Surgery Commons^™

Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

Shorter Length Of Stay And Increased Return To Work With Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy And Fusion, Philip Zakko, Alex Miller, Daniel K. Park, Jad Khalil

Conference Presentation Abstracts

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear benefit between ACDF or CDA. The primary objective of this study is to compare the outcomes of ACDF and CDA for patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Secondary objectives include assessment of early complications, procedural/perioperative outcomes, and patient-reported outcome measures after both ACDF and CDA. METHODS: Patients undergoing 1 or 2 level ACDF or CDA surgery were included. A …

Assessing Public Reported Perceptions Of Hand Surgery Provided In The Office Vs. An Ambulatory Surgery Center, Trevor Tooley, James Feng, Jannat Khan, Paul Scott Shapiro

Conference Presentation Abstracts

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey …

Pragmatic, Prospective Comparative Effectiveness Trial Of Carbon Ion Therapy, Surgery, And Proton Therapy For The Management Of Pelvic Sarcomas (Soft Tissue/Bone) Involving The Bone: The Prosper Study Rationale And Design, Bradford S Hoppe, Ivy A Petersen, Benjamin K Wilke, Todd A Dewees, Reiko Imai, Eugen B Hug, Maria Rosaria Fiore, Jürgen Debus, Piero Fossati, Shigeru Yamada, Ester Orlandi, Qing Zhang, Cihang Bao, Katharina Seidensaal, Byron C May, Anna C Harrell, Matthew T Houdek, Laura A Vallow, Peter S Rose, Michael G Haddock, Jonathan B Ashman, Krista A Goulding, Steven Attia, Sunil Krishnan, Anita Mahajan, Robert L Foote, Nadia N Laack, Sameer R Keole, Chris J Beltran, Eric M Welch, Mohammed Karim, Safia K Ahmed

Faculty, Staff and Student Publications

Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic …

Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

Surgeon Estimations Of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable., Parker L Brush, Adrian Santana, Gregory R Toci, Eric Slotkin, Michael Solomon, Tristan Jones, Arjun Saxena

Rothman Institute Papers

BACKGROUND: Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images.

METHODS: We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey …

Understanding The Burden Of Traumatic Injuries At The United States-Mexico Border: A Scoping Review Of The Literature, Benjamin A. Keller, Jeffrey Skubic, Monica Michelle Betancourt-Garcia, Romeo C. Ignacio, Jason S. Radowsky, Alan H. Tyroch, Carlos Palacio Lascano, Bellal Joseph, Collin Stewart, Aaron Silva

School of Medicine Publications

The United States-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US–Mexico border to draw attention to the problem, …

A Trinetx Registry Analysis Of The Need For Second Procedures Following Index Anterior And Posterior Urethroplasty, Zachary J. Prebay, Adam M. Ostrovsky, Matthew Buck, Paul H. Chung

Department of Urology Faculty Papers

Background: We queried a global database to understand re-intervention rates following urethroplasty with the goal of evaluating whether they align with previously published data. Methods: Using the TriNetX database and Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD) codes, we identified adult male patients with urethral stricture disease (ICD N35) who underwent one-stage anterior (CPT 53410) or posterior urethroplasty (CPT 53415), with or without (substitution urethroplasty) a tissue flap (CPT 15740) or buccal graft (CPT 15240 or 15241). We set urethroplasty as the index event and used descriptive statistics to report the incidence of secondary procedures (using CPT …

Breast Cancer Molecular Subtype Classification According To Immunohistochemistry Markers And Its Association With Pathological Characteristics Among Women Attending Tertiary Hospitals In Tanzania., Allyzain Ismail

Master of Surgery

Background: Breast cancer immunohistochemistry is a biological characteristic of the tumour which has a role to diagnose molecular subtype, prognosticate and guide treatment and categorised into 4 subtypes, Luminal A, Luminal B, Human Epidermal Growth Factor Receptor 2 (HER2) enriched and Triple Negative Breast Cancer (TNBC). Objectives: To determine the prevalence of each molecular subtype of breast cancer and determine their association with pathological and demographic characteristics. Methods: A retrospective cross-sectional study was carried out at two tertiary referral hospitals on participants who were recruited from the cancer registries from 2015-2022 and had a breast tissue biopsy confirming primary breast …

Gibbon Surgical Review, Volume 6, Issue 1, 2023

Gibbon Surgical Review

Table of Contents

6 - Dr. Thomas Mütter’s Legacy: The Mütter Museum

8 - The History and Progression of Laparoscopic Surgery

10 - An Interview with Dr. Andrew Morgan

12 - A Surgical Perspective of the Effects of the COVID-19 Pandemic on Healthcare

