Medical Specialties Commons^™

John H. Moore Jr., Md Clinical Professor Of Plastic Surgery And Former Alumni Association President

Jefferson Surgical Solutions

John H. Moore Jr., MD, longtime clinical professor of plastic surgery at Jefferson and former president of the Jefferson Medical College (JMC) Alumni Association, died at home on September 26, 2011.

Born in Pittsburgh in 1953, Moore received his bachelor’s degree from the University of Virginia, where he stayed on for his medical degree. After completing his internship at Thomas Jefferson University Hospital in 1980, he completed a general surgery residency. He then participated in a fellowship in hand surgery and microsurgery at Jefferson and completed a plastic surgery residency at the Eastern Virginia Graduate School of Medicine.

In 1987, …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Zhi Ven Fong, Jmc ’12 Secretary, Gibbon Surgical Society

Jefferson Surgical Solutions

Born and raised in Kuala Lumpur, Malaysia, Zhi Ven Fong spent his first two years of medical school at the International Medical University (IMU) in Malaysia before coming to Philadelphia to study at Jefferson Medical College. And while medical school alone would be enough to keep most students busy, Zhi, 23, has seized every opportunity to build his skills and knowledge as a physician scientist.

“I aspire to be a leader in an academic field like surgery, so I realized I needed experience in research,” Zhi says. “After consulting with senior students, I reached out to Dr. Ernest Rosato, who …

Building A Legacy Of Hope Against Ovarian Cancer

Jefferson Surgical Solutions

Cancer – let alone a rare form of ovarian cancer – wasn’t on Sandy Parvin’s radar when her 11-year-old daughter Sarah was nauseous and vomiting for a few days in the spring of 2005.

“Honestly, we thought she had the flu,” Sandy said. The virus had been going around so Sandy took her daughter to their family physician.

The doctor sent Sarah to the hospital to get some IV fluids. It quickly turned into a parent’s worst nightmare. Sarah was put on a heart monitor and four physicians were there asking questions. Her calcium levels were far too high.

“They …

Gerald A. Isenberg, Md, Facs

Jefferson Surgical Solutions

As Professor of Surgery, Division of Colorectal Surgery; Director, Surgical Undergraduate Education, Jefferson Medical College (JMC); Program Director, Colorectal Residency Program, Thomas Jefferson University Hospital; and Chair, Curriculum Committee, JMC, Gerald A. Isenberg, MD, FACS, is equally focused on – and passionate about – clinical practice and medical education.

Indeed, as he reflects on his career at Jefferson, which spans nearly 25 years, Dr. Isenberg is appreciative of the opportunity to build a busy and vibrant colorectal surgery practice. But he clearly also values his experiences as an educator – particularly the many opportunities to lead and innovate.

In years …

Jefferson Researchers Identify Potential Diagnostic, Prognostic Tools For Pancreatic Cancer

Jefferson Surgical Solutions

When it comes to diagnosing and treating cancer, early detection is important. While other cancers can be identified through routine screenings, pancreatic cancer has been notoriously difficult to diagnose early. After pancreatic cancer is diagnosed, the optimal course of treatment is not always clear.

Hwyda Arafat, MD, PhD, Associate Professor of Surgery at Thomas Jefferson University and co-director of the Jefferson Pancreatic, Biliary and Related Cancers Center, and Jordan M. Winter, MD, Assistant Professor of Surgery, are working to change that.

Together with Mon-Li Chu, PhD, Professor and Vice Chair of the Department of Dermatology and Cutaneous Biology, Dr. Arafat …

Overview

Jefferson Surgical Solutions

Charles J. Yeo, MD, FACS

Samuel D. Gross Professor and

Chair, Department of Surgery

In this issue, Surgical Solutions focuses on our trauma expertise, recent progress in bench research, the contributions of Dr. Gerald Isenberg, insights from medical student Zhi Ven Fong, and pays tribute to Dr. John Moore. A very busy issue!

I was moved by a recent editorial in the New England Journal of Medicine dated February 16, 2012. In the piece entitled “What We Talk About When We Talk About Health Care Costs”, Peter Neumann of Tufts University quotes from the American College of Physicians Ethics Manual, …

Surgeon Speaks

Jefferson Surgical Solutions

Kris Kaulback, MD, FACS

Assistant Professor,

Division of Acute Care Surgery at Jefferson

Medical Director, Trauma Center at Paoli Hospital

Following a major, multisystem trauma, being seen by a trauma center within 60 minutes can mean the difference between life and death. Thanks to Paoli Hospital’s accredited Level II trauma center, which opened on October 1, 2010, more people in Chester County are receiving critical care within the “golden hour.”

