Medical Specialties Commons^™

Large Right Lower Quadrant Abdominal Mass, Isheeta Madeka, Cannon Greco-Hiranaka, Ozlem Kulak, Wilbur Bowne

Jefferson Hospital Staff Papers and Presentations

No abstract provided.

Impact Of Climate Change On Surgery: A Scoping Review To Define Existing Knowledge And Identify Gaps, Tina Bharani, Rebecca Achey, Harris Jamal, Alexis Cherry, Malcolm K. Robinson, Guy J. Maddern, Deirdre K. Tobias, Divyansh Agarwal

Department of Surgery Faculty Papers

With climate change accelerated at a worrisome rate, global warming also will have implications for surgery and surgical practice. The goal of this current study was to systematically survey the literature and better understand how climate change has affected surgical disease burden, surgical care delivery, and surgical outcomes. We performed a comprehensive scoping review, screening 3334 unique citations from three databases – 1766 from Embase, 1329 from Pubmed and 239 from Scopus – to identify studies that had associated climate change with surgery. After systematic searching, quality appraisal, and data extraction, we synthesized findings from qualitative and quantitative studies. Twenty-six …

Cavernous Malformations Of The Central Nervous System: An International Consensus Statement, Anastasia Tasiou, Alexandros G. Brotis, Adamantios Kalogeras, Christos Tzerefos, Cargill H. Alleyne, Alexandros Andreou, Andreas K. Demetriades, Nikolaos Foroglou, Robert M. Friedlander, Bengt Karlsson, Neil Kitchen, Torstein R. Meling, Aristotelis Mitsos, Vasilios Panagiotopoulos, Themistoklis Papasilekas, Giacomo Pavesi, Lukas Rasulic, Alejandro N. Santos, Robert F. Spetxler, Ulrich Sure, Stavropoula Tjoumakaris, Christos M. Tolias, Peter Vajkoczy, Kostas N. Fountas

Department of Neurosurgery Faculty Papers

Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial.

Research question: A consensus may navigate neurosurgeons through the decision-making process of selecting the optimal treatment for asymptomatic and symptomatic CMs.

Material and methods: A 17-item questionnaire was developed to address controversial issues in relation to aspects of the treatment, surgical planning, optimal surgical strategy for specific age groups, the role of stereotactic radiosurgery, as well as a follow-up pattern. …

Postoperative Discharge Destination Impacts 30-Day Outcomes: A National Surgical Quality Improvement Program Multi-Specialty Surgical Cohort Analysis, Carlos Riveros, Sanjana Ranganathan, Yash Shah, Emily Huang, Jiaqiong Xu, Michael Geng, Zachary Melchiode, Siqi Hu, Brian Miles, Nestor Esnaola, Dharam Kaushik, Angela Jerath, Christopher Wallis, Raj Satkunasivam

Student Papers, Posters & Projects

Surgical patients can be discharged to a variety of facilities which vary widely in intensity of care. Postoperative readmissions have been found to be more strongly associated with post-discharge events than pre-discharge complications, indicating the importance of discharge destination. We sought to evaluate the association between discharge destination and 30-day outcomes. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were dichotomized based on discharge destination: home versus non-home. The main outcome of interest was 30-day unplanned readmission. The secondary outcomes included post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, …

Republication Of “Open Repair Of Acute Achilles Tendon Ruptures: Is The Incidence Of Clinically Significant Wound Complications Overestimated?”, Meghan E. Bishop, Carly D. Comer, Justin M. Kane, Mitchell G. Maltenfort, Steven M. Raikin

Department of Orthopaedic Surgery Faculty Papers

Background:

Methods:

Analyses Of Orthopaedic Surgery Residency Interviews, Alexander J Adams, Matthew Sherman, James J. Purtill

Rothman Institute Faculty Papers

Interviews are a critical component of orthopaedic surgery residency selection for both the applicant and the program. Some institutions no longer report Alpha Omega Alpha (AOA) designation or class rank, and US Medical Licensing Examination (USMLE) Step 1 recently switched to pass/fail scoring. During the coronavirus disease 2019 (COVID-19) pandemic, all Accreditation Council for Graduate Medical Education programs conducted virtual interviews and subinternship rotations were restricted. These changes offer significant challenges to the residency match process. The purpose of this study was to examine the residency applicant interview and ranking process at a large urban academic university setting. We hypothesized …

Surgery In Advanced Ovary Cancer: Primary Versus Interval Cytoreduction, Mackenzie Cummings, Olivia Nicolais, Mark S. Shahin

Department of Obstetrics and Gynecology Faculty Papers

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical …

Gibbon Surgical Society Email Newsletter - Get To Know Gibbon, Gibbon Surgical Society

Gibbon Surgical Society Newsletter

No abstract provided.