14 - An Interview with Dr. Deviney Rattigan

16 - The Importance of Mentorship in Improving the Outlook and Perception of General Surgery Among Medical Students

18 - Surgical Fellow Spotlight: An Interview with Dr. Steve Gurien

20 - Point of Care Ultrasound in General Surgery Training

22 - Surgical Resident Spotlight: An Interview with Hamza Rshaidat …

Long-Term Safety And Efficacy Of Non-Absorbable Abdominal Mesh For Apical Prolapse Surgery: A 10-Year Experience At Tertiary Care Hospital, Samia Aijaz, Novera G. Chughtai, Urooj Kashif, Summera Malik

Department of Obstetrics & Gynaecology

Objectives: To evaluate the complications of apical prolapse correction with abdominally placed mesh and to assess the long-term efficacy of Sacrohysteropexy and Sacrocolpopexy.
Method: A retrospective cohort study was conducted at the Department of Gynecology and Obstetrics, Aga Khan University Hospital. All women who underwent apical prolapse surgery using abdominal mesh from January 2010 to December 2019 at AKUH were included. Patients with missing routine follow up visits and incomplete data up to one year post op were excluded. Patient notes were reviewed, and subjective and objective success and complications were analyzed. Safety was measured by incidence of intra, early …

Approaches For Optimizing Venous Thromboembolism Prevention In Injured Patients: Findings From The Consensus Conference To Implement Optimal Venous Thromboembolism Prophylaxis In Trauma, Amanda L Teichman, Bryan A Cotton, James Byrne, Navpreet K Dhillon, Allison E Berndtson, Michelle A Price, Tracy J Johns, Eric J Ley, Todd Costantini, Elliott R Haut

Faculty, Staff and Student Publications

Venous thromboembolism (VTE) is a major issue in trauma patients. Without prophylaxis, the rate of deep venous thrombosis approaches 60% and even with chemoprophylaxis may be nearly 30%. Advances in VTE reduction are imperative to reduce the burden of this issue in the trauma population. Novel approaches in VTE prevention may include new medications, dosing regimens, and extending prophylaxis to the postdischarge phase of care. Standard dosing regimens of low-molecular-weight heparin are insufficient in trauma, shifting our focus toward alternative dosing strategies to improve prophylaxis. Mixed data suggest that anti-Xa-guided dosage, weight-based dosing, and thromboelastography are among these potential strategies. …

Open Posterior Reduction And Stabilization Of Ao Spine C3 Sacral Fractures, Philipp Kobbe, Gregory D. Schroeder, Klaus J. Schnake, Lorin M. Benneker, Mark Lambrechts, Frank Hildebrand, Richard M. Sellei

Rothman Institute Papers

AO Spine C3 sacral fractures are defined by separation of the spine including S1 from the pelvic ring and are usually result of a high-energy injury. Besides their high biomechanical instability and high rate of associated neurological impairment, these fractures are often extremely difficult to reduce due to severe bony impaction and dislocation. Additional difficulties in management of these fractures arise from only a thin-layer of soft-tissue coverage overlying the injured area.

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.

Prospective Study Of Pain Outcomes Associated With Breast Surgery In Women With Nonhereditary Breast Cancer, Demetria J Smith-Graziani, Patricia A Parker, Susan K Peterson, Isabelle Bedrosian, Y Shen, Dalliah M Black, Sarah M Desnyder, Kelly K Hunt, Wenli Dong, Abenaa M Brewster

Faculty, Staff and Student Publications

OBJECTIVE: To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes.

SUMMARY OF BACKGROUND DATA: Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery.

METHODS: Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and …

Independent Associations Of Neighborhood Deprivation And Patient-Level Social Determinants Of Health With Textbook Outcomes After Inpatient Surgery, Susanne Schmidt, Jeongsoo Kim, Michael A Jacobs, Daniel E Hall, Karyn B Stitzenberg, Lillian S Kao, Bradley B Brimhall, Chen-Pin Wang, Laura S Manuel, Hoah-Der Su, Jonathan C Silverstein, Paula K Shireman

Faculty, Staff and Student Publications

OBJECTIVE: Assess associations of Social Determinants of Health (SDoH) using Area Deprivation Index (ADI), race/ethnicity and insurance type with Textbook Outcomes (TO).

SUMMARY BACKGROUND DATA: Individual- and contextual-level SDoH affect health outcomes, but only one SDoH level is usually included.