As Kris Kaulback, MD, FACS, explains, Paoli earned accreditation by addressing the extensive standards outlined by the Pennsylvania State Trauma Foundation (PSTF). Accreditation reflects the resources available at Paoli around …

A Comparative Analysis Of Toluidine Blue With Frozen Section In Oral Squamous Cell Carcinoma, Montasir Junaid, Moaz M. Choudhary, Zain A. Sobani, Ghulam Murtaza, Sadaf Qadeer, Naeem S. Ali, Mumtaz J. Khan, Anwar Suhail

Department of Surgery Docs

Background:Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins.

Methods:

After obtaining clearance from the in-house ethical …

External Iliac Artery Stenting: High Incidence Of Concomitant Revascularization Procedures, Vance L. Smith, Laura Peterson, Jean E. Starr, Bhagwan Satiani

Department of Surgery Faculty Publications

Objectives: To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS). Methods: Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle–brachial indices, and primary patency were compared between group 1 (EIAS without distal revascularization) and group 2 (EIAS with concomitant distal revascularization).Results: No mortality and a 100% immediate technical success rate was recorded in group 1 (n = 12) and group 2 (n = 24). Eleven patients (30.6%) also had stenting of the adjacent common iliac artery. Two thirds …

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

Thickened Ascending Aortic Wall Mimicking Intramural Hematoma., Kentaro Yamane, Hitoshi Hirose, Benjamin A. Youdelman, James Diehl

Department of Surgery Faculty Papers

A 45-year-old Hispanic woman presented with a 3-day history of ‘‘burning’’ chest pain. A computed tomo- graphic angiogram of the chest revealed the ascending aorta had a maximum diameter of 40 mm with marked thickening of the aortic wall (Figure 1), which we con- cluded was an intramural hematoma. On entering the pericardium, a milky-white plaque-like area on the ascending aorta was encountered (Figure 2). The ascending aorta was firm to palpation. Intraoperative transesophageal echocardiography and epiaortic ultra- sound showed a hyperechoic aortic wall with no find- ings compatible with aortic dissection. The ascending aorta had an irregular surface contour, …

Microaesthetics Of The Smile: Extraction Vs. Non-Extraction, Sanam Tauheed, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare microaesthetics in pre- and post-orthodontic cases, treated with non-extraction and extraction treatment and assessed whether the achieved microaesthetic parameters are comparable to the proposed norms.

STUDY DESIGN: Quasi-experimental study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic, the Aga Khan University Hospital, Karachi, from January 2005 to December 2009.

METHODOLOGY: Orthodontic records of 31 cases treated with non-extraction therapy and 26 cases treated with extraction of upper first premolars were selected. Patients were of Pakistani origin, aged between 12 to 30 years. Microaesthetics was assessed by measuring maxillary central incisor crown width-height ratio, connectors between the maxillary anterior …

Short Term Results Of Ligament Reconstruction And Tendon Interposition Resection Arthroplasty For Basal Joint Arthritis, Kashif Abbas, Pervaiz Hashmi, Hasnain Raza

Section of Orthopaedic Surgery

Carpometacarpal (CMC) joint of the thumb is the second most common site afflicted by osteoarthritis. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Different procedures have been described in literature. Ligament reconstruction with tendon interposition (LRTI) is the most commonly performed procedure in North America for this problem. The Aim of study was to evaluate early results of ligament reconstruction and tendon interposition for CMC joint arthritis. This is a case series of ten patients operated in a tertiary care …

A Progressive Postresection Walking Program Significantly Improves Fatigue And Health-Related Quality Of Life In Pancreas And Periampullary Cancer Patients., Theresa Yeo, Sherry A Burrell, Patricia K Sauter, Eugene P Kennedy, Harish Lavu, Benjamin E Leiby, Charles Yeo

College of Nursing Faculty Papers & Presentations

BACKGROUND: As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients.

STUDY DESIGN: One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 …

Technique Of Anaesthesia For Different Grades Of Caesarean Section: A Cross-Sectional Study, Samina Ismail, Faraz Shafiq, Aliya Malik

Department of Anaesthesia

OBJECTIVE: The percentage use of regional anaesthesia (RA) and failure rate of RA for different grades of caesarean section (CS) has become a marker of quality for obstetric anaesthesia service. The objective of our prospective observational study is to find out the technique of anaesthesia used in different grades of CS, reasons for choosing general anaesthesia (GA) and failure rate of RA in our hospital setting.

