Medical Specialties Commons^™

Outcomes Of Recurrent Laryngeal Nerve Injury Following Congenital Heart Surgery: A Contemporary Experience., Fahad A Alfares, Conor F Hynes, Ghedak Ansari, Reginald Chounoune, Manelle Ramadan, Conner Shaughnessy, Brian K. Reilly, David Zurakowski, Richard A. Jonas, Dilip S. Nath

Surgery Faculty Publications

OBJECTIVE: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition.

DESIGN: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus.

RESULTS: The incidence of post-operative vocal cord paralysis was 1.1% (32 …

Mutational Profiles Reveal An Aberrant Tgf-Β-Cea Regulated Pathway In Colon Adenomas., Jian Chen, Gottumukkala S Raju, Wilma Jogunoori, Shoujun Gu, Lopa Mishra, + 27 More

Surgery Faculty Publications

Mutational processes and signatures that drive early tumorigenesis are centrally important for early cancer prevention. Yet, to date, biomarkers and risk factors for polyps (adenomas) that inordinately and rapidly develop into colon cancer remain poorly defined. Here, we describe surprisingly high mutational profiles through whole-genome sequence (WGS) analysis in 2 of 4 pairs of benign colorectal adenoma tissue samples. Unsupervised hierarchical clustered transcriptomic analysis of a further 7 pairs of adenomas reveals distinct mutational signatures regardless of adenoma size. Transitional single nucleotide substitutions of C:G>T:A predominate in the adenoma mutational spectrum. Strikingly, we observe mutations in the TGF-β pathway …

Vitamin D Deficiency Promotes Liver Tumor Growth In Transforming Growth Factor-Β/Smad3-Deficient Mice Through Wnt And Toll-Like Receptor 7 Pathway Modulation., Jian Chen, Lior H Katz, Nina M Muñoz, Shoujun Gu, Ji-Hyun Shin, Lopa Mishra, +13 Additional Authors

Surgery Faculty Publications

Disruption of the TGF-β pathway is associated with liver fibrosis and suppression of liver tumorigenesis, conditions associated with low Vitamin D (VD) levels. However, potential contributions of VD to liver tumor progression in the context of TGF-β signaling remain unexplored. Our analyses of VD deprivation (VDD) in in vivo models of liver tumor formation revealed striking three-fold increases in tumor burden in Smad3(+/-) mice, with a three-fold increase in TLR7 expression compared to controls. ChIP and transcriptional assays confirm Smad3 binding at two TLR7 promoter SBE sites. Molecular interactions between TGF-β pathway and VDD were validated clinically, where an absence …

Transoral Fundoplication Offers Durable Symptom Control For Chronic Gerd: 3-Year Report From The Tempo Randomized Trial With A Crossover Arm, Karim S. Trad, Mark Fox, Gilbert Simoni, Ahmad Shughoury, Peter Mavrelis, Mamoon Raza, Jeffrey Heise, William Barnes

Surgery Faculty Publications

Background

Four randomized controlled trials have demonstrated the short-term efficacy and safety of transoral esophagogastric fundoplication (TF) performed with the EsophyX® device in eliminating troublesome gastroesophageal reflux disease (GERD) symptoms in well-selected patient populations. The aim of this study was to assess the durability of these outcomes at 3 years post-procedure.

Methods

The TF EsophyX versus Medical PPI Open Label trial was conducted in seven US sites. Between June and August 2012, we enrolled patients with small (<2 cm) or absent hiatal hernias who suffered from troublesome GERD symptoms while on PPI therapy for at least 6 months and had abnormal esophageal acid exposure (EAE). Randomization was to TF group (n = 40) or to PPI group (n = 23). Following evaluation at 6 months, all remaining PPI patients (n …

Adult Gli2+/-;Gli3Δ699/+ Male And Female Mice Display A Spectrum Of Genital Malformation., Fei He, Pedram Akbari, Rong Mo, Jennifer J Zhang, Chi-Chung Hui, Peter C. Kim, Walid A Farhat

Surgery Faculty Publications

Disorders of sexual development (DSD) encompass a broad spectrum of urogenital malformations and are amongst the most common congenital birth defects. Although key genetic factors such as the hedgehog (Hh) family have been identified, a unifying postnatally viable model displaying the spectrum of male and female urogenital malformations has not yet been reported. Since human cases are diagnosed and treated at various stages postnatally, equivalent mouse models enabling analysis at similar stages are of significant interest. Additionally, all non-Hh based genetic models investigating DSD display normal females, leaving female urogenital development largely unknown. Here, we generated compound mutant mice, Gli2+/-;Gli3Δ699/+, …

