Medical Specialties Commons^™

Visualizing New Possibilities In Vascular Surgery

Jefferson Surgical Solutions

No abstract provided.

Meet Our Surgical Interns

Jefferson Surgical Solutions

No abstract provided.

Trends In Plastic And Reconstructive Surgery

Jefferson Surgical Solutions

No abstract provided.

Overview From The Chairman

Jefferson Surgical Solutions

No abstract provided.

Col. Darnell Waun's Second Chance At Life

Jefferson Surgical Solutions

No abstract provided.

Download The Pdf Of The Full Issue

Jefferson Surgical Solutions

No abstract provided.

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 …

Using Hyperosmolar Stress To Measure Biologic And Stress-Activated Protein Kinase Responses In Preimplantation Embryos, Yufen Xie, W Zhong, Y Wang, A Trostinskaia, F Wang, Elizabeth E. Puscheck, D. A. Rappolee

Department of Obstetrics and Gynecology Research Publications

We used hyperosmolar stress to test blastocysts for their biologic and enzymatic responses to culture stress. Embryos mount dose- and time-dependent responses to hyperosmolar stress. Biological responses included slowed cavitation and cell accumulation and increased apoptosis at increasing doses. These responses were preceded by stress-activated protein kinase (SAPK) phosphorylation and nuclear translocation consistent with its causal role. For cavitation and new cell cycle initiation, 200 mM sorbitol caused stasis. Above 200 mM, sorbitol was ultimately lethal and below 200 mM, its embryos had milder effects. Phosphorylated SAPK was induced rapidly in embryos at 0.5 h in a dose-dependent manner from …

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. …

Medical Education Digest, Vol. 9 No. 3 (May/June 2007), Nova Southeastern University

Medical Education Digest

No abstract provided.

Return Of Spontaneous Circulation And Survival At Hospital Discharge In Patients With Out-Of-Hospital And Emergency Department Cardiac Arrests In A Tertiary Care Centre., Rifat Rehmani, Syed Muhammad Baqir, Siraj Amanullah

Department of Emergency Medicine

OBJECTIVE:

To examine clinical variables and outcomes in patients with out-of-hospital (unwitnessed) and emergency department (ED; witnessed) cardiac arrests at a tertiary care hospital in Karachi.

METHODS:

A prospective observational study was conducted to note that outcomes in patients with first attempted cardiopulmonary resuscitation in the Emergency Department of the Aga Khan University Hospital, Karachi, between Jan. 2000 and Dec. 2000. Cardiac arrest was defined as absence of a palpable central pulse and apnoea. Return of spontaneous circulation (ROSC) and survival at hospital discharge were primary outcomes. Logistic regression was applied to determine predictors for ROSC.

RESULTS:

Of 106 patients …

Gender Differences In Acute Cardiac Care: Where It’S Not (Poster), Marna R. Greenberg Do, Mph, Facep, Valerie Rupp Rn, Bsn, Anne Marie Crown, Sharon R. Kimmel

Department of Emergency Medicine

No abstract provided.

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

A Review Of The Methodological Features Of Systematic Reviews In Maternal Medicine, Lumaan Sheikh, Shelley Johnston, Shakila Thangaratinam, Mark D. Kilby, Khalid S. Khan

Department of Obstetrics & Gynaecology

Background: In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine.

Methods: Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and …

Reproducibility Of Two Non-Consecutive Scans Using A Newtom 3g; In Vitro Model, Hyoung Jin Park

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The aim of this study was to evaluate the reproducibility of mineral density measurement expressed in Hounsfield Units (HU) using a phantom device with known mineral densities and the NewTom 3G Cone Beam Computerized Tomography (CBCT).