METHODS: This prospective cross sectional study was carried in the obstetric unit of Aga Khan University Hospital from 1st January 2010 to 31st May 2011. The anaesthetist performing the procedure filled out the data …

Profiling The Ethnic Characteristics Of Domestic Injuries In Children Younger Than Age 5 Years., Tolulope A. Oyetunji, Adrienne A. Stevenson, Aderonke O. Oyetunji, Sharon K. Onguti, Sarah A. Ames, Adil H. Haider, Benedict C. Nwomeh

Manuscripts, Articles, Book Chapters and Other Papers

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per …

Christian Albert Theodor Billroth, M.D., Founding Father Of Abdominal Surgery (1829-1894)., Zhi Ven Fong, B.S., Harish Lavu, Md, Ernest L. Rosato, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

In the 1800s, the field of surgery was in its infancy, somewhat primitive and embryonic. The technical nature of surgery was the basis for the dividing line between the disciplines of surgery and internal medicine. Sterilization was not a common practice. Radical surgical resections and experimentation in medicine were shunned. With his boldness equaled only by his innovation and resourcefulness, Theodor Billroth would become a pioneer not only in the development of modern surgery, but also in the advancement of its cultural and historical significance.

Theodor Billroth And His Musical Life., Patrick A. Hartendorp, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Although most widely recognized for the two types of gastric reconstructions that bear his name, Christian Albert Theodor Billroth was one of the most innovative surgeons of his time. His contributions included developing techniques for procedures on the larynx, breast, and esophagus. He pioneered sterility and antisepsis in operating rooms. He also improved surgical education by advocating for longer apprenticeships, which helped create a framework for today’s residency programs. However, what often goes unnoticed was Dr. Billroth’s love for music, a passion that fueled him throughout his life.

Angioembolization In Itractable Epistaxis—A Tertiary Care Experience, Maqbool Ahmed Baloch, Mohammad Sohail Awan, Hassan Nabeel Humayun

Department of Surgery Docs

Objective: To review the role of angioembolization in the control of intractable epistaxis at our institution. Methods: A retrospective review of the charts of the patients between Jan 2001 to June 2010 at Aga Khan University Hospital, Karachi was done. All patients who underwent angioembolization for intractable epistaxis were included in the study. Patients with nasal or nasopharyngeal mass were excluded. Data was analyzed by using SPSS version 16. Results: Total numbers of the patients were 16. Fourteen (87.5%) patients were male and 2(12.5%) were female with mean age 51.2 ± 12.922 years (range 26-71 years). In 11(68.75%) patients there …

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:

Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Early Versus Delayed Decompression For Traumatic Cervical Spinal Cord Injury: Results Of The Surgical Timing In Acute Spinal Cord Injury Study (Stascis), Michael G. Fehlings, Alexander Vaccaro, Jefferson R. Wilson, Anoushka Singh, David W. Cadotte, James S. Harrop, Bizhan Aarabi, Christopher Shaffrey, Marcel Dvorak, Charles Fisher, Paul Arnold, Eric M. Massicotte, Stephen Lewis, Raja Rampersaud

Department of Neurosurgery Faculty Papers

Background: There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (,24 hours after injury) versus late ($24 hours after injury) decompressive surgery after traumatic cervical SCI.

Methods: We performed a multicenter, international, prospective cohort study (Surgical Timing in Acute Spinal Cord Injury Study: STASCIS) in adults aged 16–80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was …

A Placebo-Controlled, Double-Blind, Dose-Escalation Study To Assess The Safety, Tolerability And Pharmacokinetics/Pharmacodynamics Of Single And Multiple Intravenous Infusions Of Azd9773 In Patients With Severe Sepsis And Septic Shock, Peter E. Morris, Brian Zeno, Andrew C. Bernard, Xiangning Huang, Shampa Das, Timi Edeki, Steven G. Simonson, Gordon R. Bernard

Surgery Faculty Publications

INTRODUCTION: Tumor necrosis factor-alpha (TNF-α), an early mediator in the systemic inflammatory response to infection, is a potential therapeutic target in sepsis. The primary objective of this study was to determine the safety and tolerability of AZD9773, an ovine, polyclonal, anti-human TNF-α Fab preparation, in patients with severe sepsis. Secondary outcomes related to pharmacokinetic (PK) and pharmacodynamic (PD) parameters.