Two Cases Of Monoclonal Nodular Pulmonary Amyloidosis And Review Of The Literature, Kendal Endicott, Conor Hynes, Cindy M. Hsieh, Edina Paal, Gregory D. Trachiotis

Surgery Faculty Publications

Nodular pulmonary amyloidosis (NPA) is an uncommon pathology of insoluble protein depositing in pulmonary parenchyma. This localized pulmonary form of amyloidosis is most often found to contain combinations of kappa and lambda immunoglobulin light chain and immunoglobulin heavy chain proteins with a polyclonal lymphoplasmacystic infiltrate. Herein we present two cases of NPA of the rarely reported monoclonal (light-chain restricted) form with review of the literature and discussion of the clinical, radiographic, and histologic features of NPA.

Surgeon's Guide To Anticoagulant And Antiplatelet Medications Part Two: Antiplatelet Agents And Perioperative Management Of Long-Term Anticoagulation., Louise Y Y Yeung, Babak Sarani, Jordan A Weinberg, Paul B Mcbeth, Addison K May

Surgery Faculty Publications

An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two part review, agents commonly encountered by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part one, we review warfarin and the new direct oral anticoagulants. In part two, we review …

Current And Desired Practice Patterns Of Trauma And Acute Care Surgeons (T/Acs), Nathan M. Droz, Melissa L. Whitmill, Priti Parikh, Kimberly M. Hendershot

Department of Surgery Faculty Publications

Resident hour restrictions and the addition of emergency general surgery (EGS) have changed how the T/ACS team functions and their work patterns. The purpose of our study is to report current practice patterns of T/ACS and compare those to desired practice patterns of the future workforce in the field (residents/fellows).

Radioresistance Of Brain Tumors, K. Kelley, J. Knisely, M. Symons, R. Ruggieri

Journal Articles

Radiation therapy (RT) is frequently used as part of the standard of care treatment of the majority of brain tumors. The efficacy of RT is limited by radioresistance and by normal tissue radiation tolerance. This is highlighted in pediatric brain tumors where the use of radiation is limited by the excessive toxicity to the developing brain. For these reasons, radiosensitization of tumor cells would be beneficial. In this review, we focus on radioresistance mechanisms intrinsic to tumor cells. We also evaluate existing approaches to induce radiosensitization and explore future avenues of investigation.

Recipient Criteria Predictive Of Graft Failure In Kidney Transplantation, E. P. Molmenti, A. Alex, L. Rosen, M. Alexander, J. Nicastro, E. Siskind, L. Alex, E. Sameyah, M. Bhaskaran, N. Ali, A. Basu, M. Sachdeva, S. Agorastos, P. Rajendran, P. Krishnan, P. Ramadas, L. Amodu, J. Cagliani, S. Rehman, A. Kressel, C. B. Sethna, R. Schwarz, S. Fishbane, A. Bellucci, G. Coppa, H. Rilo, C. L. Molmenti, +4 Additional Authors

Journal Articles

Several classifications systems have been developed to predict outcomes of kidney transplantation based on donor variables. This study aims to identify kidney transplant recipient variables that would predict graft outcome irrespective of donor characteristics. All U.S. kidney transplant recipients between October 25,1999 and January 1, 2007 were reviewed. Cox proportional hazards regression was used to model time until graft failure. Death-censored and nondeath-censored graft survival models were generated for recipients of live and deceased donor organs. Recipient age, gender, body mass index (BMI), presence of cardiac risk factors, peripheral vascular disease, pulmonary disease, diabetes, cerebrovascular disease, history of malignancy, hepatitis …

Milk Fat Globule-Epidermal Growth Factor-Factor Viii Downregulates Interleukin-17 Expression In Sepsis By Modulating Stat3 Activation, C. Cen, M. Aziz, W.L. Yang, J. Nicastro, G. F. Coppa, P. Wang

Journal Articles

BACKGROUND: Milk fat globule-epidermal growth factor-factor VIII (MFG-E8) is a secretory glycoprotein with a known role in inflammation. In sepsis, interleukin (IL)-17 acts as a proinflammatory cytokine to exaggerate systemic inflammation. We hypothesize that MFG-E8 downregulates IL-17 expression in sepsis. METHODS: Sepsis was induced in 8-week-old male C57BL/6 mice by cecal ligation and puncture (CLP). Recombinant mouse MFG-E8 (rmMFG-E8) at a dosage of 20 mug/kg body weight or phosphate-buffered saline was concurrently injected. After 10 hours, blood and spleen samples were harvested for analysis. For in vitro studies, splenocytes isolated from healthy mice pretreated with rmMFG-E8 and splenocytes from MFG-E8 …

