Surgery Commons^™

Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md

Administration & Leadership

No abstract provided.

Use Of Geocoding And Us Census Data To Assess Determinants Of Outcome In Trauma Patients, Krista M. Goodman Md, John J. Hong Md, Sherrine Eid Mph, Leslie Baga Bsn, Ccrc, Michael M. Badellino Md, Mph, Facs, Michael D. Pasquale Md, Facs

Department of Surgery

No abstract provided.

Expression Of Microphthalmia Transcription Factor In Sentinel Lymph Nodes Of Patients With Melanoma, Minia Hellan, Michelle S. Gentile, Luay Ailabouni, George I. Salti

Department of Surgery Faculty Publications

Background: Sentinel lymph node biopsy is widely used in the management of melanoma patients. Multiple markers are used to stain sentinel lymph node tissue including S100, HMB-45 and melan A with different success. We investigated, for the first time, the use of Microphthalmia transcription factor (Mitf) staining in a larger series of sentinel lymph nodes. Mitf is a transcription factor essential for the development and survival of melanocytes. It has been introduced recently as a sensitive and specific marker for melanomas. Methods: Thirty patients with cutaneous melanoma were included in our study: twenty patients underwent sentinel lymph node biopsy; ten …

Congenital Diaphragmatic Hernia Presenting In The Sixth Decade Mimicking Pneumonia, Saulat H. Fatimi, Nida Sajjad, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

Congenital diaphragmatic hernia presentation in adults is extremely rare. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms and diagnosis can be difficult. We report a case of a 64 year old male who presented with a six month history of cough, shortness of breath and weight loss. The most common strategy to treat a Bochdalek hernia is via a thoracotomy or laparotomy or both. In our patient the repair was performed with a thoracotomy.

Surgical Management Of Complete Atrioventricular Septal Defect: Associations With Surgical Technique, Age, And Trisomy 21., Andrew M. Atz, John A. Hawkins, Minmin Lu, Meryl S. Cohen, Steven D. Colan, James Jaggers, Ronald V. Lacro, Brian W. Mccrindle, Renee Margossian, Ralph S. Mosca, Lynn A. Sleeper, L Luann Minich, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: We sought to evaluate the contemporary results after repair of a complete atrioventricular septal defect and to determine the factors associated with suboptimal outcomes.

METHODS: The demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of a complete atrioventricular septal defect in 120 children in a multicenter observational study from June 2004 to 2006.

RESULTS: The median age at surgery was 3.7 months (range, 9 days to 1.1 years). The type of surgical repair was a single patch (18%), double patch (72%), and a single atrial septal defect patch with primary ventricular septal defect …

Evaluation Of The Use Of Patient-Focused Simulation For Student Assessment In A Surgery Clerkship., Gerald A Isenberg, Katherine W Berg, Judith A Veloski, Dale D Berg, J J. Veloski, Charles Yeo

Department of Surgery Faculty Papers

BACKGROUND: The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills.

METHODS: Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models.

RESULTS: A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for …

Endothelial Differentiation Of Adipose-Derived Stem Cells From Elderly Patients With Cardiovascular Disease., Ping Zhang, Neil Moudgill, Eric Hager, Nicolas Tarola, Christopher Dimatteo, Stephen Mcilhenny, Thomas Tulenko, Paul J Dimuzio

Department of Surgery Faculty Papers

Adipose-derived stem cells (ASCs) possess significant therapeutic potential for tissue engineering and regeneration. This study investigates the endothelial differentiation and functional capacity of ASCs isolated from elderly patients. Isolation of ASCs from 53 patients (50-89 years) revealed that advanced age or comorbidity did not negatively impact stem cell harvest; rather, higher numbers were observed in older donors (>70 years) than in younger. ASCs cultured in endothelial growth medium-2 for up to 3 weeks formed cords upon Matrigel and demonstrated acetylated-low-density lipoprotein and lectin uptake. Further stimulation with vascular endothelial growth factor and shear stress upregulated endothelial cell-specific markers (CD31, …

Acute Effects Of A Selective Cannabinoid-2 Receptor Agonist On Neuroinflammation In A Model Of Traumatic Brain Injury., Melanie B Elliott, Ronald F Tuma, Peter S Amenta, Mary F Barbe, Jack I Jallo

