Surgery Commons^™

Are We Doing It For The Money? A Salary Survey Of The United States Surgical Program Directors, Alexander Hoey, Ba, Brian Hoey, Md, Stanislaw Stawicki, Md

Phase 1

Compensation packages and job responsibilities for United States surgical program directors (PD) vary considerably from one institution to the next. With limited compensation data available for PD’s, this survey reassesses and compares the salaries, benefits, duties, and contract arrangements of all allopathic U.S. surgical PDs. Questionnaires regarding these areas of interest were mailed out electronically to all of the PDs and data was compared between the individuals’ responses using Chi-Squared and Fischer Exact Tests. Fifty-five percent of the PDs responded, revealing significant variation in total compensation packages, size of the dedicated stipend for the role, and time spent on clinical …

The Pathway To Low Outlier Status In Venous Thromboembolism Events: An Analysis Of Pancreatic Surgery In Acs Nsqip, Samantha L. Savitch, Tyler M. Bauer, Nikosi H. Alvarez, Adam P. Johnson, Theresa P. Yeo, Harish Lavu, Charles J. Yeo, Jordan M. Winter, Geno J. Merli, Scott W. Cowan

Phase 1

Introduction: Our institution’s hepatopancreaticobiliary service (HPBS) is a high-volume pancreatic surgery service, which has demonstrated consistently low rates of symptomatic venous thromboembolism (VTE) compared to similar institutions as reported by NSQIP. We sought to determine if the HPBS’s regimented multimodal VTE prophylaxis pathway plays a role in achieving consistently low VTE rates.

Methods: We queried the ACS NSQIP Participant User File and our institution’s data from 2011-2016 for major pancreatic operations. We used Chi-squared analysis to compare the HPBS and national patient populations, and created a matched dataset based on preoperative patient factors. Univariate and multivariate analyses were performed on …

Assessing The Operative Log Data Of Traditional (5+2) Vs. Integrated (0+5) Vascular Training Programs, Ernest Gillan, Bs, Anthony Feghali, Md, Tuong Nguyen, Md, Dawn Salvatore, Md, Paul Dimuzio, Md, Babak Abai, Md

Phase 1

Introduction: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program. Operative experience can be used as a surrogate marker for success in the evolving field of vascular surgery training.

Objective: The purpose of this study is to compare the operative experience of those graduating from the traditional (5+2) vascular training program with the integrated (0+5) program.

Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2018. Mean case numbers were compared between integrated vascular residents and traditional …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Low Cost Reconstructive Options After Musculoskeletal Tumour Resection In Developing Countries: Affordable, Effective And Durable Alternatives, Arif Ali, Obada Hasan, Ahmed Habib, Masood Umer

Section of Orthopaedic Surgery

Over the last two, three decades, the overall survival rates for non-metastatic malignant tumours of the bone have dramatically improved. This has become possible due to the recent advances and multidisciplinary approach towards these diseases, specifically the advent of multi-agent chemotherapy and radiotherapy. Limb salvage has now become the norm in the treatment of musculoskeletal tumours without compromising on the overall survival and recurrence of the disease. In the era of metal, prosthetic reconstruction has become the standard procedure specifically in the large tumours which involve the joints as this method of reconstruction helps in joint mobility and early weight-bearing. …

Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …

Transcatheter Arterial Embolization Versus Surgery For Refractory Non-Variceal Upper Gastrointestinal Bleeding: A Meta-Analysis., Antonio Tarasconi, Gian Luca Baiocchi, Vittoria Pattonieri, Gennaro Perrone, Hariscine Keng Abongwa, Sarah Molfino, Nazario Portolani, Massimo Sartelli, Salomone Di Saverio, Arianna Heyer, Luca Ansaloni, Federico Coccolini, Fausto Catena

Student Papers, Posters & Projects

Background: Nowadays, very few patients with non-variceal upper gastrointestinal bleeding fail endoscopic hemostasis (refractory NVUGIB). This subset of patients poses a clinical dilemma: should they be operated on or referred to transcatheter arterial embolization (TAE)?

Objectives: To carry out a systematic review of the literature and to perform a meta-analysis of studies that directly compare TAE and surgery in patients with refractory NVUGIB.