METHODS: In this double-blind, placebo-controlled, multicenter Phase IIa study, patients were sequentially enrolled into five escalating-dose cohorts (single doses of 50 or 250 units/kg; multiple doses of 250 units/kg loading and 50 units/kg maintenance, 500 units/kg loading and 100 units/kg maintenance, …

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.

John Blair Deaver, M.D., And His Marvelous Retractor., Timothy E. Newhook, Md, Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

John Blair Deaver was born near Buck, Pennsylvania, in Lancaster County on July 25, 1855, to Dr. Joshua Montgomery Deaver and Elizabeth Clair Moore. The elder Deaver was a reputable country physician, educated at the University of Maryland, who fathered three physicians and a college president. John Blair Deaver (Fig. 1) went to boarding school at West Nottingham Academy in Maryland. After boarding school he taught in Lancaster County country schools to raise funds to attend the nation’s first medical school, the University of Pennsylvania. On receiving his M.D. degree in 1878, Dr. Deaver completed 1-year internships at both Germantown …

Asymptomatic Presentation Of Giant Bulla Of The Left Apical And Anterior Segment Of The Left Upper Lobe Of The Lung With Near Complete Atelectasis Of The Remaining Left Lung, Saulat H. Fatimi, Mahrukh Riaz, Hashim Muhammad Hanif, Marium Muzaffar

Section of Cardiothoracic Surgery

Giant bullae may be found in association with emphysema. They present as pockets of entrapped air which grow as the surrounding lung retracts away. As they do not take part in gas exchange and merely occupy space, their presence leads to severe impediment of mechanical ventilation in the adjacent lung parenchyma. Patients may present with dyspnoea, exercise intolerance and a feeling of pressure in the chest. The case of a 54 year old gentleman is presented, who was found to have a giant bulla occupying his left hemithorax on a routine chest X-ray. The patient remained asymptomatic despite the large …

Surgical Outcome In Pet-Positive, Mri-Negative Patients With Temporal Lobe Epilepsy, Carla Lopinto-Khoury, Michael R. Sperling, Christopher Skidmore, Maromi Nei, James Evans, Ashwini Sharan, Scott Mintzer

Department of Neurology Faculty Papers

PURPOSE:

Fluorodeoxyglucose positron emission computed tomography (FDG-PET) hypometabolism is important for surgical planning in patients with temporal lobe epilepsy (TLE), but its significance remains unclear in patients who do not have evidence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI). We examined surgical outcomes in a group of PET-positive, MRI-negative patients and compared them with those of patients with MTS.

METHODS:

We queried the Thomas Jefferson University Surgical Epilepsy Database for patients who underwent anterior temporal lobectomy (ATL) from 1991 to 2009 and who had unilateral temporal PET hypometabolism without an epileptogenic lesion on MRI (PET+/MRI-). We compared …

The Formal And Informal Surgical Ethics Curriculum: Views Of Resident And Staff Surgeons In Toronto., Frazer Howard, Martin F. Mckneally, Ross E.G. Upshur, Alex V. Levin

Wills Eye Hospital Papers

BACKGROUND: Understanding what staff surgeons think surgical trainees should learn and the ethical issues that trainees need to manage can strengthen surgical ethics education.

METHODS: Participants were recruited from the 15 surgical specialty and subspecialty programs at the University of Toronto. Semistructured interviews and focus groups were conducted with 13 ethics coordinators from the surgical staff and 64 resident trainees. Data were analyzed qualitatively using modified thematic analysis.

RESULTS: All coordinators and trainees felt that ethics education was an important component of surgical training. Real cases, varying teaching methods, and teachers with applicable clinical experience were valued. Trainees identified intraprofessional …

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.

Glenohumeral Tuberculous Arthritis Complicated With Beta Haemolytic Streptococcus: An Extraordinary Rare Association: A Case Report, Rizwan Haroon Rashid, Muhammad Usman Sarwar, Jaweed Akhter, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Septic arthritis of the glenohumeral joint is a rare entity and its diagnosis is difficult with a superadded infection in the presence of underlying tuberculosis. We report the first case of group B beta haemolytic streptococcal glenohumeral arthritis with underlying tuberculosis.
Case Presentation: A 40 year old lady previously diagnosed to have poliomyelitis, rheumatoid arthritis, hepatitis C, and diabetes mellitus for the last 10 years, presented to the emergency room with diabetic ketoacidosis. Two weeks prior to presentation she developed fever along with pain and swelling in left shoulder with uncontrolled blood sugars. Local examination of the shoulder revealed …