülent Bektaşer, Erkan Akgün, Tolga Tolunay, Mahmut Uğurlu

Turkish Journal of Medical Sciences

To compare the clinical and the functional efficiency of 2 surgical methods that are used in open primary repair of acute Achilles tendon ruptures: one that utilizes the augmentation of the plantaris tendon and one that does not. Materials and methods: Data were evaluated from 41 patients that underwent surgical repair for acute Achilles tendon ruptures with these 2 different surgery methods. In the first group, which included 21 patients (19 male, 2 female; mean age: 36.8 years; age range: 22 to 49), we performed augmentation with the plantaris tendon after an end-to-end primary repair with a modified Kessler technique. …

Systematic Review Of Home Physiotherapy After Hip Fracture Surgery, Saurabh Mehta, Jean-Sébastien Roy

Physical Therapy Faculty Research

OBJECTIVE: To compare the benefits of home physiotherapy, institution-based physiotherapy and no physiotherapy following hip fracture surgery.

DESIGN: Systematic review and meta-analysis of randomized controlled trials.

METHODS: Two reviewers independently extracted data from 5 included studies. Standardized mean differences were pooled for health-related quality of life and performance-based outcomes. Review Manager Version 5 was used for data analysis.

RESULTS: Analysis of the 5 included studies indicated that home physiotherapy was better than no physiotherapy and similar to outpatient physiotherapy in improving patient-reported health-related quality of life. Performance-based outcomes were marginally better following outpatient physiotherapy compared with home physiotherapy 3 and …

A Comparison Of The Effects Of Intrathecal Ropivacaine And Bupivacaine During Cesarean Section*, Nuray Camgöz Eryilmaz, Berri̇n Günaydin

Turkish Journal of Medical Sciences

To compare the effects of intrathecal plain bupivacaine or ropivacaine with those of opioids on sensory and motor block characteristics during cesarean section (C/S). Materials and methods: Fifty-two ASA I or II women were randomly allocated into 2 groups to administer either 10 mg of 0.5% plain bupivacaine (Group B), or 15 mg of 0.75% plain ropivacaine (Group R) with 25 \mug fentanyl and 100 µg morphine for spinal anesthesia. Characteristics of the sensory and motor block were recorded. Results: The time to achieve sensory block at T_6 was significantly faster in Group B than in Group R (2.7 ± …

Gender Differences In Lung Cancer Treatment And Survival, Margaret Anne Kowski

USF Tampa Graduate Theses and Dissertations

The objectives of this research were to test treatment and survival differences between women and men with lung cancer as there is minimal investigation in the literature. Three research questions were developed with statistical testing for gender differences based on similar cancer type, stage, treatment assignment and survival. Data for 44,863 primary lung cancer cases were collected from eight U.S. state-based cancer registries to investigate the research questions. The lung cancer incidence data included the morphological cell-types of adenocarcinoma (AC); squamous cell carcinoma (SCC); large cell carcinoma (LCC) and small cell carcinoma (SCC). Stage, grade, treatment type, as well as, …

Ventral Hernia Repairs: 10 Year Single Institution Review At Thomas Jefferson University Hospital, Frederick C. Sailes, Md, Jason Walls, Md, Daria Guelig, Md, Mike Mirzabeigi, Ma, William D. Long, Ms, Albert Crawford, Phd, John H. Moore Jr, Md, Facs, Steven E. Copit, Md, Gary A. Tuma, M.D, James Fox, Md

Department of Surgery Faculty Papers

Abstract

Background Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Ramirez 1 et al describes the “component separation” technique to mobilize the rectus-abdominus internal oblique and external oblique flap to correct the defect. The recurrence rate of incisional hernias increases to 20% after gastric bypass or extensive weight loss.2 The incidence of ventral hernias after failed recurrent hernia repair increases to 40%.3 It has been reported that utilizing the sliding myofascial flap repair technique, the recurrence rate was reduced to 8.5%.4

Materials and Methods This …

Composite Tissue Allotransplantation To Treat Veterans With Complex Amputation Injuries, Vivian C. Mcalister, Ray Kao, Brian Church, Markus Besemann, Rob Stiegelmar

Vivian C. McAlister

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% …