Surgery Commons^™

A Prospective Study Of Patterns Of Regret In The Year After Hysterectomy, Roopina Sangha, Andrew Bossick, Wan-Ting K. Su, Chad Coleman, Neha Chavali, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: This study sought to identify patterns of self-reported regret after hysterectomy.

Methods: Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes.

Results: Three latent …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Bioactivating A Bone Substitute Accelerates Graft Incorporation In A Murine Model Of Vertical Ridge Augmentation, Jinlong Chen, Xue Yuan, Zhijun Li, Daniel J Bahat, Jill A Helms

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: Compared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process.

METHODS: Wild-type and transgenic Wnt "reporter" mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin …

Osseous Changes Following Reverse Total Shoulder Arthroplasty Combined With Latissimus Dorsi Transfer: A Case Series, Jason S Klein, Peter S Johnston, Benjamin W Sears, Manan S Patel, Armodios M Hatzidakis, Mark D. Lazarus

Department of Orthopaedic Surgery Faculty Papers

Background: This is the first report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT).

Methods: A multicenter, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012 and 2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications, and need for revision surgery.

Results: Twenty-four patients were included with an average age of 70.7 ± 7.9 years and follow-up of 16.3 (3-50) months. Ten patients …

Outcomes And Management Approaches Of Resuscitative Endovascular Balloon Occlusion Of The Aorta Based On The Income Of Countries, Ramiro Manzano-Nunez, David Mcgreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Aast-Aorta Investigators And The Abotrauma Registry Group

Department of Surgery Faculty Publications

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and …

Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya

The VAD Journal

The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system consists of an internal integrated controller, a battery coupled with an internal thoracic coil ring, and the LVAD pump. External equipment includes a power transmission …

Angiotensin Inhibition And Gastrointestinal Bleeding Prevention In Patients With Left Ventricular Assist Devices, Phillip A. Weeks

The VAD Journal

Gastrointestinal bleeding remains a common complication in advanced heart failure patients following implantation of continuous-flow left ventricular assist devices. While the cause is likely multifactorial, development of arterial venous malformations in the gastrointestinal mucosa are a key factor. Inhibition of angiotensin II activity has been postulated to disrupt the signaling that promotes angiogenesis in these patients. We aim to review the theoretical basis for angiotensin receptor blockade, which has been proposed and explore the published evidence regarding this therapy and gastrointestinal bleeding in LVAD patients.

Management Of Early Rectal Cancer: Current Practice And Future, Bhavani Mothe, Hasnain Zafar, Shakil Ahmed

Section of General Surgery

Early rectal cancer management includes tumour stages TiS, T1 and some selected T2 lesions that undergo appropriate clinical pre-operatie evaluation. Local excision of these lesions with acceptable recurrence rate can be achieved through various transanal endoscopic techniques like transanal endoscopic microsurgery (TEM) and transanal minimal invasive surgery (TAMIS) that are superior to simple transanal excision (TAE). The current literature review was planned to present the oncological evaluation of local excision in the context of available evidence. An overview of perioperative adjuvant therapies employed along with local excision is presented, with an update on the latest trials.

Surgical Outcomes Of Intramedullary Spinal Cord Ependymomas, Ummey Hani, Muhammad Waqas Saeed Baqai, Muhammad Shahzad Shamim

Section of Neurosurgery

Intramedullary Spinal Cord Ependymomas (ISCE) are uncommon pathologies that need to be aggressively managed before clinical deterioration sets in. Novel application of different therapeutic strategies is being assessed for improving long-term outcomes in patients presenting with these rare neoplasms. In this review, we have discussed the existing literature on ISCEs, and the role of surgery in determining outcomes in terms of neurological status, progression-free survival (PFS) and overall survival (OS).

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes., Eric O Klineberg, Peter G Passias, Gregory W Poorman, Cyrus M Jalai, Abiola Atanda, Nancy Worley, Samantha Horn, Daniel M Sciubba, D Kojo Hamilton, Douglas C Burton, Munish Chandra Gupta, Justin S Smith, Alexandra Soroceanu, Robert A Hart, Brian Neuman, Christopher P Ames, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

STUDY DESIGN: Retrospective review of prospective database.