Multi-Institutional Study Validates Safety Of Intraoperative Cesium-131 Brachytherapy For Treatment Of Recurrent Head And Neck Cancer, Adam J. Luginbuhl, Alyssa Calder, David Kutler, Chad Zender, Trisha Wise-Draper, Jena Patel, Michael Cheng, Vidhya Karivedu, Tingting Zhan, Bhupesh Parashar, Shuchi Gulati, Min Yao, Pierre Lavertu, Vinita Takiar, Alice Tang, Jennifer Johnson, William M. Keane, Joseph Curry, David Cognetti, Voichita Bar-Ad

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Introduction: Surgery is the primary treatment for resectable, non-metastatic recurrent head and neck squamous cell carcinoma (HNSCC). We explore the safety and oncologic benefit of intraoperative Cesium-131 (Cs-131) brachytherapy combined with salvage local and/or regional surgical resection.

Methods and materials: Findings were reported from a single arm multi-institutional prospective phase 1/2 trial involving surgery plus Cs-131 (surgery + Cs-131) treatment. The results of two retrospective cohorts-surgery alone and surgery plus intensity modulated radiation therapy (surgery + ReIMRT)-were also described. Included patients had recurrent HNSCC and radiation history. Safety, tumor re-occurrence, and survival were evaluated.

Results: Forty-nine patients were enrolled in …

Surgical Treatment Of Femoroacetabular Impingement: Minimum 10-Year Outcome And Risk Factors For Failure, Hamed Vahedi, Steven Yacovelli, Claudio Diaz, Javad Parvizi

Rothman Institute Faculty Papers

Background: Femoroacetabular impingement (FAI) is a well-known cause of hip pain and dysfunction in young adults. Surgical treatment has been widely popularized during the past decade. However, most reported results have been limited to short-term and intermediate-term follow-up. The long-term success rate and risk factors for failure are largely unknown. This study aimed to report the long-term (minimum, 10 years) clinical outcomes of surgical treatment of FAI and to describe the clinical and radiographic parameters associated with the failure of treatment involving femoroacetabular osteoplasty (FAO) and labral repair.

Methods: Using our prospective hip preservation database, 164 patients (178 hips) who …

High-Dose-Rate Brachytherapy For The Treatment Of Basal And Squamous Cell Carcinomas On Sensitive Areas Of The Face: A Report Of Clinical Outcomes And Acute And Subacute Toxicities, James M. Taylor, Bahar Dasgeb, Spencer Liem, Ayesha Ali, Amy Harrison, Mitchell Finkelstein, Jisun Cha, Rani Anne, Steven Greenbaum, William Sherwin, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face.

Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos …

Postoperative Opioid-Prescribing Practices In Nasal Surgery: A Prospective Study, Brian M. Yan, S. Hamad Sagheer, Cory D. Bovenzi, Uche Nwagu, David Cognetti, Howard Krein, Ryan Heffelfinger

Phase 1

Introduction: Within facial plastic and reconstructive surgery (FPRS), prescription practices have trended toward prescribing larger amounts of perioperative opioids. However, there is limited literature regarding the postoperative pain experience and opioid consumption for FPRS. The purpose of our study was to investigate opioid prescription and consumption following procedures of the nose, with the aim of developing evidence-based guidelines for postoperative pain management.

Methods: In this prospective single center study, morphine milligram equivalents (MME) consumption and pain scores were collected in 72 patients who underwent nasal surgery. Patient demographics, MME use, and pain scores were examined. MME use was compared …

Residency Recruitment: Changes And Challenges, Karen A. Chojnacki, Md, Facs

Department of Surgery Presentations and Grand Rounds

No abstract provided.

A Multi-Institutional Analysis Of Sternoclavicular Joint Coverage Following Osteomyelitis, Sammy Othman, Omar Elfanagely, Saïd C Azoury, Geoffrey M Kozak, Jessica Cunning, Arturo J Rios-Diaz, Prashanth Palvannan, Patrick J. Greaney, Matthew Jenkins, Doraid Jarrar, Stephen J Kovach, John P Fischer

Department of Surgery Faculty Papers

BACKGROUND: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.