METHODS: Three healthcare system cohort study using National Surgical Quality Improvement Program (2013-2019) linked with ADI risk-adjusted for frailty, case status and operative stress examining TO/TO components (unplanned reoperations, complications, mortality, Emergency Department/Observation Stays and readmissions).

RESULTS: Cohort (34,251 cases) mean age 58.3 [SD=16.0], 54.8% females, 14.1% Hispanics, 11.6% Non-Hispanic Blacks, 21.6% with ADI>85, and 81.8% TO. Racial and …

Development Of The Illinois Surgical Quality Improvement Collaborative (Isqic): Implementing 21 Components To Catalyze Statewide Improvement In Surgical Care, Karl Y Bilimoria, Michael F Mcgee, Mark V Williams, Julie K Johnson, Amy L Halverson, Kevin J O'Leary, Paula Farrell, Juliana Thomas, Remi Love, Lindsey Kreutzer, Allison R Dahlke, Brianna D'Orazio, Steven Reinhart, Katelyn Dienes, Mark Schumacher, Ying Shan, Christopher Quinn, Vivek N Prachand, Susan Sullivan, Kimberly A Cradock, Kelsi Boyd, William Hopkinson, Colleen Fairman, David Odell, Jonah J Stulberg, Cindy Barnard, Jane Holl, Ryan P Merkow, Anthony D Yang

Faculty, Staff and Student Publications

INTRODUCTION: In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research.

METHODS: ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed …

Transabdominal Cerclage During Pregnancy: A Retrospective Single Operator Series Over A Quarter Century, David R Hall, Mari Van De Vyver

Faculty, Staff and Student Publications

OBJECTIVE: To describe the pregnancy outcomes and complications observed in a series of cases of transabdominal cerclage (TAC), which is reserved for highly selected women with recurrent mid-trimester pregnancy loss, due to cervical insufficiency.

METHODS: A retrospective audit covering 25 years (January 1, 1997 to December 31, 2021) was performed at the Obstetric Special Care division, Tygerberg Academic Hospital in Cape Town, South Africa. All 118 pregnancies from 94 procedures, operated and managed by the principal author were included for descriptive analysis.

RESULTS: Eighty-four (91.3%) of the 92 first pregnancies after first insertion had successful outcomes. All second and third …

Ninety-Day Mortality Following Transoral Robotic Surgery Or Radiation At Commission On Cancer-Accredited Facilities, James R Janopaul-Naylor, Manali Rupji, Rachel A Tobillo, Joshua W Lorenz, Jeffrey M Switchenko, Sibo Tian, Azeem S Kaka, David C Qian, Ashley J Schlafstein, Conor E Steuer, Jill S Remick, Soumon Rudra, Mark W Mcdonald, Nabil F Saba, William A Stokes, Mihir R Patel, James E Bates

Faculty, Staff and Student Publications

BACKGROUND: Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown.

METHODS: NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities.

RESULTS: 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p < 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality.

CONCLUSIONS: There is minimal difference between 90-day mortality …

Predictors Of Emergency Room Visits After Ambulatory Breast Cancer Surgery In The Medicare Population, Susie X Sun, Zhigang Duan, Henry M Kuerer, Sarah M Desnyder, Carrie Cunningham, Hui Zhao, Sharon H Giordano

Faculty, Staff and Student Publications

Background: Emergency department (ED) overuse is a large contributor to healthcare spending in the USA. We examined the rate of and risk factors for ED visits following outpatient breast cancer surgery.

Patients and methods: Using linked data from the Surveillance, Epidemiology, and End Results (SEER) program and Medicare, we identified women who underwent curative breast cancer surgery between 2003 and 2015. Our outcome of interest was ED visits within 30 days of surgery. Multivariate regression was used to evaluate the odds of ED visit while controlling for clinical and socioeconomic variables. Secondary analyses assessed admission from the ED as well …

Novel Therapeutic Medications For Venous Thromboembolism Prevention In Trauma Patients: Findings From The Consensus Conference To Implement Optimal Venous Thromboembolism Prophylaxis In Trauma, Navpreet K Dhillon, Elliott R Haut, Michelle A Price, Todd W Costantini, Amanda L Teichman, Bryan A Cotton, Eric J Ley

Faculty, Staff and Student Publications

Trauma patients are at high risk for venous thromboembolism (VTE). Despite evidence-based guidelines and concerted efforts in trauma centers to implement optimal chemoprophylaxis strategies, VTE remains a frequent diagnosis in trauma patients. Current chemoprophylaxis strategies largely focus on the subcutaneous injection of low-molecular-weight heparin, which is administered twice daily. Novel approaches to pharmacologic VTE prophylaxis have the potential to reduce VTE rates by improving patient compliance through oral administration or through their ability to target alternative pathways that mediate thrombosis. While novel pharmacologic VTE prophylaxis strategies have been studied in nontrauma patients, there is a paucity of literature in trauma …