Materials and methods: We searched PubMed, Ovid MEDLINE, and Embase. A combination of the MeSH terms "gastrointestinal bleeding"; "gastrointestinal hemorrhage"; "embolization"; "embolization, therapeutic"; and "surgery" were used (("gastrointestinal bleeding" or "gastrointestinal hemorrhage") and ("embolization" or "embolization, therapeutic") …

The Insula And Its Epilepsies, Barbara C. Jobst, Jorge Gonzalez-Martinez, Jean Isnard, Philippe Kahane, Nuria Lacuey, Samden D. Lahtoo, Dang K. Nguyen, Chengyuan Wu, Fred Lado

Department of Neurosurgery Faculty Papers

Insular seizures are great mimickers of seizures originating elsewhere in the brain. The insula is a highly connected brain structure. Seizures may only become clinically evident after ictal activity propagates out of the insula with semiology that reflects the propagation pattern. Insular seizures with perisylvian spread, for example, manifest first as throat constriction, followed next by perioral and hemisensory symptoms, and then by unilateral motor symptoms. On the other hand, insular seizures may spread instead to the temporal and frontal lobes and present like seizures originating from these regions. Due to the location of the insula deep in the brain, …

Patient Perceptions Of Planned Organ Removal During Hysterectomy, Zeinab Kassem, Chad M. Coleman, Andrew S. Bossick, Wan-Ting Su, Roopina Sangha, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women’s self-reported expectations of how they think their anatomy will change after hysterectomy.

Methods: Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups.

Results: Most of the 456 study participants (mean age: …

Diffusion-Weighted Magnetic Resonance Imaging May Be Useful In Differentiating Fungal Abscess From Malignant Intracranial Lesion: Case Report, Syeda Maheen Batool, Fatima Mubarak, Ather Enam

Section of Neurosurgery

Background: Diffusion-weighted magnetic resonance has a well-defined role in differentiating between important intracranial lesions. Sometimes, the surgeon is faced with a dilemma of how to diagnose an infectious versus malignant lesion.
Case Description: A 28-year-old male presented to the neurosurgery clinic with complaints of headache and left-sided weakness for 2 weeks. Neurological examination was intact. Magnetic resonance imaging (MRI) scan showed a large infiltrating heterogeneous mass involving the right parietal lobe. On further reviewing, there was homogenous diffusion restriction in the center of lesion. In addition, its aggressive behavior confirmed it to be a fungal abscess.
Conclusions: Correctly identifying an …

Hemispheric Regional Based Analysis Of Diffusion Tensor Imaging And Diffusion Tensor Tractography In Patients With Temporal Lobe Epilepsy And Correlation With Patient Outcomes., Mahdi Alizadeh, Lauren Kozlowski, Jennifer Muller, Neha Ashraf, Shiva Shahrampour, Feroze B. Mohamed, Chengyuan Wu, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Imaging in the field of epilepsy surgery remains an essential tool in terms of its ability to identify regions where the seizure focus might present as a resectable area. However, in many instances, an obvious structural abnormality is not visualized. This has created the opportunity for new approaches and imaging innovation in the field of epilepsy, such as with Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT). In this study, we aim to evaluate the use of DTI and DTT as a predictive model in the field of epilepsy, specifically Temporal Lobe Epilepsy (TLE), and correlate their clinical significance …

Functional And Structural Studies Of Tolloid-Like 1 Mutants Associated With Atrial-Septal Defect 6., Lukasz Sieron, Marta Lesiak, Izabela Schisler, Zofia Drzazga, Andrzej Fertala, Aleksander L. Sieron

Department of Orthopaedic Surgery Faculty Papers

Inactive mammalian tolloid-like 1 (tll1) and mutations detected in tolloid-like 1 (TLL1) have been linked to the lack of the heart septa formation in mice and to a similar human inborn condition called atrial-septal defect 6 (ASD6; OMIM 613087, formerly ASD II). Previously, we reported four point mutations in TLL1 found in approximately 20% of ASD6 patients. Three mutations in the coding sequence were M182L, V238A, and I629V. In this work, we present the effects of these mutations on TLL1 function. Three recombinant cDNA constructs carrying the mutations and one wild-type construct were prepared and then expressed in HT-1080 cells. …

Correction To: Sequencing And Curation Strategies For Identifying Candidate Glioblastoma Treatments (Vol 12, 56, 2019), M. O. Frank, T. Koyama, K. Rhrissorrakrai, N. Robine, F. Utro, A. Emde, B. Chen, J. Boockvar, A. Demopoulos, R. B. Darnell, +39 Additional Authors

Journal Articles

No abstract provided.