METHODS: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.

RESULTS: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were …

When Limb Surgery Has Become The Only Life-Saving Therapy In Fop: A Case Report And Systematic Review Of The Literature, Esmée Botman, Sanne Treurniet, Wouter D Lubbers, Lothar A Schwarte, Patrick R Schober, Louise Sabelis, Edgar J G Peters, Annelies Van Schie, Ralph De Vries, Zvi Grunwald, Bernard J Smilde, Jakko A Nieuwenhuijzen, Marieke Visser, Dimitra Micha, Nathalie Bravenboer, J Coen Netelenbos, Bernd P Teunissen, Pim De Graaf, Pieter G H M Raijmakers, Jan Maerten Smit, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical …

Male Luts – Introduction And Overview, Thenappan Chandrasekar, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline & Goals

• Background – What are “LUTS”?

• Anatomy

• Pathophysiology

• Storage – bladder filling symptoms
• Voiding – urine flow symptoms
• Post-micturition

• Major etiologies and management

• BPH / BOO
• OAB
• Nocturia

• Related to Prostate Cancer?

Surgery Myths And Facts, Heli Patel

Gibbon Surgical Review

Throughout social media, television shows, movies, and “public perception”, surgical residents and attendings are often stereotyped into a personality that is most often incorrect. Unless you are a surgeon, it is often hard to understand what exactly the life entails. Add in some Hollywood drama and social media, and what you get is a wildly disproportionate picture of what surgeons’ personalities are like. As a medical student, it is often difficult to separate fact from fiction, so here are some of the most common myths debunked.

Bedside To Bench: Basic Science Research During General Surgery Residency, Signe Caksa

Gibbon Surgical Review

Clinical, basic science, and quality improvement research is becoming increasingly integrated into general surgery residency programs, providing aspiring surgeons with an avenue to engage with academia and improve patient care early on in their careers. For example, as an essential part of their training, general surgery residents at Thomas Jefferson University Hospital (TJUH) complete one to two years of research, usually between their PGY3 and PGY4 years. The goal of this protected research time is for residents to gain hands-on surgical research skills and work on translational research projects that correlate with clinical cases, while also becoming more competitive for …

Interview With Dr. Dawn Salvatore, Preeyal Patel

Gibbon Surgical Review

A medical student’s path to surgery is notoriously long and arduous. Traditionally, students who are interested in the field begin to prepare their qualifications from day one, especially given the competitive nature of acceptance into surgical programs. For students who develop an interest in surgery during their later years of medical school, it can be a daunting task to pursue a track in which they already feel behind. Often times, these students are discouraged from applying to surgical residencies, worrying that their non-traditional path may hinder their success. However, Dr. Dawn Salvatore can reassure students that a non-traditional path to …

Interview With Dr. Geoffrey Krampitz, Colin Yost

Gibbon Surgical Review

Geoffrey Krampitz, MD, PhD is a hepatopancreaticobiliary surgeon with an extensive background in surgical oncology, stem cell science, and cancer immunotherapy research who recently joined the faculty here at Thomas Jefferson University as an Assistant Professor of Surgery. After earning his BSE in biomedical engineering at Johns Hopkins University and before starting medical training, Dr. Krampitz worked in consulting in the San Francisco Bay Area and eventually helped launch two internet startup companies in Silicon Valley. He then went to UC San Francisco for his Master’s degree, where he investigated the role of HIF1-alpha in stem cell differentiation. Dr. Krampitz …

Primum Non Nocere: Surgeons And The Politics Of Firearm Trauma, Kaushal Desai

Gibbon Surgical Review

The crisis of firearm violence in America continues to worsen and the call to action cannot be ignored. If we are to make a real impact, we must be just as skilled policy makers as proceduralists. We must wield the pen as well as we wield the scalpel. All the clinical knowledge and surgical skills in the world will make no difference if we do not reduce the number of firearm injuries. The skillset we need is policy analysis and lobbying, which can only be developed through political activism and engagement, not more practice questions and Online MedEd.

Longevity In Surgery: A Conversation With Two Temple Surgeons About How They Continually Find Joy In Their Careers, Kelsey Muir

Gibbon Surgical Review

Both Dr. Daly and Dr. Pontari describe the stress and pressure that comes with a long career in patient care, however intertwined with the stress is their overwhelming gratitude and joy for surgery. Maintaining that perspective for medicine and patient care has required two things: community and an outlet. Dr. Daly and Dr. Pontari expressed the need to be able to share their anxieties and struggles with someone to process the stress, the difficulties, and the demands of a surgical career.

