Surgery Commons^™

Department Of Surgery Update, July 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.

Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma

Section of Neurosurgery

Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …

Meshless Mechanics And Point-Based Visualization Methods For Surgical Simulations, Rifat Aras

Computational Modeling & Simulation Engineering Theses & Dissertations

Computer-based modeling and simulation practices have become an integral part of the medical education field. For surgical simulation applications, realistic constitutive modeling of soft tissue is considered to be one of the most challenging aspects of the problem, because biomechanical soft-tissue models need to reflect the correct elastic response, have to be efficient in order to run at interactive simulation rates, and be able to support operations such as cuts and sutures.

Mesh-based solutions, where the connections between the individual degrees of freedom (DoF) are defined explicitly, have been the traditional choice to approach these problems. However, when the problem …

The Impact Of Patellar Resurfacing In Two-Stage Revision Of The Infected Total Knee Arthroplasty., Aaron Glynn, Ronald Huang, Javad Mortazavi, Javad Parvizi Md

Rothman Institute Papers

Evidence for optimal management of the patellofemoral joint in revision surgery for the infected TKA is limited. We reviewed 69 infected TKAs undergoing two-stage revision. Fifty four patellae were resurfaced, 11 had patelloplasty performed, two were augmented with trabecular metal, one had impaction grafting, and one knee underwent patellectomy. Average follow-up was 4.5years. The patients that received patellar resurfacing at re-implantation experienced statistically significant improvements in KSS pain score, functional KSS, and patellar score (P

Feasibility Of Diagnosis Of Postcardiotomy Tamponade By Miniaturized Transesophageal Echocardiography., Hitoshi Hirose, Md, Shreya Gupta, Bs, Harrsion Pitcher, Md, Joseph Miessau, Ms, Qiong Yang, Md, Jenny Yang, Md, Nicholas Cavarhocchi, Md

Department of Surgery Faculty Papers

BACKGROUND: Pericardial tamponade after cardiac surgery is a critical diagnosis that can be difficult to diagnose using conventional cardiac monitoring. Transesophageal echocardiography can provide comprehensive information to make the diagnosis but is not always available, whereas transthoracic echocardiography has its utility limited because of the body habitus or other surgical effects. New monitoring devices, miniaturized hemodynamic transesophageal echocardiography (hTEE), which allows point of care assessment of cardiac filling and functions, may aid in diagnosis of postcardiotomy tamponade.

METHODS: From May 2011 to July 2013, 21 patients underwent hTEE to rule out pericardial tamponade for clinical suspicion of tamponade after open …

Targeting The Wnt/Β-Catenin Signaling Pathway In Liver Cancer Stem Cells And Hepatocellular Carcinoma Cell Lines With Fh535, Roberto Gedaly, Roberto Galuppo, Michael F. Daily, Malay B. Shah, Erin Colleen Maynard, Changguo Chen, Xiping Zhang, Karyn A. Esser, Donald A. Cohen, B. Mark Evers, Jieyun Jiang, Brett T. Spear

Surgery Faculty Publications

Activation of the Wnt/β-catenin pathway has been observed in at least 1/3 of hepatocellular carcinomas (HCC), and a significant number of these have mutations in the β-catenin gene. Therefore, effective inhibition of this pathway could provide a novel method to treat HCC. The purposed of this study was to determine whether FH535, which was previously shown to block the β-catenin pathway, could inhibit β-catenin activation of target genes and inhibit proliferation of Liver Cancer Stem Cells (LCSC) and HCC cell lines. Using β-catenin responsive reporter genes, our data indicates that FH535 can inhibit target gene activation by endogenous and exogenously …

Sphingosine-1-Phosphate Promotes The Differentiation Of Adipose-Derived Stem Cells Into Endothelial Nitric Oxide Synthase (Enos) Expressing Endothelial-Like Cells., Divya Arya, Shaohua Chang, Paul J Dimuzio, Jeffrey Carpenter, Thomas N Tulenko

Department of Surgery Faculty Papers

BACKGROUND: Adipose tissue provides a readily available source of autologous stem cells. Adipose-derived stem cells (ASCs) have been proposed as a source for endothelial cell substitutes for lining the luminal surface of tissue engineered bypass grafts. Endothelial nitric oxide synthase (eNOS) is a key protein in endothelial cell function. Currently, endothelial differentiation from ASCs is limited by poor eNOS expression. The goal of this study was to investigate the role of three molecules, sphingosine-1-phosphate (S1P), bradykinin, and prostaglandin-E1 (PGE1) in ASC endothelial differentiation. Endothelial differentiation markers (CD31, vWF and eNOS) were used to evaluate the level of ASCs differentiation capability. …

Hiv-1 Subtype A Gag Variability And Epitope Evolution, Syed Hani Abidi, Marcia L. Kalish, Farhat Abbas, Sarah Rowland-Jones, Syed Ali

Section of Urology

Objective: The aim of this study was to examine the course of time-dependent evolution of HIV-1 subtype A on a global level, especially with respect to the dynamics of immunogenic HIV gag epitopes.
Methods: We used a total of 1,893 HIV-1 subtype A gag sequences representing a timeline from 1985 through 2010, and 19 different countries in Africa, Europe and Asia. The phylogenetic relationship of subtype A gag and its epidemic dynamics was analysed through a Maximum Likelihood tree and Bayesian Skyline plot, genomic variability was measured in terms of G → A substitutions and Shannon entropy, and the time-dependent …

Utility Of The Stop-Bang Questionnaire For Identifying Obstructive Sleep Apnea In Patients Undergoing Bariatric Surgery, Karen Jablonski, Md, Ritu G. Grewal, Md, Ramya Punati,, Shivam Saxena, Karl Doghramji, Md, Alec Beekley, Md, David S. Tichansky, Md

Department of Surgery Faculty Papers

Introduction

Patients undergoing bariatric surgery are at high risk for obstructive sleep apnea (OSA).

OSA has been associated with an increased risk of perioperative complications, but is under-recognized and underdiagnosed in the bariatric population.

It is currently recommended that all patients considering bariatric surgery for obesity should be evaluated for OSA.

In the general pre-surgical population, the STOP-BANG questionnaire is a validated screening tool for identifying OSA.

We hypothesize that in bariatric patients the STOP-BANG questionnaire plus other clinical variables can predict OSA.

Department Of Surgery Update, June 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.

Reuse Of Liver Grafts Following Brain Death Of The Initial Recipient, Hideaki Tanaka, Vivian Mcalister, Mark Levstik, Cameron Ghent, Paul Marotta, Douglas Quan, William Wall

Data and Test Instruments

AIM: To determine if there is a reasonable prospect of success of a re-use liver transplantation. METHODS: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts. RESULTS:A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of …

Francis F. Maury, M.D. (1840 To 1879): An Often Forgotten Pioneer In Early American Surgery., Guillaume S. Chevrollier, B.S., Scott W. Cowan, Md, Charles J. Yeo, Md, John C. Kairys, Md

Department of Surgery Gibbon Society Historical Profiles

Francis F. Maury (Fig. 1) was born on August 9, 1840, in Danville, Kentucky, where he was raised on a farm by his mother and father. His father was an Episcopal clergyman of Huguenot descent, whose forefathers had fled from France to escape religious persecution. After receiving a Bachelor of Arts degree from Center College in the summer of 1860, he entered medical school at the University of Virginia. After one full term, he matriculated to Philadelphia’s Jefferson Medical College and completed his medical education as a private student under the direction of Dr. Samuel D. Gross.1, 2 He obtained …

Ambroise Paré (1510 To 1590): A Surgeon Centuries Ahead Of His Time., James T. Shen, B.S., Michael Weinstein, Md, Alec C. Beekley, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

In their extensive writings, Hippocrates and Celsus counseled physicians to be knowledgeable in both the medical and surgical management of patient recovery. However, their words fell by the wayside because cutting of the body was forbidden by the Roman Catholic Church. Furthermore, the contemporaneous Arabic medical teachings emphasized tradition and authority over observation and personal experience. This created an ever-growing rift between the schools of surgical and pharmacologic medicine with both groups denying their involvement in the other domain. Surgeons had been plagued by postoperative complications including infection, malnutrition, and muscular wasting for centuries. Surgeons were forced to re-examine how …

Transcatheter Versus Surgical Closure Of Atrial Septum Defect: A Debate From A Developing Country, Waleed T. Siddiqui, Tariq Usman, Mehnaz Atiq, Muneer Amanullah

Department of Radiology

Abstract

INTRODUCTION:

This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septumdefect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure.

METHODS:

We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes …

Inter-Observer Variability In Diagnosing Radiological Features Of Aneurysmal Subarachnoid Hemorrhage; A Preliminary Single Centre Study Comparing Observers From Different Specialties And Levels Of Training, Usman T Siddiqui, Anjum F. Khan, Muhammad Shahzad Shamim, Rana Shoaib Hamid, Muhammad Mehboob Alam, Emaduddin Siddiqui

Department of Surgery Docs

No abstract provided.

Functional Health Status In Children And Adolescents After Fontan: Comparison Of Generic And Disease-Specific Assessments., Brian W. Mccrindle, Victor Zak, Victoria L. Pemberton, Linda M. Lambert, Victoria L. Vetter, Wyman W. Lai, Karen Uzark, Renee Margossian, Andrew M. Atz, Amanda Cook, Jane W. Newburger, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: The aim of this study was to compare associations between generic versus disease-specific functional health status assessments and patient and clinical characteristics for patients with severe congenital heart disease.

METHODS: This was a cross-sectional observational study involving 325 single ventricle patients, aged 10-18 years, after Fontan procedure. Enrolled patients underwent a medical history review, laboratory testing, and assessment of the functional health status by completion of the generic Child Report Child Health Questionnaire and the disease-specific Congenital Heart Adolescent and Teenage questionnaire. Correlated conceptually equivalent domains from both questionnaires were identified and their associations with patient and clinical variables …

Vascular Surgery In Pakistan: Critical Issues, Zia Ur Rehman, Ziad Sophie

Department of Surgery Docs

No abstract provided.

An Uncommon Complication During Trans-Aortic Valve Replacement, Sanjeev Nair Md, Yassir Nawaz Md, Nainesh C. Patel Md, David A. Cox Md, William Combs Md, Raymond L. Singer Md, J Patrick Kleaveland Md

Department of Medicine

No abstract provided.

A Comparison Of Angiography Versus Intravascular Ultrasound In The Treatment Of Peripheral Arterial Disease, Michael Pompliano

Senior Theses

Peripheral Arterial Disease is a growing epidemic throughout the United States. It is estimated that 8 to 12 million Americans currently suffer from PAD, a disease of the circulatory system that limits blood flow to your hands and feet. This limited blood flow is due to the narrowing of the arteries that supply blood throughout your body and can disrupt the balance of the nerves and tissues that make up your extremities. If left untreated, it can cause irreparable, life- threatening damage that may result in amputation of the diseased limb. Although the mechanism of PAD is known and well …

"What Happens In Romania..." Comes Back To The United States And Becomes A Quilt, Ashley Ehlers, Kaitlyn Torres

Senior Theses

Our senior thesis project is a quilt that chronicles our experiences on the Maymester trip to Romania through the Honors College, during which we were able to shadow surgeons in the Oncology Hospital and General Surgery III Hospital in Cluj-Napoca. In our quilt, we included some of the most common surgeries we saw while shadowing Romanian doctors: breast removal, gall bladder removal, appendix removal, removal of a section of the large intestine, and removal of the uterus. The final product of this quilt shows every level of the abdominal muscles and organs from the anterior skin to the kidneys.

To …

Kyphotic Progression After Thoracolumbar Burst Fractures Treated Conservatively, With Mis, Or Via Open Approach, Mark Rivkin, Howard Eisenbrock

Research Day

Management of thoracolumbar burst fractures (AO A3) without neurological deficit is subject to debate in the literature. While TLICS provides guidance for injuries necessitating intervention, it makes little mention of best surgical approaches. Furthermore, intact patients with suspected posterior ligamentous complex injury (TLICS 4) compose an additional level of management uncertainty. Present study examined outcomes for TL burst fractures in neurologically intact patients with suspected disruption of the PLC treated with bracing, MIS, or open fixation and fusion.

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

Department of Surgery Updates

A five page newsletter created by the Department of Surgery documenting changes to the department. This issue contains news about students and faculty, a list of important dates, committee meetings, scholarly activity and more.

Roscoe Reid Graham (1890 To 1948): A Canadian Pioneer In General Surgery., Christine C. Piper, Ba, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers-often referred to as the "Graham patch"-he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient's symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy …

Surgical Management Of Pheochromocytoma In A 13-Week Pregnant Woman, Mazhar Ali Memon, Wajahat Aziz, Farhat Abbas

Section of Urology

A 34-year-old 13-week pregnant woman presented with hypertension refractory to medical therapy and on workup was found to have a right adrenal mass. Due to her persistent increased blood pressure she was advised urinary vanillylmandelic acid (VMA) and its level was raised. MRI of the abdomen showed a well-circumcised lesion in the right adrenal of 3.0×2.5 cm suggestive of pheochromocytoma. The patient was started on antihypertensives including α-blockers and β-blockers and planned for right open adrenalectomy. Intraoperatively, blood pressure was raised up to 180/110 mm Hg on slight manipulation of adrenal gland which was controlled with glyceryl-trinitrate and volatile agents. …

Rct Evaluating Safety & Efficacy Of Sodium Hyaluronate/Carboxymethylcellulose At Cesarean Delivery, Daniel G. Kiefer Md, Jolene C. Muscat Md, Jarrett Santorelli Bs, Martin R. Chavez Md, Cande V. Ananth Phd, Mph, John C. Smulian Md, Mph, Anthony M. Vintzileos Md

Department of Obstetrics & Gynecology

No abstract provided.

