Surgery Commons^™

Adenomyomatous Hyperplasia Of The Ampulla Of Vater Masquerading As Malignancy: A Case Series, Patrick Hickey Do, Saba Ahmad Md, Matthew Sullivan Do, Miriam L. Enriquez Md, Jeffrey Brodsky Md, Hiral Shah Md

Department of Medicine

No abstract provided.

The Geriatric Trauma Team: A Novel Approach To Caring For Elderly Trauma Patients, Mary F. Stuever, Kimberly M. Hendershot, Priti Parikh, A. Russeau, Mary C. Mccarthy, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

No abstract provided.

Cervical Vertebral Anomalies In Skeletal Malocclusions: A Cross-Sectional Study On Orthodontic Patients At The Aga Khan University Hospital, Pakistan, Saman Faruqui, Mubassar Fida, Attiya Shaikh

Section of Orthopaedic Surgery

Introduction: Morphological deviations of the cervical vertebral column have been described in relation to craniofacial aberrations and syndromes. Furthermore, it has recently been shown that abnormal morphology of upper cervical vertebrae is associated with malformation of the jaws and occlusion. Accordingly, it is relevant to focus on similar associations in patients with skeletal malocclusions. Therefore, the objectives of this study are to: (a) Identify the anomalies of the cervical column in patients with skeletal malocclusions (b) Determine the association between cervical vertebral anomalies and skeletal malocclusions.
Materials and Methods: This cross-sectional study was conducted on a total of 90 subjects …

Robotic Sublobar Resection For The Surgical Management Of Isolated Pulmonary Nodules, Michael F. Szwerc Md, Victor Reis Md, Kyle M. Langston Pa-C, Alec Talsania Md, Alex Werner

Department of Surgery

No abstract provided.

Department Of Surgery Update, October 2014, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, notes and pictures on the postgraduate symposium and more.

Efficacy Of Transoral Fundoplication For Treatment Of Chronic Gastroesophageal Reflux Disease Incompletely Controlled With High-Dose Proton-Pump Inhibitors Therapy: A Randomized, Multicenter, Open Label, Crossover Study., Karim S. Trad, Gilbert Simoni, William Edris Barnes, Ahmad Bassel Shughoury, Mamoon Raza, Jeffrey Alan Heise, Daniel Gilles Turgeon, Mark Alan Fox, Peter George Mavrelis

Surgery Faculty Publications

Background

The aim of this randomized, crossover study was to determine if transoral fundoplication (TF) could further improve clinical outcomes in partial responders to high-dose (HD) proton-pump inhibitor (PPI) therapy and to evaluate durability of TF.

Methods

In seven United States centers, patients with hiatal hernia ≤2 cm and abnormal esophageal acid exposure (EAE) were randomized to TF (n = 40) or HD PPIs (n = 23) group. At 6-month follow-up, PPI patients underwent crossover. We assessed clinical outcomes 6-month post TF in crossover patients (COP), as compared to 6-month of HD PPI therapy, and 12-month outcomes in patients initially …

Impact Of Pre-Stage Ii Hemodynamics And Pulmonary Artery Anatomy On 12-Month Outcomes In The Pediatric Heart Network Single Ventricle Reconstruction Trial., Ranjit Aiyagari, John F. Rhodes, Peter Shrader, Wolfgang A. Radtke, Varsha M. Bandisode, Lisa Bergersen, Matthew J. Gillespie, Robert G. Gray, Lin T. Guey, Kevin D. Hill, Russel Hirsch, Dennis W. Kim, Kyong-Jin Lee, Andrew N. Pelech, Jeremy Ringewald, Cheryl Takao, Julie A. Vincent, Richard G. Ohye, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.

METHODS: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.