John H. Gibbon, Jr., Md

Gibbon Surgical Review

Dr. John Heysham Gibbon, Jr. graduated from Jefferson Medical College in 1927, and in a brief series of events, he was named Fellow at Massachusetts General Hospital. In 1930, he found himself assisting Dr. Edward Churchill in an emergency pulmonary embolectomy. At that time the procedure was one of desperation, as no patient in the U.S. had survived the removal of blood clots in open-heart surgery. As Dr. Gibbon recorded the patient’s waning vital signs prior to the procedure he thought, “If only we could remove the blood from her body by bypassing her lungs, and oxygenate it, then return …

Gibbon Surgical Society

Gibbon Surgical Review

The John H. Gibbon, Jr. Surgical Society (GSS) at Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University is a unique student interest group that has been working hard to increase interest in the field of surgery among medical students for the last 37 years. The society has over 400 total active members on a year to year basis, spread across the four-year curriculum. The GSS increases exposure and interest to the surgical field through a unique blend of episodic and longitudinal programming that helps bring together students, residents, and faculty in an educational setting.

The Utility Of Surgical Simulation In Student Education, Jared Raikin

Gibbon Surgical Review

The use of simulation in the field of surgery has become a heavily researched topic over the last few decades, but it is by no means a new concept. The first recorded use of surgical simulation dates back 2,500 years with evidence of nasal models for flap reconstruction made of leaf and clay.1 But simulation as we know it today did not take shape until the 1980s with the invention of the Comprehensive Anesthesia Simulation Environment (CASE) mannequins. The use of nonorganic simulation tools revolutionized the field and continues to play a large role in medical education. These modalities have …

General Surgery 101: Nissen Fundoplication, Kelley Yuan, Tyler Bauer

Gibbon Surgical Review

The first time that medical students enter the OR can be a jarring experience. Successfully maintaining sterility is hard enough, but remembering relevant patient history, answering “pimp” questions, and performing basic suturing skills can make the third year medical student experience difficult. In this article we describe a common surgery performed by both general and thoracic surgeons with a specific focus on “medical student level” understanding. This piece is the product of a collaboration between an MS1 and MS4, both of whom are interested in a career in surgery. We hope you find it helpful!

Gibbon Surgical Review, Volume 3, Issue 1, 2020

Gibbon Surgical Review

Table of Contents

4 - Interview with Dr. Geoffrey Krampitz

8 - Primum Non Nocere: Surgeons and the Politics of Firearm Trauma

10 - General Surgery 101: Nissen Fundoplication

14 - Interview with Dr. Dawn Salvatore

16 - The Utility of Surgical Simulation in Student Education

18 - Bedside to Bench: Basic Science Research During General Surgery Residency

20 - Longevity in Surgery: A Conversation with Two Temple Surgeons About How They Continually Find Joy in Their Careers

22 - Surgery Myths and Facts

24 - Gibbon Surgical Society

25 - John H. Gibbon Jr., MD

26 - Editorial Board …

3d Printed Liver Models As A Tool To Improve Pre-Surgical Consultation And Enhance Patient Consent, Miranda Sill, Nathan Ott, Robert S. Pugliese, Pharmd, Bcps

Phase 1

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery.

Methods: Creation of the model began with the segmentation of the patient's abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Opioid Tolerance Influences Outcomes After Lumbar Fusion In Patients With Degenerative Pathology, Noah Levy, Max Detweiler, Dhruv K.C. Goyal, Ariana Reyes, Alexander R. Vaccaro

Phase 1

Introduction: Extended opioid use prior to surgery has been implicated in poorer postoperative outcomes. However, it remains unclear if there is a significant difference in postoperative outcomes among preoperative opioid-naïve and opioid-tolerant patients who undergo lumbar spinal fusion. The purpose of this study was to determine the effect of preoperative opioid use on patient-reported outcome measures in patients undergoing lumbar spinal fusion.

Methods: This retrospective cohort analysis identified 260 patients who underwent lumbar spinal fusion at a high-volume, single institution. There were two cohorts: patients who were opioid-naïve (defined as total opioid consumption of ≤ 7 days in …