Department of Neurosurgery Faculty Papers

Proposed therapeutic strategies for attenuating secondary traumatic brain injury (TBI) include modulation of acute neuroimmune responses. The goal of this study was to examine the acute effects of cannabinoid-2 receptor (CB(2)R) modulation on behavioral deficits, cerebral edema, perivascular substance P, and macrophage/microglial activation in a murine model of TBI. Thirty male C57BL/6 mice underwent sham surgery, or cortical contusion impact injury (CCI). CCI mice received vehicle or the CB(2)R agonist 0-1966 at 1 and 24 h after injury. Performance on the rotarod, forelimb cylinder, and open-field tests were evaluated before and at 48 h after sham or CCI surgery. Cerebral …

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 …

Download The Full Pdf Of Jefferson Surgical Solutions Spring 2011, Volume 6, Number 1

Jefferson Surgical Solutions

No abstract provided.

News In Brief

Jefferson Surgical Solutions

No abstract provided.

Those Who Give: Making A Difference Now And Down The Road: The Howell Professorship In Pancreatic Cancer Research

Jefferson Surgical Solutions

No abstract provided.

On The Job: Dr. Goldberg Spends Research Year Targeting Breast Cancer

Jefferson Surgical Solutions

No abstract provided.

Beekley’S Combat Experience Informs Research And Protocols At Home And Abroad

Jefferson Surgical Solutions

No abstract provided.

Resident Update: Lieutenant Commander Daniel R. Grabo

Jefferson Surgical Solutions

No abstract provided.

Creating Second Chances For All Ages: The Live Donor Liver Transplant Program

Jefferson Surgical Solutions

No abstract provided.

Overview

Jefferson Surgical Solutions

No abstract provided.

About The Minimally Invasive Thoracic Surgery Program

Jefferson Surgical Solutions

No abstract provided.

From The Or To The Principal’S Office: Video Assisted Thoracoscopic Surgery Offers Faster Recovery

Jefferson Surgical Solutions

No abstract provided.

Leaking Pseudoaneurysm Of Hepatic Artery: A Potentially Life-Threatening Complication Of A Common Procedure, Muhammad Rizwan Khan, Rushna Raza, Basit Salam

Section of General Surgery

We report a case of leaking pseudoaneurysm of right hepatic artery in a 54-year old female after laparoscopic cholecystectomy who presented with massive gastrointestinal haemorrhage and was successfully managed with angiography and coil embolization.

Successful Surgical Embolectomy In Acute Massive Bilateral Pulmonary Embolism, Taimur Saleem, Saulat Hasnain Fatimi, Umair Khalid

Section of Cardiothoracic Surgery

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. A 52-year-old man presented with progressively increasing dyspnoea for three days. He had a previous history of chronic obstructive pulmonary disease and was currently a heavy smoker. Examination revealed bilateral wheezing. Chest x-ray and electrocardiography showed non-specific changes. The patient was initially treated as a case of chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, despite optimum medical management, his oxygen saturation deteriorated. Emergent computed tomography scan of chest showed bilateral massive pulmonary emboli. As the patient's haemodynamic status rapidly deteriorated, cardiothoracic surgery team …

Thomas Dent Mütter: The Humble Narrative Of A Surgeon, Teacher, And Curious Collector., Jennifer A. Baker, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Thomas Dent Mutter, a beloved teacher, respected colleague, devoted husband, surgical pioneer, and legendary collector, emerged from a tragic childhood as an ambitious young physician who would leave a permanent imprint on medical education (Fig. 1). Dr. Mutter is best known in the Philadelphia area for the museum of medical curiosities, which bears his name. Overflowing with various medical memorabilia, anatomical and pathological specimens, casts, models, watercolors, and historical instruments, the Mutter Museum often overshadows the numerous other contributions Dr. Mutter made during his shortened life.1 A quote from Henry Brooks Adams is quite apropos, ‘‘A teacher affects eternity; he …

Aortic Dissection Or Myocardial Infarction, Saulat H. Fatimi, Maria Mahboob, Awais Ashfaq

Section of Cardiothoracic Surgery

Aortic dissection is a rare and a life threatening event. Classically, aortic dissection presents as sudden, severe chest, back or abdominal pain that is characterized as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. So, a high index of clinical suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. We report a case of a 56 years old male who presented with signs and symptoms of myocardial infarction and was later found to have aortic dissection. This patient was successfully managed with surgery.