Inhibition Of Lipogenesis Reduces Inflammation And Organ Injury In Sepsis, J. P. Idrovo, W.L. Yang, A. Jacob, L. Corbo, Jeffrey Nicastro, Gene Coppa, P. Wang

Journal Articles

BACKGROUND: Sepsis is a life-threatening acute inflammatory condition associated with metabolic complications. Accumulation of free fatty acids (FFAs) induces inflammation and causes lipotoxic effects in the liver. Because fatty acid metabolism plays a role in the inflammatory response, we hypothesized that the administration of C75, a fatty acid synthase inhibitor, could alleviate the injury caused by sepsis. METHODS: Male mice were subjected to sepsis by cecal ligation and puncture (CLP). At 4 h after CLP, different doses of C75 (1- or 5-mg/kg body weight) or vehicle (20% dimethyl sulfoxide in saline) were injected intraperitoneally. Blood and liver tissues were collected …

Inhibition Of Fatty Acid Synthase With C75 Decreases Organ Injury After Hemorrhagic Shock, M. Kuncewitch, W.L. Yang, A. Jacob, A. Khader, M. Giangola, J. Nicastro, G.F. Coppa, P. Wang

Journal Articles

BACKGROUND: Hemorrhagic shock is the primary cause of morbidity and mortality in the intensive care units in patients under the age of 35. Several organs, including the lungs, are seriously affected by hemorrhagic shock and inadequate resuscitation. Excess free fatty acids have shown to trigger inflammation in various disease conditions. C75 is a small compound that inhibits fatty acid synthase, a key enzyme in the control of fatty acid metabolism that also stimulates fatty acid oxidation. We hypothesized that C75 treatment would be protective against hemorrhagic shock. METHODS: Adult male Sprague-Dawley rats were cannulated with a femoral artery catheter and …

Type Vi Choledochal Cyst—An Unusual Presentation Of Jaundice, L. Nambiar, E. Siskind, A. W. Shen, C. Fan, G. Grimaldi, C. Choy, J. Madariaga, J. Nicastro, E. P. Molmenti, G. Coppa, +1 Additional Author

Journal Articles

No abstract provided.

Combined Endoscopic And Laparoscopic Management Of Postcholecystectomy Mirizzi Syndrome From A Remnant Cystic Duct Stone: Case Report And Review Of The Literature, Arpit Amin, Yuriy Zhurov, George Ibrahim, Anthony Maffei, Jonathan Giannone, Thomas Cerabona, Ashutosh Kaul

NYMC Faculty Publications

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant …

Outcomes In Patients With Vestibular Schwannoma After Subtotal Resection And Adjuvant Radiosurgery, H. Radwan, M. Bruce Eisenberg, J. P. S. Knisely, M. M. Ghaly, M. Schulder

Journal Articles

No abstract provided.

Pericardiocentesis Followed By Thoracotomy And Repair Of Penetrating Cardiac Injury Caused By Nail Gun Injury To The Heart, Vasu Chirumamilla, Kartik Prabhakaran, Patrizio Petrone, John A. Savino, Corrado Marini, Zobair Zoha

NYMC Faculty Publications

INTRODUCTION: Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate.

PRESENTATION OF CASE: A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. The patient was hypotensive, tachycardic with prominent jugular venous distention, and had a profound lactic acidosis. Bedside ultrasound confirmed the presence of pericardial fluid. Pericardiocentesis was performed twice using a central venous catheter inserted into the pericardial space, resulting in improvement in the patient's hemodynamics. Thereafter he underwent left anterolateral thoracotomy …

Differential Protein Expression In Small Intestinal Neuroendocrine Tumors And Liver Metastases, M. K. Kim, F. Ye, D. Wang, M. Cui, S. C. Ward, R. R. Warner, S. Roayaie, M. Schwartz, D. Zhang, S. Itzkowitz, +1 Additional Author

