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Meet Our Surgical Interns

Jefferson Surgical Solutions

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Trends In Plastic And Reconstructive Surgery

Jefferson Surgical Solutions

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Overview From The Chairman

Jefferson Surgical Solutions

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Col. Darnell Waun's Second Chance At Life

Jefferson Surgical Solutions

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Jefferson Surgical Solutions

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Sentinel Node Staging For Breast Cancer: Intraoperative Molecular Pathology Overcomes Conventional Histologic Sampling Errors, Peter Blumencranz, Pat W. Whitworth, Kenneth Deck, Anne Rosenberg, Douglas Reintgen, Peter Beitsch, Anees Chagpar, Thomas Julian, Sukamal Saha, Eleftherios Mamounas, Armando Giuliano, Rache Simmons

Department of Surgery Faculty Papers

BACKGROUND:
When sentinel node dissection reveals breast cancer metastasis, completion axillary lymph node dissection is ideally performed during the same operation. Intraoperative histologic techniques have low and variable sensitivity. A new intraoperative molecular assay (GeneSearch BLN Assay; Veridex, LLC, Warren, NJ) was evaluated to determine its efficiency in identifying significant sentinel lymph node metastases (>.2 mm).

METHODS:
Positive or negative BLN Assay results generated from fresh 2-mm node slabs were compared with results from conventional histologic evaluation of adjacent fixed tissue slabs.

RESULTS:
In a prospective study of 416 patients at 11 clinical sites, the assay …

Jss Editorial Board & Credits

Jefferson Surgical Solutions

Jefferson Surgical Solutions is published by Thomas Jefferson University and Thomas Jefferson University Hospital. Jefferson Department of Surgery Curtis Building, Suite 620 1015 Walnut Street Philadelphia, PA 19107 www.JeffersonHospital.org/surgery Barry Gutman, Editor/Writer JeffGraphics, Design Editorial Board: Volume 1, Issue 1 Hwyda Arafat, MD, PhD Adam Berger, MD Cataldo Doria, MD Adam Frank, MD Gerald Isenberg, MD Robert Larson, MD John Moore, MD Scott Silvestry, MD Robert Solit, MD Thomas Tulenko, PhD Charles Yeo, MD Jennifer Brumbaugh Diane Calder Patricia McMorrow Flo Williams Information in Jefferson Surgical Solutions is not intended to provide advice on personal medical matters or to substitute …

Honoring Dr. Herbert Cohn

Jefferson Surgical Solutions

On March 28, Mae Gelb of Scranton, Pennsylvania, celebrated her 100th birthday with close friends and family, including her nephew, Herbert E. Cohn, MD, Anthony Narducci Professor and Vice Chair of Surgery, Jefferson. Mrs. Gelb's life has been nearly as healthy as it is long. Aside from giving birth, her only experience as an inpatient was when, in October 1993, at Thomas Jefferson University Hospital, she underwent a major operation performed by then-Samuel D. Gross Professor and Chair of Surgery Francis E. Rosato, MD, with moral support from Dr. Cohn. "So many physicians I know have been taught by Herb." …

News In Brief

Jefferson Surgical Solutions

Jefferson's Department of Surgery has been accepted to participate in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). The lead surgeon for this initiative is Herbert E. Cohn, MD. Developed by the United States Department of Veteran Affairs, NSQIP is one of the first outcomes-based, risk-adjusted, peer-controlled programs designed to measure and enhance the quality of surgical care. The program collects data on 133 variables, including preoperative risk factors, intraoperative variables and 30-day mortality and morbidity outcomes data – the latter entered by Kathleen Hartman, RN, BSN, the department's new Surgical Clinical Nurse Reviewer. It will enable …

On The Job

Jefferson Surgical Solutions

Patricia Kal Sauter, RN, MSN, ACNP, NCTMB, Gastrointestinal Surgery, Department of Surgery Since graduating from the University of Maryland School of Nursing, Pat Sauter had worked at the Johns Hopkins Hospital in Baltimore –the last 15 years with Charles J. Yeo, MD, whom she accompanied when he was appointed in 2005 as the Samuel D. Gross Professor and Chair of Surgery at Jefferson Medical College of Thomas Jefferson University and at Thomas Jefferson University Hospital. She works four days a week and spends the others on her farm near York, Pennsylvania, with children Kate, age 14, and Jack, 11. Describe …