OBJECTIVE: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.

METHODS: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 >weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], …

Nipple Sparing Mastectomy: A Review Of Outcomes At A 1 Single Institution, Steven Woodward, Md, Alliric Willis, Melissa Lazar, Adam C. Berger, Theodore Tsangaris

Department of Surgery Faculty Papers

Introduction

Nipple sparing mastectomy (NSM) offers patients who are not candidates for breast conserving treatment an aesthetically pleasing alternative to traditional mastectomy. Some studies have demonstrated its oncologic safety while others have demonstrated residual occult tumor cells at the nipple areolar complex (NAC). These data prompt further review of oncologic outcomes after NSM.

Methods

A single institution retrospective chart review of all NSMs performed by 4 breast surgeons at Thomas Jefferson University Hospital over a span of 2012-2019. In this cohort we review the reconstruction performed, axillary lymph node status, surgical margins, final pathology, loss of the NAC, recurrence rates, …

Ruptured Mycotic Reverse Saphenous Vein Graft Aneurysm: A Late Complication Of Mediastinitis, Yasir Bilal Khan, Shiraz Hashmi, Saulat Hasnain Fatimi

Section of Cardiothoracic Surgery

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as …

Cardioplastic Approach To Omental Flap Coverage For Severe Aortic Root Infections In The Opioid Era, Alisha R. Bonaroti, R. Wesley Edmunds, Ryan C. Decoster, James Y. Liau, Michael E. Sekela, Henry C. Vasconez

Surgery Faculty Publications

Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four …

From Leads To Leadless: A Convoluted Journey, Vipin Dulam, Joshua M. Cooper, Chethan Gangireddy, Mohammed A. Kashem, Yoshiya Toyoda, Suresh Keshavamurthy

Surgery Faculty Publications

No abstract provided.

Role Of Fine Needle Aspiration Cytology In The Diagnosis Of Parotid Gland Tumors: Analysis Of 193 Cases, Rahim Dhanani, Haissan Iftikhar, Mohammad Sohail Awan, Nida Zahid, Sehrish Nizar Ali Momin

Section of Otolaryngology, Head & Neck Surgery

Introduction: Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings.
Objective: To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the …

Orthopedic Principles To Facilitate Enhanced Recovery After Cardiac Surgery, Marc W Gerdisch, Keith B Allen, Yoshifumi Naka, Mark R Bonnell, Kevin P Landolfo, John Grehan, Kendra J Grubb, David J Cohen, T. Sloane Guy, Nirav C Patel, Vinod H Thourani

Department of Surgery Faculty Papers

Enhanced recovery after surgery (ERAS) protocols recognize early postoperative mobilization as a driver of faster postoperative recovery, return to normal activities, and improved long-term patient outcomes. For patients undergoing open cardiac surgery, an opportunity for facilitating earlier mobilization and a return to normal activity lies in the use of improved techniques to stabilize the sternal osteotomy. By following the key orthopedic principles of approximation, compression, and rigid fixation, a more nuanced approach to sternal precaution protocols is possible, which may enable earlier patient mobilization, physical rehabilitation, and recovery.

Sirolimus For Kaposiform Hemangioendothelioma And Kasabach-Merritt Phenomenon In A Neonate, Trevor B Cabrera, Allison L Speer, Matthew R Greives, Donna A Goff, Neethu M Menon, Eric W Reynolds

Faculty, Staff and Student Publications

We present a case of a neonate born with kaposiform hemangioendothelioma (KHE), complicated by Kasabach-Merritt phenomenon (KMP) and other serious conditions, who was successfully treated with sirolimus. In addition to complications from thrombocytopenia and fluid overload, during the course of therapy, our patient experienced supratherapeutic drug levels at the commonly accepted starting dose of sirolimus. Patients with KHE and KMP should be closely monitored for potential complications of both the initial disease and unexpected side effects of treatments.