RESULTS: Of 549 randomized subjects, …

Surgeon Practices And Attitudes Toward The Control Of Surgical-Site Infections In Jordan, Sara Ali Mater

Independent Study Project (ISP) Collection

The purpose of this study was to determine the attitudes and practices of Jordanian surgeons on the control of surgical-site infections, evaluated by the Center of Disease Control’s guidelines toward the prevention of surgical-site infections, in addition to gaining respondents opinions on infection control in Jordan. This study was conducted through the distribution of 75 questionnaires given to surgeons at five hospitals in Jordan. Additional insight on SSI infection control was gained through interviews with two cardiac surgeons and three infection control directors. The results of the survey were compared with the Center for Disease Control’s guide to surgical-site infection …

Development Of A Fatal Noncompressible Truncal Hemorrhage Model With Combined Hepatic And Portal Venous Injury In Normothermic Normovolemic Swine, Ujwal R. Yanala, Jason M. Johanning, Iraklis I. Pipinos, Gustavo F. Larsen, William H. Velander, Mark A. Carlson

William H. Velander Publications

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury types …

Wound Healing: Biologics, Skin Substitutes, Biomembranes And Scaffolds, Krishna S. Vyas, Henry C. Vasconez

Surgery Faculty Publications

This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds.

Physicians' Attitudes About Recommending Surgery For Early Stage Lung Cancer And Possible Reasons For Racial Disparities, Franklin R. Mcguire

Journal of Health Disparities Research and Practice

PHYSICIANS’ ATTITUDES ABOUT RECOMMENDING SURGERY FOR EARLY STAGE LUNG CANCER AND POSSIBLE REASONS FOR RACIAL DISPARITIES

ABSTRACT

Purpose: Patient refusal for lung cancer surgery is significant, but other factors, such as negative framing of the treatment discussion, may be involved. Physician attitudes could influence the nuances of and therefore the conclusions of these discussions. We determined physicians’ attitudes and the influence it has on possible decisions against lung cancer surgery, particularly surgical rates for blacks, using a companion survey.

Methods: The study is a prospective, multicenter observational trial conducted at five sites in North and South Carolina from December …

Department Of Surgery Update, September 2014, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

Patients’ Visual Experience During Phacoemulsification Cataract Surgery And Associated Fear, Tanveer Anjum Chaudhry, Amash Aqil, Kanza Aziz, Ammar Asrar Javed, Mohammad Zain Tauqir, Khabir Ahmad

Department of Surgery Docs

Abstract Background: Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia. Methods: This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults >18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon …

The Accuracy Of Three-Dimensional Bladder Ultrasonography In Determining The Residual Urinary Volume Compared With Conventional Catheterisation, Imran K. Jalbani, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine the accuracy of three-dimensional bladder ultrasonography (US, using the BVI 3000, Verathon, WA, USA) for determining the residual urinary volume, compared with the conventional catheterisation method.

PATIENTS AND METHODS:

We conducted a cross-sectional study at day-care unit of a University hospital after obtaining approval from the Ethics Review Committee of the hospital. Thirty-four patients with lower urinary tract symptoms requiring cystometrography were included. The postvoid volume was measured by bladder US, with three readings taken, and then patient was catheterised using a 12-F Nelaton catheter to measure the urinary volume. The mean of the three readings …

Factors Associated With Neurodevelopment For Children With Single Ventricle Lesions., Caren S. Goldberg, Minmin Lu, Lynn A. Sleeper, William T. Mahle, J William Gaynor, Ismee A. Williams, Kathleen A. Mussatto, Richard G. Ohye, Eric M. Graham, Deborah U. Frank, Jeffrey P. Jacobs, Catherine Krawczeski, Linda Lambert, Alan Lewis, Victoria L. Pemberton, Renee Sananes, Erica Sood, Stephanie B. Wechsler, David C. Bellinger, Jane W. Newburger, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To measure neurodevelopment at 3 years of age in children with single right-ventricle anomalies and to assess its relationship to Norwood shunt type, neurodevelopment at 14 months of age, and patient and medical factors.

STUDY DESIGN: All subjects in the Single Ventricle Reconstruction Trial who were alive without cardiac transplant were eligible for inclusion. The Ages and Stages Questionnaire (ASQ, n = 203) and other measures of behavior and quality of life were completed at age 3 years. Medical history, including measures of growth, feeding, and complications, was assessed through annual review of the records and phone interviews. The …

Vogt-Koyanagi-Harada Syndrome, Sharmeen Akram, Khabir Ahmad

Department of Surgery Docs

ABSTRACT Vogt-Koyanagi-Harada (VKH) syndrome is a rare multisystem disease of melanocyte containing organs. It is characterized by diffuse granulomatous inflammation involving various organs including eye. VKH syndrome is usually sporadic, but some familial cases have also been reported indicating a hereditary basis. VKH is not associated with mortality but it may result in long-term complications such as decreased vision associated with cataract, glaucoma and choroidal neovascularization. For successful outcomes, early aggressive treatment using systemic steroids with gradual tapering is essential. This report describes a case of VKH syndrome in a 26-year-old male of Pakistan origin who was successfully treated with …

Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction, Muhammad Waqas, Muhammad Shahzad Shamim, Badar Uddin Ujjan, Saqib Kamran Bakhshi

Section of Neurosurgery

Background: On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost.
Methods: This cross-sectional study was conducted over 1 year (2012). All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross …

Thoracoabdominal Aortic Aneurysm Repair: Current Endovascular Perspectives, Nathan Orr, David Minion, Joseph L. Bobadilla

Surgery Faculty Publications

Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered.

Design And Development Of A Miniature In Vivo Surgical Robot With Distributed Motor Control For Laparoendoscopic Single-Site Surgery, Eric J. Markvicka

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Paradigm shifts in invasiveness, recovery time, cosmesis, and cost have been seen within the field of general surgery through major advances in surgical technology. Some of the most advanced types of general surgery now include Minimally Invasive Surgery (MIS), LaparoEndoscopic Single-Site (LESS) surgery, and Natural Orifice Translumenal Endoscopic Surgery (NOTES). One of the newest and rapidly developing catalysts is robotic platforms. Such platforms have improved ergonomics and control, increased workspace and dexterity, and have surpassed the efficacy of many non-robotic platforms such as traditional laparoscopic surgical tools. This thesis presents the design and development of a four-degree-of-freedom (4- DOF) miniature …

Acute Demyelinating Polyneuropathy After Lung Transplantation: Guillain-Barré Syndrome Or Tacrolimus Toxicity?, Nirmal S. Sharma, Keith M. Wille, Charles W. Hoopes, Enrique Diaz-Guzman

Surgery Faculty Publications

Guillain-Barré syndrome (GBS) has been described after solid organ and bone marrow transplantation mostly due to viral infections and possibly calcineurin inhibitors. Incidence after bone marrow transplant is 0.3-0.7%, though incidence in other transplants is not well known. We present the first description of tacrolimus associated GBS in lung transplant recipients in the English language literature. The pathophysiology of tacrolimus-induced polyneuropathy is not known, but some have hypothesized that tacrolimus induces an inflammatory phenomenon by differential effects on T cell subsets. Diagnosis of association may be challenging and requires high index of suspicion. The optimal treatment of GBS-associated with tacrolimus …

Decreasing The Incidence Of Tuberculosis In Renal Transplant Patients: A Single Center Review, Heidi Dauter Msn, Fnp-Bc, Cctc, Brandi Kolokas Ccma, Lynsey S. Biondi Md, Facs

Department of Surgery

No abstract provided.

The Influence Of Race/Ethnicity And Place Of Service On Breast Reconstruction For Medicare Beneficiaries With Mastectomy, Tracy Onega, Julie Weiss, Karla Kerlikowske, Karen Wernli

Dartmouth Scholarship

Racial disparities in breast reconstruction for breast cancer are documented. Place of service has contributed to disparities in cancer care; but the interaction of race/ethnicity and place of service has not been explicitly examined. We examined whether place of service modified the effect of race/ethnicity on receipt of reconstruction. We included women with a mastectomy for incident breast cancer in SEER-Medicare from 2005-2009. Using Medicare claims, we determined breast reconstruction within 6 months. Facility characteristics included: rural/urban location, teaching status, NCI Cancer Center designation, cooperative oncology group membership, Disproportionate Share Hospital (DSH) status, and breast surgery volume. Using multivariable logistic …

Towards Highly-Integrated Stereovideoscopy For In Vivo Surgical Robots, Jay Carlson

Department of Electrical and Computer Engineering: Dissertations, Theses, and Student Research