Meet Our Surgical Interns

Jefferson Surgical Solutions

The staff of the Department of Surgery at Jefferson is currently assisted by an exceptional group of interns. Pictured left to right, they are: Hamid Abdollahi, MD, Jefferson Medical College (JMC), Class of 2005; Lisa Harris, MD, State University of New York (SUNY) Downstate Medical Center, Brooklyn, Class of 2005; Matthew Rosen, MD, JMC, Class of 2005; Jennifer Sullivan, MD, University of Maryland, College Park, Class of 2005; Nikolai Bildzukewicz, MD, JMC, Class of 2001 (followed by military service as a flight surgeon in the United States Navy); and Daniel Lefebvre, MD, SUNY Upstate Medical University, Syracuse, Class of 2005. …

Sailing The Straits Of Approval: The Nature Of Fda Approval And Its Implications For Surgeons, David Reiter Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Products approved by the US Food and Drug Administration (FDA) for one use are often put to other uses. This practice, known colloquially as "off-label usage," is neither illegal nor unethical. Physicians can and should pursue scientifically sound use supported by medical evidence. The FDA requires only that we:

--Be well informed about the product
--Base its use on firm scientific rationale and sound medical evidence, if available
--Maintain records of the product’s use and effects
--Carry out good medical practice
--Use good judgment
--Consider the best interests of the patient before all else

The Modifier Of Min 2 (Mom2) Locus: Embryonic Lethality Of A Mutation In The Atp5a1 Gene Suggests A Novel Mechanism Of Polyp Suppression., Amy A Baran, Karen A Silverman, Joseph Zeskand, Revati Koratkar, Ashley Palmer, Kristen Mccullen, Walter J Curran, Tina Bocker Edmonston, Linda D Siracusa, Arthur M Buchberg

Kimmel Cancer Center Faculty Papers

Inactivation of the APC gene is considered the initiating event in human colorectal cancer. Modifier genes that influence the penetrance of mutations in tumor-suppressor genes hold great potential for preventing the development of cancer. The mechanism by which modifier genes alter adenoma incidence can be readily studied in mice that inherit mutations in the Apc gene. We identified a new modifier locus of ApcMin-induced intestinal tumorigenesis called Modifier of Min 2 (Mom2). The polyp-resistant Mom2R phenotype resulted from a spontaneous mutation and linkage analysis localized Mom2 to distal chromosome 18. To obtain recombinant chromosomes for use in refining the Mom2 …

Dermatology 75 Years Ago., Lawrence Parish, Joseph A Witkowski

Department of Dermatology and Cutaneous Biology Faculty Papers

It seems that the practicing dermatologist in 2007 is being attacked on all fronts. The Food and Drug Administration has mandated a cumbersome program for monitoring isotrentinoin usage, its analogue barely comes under scrutiny. iPledge is just a plain nightmare. The acumen of the board certified dermatologist is being challenged by Maintenance of Certification proposals because other specialties are doing it; yet, the neighborhood pharmacist is unhampered in dispensing all sorts of advice about treatment. The insurance clerk thrives on denying medication, prescribed by the physician, using flawed reasoning or else suggesting that a ten days’ supply of medicine should …

A Review Of The Association Between Congestive Heart Failure And Cognitive Impairment., Michael B. Cohen, Paul J. Mather

Division of Cardiology Faculty Papers

Heart failure is a growing epidemic with an estimated 5 million Americans suffering from this condition. Several clinical trials have demonstrated a high correlation between congestive heart failure (CHF) and cognitive impairment. The severity of cognitive impairment correlates positively with the degree of CHF. The underlying mechanism for cognitive impairment remains unclear but appears to be related to cerebral hypoperfusion and impaired cerebral reactivity with selective impairment of verbal memory and attention domains. Furthermore, cognitive dysfunction represents one aspect of frailty, a novel concept that encompasses a range of clinical conditions that results in functional impairment in patients with heart …

Initiation Of A Critical Pathway For Pancreaticoduodenectomy At An Academic Institution -- The First Step In Multi-Disciplinary Team Building, Eugene P. Kennedy, Ernest L. Rosato, Patricia K. Sauter, Laura M. Rosenberg, Cataldo Doria, Ignazio R. Marino, Karen A. Chojnacki, Adam C. Berger, Charles Yeo

Department of Surgery Faculty Papers

Objective: This study was designed to identify quantifiable parameters to track performance improvements brought about by the implementation of a critical pathway for complex alimentary tract surgery.

Background: Pancreaticoduodenectomy (PD) is a complex general surgical procedure performed in varying numbers at many academic institutions. Originally associated with significant perioperative morbidity and mortality, multiple studies have now shown that this operation can be performed quite safely at high volume institutions that develop a particular expertise. Critical pathways are one of the key tools used to achieve consistently excellent outcomes as these institutions. It remains to be determined if implementation …

Nasal Airflow And Odorant Transport Modeling In Patients With Chronic Rhinosimusitis, Kai Zhao, Beverly J. Cowart, N. E. Rawson, Peter W. Scherer, K. T. Clock, A. A. Vainius, Pamela Dalton, Edward Pribitkin, David Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Poster presentation at Association for Chemoreception Sciences (ACHEMS) in Sarasota Florida April 25-29, 2007.

Introduction:

Our on-going clinical project aims to quantify the conductive mechanism contributing toolfactory loss in chronic rhinosinusitis (CRS) patients, in addition to other inflammatory causes(see Yee, et al, 200 and Feng, et al, 203). CRS, a common disease affecting 32 millionAmericans annually, is reportedly associated with at least 15% of all olfactory losses. Airwayconstriction as a result of inflammation or the presence of polyps may limit odor access to thereceptor sites and lead to olfactory dysfunction. As yet, the functional impact of various nasalobstructions as sequelae …

Building A Better Bypass Graft

Jefferson Surgical Solutions

Jefferson vascular surgeon obtains three research grants. Vascular surgeon Paul DiMuzio, MD, FACS,Assistant Professor of Surgery and Radiology,Jefferson Medical College (JMC) of ThomasJefferson University, has been awarded grantsfrom the National Institutes of Health (NIH),American Vascular Association and AmericanHeart Association totaling $975,000. Thesefunds will further his team's research to usetissue engineering and stem cell technologyto develop a novel bypass graft for patientswho lack autogenous tissues for vascularprocedures such as coronary and peripheralartery bypass and hemodialysis access. "Today, the gold standard for creatingthese grafts is using the patient's saphenousvein or another artery," Dr. DiMuzio says."When those are unavailable because theyare diseased, too …

Pathophysiology, Diagnosis, And Treatment Of Spinal Meningoceles And Arachnoid Cysts, Ryan M. Dahlgren, Eli M. Baron, Alexander R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

Though the nomenclature regarding spinal arachnoid cysts and meningoceles is confusing and sometimes overlapping, spinal arachnoid cysts and meningoceles are distinct entities with different presentations and etiologies. Meningoceles are usually congenital lesions discovered at infancy with a high incidence of associated anomalies. Spinal arachnoid cysts are most often asymptomatic but can cause nerve root and/or cord compression. We review the presentation, pathophysiology, and management of these lesions.

Management Of Morel-Lavallee Lesion Of The Knee: Twenty-Seven Cases In The National Football League, Samir G. Tejwani, Steven B. Cohen, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion.

PURPOSE: To review the authors' experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a …

Predoctoral Directors: Who Are They And What Do They Do In These Trying Times?, John Gazewood, Katherine Margo, Christine Jerpbak, Sandra Burge, Thea Ballinger, Richard Usatine

Department of Family & Community Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Family medicine faces declining student interest and funding. Predoctoral directors will help lead efforts to overcome these challenges. Academic success will be important for predoctoral directors to be effective leaders in academic health centers. We therefore sought to describe predoctoral directors and factors associated with their academic success.

METHODS: We carried out a cross-sectional survey of all family medicine predoctoral directors at US allopathic medical schools using a Web-based questionnaire. The response rate was 82%. We measured academic success using a variable combining rank and tenure status. We used bivariate analysis and multiple linear regression …

Association Of The Tensin N-Terminal Protein-Tyrosine Phosphatase Domain With The Alpha Isoform Of Protein Phosphatase-1 In Focal Adhesions, Masumi Eto, Jason Kirkbride, Elizabeth Elliott, Su Hao Lo, David L. Brautigan

Department of Molecular Physiology and Biophysics Faculty Papers

Focal adhesions attach cultured cells to the extracellular matrix, and we found endogenous protein phosphatase-1alpha isoform (PP1alpha) localized in adhesions across the entire area of adherent fibroblasts. However, in fibroblasts migrating into a scrape wound or spreading after replating PP1alpha did not appear in adhesions near the leading edge but was recruited into other adhesions coincident in time and space with incorporation of tensin. Endogenous tensin and PP1alpha co-precipitated from cell lysates with isoform-specific PP1 antibodies. Chemical cross-linking of focal adhesion preparations with Lomant's reagent demonstrated molecular proximity of endogenous PP1alpha and tensin, whereas neither focal adhesion kinase nor vinculin …

Rotator Cuff Contusions Of The Shoulder In Professional Football Players: Epidemiology And Magnetic Resonance Imaging Findings, Steven B. Cohen, Jeffrey D. Towers, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players.

PURPOSE: To determine a single professional football team's incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: From 1999 to 2005, a North American professional football team's injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a …

Three-Portal Technique For Anterior Cruciate Ligament Reconstruction: Use Of A Central Medial Portal, Steven B. Cohen, Freddie H. Fu

Department of Orthopaedic Surgery Faculty Papers

Standard endoscopic reconstruction of the anterior cruciate ligament (ACL) is performed with the use of 2 arthroscopic portals. The surgical error most commonly associated with ACL reconstruction is improper positioning of the tunnel. Errors in femoral tunnel position may be related to poor visualization of the lateral wall. When anatomic double-bundle ACL reconstruction is performed, proper visualization of the lateral wall is essential to ensure correct placement of both tunnels. We propose the use of a central portal, in addition to more standard anterolateral and anteromedial portals, to enhance visualization of the lateral wall. In addition, the arthroscope can be …

Hepatitis C Risk Assessment, Testing And Referral For Treatment In Urban Primary Care: Role Of Race And Ethnicity., Stacey B. Trooskin, Victor J. Navarro, Robert J. Winn, David J. Axelrod, A. Scott Mcneal, Maricruz Velez, Steven K. Herrine, Simona Rossi

Division of Gastroenterology and Hepatology Faculty Papers

AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.

METHODS: Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected.

RESULTS: Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested …

Development Of A Reliable And Construct Valid Measure Of Nutritional Literacy In Adults, James J. Diamond

Department of Family & Community Medicine Faculty Papers

NOTE: The Nutritional Literacy Scale can be found here: http://jdc.jefferson.edu/nls/1/

Background: Research into the relation of literacy to health status has not included measures of nutritional literacy. This may be a critical area in the study of chronic conditions such as hypertension and diabetes, which can both relate to obesity and nutrition. This paper details the development and psychometric characteristics of the Nutritional Literacy Scale (NLS), offered as a measure of adults' ability to comprehend nutritional information.

Methods: In order to assess the internal consistency and construct validity of the NLS, demographic data, readability statistics, NLS scores and …

Genome-Wide Analysis Of Neuroblastomas Using High-Density Single Nucleotide Polymorphism Arrays., Rani E George, Edward F Attiyeh, Shuli Li, Lisa A Moreau, Donna Neuberg, Cheng Li, Edward A Fox, Matthew Meyerson, Lisa Diller, Paolo Fortina, A Thomas Look, John M Maris

Cardeza Foundation for Hematologic Research

BACKGROUND: Neuroblastomas are characterized by chromosomal alterations with biological and clinical significance. We analyzed paired blood and primary tumor samples from 22 children with high-risk neuroblastoma for loss of heterozygosity (LOH) and DNA copy number change using the Affymetrix 10K single nucleotide polymorphism (SNP) array.

FINDINGS: Multiple areas of LOH and copy number gain were seen. The most commonly observed area of LOH was on chromosome arm 11q (15/22 samples; 68%). Chromosome 11q LOH was highly associated with occurrence of chromosome 3p LOH: 9 of the 15 samples with 11q LOH had concomitant 3p LOH (P = 0.016). Chromosome 1p …

Cephalalgiaphobia: A Possible Specific Phobia Of Illness., Mario F P Peres, Juliane P P Mercante, Vera Z Guendler, Felipe Corchs, Marcio A Bernik, Eliova Zukerman, Stephen Silberstein

Department of Jefferson Headache Center Papers and Presentations

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild …

Jefferson Scale Of Patient's Perceptions Of Physician Empathy: Preliminary Psychometric Data., Gregory C. Kane, Joanne L. Gotto, Salvatore Mangione, Susan West, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

AIM: To develop a brief scale for measuring patient's perceptions of their physician's empathic engagement and to provide preliminary evidence in support of aspects of the scale's psychometrics.

METHOD: Study comprised 225 patients, out of 436 patients (52% response rate) seen by 166 residents in the internal medicine residency program at the Jefferson Hospital Ambulatory Clinic as part of their ambulatory training at Thomas Jefferson University Hospital. A 5-item questionnaire entitled the Jefferson Scale of Patient's Perceptions of Physician Empathy was developed and administered to the study participants. Its factor structure, item-total score correlations, and correlations with several relevant criterion …

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.