A Hyperpigmented Plaque In A Female Patient, Harel G. Schwartzberg, Alexandra Bourgeois, Amber Souers, Jeremy Atkinson, Pamela Martin

School of Medicine Faculty Publications

No abstract provided.

Complex Reconstruction After Extreme Fournier’S Gangrene; A Case Report, Serban Dumitrache, Leonida A. Goman, Raluca Dutu, Raluca Capatina, Carmen Giuglea, Dan M. Enescu

Journal of Mind and Medical Sciences

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft …

Covid-19 Outbreak Impact On Plastic Surgery Residents From Romania, Cristina N. Marina, Daniela E. Gheoca-Mutu, Laura Răducu, Adelaida Avino, Lăcrămioara A. Brîndușe, Corina M. Stefan, Razvan V. Scaunasu, Cristian R. Jecan

Journal of Mind and Medical Sciences

The COVID-19 outbreak triggered a global crisis with long-term effects on people’s daily lives. It has altered surgical practice and education and imposed major changes in healthcare systems and resources. In order to analyze the impact the COVID-19 pandemic has had on Romanian Plastic Surgery residents, we carried out an anonymous questionnaire through Google forms. Survey items addressed aspects such as how the pandemic has affected their surgical practice, their exposure to the virus, and the protective measures that have been implemented to minimize risk. Among other results, our study found that nearly 1 in 5 respondents had contact with …

The Use Of Ndyag Laser Combined With Pulsed Light In The Treatment Of Rosacea, Valeriu Ardeleanu, Lavinia Alexandra Moroianu, Vlad Denis Constantin, Petrisor Banu, Florin Silviu Groseanu, Ioana Paunica, Ana Maria Dascalu, Alin Laurentiu Tatu

Journal of Mind and Medical Sciences

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without …

The Quality Of Sexual Life After Vaginal Surgical Interventions, Maria Pană, Romina-Marina Sima, Oana-Denisa Bălălău, Anca-Daniela Stănescu, Liana Pleş, Mircea-Octavian Poenaru

Journal of Mind and Medical Sciences

Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and …

Simultaneous Bilateral Patellar Tendon Rupture In A Young Adult Male: A Case Report And Review Of The Literature., Adrian Moy, Ethan Song, Sean J. Wallace Md, Robert Teixeira Md, Daniel Torres

Department of Surgery

A bilateral patellar tendon rupture is extremely rare and has only been documented in case reports. Although the etiology remains unknown, predisposing factors include steroid usage, systemic diseases, and tendinopathies. In the present case, a healthy 33-year-old male with a prior history of bilateral patellar tendonitis and a diagnosis of Osgood-Schlatter disease during adolescence experienced simultaneous bilateral patellar tendon rupture after playing volleyball. He underwent bilateral patellar repair without complications. In the absence of trauma, spontaneous bilateral patellar tendon ruptures are associated with several predisposing factors, including systemic diseases, prior corticosteroid or fluoroquinolone usage, and history of tendinopathy. Injuries can …

In Reply: Access-Site Complications In Transfemoral Neuroendovascular Procedures: A Systematic Review Of Incidence Rates And Management Strategies, Pascal Jabbour, Ahmad Sweid

Department of Neurosurgery Faculty Papers

No abstract provided.

The De Garengeot Hernia: A Case Report Of An Unusual Presentation Of Appendicitis., Davek Sharma, Jacob Katsnelson, Emmanuel Nwachuku, Jeffrey Kolff

Abington Jefferson Health Papers

INTRODUCTION: A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases as cited by the literature.

