Surgery Commons^™

Point-Of-Care Ultrasound Used To Exclude Penile Fracture, Adam Ash, Joel Miller, David Preston

Surgery Faculty Publications

This is a case report of a superficial penile hematoma that was difficult to distinguish clinically from a penile fracture. Such cases occur with relative frequency, and because definitive treatment is an urgent surgery, timely diagnosis is essential to avoid complications. Typical imaging modalities such as cavernosonography and magnetic resonance imaging can be invasive (cavernosonography) or time consuming (magnetic resonance imaging) and may not be readily available. Ultrasound has been used successfully in such cases, and, in this case, we used point-of-care ultrasound combined with a brief period of observation to exclude penile fracture.

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, …

Region 11 Meld Na Exception Prospective Study, Robert A. Fisher, Douglas M. Heuman, Ann M. Harper, Martha K. Behnke, Alastair D. Smith, Mark W. Russo, Steven Zacks, John W. Mcgillicuddy, James Eason, Michael K. Porayko, Patrick Northup, Michael R. Marvin, Johnathan Hundley, Satheesh Nair

Surgery Faculty Publications

Introduction. Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation.

Material and methods. From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception.

Results. Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to …

Primary Closure Without Diversion In Management Of Operative Blunt Duodenal Trauma In Children, Katherine Smiley, Tiffany Wright, Sean Skinner, Joseph A. Iocono, John M. Draus

Surgery Faculty Publications

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages < 14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. …

Autoimmune Enteropathy With A Cd8+ Cd7- T-Cell Small Bowel Intraepithelial Lymphocytosis: Case Report And Literature Review, Shrinivas Bishu, Violeta Arsenescu, Eun Y. Lee, H. David Vargas, Willem J. S. De Villiers, Razvan Arsenescu

Surgery Faculty Publications

Background

Adult onset autoimmune enteropathy (AIE) is a rare condition characterized by diarrhea refractory to dietary therapy diagnosed in patients with evidence of autoimmune conditions. Auto-antibodies to gut epithelial cells and other tissues are commonly demonstrated. Despite increasing awareness, the pathogenesis, histologic, immunologic and clinical features of AIE remain uncertain. There remains controversy regarding the diagnostic criteria, the frequency and types of auto-antibodies and associated autoimmune conditions, and the extent and types of histologic and immunologic abnormalities. CD4+ T-cells are thought to at least responsible for this condition; whether other cell types, including B- and other T-cell subsets are involved, …

Nfatc1 Regulation Of Trail Expression In Human Intestinal Cells, Qingding Wang, Yuning Zhou, Heidi L. Weiss, Chi-Wing Chow, B. Mark Evers

Surgery Faculty Publications

TNF-related apoptosis-inducing ligand (TRAIL; Apo2) has been shown to promote intestinal cell differentiation. Nuclear factor of activated T cells (NFAT) participates in the regulation of a variety of cellular processes, including differentiation. Here, we examined the role of NFAT in the regulation of TRAIL in human intestinal cells. Treatment with a combination of phorbol 12-myristate 13-acetate (PMA) plus the calcium ionophore A23187 (Io) increased NFAT activation and TRAIL expression; pretreatment with the calcineurin inhibitor cyclosporine A (CsA), an antagonist of NFAT signaling, diminished NFAT activation and TRAIL induction. In addition, knockdown of NFATc1, NFATc2, NFATc3, and NFATc4 blocked PMA/Io increased …

Safety And Tolerability Of An Ovine-Derived Polyclonal Anti-Tnfα Fab Fragment (Azd9773) In Patients With Severe Sepsis, Peter E. Morris, Brian Zeno, Andrew C. Bernard, Xiangning Huang, Steven G. Simonson, Gordon R. Bernard

Surgery Presentations

Sepsis remains a significant medical problem. TNFα is a central cytokine in sepsis pathophysiology. We conducted a phase IIa trial in patients with severe sepsis to assess the safety and tolerability of an intravenously infused ovine-derived polyclonal anti-TNFα Fab fragment (AZD9773).

Microsurgical Reconstruction Of Large, Locally Advanced Cutaneous Malignancy Of The Head And Neck, Joseph L. Hill, Brian Rinker

Surgery Faculty Publications

Large, locally advanced cutaneous malignancy of the head and neck region is rare. However, when present, they impart a significant reconstructive challenge. These cancers have a tendency to invade peripheral tissues covering a large surface area as well as expose deeper structures such as skull, dura, orbit, and sinus after resection. Complicating the reconstructive dilemma is the high incidence of individuals who have undergone previous surgery in the region as well as adjuvant radiation therapy, which may preclude the use of local flaps or skin graft. Free tissue transfer provides a reconstructive surgeon the ability to provide well-vascularized tissue with …