Materials and Methods: A phantom device made of 21 HA cylindrical disks with known densities was fabricated. The phantom was scanned in 6, 9, and 12 inch fields of view using a NewTom 3G CBCT. The scans were repeated at non-consecutive sessions. Volumetric data in each of the scans were formatted to DICOM images. HU values of the regions of interest were retrieved …

Radiation-Induced Increases In Pkc Modulate Integrin Expression And Contribute To Fibrotic Changes, Pinal Rushikesh Pandya

Loma Linda University Electronic Theses, Dissertations & Projects

The sequences of events in fibrosis are similar to those in wound healing; however, the normal termination and resolution stages do not take place. The initial cellular response following ionizing radiation involves accumulation of the ECM (extracellular matrix) including collagen, fibronectin and the interaction of many growth factors (cytokines) with their receptors. There are a number of unanswered questions regarding many aspects of radiation-induced fibrosis, including the initial triggers and physical changes that initiate the process. We have confirmed that elevated pKC and other cellular changes following radiation are similar to those found at sites of inflammation. This information leads …

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 …

Epidermoid Cyst Of The Ovary, Romana Idress, Zubair Ahmad, Khurrum Minhas, Naila Kayani

Department of Pathology and Laboratory Medicine

Epidermoid cysts of the ovary are rare lesions and are uniformly incidental findings in hysterectomy specimens. They must be differentiated from mature cystic teratomas of the ovary, and some authors believe them to be monodermal teratomas. The histogenesis is still uncertain. We report an epidermoid cyst of the ovary which was an incidental finding.

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 …

Labrad : Vol 32, Issue 2 - May 2007, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Transcription Mediated Amplification for the Diagnosis of HCV RNA
• Vanillyl Mandelic Acid
• Diagnosis of Pneumocystic Jiroveci Infection in Microbiology Laboratory
• Lab Diagnosis of Metabolic Bone Diseases
• 24 Hours Urinary Specimen Collection
• Genetic Analysis of Duchenne Muscular Dystrophy
• Hybrid of Cystic Adenomatoid Malformation with Pulmonary Sequestration
• How Can We Achieve Good Response from Trans-Artial Chemo-Embolization (TACE)?
• Anti factor Xa Assay
• Automated Reticulocyte Count
• Triple Screen Test2
• 2nd Biennial Conference for Chemical Pathologists: PSCP Collaborate with AKU

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 …

Regulation Of Alpha-1-Adrenoceptor-Mediated Contractions Of The Uterine Artery By Pkc, Hongying Zhang

Loma Linda University Electronic Theses, Dissertations & Projects

Pregnancy is associated with a significant decrease in uterine vascular tone and a striking increase in uterine blood flow, which ensures normal fetal development. Multiple mechanisms are involved in the adaptation of uterine artery contractility during pregnancy. Both protein kinase C (PKC) and activation of ai-adrenoceptors play important roles in the regulation of uterine artery contractility. In addition, PKC mediates the pregnancyassociated decrease in myogenic tone of the uterine artery, and interacts with ajadrenoceptors leading to modulation of ai-adrenoceptor-mediated contractions of vascular smooth muscle. Yet, whether or to what extent PKC regulates ai-adrenoceptormediated contractions of the uterine artery and their …

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 …

Na/K-Atpase Beta1 Subunit Expression Is Required For Blastocyst Formation And Normal Assembly Of Trophectoderm Tight Junction-Associated Proteins., Pavneesh Madan, Keeley Rose, Andrew J Watson

Obstetrics & Gynaecology Publications

Na/K-ATPase plays an important role in mediating blastocyst formation. Despite the expression of multiple Na/K-ATPase alpha and beta isoforms during mouse preimplantation development, only the alpha1 and beta1 isoforms have been localized to the basolateral membrane regions of the trophectoderm. The aim of the present study was to selectively down-regulate the Na/K-ATPase beta1 subunit employing microinjection of mouse 1 cell zygotes with small interfering RNA (siRNA) oligos. Experiments comprised of non-injected controls and two groups microinjected with either Stealthtrade mark Na/K-ATPase beta1 subunit oligos or nonspecific Stealthtrade mark siRNA as control. Development to the 2-, 4-, 8-, and 16-cell and …