From Bench To Bedside And Beyond: Potential Uses Of Vivo In An Academic Medical Center, John C. Kairys, Md, Facs, Jack London, Phd, Karl Steiner, Phd

Department of Surgery Faculty Papers

PowerPoint presentation:  From Bench to Bedside and Beyond:Potential Uses of VIVO in an Academic Medical Center.

A Phase I/Iia Clinical Trial Of A Recombinant Rho Protein Antagonist In Acute Spinal Cord Injury., Michael G Fehlings, Nicholas Theodore, James Harrop, Gilles Maurais, Charles Kuntz, Chris I Shaffrey, Brian K Kwon, Jens Chapman, Albert Yee, Allyson Tighe, Lisa Mckerracher

Department of Neurosurgery Faculty Papers

Multiple lines of evidence have validated the Rho pathway as important in controlling the neuronal response to growth inhibitory proteins after central nervous system (CNS) injury. A drug called BA-210 (trademarked as Cethrin(®)) blocks activation of Rho and has shown promise in pre-clinical animal studies in being used to treat spinal cord injury (SCI). This is a report of a Phase I/IIa clinical study designed to test the safety and tolerability of the drug, and the neurological status of patients following the administration of a single dose of BA-210 applied during surgery following acute SCI. Patients with thoracic (T2-T12) or …

Pediatric Traumatic Putamenal Strokes: Mechanisms And Prognosis, Zain A. Sobani, Arshad Ali

Section of Neurosurgery

Background: Studies have shown that nearly 3% of closed head injuries result in basal ganglia hemorrhages and that this may be a more frequent occurrence in pediatric patients. Various mechanisms based on shearing forces have been implicated in the injury; however, the underlying mechanism leading to the increased incidence in pediatric patients has not been well described. Angiographic data suggest that putamenal perforators in children are more severely stretched at acute angles compared to those in adults, which may be a contributing factor to the increased incidence.
Case description: We discuss a series of five relatively benign cases of traumatic …

Treatment Of Complex Fistula In Ano With Cable-Tie Seton: A Prospective Case Series., Ayaz Ahmad Memon, Ghulam Murtaza, Rizwan Azami, Hasnain Zafar, Tabish Chawla, Altaf Ali Laghari

Department of Surgery Docs

Objective:To determine the fecal incontinence and recurrence rate in Patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital.

Methods:

This is a prospective case series of Patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from March 2003 to March 2009. Patients were seen in the clinic after 72 hours of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner's score.

Results: …

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Section of General Surgery

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.

Knowledge And Attitudes Of Pakistani Women Towards Anaesthesia Techniques For Caesarean Section, Imtiaz Ahmad, Gauhar Afshan

Department of Anaesthesia

OBJECTIVE: To assess knowledge and attitudes of Pakistani women towards different options of anaesthesia techniques for caesarean section and also to identify their sources of information about them.

METHODS: A total of 410 women scheduled for elective caesarean section were enrolled after informed written consent in this hospital based cross sectional survey. The women were interviewed preferably in Urdu (national) language according to structured pre coded questionnaire by one of the investigators and the sequence of questions was strictly followed. This survey included pertinent questions to assess knowledge and attitudes of our women towards choices of anaesthesia techniques. The questionnaire …

Dual Chamber Pacemaker Implants--A New Opportunity In Pakistan For Children With Congenital And Acquired Complete Heart Block, Awais Ashfaq, Mansoor Ahmed Khan, Mehnaz Atiq, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

Implantation of cardiac pacemakers has been practiced for at least five decades with continuous developments of the hardware. The invention of dual chamber pacemakers has initiated a debate concerning its superiority over single chamber ventricular pacemakers. Throughout the world, surgeons have been using dual chambered permanent pacemakers with successful follow ups. However, Pakistan has not yet taken the advantage of such pacemaker devices till now. We report three cases that underwent a dual chamber permanent pacemaker implantation for the first time in children less than 8 kg with successful follow ups.