Modulation Of Outer Hair Cell Electromotility By Cochlear Supporting Cells And Gap Junctions, Ning Yu, Hong-Bo Zhao

Surgery Faculty Publications

Outer hair cell (OHC) or prestin-based electromotility is an active cochlear amplifier in the mammalian inner ear that can increase hearing sensitivity and frequency selectivity. In situ, Deiters supporting cells are well-coupled by gap junctions and constrain OHCs standing on the basilar membrane. Here, we report that both electrical and mechanical stimulations in Deiters cells (DCs) can modulate OHC electromotility. There was no direct electrical conductance between the DCs and the OHCs. However, depolarization in DCs reduced OHC electromotility associated nonlinear capacitance (NLC) and distortion products. Increase in the turgor pressure of DCs also shifted OHC NLC to the negative …

Surgical Treatment Of A Rare Primary Renal Carcinoid Tumor With Liver Metastasis, Roberto Gedaly, Hoonbae Jeon, Thomas D. Johnston, Patrick P. Mchugh, Randall G. Rowland, Dinesh Ranjan

Surgery Faculty Publications

BACKGROUND: Carcinoid tumors are characteristically low grade malignant neoplasms with neuroendocrine differentiation that arise in various body sites, most commonly the lung and gastrointestinal tract, but less frequently the kidneys, breasts, ovaries, testes, prostate and other locations. We report a case of a carcinoid of renal origin with synchronous single liver metastases on radiological studies.

CASE PRESENTATION: A 45 year-old patient who presented with abdominal pain was found on CT scan to have lesions in the right ovary, right kidney, and left hepatic lobe. CA-125, CEA, and CA 19-9 were within normal limits, as were preoperative liver function tests and …

Laser Skin Graft Harvesting Apparatus And Related Method, David S. Kirn

Surgery Faculty Patents

A laser dermatome is disclosed for harvesting and meshing grafts of skin. A roller driven by a motor lifts the leading edge of a portion of skin for cutting by a beam of light generated by a laser. Adhesive tape attached to the roller aids in lifting the portion of skin and is further utilized to secure the severed portion of skin to the roller. A stage mounted atop an axle supports the laser or a beam director. The movement of the stage is controlled by second and third motors which drive the stage along or rotate it about the …

Portocaval-Right Atrial Shunt, Bradley B. Hill

Surgery Faculty Patents

A shunt includes a tubular body having first and second legs at a proximal end and a third leg at a distal end. A fluid distensible balloon and cooperating insufflation conduit are carried on the tubular body. The first leg of the tubular body includes a longitudinal slit for receiving the second leg whereby the first and second legs may be positioned substantially coaxial so as to allow easier introduction of the shunt into the blood vessel of a patient. Similarly, the second leg having a longitudinally slit for receiving a portion of the cooperating insufflation conduit and also holding …

Angled Snare Assembly, Bradley B. Hill

Surgery Faculty Patents

A snare assembly includes an outer, flexible sheath having a distal opening and a loop received for relative sliding movement with respect to the sheath. The loop has a proximal end and a distal end. The loop is formed from a resilient wire and includes a substantially 180° reverse bend at a midpoint forming the distal end and the ends of the wire are fastened together at the proximal end. A control handle is carried on the sheath for extending and retracting the loop out of and into the sheath through the distal opening. A flexible connector connects the control …

Method For Employing The Delta Opioid Dadle To Extend Tissue Survival Time During Ischemia, Sufan Chien

Surgery Faculty Patents

This invention concerns a method for extending the survival time of mammalian lung tissue subjected to ischemia, by which said tissue is perfused with a preservation solution comprising a therapeutic dose of the delta opioid DADLE ([D-Ala²,D-Leu⁵]-Enkephalin) under hypothermic conditions.

Method Of Tendon Repair, Bradley B. Hill

Surgery Faculty Patents

A method for repairing a transected or torn flexor or extensor tendon of a finger that has retracted proximally within its protective sheath includes the steps of: (a) visually locating a distal end of the tendon within the sheath; (b) engaging the distal end of the tendon, (c) pulling the tendon distally through the sheath to a tendon mending position; and (d) repairing the tendon.

Multiple Function Intubation Apparatus And Method, Jane A. Norton, Diana L. Twyman, A. Byron Young, Robert Rapp

Surgery Faculty Patents

An apparatus and its method of use are provided allowing lavage, sump and enteral feeding operations with only one intubation. The apparatus includes a first tube having two distinct passageways. One of these passageways completely contains a second, feeding tube during intubation. Once the first tube is in place in the patient, the second tube is extended from the first tube so as to enter the stomach. The extension of the second tube opens ports in the first passageway of the first tube, thereby allowing sump or lavage treatment with the second passageway of the first tube serving as an …