Journal Articles

OBJECTIVE: Small intestinal neuroendocrine tumors (SI-NETs) are often detected after they have become metastatic. Using a novel protein array, we identified pathways important in SI-NET metastasis development in surgically resected patients. METHODS: Paired primary tumors and liver metastases from 25 patients undergoing surgical resection for metastatic SI-NETs were harvested. Extracted proteins were separated by sodium dodecyl sulfate gel and multiplex immunoblots were performed with 136 antibodies. Significant Analysis of Microarray was used to select for differentially expressed proteins. A tissue microarray was constructed from 27 archived specimens and stained by immunohistochemistry. RESULTS: Comparing primary SI-NETs with matched normal small-bowel mucosa, …

Key Perspectives On Auditory Outcomes Following Radiosurgery For Vestibular Schwannoma, Tumor Treating Fields For Glioblastoma, And A Proposed Myelopathy Score For Cervical Decompression Surgery, Intracranial Pressure Monitoring In Diffuse Traumatic Brain Injury., Jonathan H. Sherman, Gordon Li, Jin Mo Cho, Winward Choy, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

The Anatomy Of Nursing Interruptions: Who-What-When-Where, Pratik J. Parikh, Nicole Craker, Robert A. Myers, Jessy M. Eid, Priti Parikh, Kathy Zink, Mary C. Mccarthy

Department of Surgery Faculty Publications

Although interruptions experienced by nurses during intensive care have been indicated to affect patient safety, not much is known regarding the complex situations that drive interruptions to eventually aid in intervention design and implementation.

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

Minimally Invasive Surgery In Pediatric Trauma: One Institution's 20-Year Experience, Gustavo Stringel, Min Li Xu, Joseph Lopez

NYMC Faculty Publications

BACKGROUND: Minimally invasive surgery (MIS) for trauma in pediatric cases remains controversial. Recent studies have shown the validity of using minimally invasive techniques to decrease the rate of negative and nontherapeutic laparotomy and thoracotomy. The purpose of this study was to evaluate the diagnostic accuracy and therapeutic options of MIS in pediatric trauma at a level I pediatric trauma center.

METHODS: We reviewed cases of patients aged 15 years and younger who had undergone laparoscopy or thoracoscopy for trauma in our institution over the past 20 years. Each case was evaluated for mechanism of injury, computed tomographic (CT) scan findings, …

On The Dead End Of Current Research On Burnout's Prevalence, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Dimou et al. (2016) concluded that >50% of surgeons experience burnout. For three reasons, we think that such conclusions are unwarranted. First, there are no consensual or binding diagnostic criteria for burnout. Second, recent research (e.g., Bianchi, Schonfeld, & Laurent, 2015) suggests that burnout is actually a depressive syndrome. Finally, we note that researchers’ recommendations about stress-reducing organizational changes often remain incantatory because they insufficiently consider the economic issues and macrosocial power relationships that can hamper the recommendations’ implementation. Current practices in burnout research have led to an accumulation of results, the clinical meaning of which is obscure.

Application Of Medical Student Research Objectives In An International Medical Elective: Voluntary Medical Male Circumcision In Swaziland, Alison M. Bales, David J. Dennis, Robert C. Siska, Michael A. Schneider, Echo Vanderwal, Harry Vanderwal, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Neurosurgery Concepts: Key Perspectives On Intrathecal Fluorescein For Detecting Intraoperative Cerebrospinal Fluid Leak During Endoscopic Endonasal Surgery, Spinal Intraarterial Chemotherapy, Oligoastrocytoma Classification By In Situ Molecular Genetics, And Prenatal Myelomeningocele Closure And The Need For Cerebrospinal Fluid Shunt Placement., Anand V Germanwala, Winward Choy, Jonathan H. Sherman, Sandi Lam, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Preoperative Incidence Of Penile Abnormalities Found During Voluntary Male Medical Circumcision In Swaziland, Anthony R. Oddo, Elizabeth Ruedrich, Christopher Zust, Lindsey Marugg, Echo Vanderwal, Rebekah Sartori, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Pyoderma Gangrenosum Following Bilateral Deep Inferior Epigastric Perforator Flaps, Eric Clayman, Kristen Marcet, Lauren Kuykendall, Dunya M. Atisha

Surgery Faculty Publications

Pyoderma gangrenosum (PG) is an atypical ulcerative cutaneous condition, with an estimated six cases per million people per year in the United States.[1] One-half of patients have idiopathic disease, and it is most commonly associated with underlying systemic inflammatory conditions or hematologic malignancies.[1] [2] There have been several reported cases of PG following breast reduction procedures; however, postsurgical PG (PSPG) is rarely seen following autologous tissue breast reconstruction.[3]

In this article, the authors report the clinical course, treatment, and outcome of a patient diagnosed with PSPG following a delayed breast reconstruction with …