An Iliac-Appendiceal Fistula Causing Gastrointestinal Bleeding, S. D. Gurien, A. Stright, M. Garuthara, J. D. Klein, M. Rosca

Journal Articles

© 2019 The Authors Aortoenteric fistulas are an uncommon cause of gastrointestinal bleeding, and iliac-appendiceal fistulas are an even rarer cause. We describe a case of an iliac-appendiceal fistula in a patient who presented several months after aortic reconstruction with gastrointestinal bleeding. An extensive workup revealed that the source of bleeding was localized to the appendiceal orifice. The patient underwent an appendectomy with a two-stage procedure involving the iliac graft for definitive repair and ultimately recovered well. Despite the rarity of aortoenteric and iliac-appendiceal fistulas causing gastrointestinal bleeding, keeping a high index of suspicion in patients with a prior vascular …

Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment For Skin Laxity, E. Dayan, C. Chia, A. J. Burns, S. Theodorou

Journal Articles

© 2019 Oxford University Press. All rights reserved. Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not severe enough to justify an excisional procedure, but not mild enough to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional …

How Many Lymph Nodes Are Enough? Assessing The Adequacy Of Lymph Node Yield For Staging In Favorable Histology Wilms Tumor, A. F. Saltzman, D. E. Smith, D. Gao, D. Ghosh, A. Amini, J. H. Aldrink, R. Dasgupta, K. W. Gow, R. D. Glick, N. G. Cost, +1 Additional Author

Journal Articles

© 2019 Elsevier Inc. Purpose: Current investigational priorities in the treatment of favorable histology Wilms tumor (FHWT) center on accurate staging and risk-stratification. The extent of lymph node (LN) sampling has not been clearly defined; its importance cannot be overstated as it guides adjuvant therapy. The identification of a minimum LN yield to minimize the risk of harboring occult metastatic disease could help development of surgical guidelines. This study focuses on using the beta-binomial distribution to estimate the risk of occult metastatic disease in patients with FHWT. Materials & methods: The National Cancer Database was queried for patients with unilateral …

Anti-Human Interleukin(Il)-4 Clone 8d4-8 Cross-Reacts With Myosin-9 Associated With Apoptotic Cells And Should Not Be Used For Flow Cytometry Applications Querying Il-4 Expression, Robert Z. Harms, Kiana Borengasser, Vikas Kumar, Nora Sarvetnick

Journal Articles: Surgery

Interleukin(IL)-4 is produced by T cells and other leukocytes and is a critical mediator of monocyte and B cell responses. During routine flow cytometry panel validation for the investigation of intracellular cytokines, we observed unique IL-4 expression patterns associated with the widely available monoclonal antibody 8D4-8. Namely, IL-4 (8D4-8) expression was observed in the absence of cellular activation and enhanced following staurosporine exposure. Mass spectrometry analysis of immunoprecipitates from peripheral blood lymphocytes (PBL) revealed that 8D4-8 cross-reacts with the ubiquitous cytoskeletal protein myosin-9. We confirmed these results by western blotting immunoprecipitates, using immunofluorescence among staurosporine-treated Caco-2 cells, and by surface-labeling …

Use Of Endoloop In Video-Assisted Thoracoscopic Enucleation Of A Very Rare Esophageal Tumor, Yahya Alwatari, Wayne Tse, Kasia Trebska-Mcgowan, Rachit D. Shah

Surgery Publications

A gastrointestinal stromal tumor is an infrequent tumor of the gastrointestinal tract with very rare involvement of the esophagus. We present a case of a patient with dysphagia and a 4 cm submucosal mass. The patient underwent thoracoscopic enucleation with complete resection of the mass. We present case details and operative video highlighting the important surgical steps of exposure and retraction. We believe that the Endoloop is a very useful tool in providing countertraction needed during minimally invasive resection of such lesions.

Traumatic Bladder Ruptures: A Ten-Year Review At A Level 1 Trauma Center, John Barnard, Tyler Overholt, Ali Hajiran, Chad Crigger, Morris Jessop, Jennifer Knight, Chad Morley

Faculty & Staff Scholarship

Abstract

Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. The present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder …

Unusual Presentation Of Recurrent Gallstone Ileus: A Case Report And Literature Review, Osayande Osagiede, Paula Pacurari, Dorin Colibaseanu, Nezar Jrebi

Faculty & Staff Scholarship

Background. Gallstone ileus (GSI) is a rare form of small bowel obstruction (SBO) in patients with cholelithiasis, which is often poorly managed. Enhanced abdominal computed tomography (CT) with contrast is considered the most helpful diagnostic tool, as it is highly sensitive, specific, and accurate. We report an interesting case of recurrent GSI that was not detected by CT but diagnosed intraoperatively. Case Presentation. A 49-year-old female with a previous history of choledocholithiasis and ERCP presented to the emergency department following episodes of sudden cramping, epigastric pain, and nausea. An abdominal CT revealed evidence of SBO with clear evidence of GSI …

Long-Term Effectiveness Of Balloon Catheter Sinuplasty In Pediatric Chronic Maxillary Sinusitis, Habib G. Zalxal, Chadi A. Makary, Hassan Ramadan

Faculty & Staff Scholarship

The objective of our study was to assess the long-term effectiveness of balloon catheter sinuplasty in the treatment of pediatric chronic maxillary sinusitis following failed first-line medical and surgical management with adenoidectomy. Pediatric patients younger than 12 years were reviewed for having failed previous adenoidectomy and undergone a balloon catheter sinuplasty between August 2006 and March 2011 for chronic rhinosinusitis. Demographic data and clinical characteristics were recorded in patients who met inclusion criteria. Outcomes were assessed by need for functional endoscopic sinus surgery and persistence of chronic infection within at least 5 years of follow-up. Failure was defined by any …

Modeling Human Cancer-Induced Cachexia, Erin E. Talbert, Maria C. Cuitin˜ O, Katherine J. Ladner, Priyani V. Rajasekerea, Melissa Siebert, Reena Shakya, Gustavo W. Leone, Michael C. Ostrowski, Brain Paleo, Noah Weisleder, Peter J. Reiser, Amy Webb, Cynthia D. Timmers, Daniel S. Eiferman, David C. Evans, Mary E. Dilhoff, Carl R. Schmidt

Faculty & Staff Scholarship

Talbert et al. developed an inducible mouse model of cachexia caused by pancreatic cancer. This model exhibits features of the human condition, including the progressive depletion of muscle and adipose tissue associated with tumor progression.

First Series Of Minimally Invasive, Robot-Assisted Tracheobronchoplasty With Mesh For Severe Tracheobronchomalacia, R. Lazzaro, B. Patton, P. Lee, J. Karp, E. Mihelis, S. Vatsia, S. J. Scheinerman

Journal Articles

No abstract provided.

Single-Direction Thoracoscopic Lobectomy: A Step In The Right Direction, J. S. Young, P. C. Lee

Journal Articles

No abstract provided.

Predictors And Impact Of Right Heart Failure Severity Following Left Ventricular Assist Device Implantation, R. D. Baxter, K. M. Tecson, S. Still, J. D. G. Collier, J. Felius, S. M. Joseph, S. A. Hall, B. Lima

Journal Articles

No abstract provided.

Incidence Of Acute Kidney Injury In Patients With Chronic Renal Insufficiency: Transcatheter Versus Surgical Aortic Valve Replacement, M. Catalano, D. Lin, H. Cassiere, N. Kohn, B. Rutkin, G. Maurer, J. A. Berg, R. Esposito, A. Hartman, P. Yu, +1 Additional Author

Journal Articles

No abstract provided.

Robotic Sleeve Resections: New Territory But Not The Final Frontier, B. D. Patton

Journal Articles

No abstract provided.

Consensus Statement From The International Consensus Meeting On The Role Of Decompressive Craniectomy In The Management Of Traumatic Brain Injury: Consensus Statement, P. J. Hutchinson, A. G. Kolias, T. Tajsic, A. Adeleye, A. T. Aklilu, T. Apriawan, A. H. Bajamal, E. J. Barthelemy, J. S. Ullman, F. Servadei, +41 Additional Authors

Journal Articles

No abstract provided.

Cold-Inducible Rna-Binding Protein Induces Neutrophil Extracellular Traps In The Lungs During Sepsis, Y. Ode, M. Aziz, H. Jin, A. Arif, J. G. Nicastro, P. Wang

Journal Articles

No abstract provided.

Extracellular Cold Inducible Rna-Binding Protein Mediates Binge Alcohol-Induced Brain Hypoactivity And Impaired Cognition In Mice, A. Jacob, Y. Ma, E. Nasiri, M. Ochani, J. Carrion, S. Peng, M. Brenner, P. T. Huerta, P. Wang

Journal Articles

No abstract provided.