PRESENTATION OF CASE: A 64-year-old female presented to the Emergency Department of our hospital with acute onset of a right-sided groin bulge that occurred earlier that day after doing heavy lifting. Her workup revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the appendiceal tip was incarcerated within the hernia …

The Role Of Nerves In Skeletal Development, Adaptation, And Aging., Ryan E Tomlinson, Blaine A Christiansen, Adrienne A Giannone, Damian C Genetos

Department of Orthopaedic Surgery Faculty Papers

The skeleton is well-innervated, but only recently have the functions of this complex network in bone started to become known. Although our knowledge of skeletal sensory and sympathetic innervation is incomplete, including the specific locations and subtypes of nerves in bone, we are now able to reconcile early studies utilizing denervation models with recent work dissecting the molecular signaling between bone and nerve. In total, sensory innervation functions in bone much as it does elsewhere in the body-to sense and respond to stimuli, including mechanical loading. Similarly, sympathetic nerves regulate autonomic functions related to bone, including homeostatic remodeling and vascular …

How Accurate Is The Neurosurgery Literature? A Review Of References., Thiago S Montenegro, Kevin Hines, Glenn A Gonzalez, Umma Fatema, Paul P Partyka, Sara Thalheimer, James Harrop

Department of Neurosurgery Faculty Papers

BACKGROUND: The reference list is an important part of academic manuscripts. The goal of this study is to evaluate the reference accuracy in the field of neurosurgery.

METHODS: This study examines four major peer-reviewed neurosurgery journals, chosen based on their clinical impact factor: Neurosurgery, J Neurosurg, World Neurosurg, and Acta Neurochir. For each of the four journals, five articles from each of the journal's 12 issues published in 2019 were randomly selected using an online generator. This resulted in a total of 240 articles, 60 from each journal. Additionally, from each article's list of references, one reference was again randomly …

Sphenopalatine Ganglion Stimulation Upregulates Transport Of Temozolomide Across The Blood-Brain Barrier, Thana N. Theofanis, Ankit K. Rochani, Richard F. Schmidt, Michael J. Lang, Geoffrey P. Stricsek, Robert H. Rosenwasswer, Ashwini D. Sharan, Gagan Kaushal, Lorraine Iacovitti

Department of Neurosurgery Faculty Papers

Sphenopalatine ganglion (SPG) stimulation has been shown to reversibly alter blood-brainbarrier (BBB) permeability. It is widely used for the treatment of cluster headaches in Europe and iswell tolerated in humans. The therapeutic potential for SPG stimulation in other central nervoussystem (CNS) diseases has yet to be explored. Glioblastoma Multiforme (GBM) remains one of themost difficult primary CNS neoplasms to treat, with an average survival of approximately 18 months atthe time of diagnosis. Since 2004, the gold standard of treatment for GBM in the United States includessurgery followed by treatment with temozolomide (TMZ) and radiation. We sought to determine ifSPG stimulation …

Unusual Case Of Pump Thrombosis In Lvad Patient With Covid-19 — Diagnostic Challenges, William H. Frick Md, Ryan D. Mallory, Maya Guglin, Eve Anderson, Erin N. Lushin, Rey P. Vivo, Kashif Saleem, Roopa A. Rao

The VAD Journal

We present the first reported case of left ventricular assist device (LVAD) pump thrombosis in the setting of the coronavirus pandemic. We describe the clinical features of the case which helped to differentiate coronavirus disease 19 (COVID-19) from LVAD pump thrombosis. The patient is 56-year-old female supported by destination LVAD therapy. She was originally implanted with a HeartMate II device in 2015 and underwent two pump exchanges in 2017 and 2019 for pump thrombosis, despite medication adherence. Shortly after routine lab work revealed near doubling of her lactate dehydrogenase (LDH) levels, she tested positive for COVID-19. She then developed power …

Prophylactic Mesh Placement For The Prevention Of Incisional Hernia In High-Risk Patients After Abdominal Surgery: A Systematic Review And Meta-Analysis, Jawad Ahmed, Nimra Hasnain, Iayla Fatima, Farheen Malik, Muhammad A. Chaudhary, Junaid Ahmad, Mehreen Malik, Laraib Malik, Muhammad Osama, Mirza Zain Baig, Faisal Khosa, Faiz Bhora

Department of Anaesthesia

Background and objectives: In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC).
Materials and methods: PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses …