Surgery Commons^™

Inhibition Of Lipogenesis Reduces Inflammation And Organ Injury In Sepsis, J. P. Idrovo, W.L. Yang, A. Jacob, L. Corbo, Jeffrey Nicastro, Gene Coppa, P. Wang

Journal Articles

BACKGROUND: Sepsis is a life-threatening acute inflammatory condition associated with metabolic complications. Accumulation of free fatty acids (FFAs) induces inflammation and causes lipotoxic effects in the liver. Because fatty acid metabolism plays a role in the inflammatory response, we hypothesized that the administration of C75, a fatty acid synthase inhibitor, could alleviate the injury caused by sepsis. METHODS: Male mice were subjected to sepsis by cecal ligation and puncture (CLP). At 4 h after CLP, different doses of C75 (1- or 5-mg/kg body weight) or vehicle (20% dimethyl sulfoxide in saline) were injected intraperitoneally. Blood and liver tissues were collected …

Inhibition Of Fatty Acid Synthase With C75 Decreases Organ Injury After Hemorrhagic Shock, M. Kuncewitch, W.L. Yang, A. Jacob, A. Khader, M. Giangola, J. Nicastro, G.F. Coppa, P. Wang

Journal Articles

BACKGROUND: Hemorrhagic shock is the primary cause of morbidity and mortality in the intensive care units in patients under the age of 35. Several organs, including the lungs, are seriously affected by hemorrhagic shock and inadequate resuscitation. Excess free fatty acids have shown to trigger inflammation in various disease conditions. C75 is a small compound that inhibits fatty acid synthase, a key enzyme in the control of fatty acid metabolism that also stimulates fatty acid oxidation. We hypothesized that C75 treatment would be protective against hemorrhagic shock. METHODS: Adult male Sprague-Dawley rats were cannulated with a femoral artery catheter and …

Type Vi Choledochal Cyst—An Unusual Presentation Of Jaundice, L. Nambiar, E. Siskind, A. W. Shen, C. Fan, G. Grimaldi, C. Choy, J. Madariaga, J. Nicastro, E. P. Molmenti, G. Coppa, +1 Additional Author

Journal Articles

No abstract provided.

Combined Endoscopic And Laparoscopic Management Of Postcholecystectomy Mirizzi Syndrome From A Remnant Cystic Duct Stone: Case Report And Review Of The Literature, Arpit Amin, Yuriy Zhurov, George Ibrahim, Anthony Maffei, Jonathan Giannone, Thomas Cerabona, Ashutosh Kaul

NYMC Faculty Publications

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant …

Outcomes In Patients With Vestibular Schwannoma After Subtotal Resection And Adjuvant Radiosurgery, H. Radwan, M. Bruce Eisenberg, J. P. S. Knisely, M. M. Ghaly, M. Schulder

Journal Articles

No abstract provided.

Pericardiocentesis Followed By Thoracotomy And Repair Of Penetrating Cardiac Injury Caused By Nail Gun Injury To The Heart, Vasu Chirumamilla, Kartik Prabhakaran, Patrizio Petrone, John A. Savino, Corrado Marini, Zobair Zoha

NYMC Faculty Publications

INTRODUCTION: Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate.

PRESENTATION OF CASE: A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. The patient was hypotensive, tachycardic with prominent jugular venous distention, and had a profound lactic acidosis. Bedside ultrasound confirmed the presence of pericardial fluid. Pericardiocentesis was performed twice using a central venous catheter inserted into the pericardial space, resulting in improvement in the patient's hemodynamics. Thereafter he underwent left anterolateral thoracotomy …

Differential Protein Expression In Small Intestinal Neuroendocrine Tumors And Liver Metastases, M. K. Kim, F. Ye, D. Wang, M. Cui, S. C. Ward, R. R. Warner, S. Roayaie, M. Schwartz, D. Zhang, S. Itzkowitz, +1 Additional Author

Journal Articles

OBJECTIVE: Small intestinal neuroendocrine tumors (SI-NETs) are often detected after they have become metastatic. Using a novel protein array, we identified pathways important in SI-NET metastasis development in surgically resected patients. METHODS: Paired primary tumors and liver metastases from 25 patients undergoing surgical resection for metastatic SI-NETs were harvested. Extracted proteins were separated by sodium dodecyl sulfate gel and multiplex immunoblots were performed with 136 antibodies. Significant Analysis of Microarray was used to select for differentially expressed proteins. A tissue microarray was constructed from 27 archived specimens and stained by immunohistochemistry. RESULTS: Comparing primary SI-NETs with matched normal small-bowel mucosa, …

Key Perspectives On Auditory Outcomes Following Radiosurgery For Vestibular Schwannoma, Tumor Treating Fields For Glioblastoma, And A Proposed Myelopathy Score For Cervical Decompression Surgery, Intracranial Pressure Monitoring In Diffuse Traumatic Brain Injury., Jonathan H. Sherman, Gordon Li, Jin Mo Cho, Winward Choy, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

The Anatomy Of Nursing Interruptions: Who-What-When-Where, Pratik J. Parikh, Nicole Craker, Robert A. Myers, Jessy M. Eid, Priti Parikh, Kathy Zink, Mary C. Mccarthy

Department of Surgery Faculty Publications

Although interruptions experienced by nurses during intensive care have been indicated to affect patient safety, not much is known regarding the complex situations that drive interruptions to eventually aid in intervention design and implementation.

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

Minimally Invasive Surgery In Pediatric Trauma: One Institution's 20-Year Experience, Gustavo Stringel, Min Li Xu, Joseph Lopez

NYMC Faculty Publications

BACKGROUND: Minimally invasive surgery (MIS) for trauma in pediatric cases remains controversial. Recent studies have shown the validity of using minimally invasive techniques to decrease the rate of negative and nontherapeutic laparotomy and thoracotomy. The purpose of this study was to evaluate the diagnostic accuracy and therapeutic options of MIS in pediatric trauma at a level I pediatric trauma center.

METHODS: We reviewed cases of patients aged 15 years and younger who had undergone laparoscopy or thoracoscopy for trauma in our institution over the past 20 years. Each case was evaluated for mechanism of injury, computed tomographic (CT) scan findings, …

On The Dead End Of Current Research On Burnout's Prevalence, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Dimou et al. (2016) concluded that >50% of surgeons experience burnout. For three reasons, we think that such conclusions are unwarranted. First, there are no consensual or binding diagnostic criteria for burnout. Second, recent research (e.g., Bianchi, Schonfeld, & Laurent, 2015) suggests that burnout is actually a depressive syndrome. Finally, we note that researchers’ recommendations about stress-reducing organizational changes often remain incantatory because they insufficiently consider the economic issues and macrosocial power relationships that can hamper the recommendations’ implementation. Current practices in burnout research have led to an accumulation of results, the clinical meaning of which is obscure.

Application Of Medical Student Research Objectives In An International Medical Elective: Voluntary Medical Male Circumcision In Swaziland, Alison M. Bales, David J. Dennis, Robert C. Siska, Michael A. Schneider, Echo Vanderwal, Harry Vanderwal, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Neurosurgery Concepts: Key Perspectives On Intrathecal Fluorescein For Detecting Intraoperative Cerebrospinal Fluid Leak During Endoscopic Endonasal Surgery, Spinal Intraarterial Chemotherapy, Oligoastrocytoma Classification By In Situ Molecular Genetics, And Prenatal Myelomeningocele Closure And The Need For Cerebrospinal Fluid Shunt Placement., Anand V Germanwala, Winward Choy, Jonathan H. Sherman, Sandi Lam, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Preoperative Incidence Of Penile Abnormalities Found During Voluntary Male Medical Circumcision In Swaziland, Anthony R. Oddo, Elizabeth Ruedrich, Christopher Zust, Lindsey Marugg, Echo Vanderwal, Rebekah Sartori, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Pyoderma Gangrenosum Following Bilateral Deep Inferior Epigastric Perforator Flaps, Eric Clayman, Kristen Marcet, Lauren Kuykendall, Dunya M. Atisha

Surgery Faculty Publications

Pyoderma gangrenosum (PG) is an atypical ulcerative cutaneous condition, with an estimated six cases per million people per year in the United States.[1] One-half of patients have idiopathic disease, and it is most commonly associated with underlying systemic inflammatory conditions or hematologic malignancies.[1] [2] There have been several reported cases of PG following breast reduction procedures; however, postsurgical PG (PSPG) is rarely seen following autologous tissue breast reconstruction.[3]

In this article, the authors report the clinical course, treatment, and outcome of a patient diagnosed with PSPG following a delayed breast reconstruction with …

Is Therapeutic Play Effective At Reducing Preoperative Anxiety In Children Age 4 Through 12?, Samantha L. Mclaughlin

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not therapeutic play is effective at reducing preoperative anxiety in children age 4 through 12.

STUDY DESIGN: Three single blind, randomized controlled trials that were published between 2008 and 2010 and published in the English language.

DATA SOURCES: Each of the three studies that evaluate the effectiveness of therapeutic play in pediatric populations were found using the PubMed database based on their relevance to the clinical question and their inclusion of patient oriented outcomes.

OUTCOMES MEASURED: These three articles compared anxiety and stress levels in preoperative therapeutic …

Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta …

The Role Of Fat Grafting And Adipose-Derived Stem Cells In Breast Reconstruction, Krishna S. Vyas

Theses and Dissertations--Clinical and Translational Science

Fat grafting is a common surgical procedure that involves the transfer of fat from one area of the body to another in order to improve contour deformities, such as in breast reconstruction. Advantages of the technique include using autologous tissue rather than a foreign body and the added benefit of having liposuction to remove fat from an undesirable location. Although adipose tissue could be the ideal soft tissue filler, fat grafting is plagued by tremendous variability in long-term retention, with volume survival rates of 20-80%, resulting in suboptimal outcomes and repetitive procedures.

The mechanisms contributing to long-term fat graft survival …

The Impact Of The Introduction Of The Pecarn Head Ct Rules On The Utilisation Of Head Ct Scans For Children With Mild Head Injury At The Aga Khan University Hospital, Nairobi., Isaac Oluoch Kobe

Master of Medicine in General Surgery

Background: Head injury is the most common cause of childhood morbidity and mortality worldwide. Mild head injury comprises 90% of cases of head injury in children. Head CT scans are few, expensive and have the side effect of ionizing radiation whose effect is potentiated in children and also associated risk of sedation that is often required when doing CT scans in young children. The decision to order CT scans of the head is thus made on the basis of clinical decision rules of which the PECARN CT head rule has been found to be most sensitive and useful. Objectives: Primary: …

Successful Management Of A Stab Wound To The Left Ventricle, Jaleed Ahmad Gillani, Hamza Ar Khan, Omar Irfan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein …

Myxoid Liposarcoma Originating In The Anterior Mediastinum, Mohammad Harisullah Khan, Ramsha Kashif, Hamza Abdur Rahim Khan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Myxoidliposarcomas ofthe head and neck aremostly metastaticin nature, with the primarylesion usually in lower extremities or retroperitoneum. Primary mediastinal liposarcomas are even rare Although there have been previous cases reporting their incidence, there is no evidence of any case comprising of both the neck and the mediastinal region yet. We here present a case of a 43 year old male with a primary liposarcoma of the myxoid subtype originating in the anterior mediastinumThis is the first time such a case haspres ented in literature. The patient presented with a right sided neck swelling associated with pain and shortness of breath …

Diagnostic Accuracy Of Ct Scan In Staging Resectable Esophageal Cancer, Rizwan Sultan, Zishan Haider, Tabish Chawla

Department of Surgery Docs

Abstract

INTRODUCTION:

CT scan is an important tool in staging of esophageal cancer. Survival can be improved by providing neoadjuvant treatment which depends on stage of esophageal cancer. So it is very important to stage the disease accurately.

METHODS:

The objective of this study is to determine diagnostic accuracy of CT scan to stage esophageal cancer. Ct scans of 62 patients included in the study were reviewed by a Consultant radiologist who was blinded to the final stage of tumour. Diagnosticaccuracy measured by comparing with histopathological staging.

RESULTS:

Accuracy, sensitivity and specificity of CT for T2 and T3 are 66%, …

A Microfluidic-Based Tactile Sensor For Palpating Mice Tumor Tissues, Yichao Yang, Garett Johnson, Dean Krusienski, Siqi Guo, Cheng Lin, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

In light of the need of tissue palpation for Robotics-assisted Minimally Invasive Surgery (RMIS), this paper presents a microfluidic-based tactile sensor for palpating mice tissues for tumor localization. The core of the sensor is a 3x3 sensing-plate/transducer array built into a single polydimethylsiloxane (PDMS) microstructure, with a transducer spacing of 3.75mmx1.5mm. Mounted on a robot, the sensor is pressed against a tissue region with a pre-defined indentation depth pattern, and consequently the stiffness distribution across the tissue region translates to the deflection distribution of the sensing-plate array and is captured by the transducer array underneath as resistance changes. Thus, the …

T-Tube Placement As A Method For Treating Penetrating Oesophageal Injuries, Roger Gill, K. M. Inam Pal, Fatima Mannan, Amber Bawa, Saulat H. Fatimi

Department of Surgery Docs

Introduction: Penetrating oesophageal injuries are extremely rare. Their timely recognition can be difficult and optimal treatment remains controversial. Early recognition of injury is possible with the help of a high index of suspicion and early radiological and endoscopic examinations. Prompt surgical intervention with primary repair of injury, should be the goal.
Presentation of cases: We describe two cases of penetrating oesophageal trauma where T-Tube placement through the oesophageal defect, was successfully employed. Both cases proved to be challenging due to time lapse after injury and anatomical location.
Discussion: Penetrating injuries to the Oesophagus are rare with a reported …

Artificial Disc Replacement As An Alternative To Lumbar Spinal Function In The Treatment Of Chronic Low Back Pain, Jennifer Polniak

Physician Assistant Scholarly Project Posters

Chronic low back pain leads to activity limitations for the patient and widespread burdens on health care systems. Lumbar fusion has been the “gold standard” surgery for severe chronic low back pain non-responsive to conservative treatment, however it has been associated with continued limitations in spinal mobility. This study was executed in order to compare an alternative surgical intervention, artificial disc replacement, with lumbar spinal fusion in the treatment of chronic low back pain in terms of long term spinal function. Literature searches of trials, guidelines and systematic reviews within the past 5 years were completed exploring surgical procedures, associated …

An Unusual Case Of Cauda Equina Secondary To Spinal Metastasis Of Thyroid Cancer, Shabbir Akhtar, Mohammad Adeel

Department of Surgery Docs

Abstract

INTRODUCTION:

Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.

CASE REPORT:

We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of …