Culture-Independent Evaluation Of The Appendix And Rectum Microbiomes In Children With And Without Appendicitis, Hope T. Jackson, Emmanuel F. Mongodin, Katherine P. Davenport, Claire M. Fraser, Anthony D. Sandler, Steven L. Zeichner

Surgery Faculty Publications

Purpose

The function of the appendix is largely unknown, but its microbiota likely contributes to function. Alterations in microbiota may contribute to appendicitis, but conventional culture studies have not yielded conclusive information. We conducted a pilot, culture-independent 16S rRNA-based microbiota study of paired appendix and rectal samples.

Methods

We collected appendix and rectal swabs from 21 children undergoing appendectomy, six with normal appendices and fifteen with appendicitis (nine perforated). After DNA extraction, we amplified and sequenced 16S rRNA genes and analyzed sequences using CLoVR. We identified organisms differing in relative abundance using ANOVA (p

Results

We identified 290 taxa in …

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar, Ather Enam

Section of Neurosurgery

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.
Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …

Critical Role Of Tnf-Α In Cerebral Aneurysm Formation And Progression To Rupture., Robert M Starke, Nohra Chalouhi, Md, Pascal Jabbour Md, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Robert H. Rosenwasswer Md, Kosuke Wada, Kenji Shimada, David M Hasan, Nigel H Greig, Gary K Owens, Aaron Dumont

Department of Neurosurgery Faculty Papers

BACKGROUND: Alterations in TNF-α expression have been associated with cerebral aneurysms, but a direct role in formation, progression, and rupture has not been established.

METHODS: Cerebral aneurysms were induced through hypertension and a single stereotactic injection of elastase into the basal cistern in mice. To test the role of TNF-α in aneurysm formation, aneurysms were induced in TNF-α knockout mice and mice pretreated with the synthesized TNF-α inhibitor 3,6'dithiothalidomide (DTH). To assess the role of TNF-α in aneurysm progression and rupture, DTH was started 6 days after aneurysm induction. TNF-α expression was assessed through real-time PCR and immunofluorescence staining.

RESULTS: …

A Novel Parp Inhibitor Resistance Mechanism Mediated By The Rna-Binding Protein Hur, Saswati N. Chand, Nicole Meisner-Kober, Shruti Lal, Charles J. Yeo, Md, Jordan M. Winter, Md, Jonathan R. Brody, Md

Department of Surgery Faculty Papers

Abstract

Pancreatic ductal adenocarcinoma (PDA) is the 4th leading cause of cancer-related deaths in the United States, and ranks as the third most common cancer associated with BRCA mutations, not including Fanconi Anemia gene mutations such as PALB2. Current combinations of chemotherapeutics have significant toxicities and only minimally extend overall patient survival. Poly-ADP ribose polymerase (PARP) inhibitors (PARPi), which target the DNA damage repair (DDR) pathway, have delivered promising preclinical and clinical results. Although synthetic lethality conferred by PARPi is a promising approach, still “selected” patients with DNA repair-deficient tumors (e.g., BRCA2 mutated) that initially respond to such molecular-targeted therapies …

Promoter Hypermethylation Of Tumor Suppressor Genes Correlates With Tumor Grade And Invasiveness In Patients With Urothelial Bladder Cancer, Shumaila M. Bilgrami, Sohail A. Qureshi, Shahid Pervez, Farhat Abbas

Section of Urology

Purpose: To investigate the promoter methylation status at selected loci which encode for key proteins involved in apoptosis, DNA repair, cell cycle control and progression in urothelial cell carcinoma of bladder and compare the findings from tissue samples with that of plasma.
Methods: Total genomic DNA was isolated from 43 non-muscle invasive (low grade) and 33 muscle invasive (high grade) urothelial bladder cancer samples along with 10 control cases of normal bladder mucosa. Promoter methylation status was investigated for RASSF1A, APC, MGMT, CDKN2A and CDKN2B genes using real-time methylation-specific PCR with SYBR® green. Plasma samples from 16 patients with muscle …