When compared to traditional surgery, laparoscopic procedures result in better patient outcomes: shorter recovery, reduced post-operative pain, and less trauma to incisioned tissue. Unfortunately, laparoscopic procedures require specialized training for surgeons, as these minimally-invasive procedures provide an operating environment that has limited dexterity and limited vision. Advanced surgical robotics platforms can make minimally-invasive techniques safer and easier for the surgeon to complete successfully. The most common type of surgical robotics platforms -- the laparoscopic robots -- accomplish this with multi-degree-of-freedom manipulators that are capable of a diversified set of movements when compared to traditional laparoscopic instruments. Also, these laparoscopic robots …

Treatment Of Rectal War Wounds, O Van Waes, J Halm, J Vermeulen, Vivian Mcalister

Data and Test Instruments

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex.

Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans, Muhammad M. Alam, Muhammad Waqas, Hussain Shallwani, Gohar Javed

Section of Neurosurgery

Study design: A cross-sectional study.
Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various …

Department Of Surgery Update, August 2014, Wright State University Department Of Surgery

Department of Surgery Updates

A two page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, announcements, committee meetings, scholarly activity and more.

Towards Image-Guided Pediatric Atrial Septal Defect Repair, Fuad Mefleh

All Dissertations

Congenital heart disease occurs in 107.6 out of 10,000 live births, with Atrial Septal Defects (ASD) accounting for 10\% of these conditions. Historically, ASDs were treated with open heart surgery using cardiopulmonary bypass, allowing a patch to be sewn over the defect. In 1976, King et al. demonstrated use of a transcatheter occlusion procedure, thus reducing the invasiveness of ASD repair. Localization during these catheter based procedures traditionally has relied on bi-plane fluoroscopy; more recently trans-esophageal echocardiography (TEE) and intra-cardiac echocardiography (ICE) have been used to navigate these procedures. Although there is a high success rate using the transcatheter occlusion …

Bilateral Maxillary Canine-First Premolar Transposition In Permanent Dentition, Sarwat Memon, Mubassar Fida

Department of Surgery Docs

ABSTRACT Transposition is a dental anomaly characterized by the exchange of position between two adjacent teeth, especially in relation to their roots, or development and eruption of a tooth in a position normally occupied by a nonadjacent tooth. Transposition of the maxillary canine and first premolar has a low prevalence in the population and it primarily affects maxillary canines and premolars. The aetiology of the transposition remains unclear, although it has been associated with genetic factors. It may also be related to a combination of localised factors such as malformation of adjacent teeth, tooth agenesis, retention of the deciduous canine …

Axial-Centrifugal Flow Catheter Pump For Cavopulmonary Assistance, Dongfang Wang, Joseph B. Zwischenberger

Surgery Faculty Patents

An axial-centrifugal flow catheter pump for cavopulmonary assistance is provided, incorporating a rotor providing both an axial fluid flow and a centrifugal fluid flow. The rotor includes a first terminal impeller configured to provide a centrifugal and axial fluid flow in a first direction, a second terminal impeller configured to provide a centrifugal and axial fluid flow in a second direction opposite to the first direction, and a central impeller configured to provide a predominantly centrifugal fluid flow. The first and second terminal impellers each include blade arrangements configured to provide a centrifugal and axial fluid flow directed toward the …

Identification Of A Cytotoxic Form Of Dimeric Interleukin-2 In Murine Tissues, Lucile E. Wrenshall, Suzanne E. Clabaugh, David R. Cool, Prakash Arumugam, William C. Grunwald Jr., Deandra R. Smith, Gino C. Liu, John D. Miller

Department of Surgery Faculty Publications

Interleukin-2 (IL-2) is a multi-faceted cytokine, known for promoting proliferation, survival, and cell death depending on the cell type and state. For example, IL-2 facilitates cell death only in activated T cells when antigen and IL-2 are abundant. The availability of IL-2 clearly impacts this process. Our laboratory recently demonstrated that IL-2 is retained in blood vessels by heparan sulfate, and that biologically active IL-2 is released from vessel tissue by heparanase. We now demonstrate that heparanase digestion also releases a dimeric form of IL-2 that is highly cytotoxic to cells expressing the IL-2 receptor. These cells include “traditional” IL-2 …