Incidence And Predictors Of Acute Limb Ischemia In Acute Myocardial Infarction Complicated By Cardiogenic Shock., Carlos M Romero, Irfan Shafi, Aadhar Patil, Eric Secemsky, Ido Weinburg, Raghu Kolluri, Huaqing Zhao, Vladimir Lakther, Riyaz Bashir

Heart and Vascular Articles

OBJECTIVE: To describe the incidence and predictors of acute limb ischemia (ALI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

METHODS: Patients with index hospitalizations for AMI complicated by cardiogenic shock from 2016 to 2019 in the US National Readmission Database were identified. We evaluated the incidence of ALI and its associated mortality, length of stay, and cost of hospitalization. We used multivariable logistic regression to determine independent predictors of ALI in this population.

RESULTS: A total of 84,615 patients had AMI complicated by cardiogenic shock and 1302 (1.54%) developed ALI. The rates of ALI increased …

Peri-Implant Proximal Humerus Fracture Stabilized With Stacked Plating: A Case Report., Daniel T Degenova, Matthew T Glazier, John B Schrock, Brian W Skura, Taylor N Hockman, Benjamin C Taylor

Surgery Articles

INTRODUCTION: A peri-implant proximal humerus fracture is a rare complication after open reduction and internal fixation (ORIF) and poses a surgical dilemma.

CASE REPORT: A 56-year-old male sustained a peri-implant proximal humerus fracture after undergoing ORIF. We present a stacked plating method for fixation of this injury. This construct allows for decreased operative time, less soft-tissue dissection, and the ability to leave previous intact hardware in place.

CONCLUSION: We describe the rare case of a peri-implant proximal humerus treated with stacked plating.

Differences Between Patients With Diabetes Mellitus And Those Without In Cases Of Necrotizing Fasciitis., Daniel T Degenova, Scott S Hyland, Tucker Peabody, Nolan P Schmitz, Devon Myers, Robert Patterson, Jignesh Patel

Surgery Articles

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk …

Coronary Artery Bypass Grafting At Safety-Net Versus Non-Safety-Net Hospitals, William C Frankel, Christopher B Sylvester, Sainath Asokan, Christopher T Ryan, Rodrigo Zea-Vera, Qianzi Zhang, Matthew J Wall, Sandeep Markan, Joseph S Coselli, Todd K Rosengart, Subhasis Chatterjee, Ravi K Ghanta

Faculty, Staff and Students Publications

OBJECTIVES: Safety-net hospitals (SNHs) provide essential services to predominantly underserved patients regardless of their ability to pay. We hypothesized that patients who underwent coronary artery bypass grafting (CABG) would have inferior observed outcomes at SNHs compared with non-SNHs but that matched cohorts would have comparable outcomes.

METHODS: We queried the Nationwide Readmissions Database for patients who underwent isolated CABG from 2016 to 2018. We ranked hospitals by the percentage of all admissions in which the patient was uninsured or insured with Medicaid; hospitals in the top quartile were designated as SNHs. We used propensity-score matching to mitigate the effect of …

Long-Chain Polyunsaturated Lipids Associated With Responsiveness To Anti-Pd-1 Therapy Are Colocalized With Immune Infiltrates In The Tumor Microenvironment, Mary E King, Robert Yuan, Jeremy Chen, Komal Pradhan, Isabel Sariol, Shirley Li, Ashish Chakraborty, Oscar Ekpenyong, Jennifer H Yearley, Janica C Wong, Luis Zúñiga, Daniela Tomazela, Maribel Beaumont, Jin-Hwan Han, Livia S Eberlin

Faculty, Staff and Students Publications

The programmed cell death protein-1 (PD-1) is highly expressed on the surface of antigen-specific exhausted T cells and, upon interaction with its ligand PD-L1, can result in inhibition of the immune response. Anti-PD-1 treatment has been shown to extend survival and result in durable responses in several cancers, yet only a subset of patients benefit from this therapy. Despite the implication of metabolic alteration following cancer immunotherapy, mechanistic associations between antitumor responses and metabolic changes remain unclear. Here, we used desorption electrospray ionization mass spectrometry imaging to examine the lipid profiles of tumor tissue from three syngeneic murine models with …

Transcatheter Aortic Valve-In-Valve-In-Valve Replacement In A Young Woman With Transcatheter Structural Valve Deterioration Within A Degenerated Aortic Root Homograft, Jonathan C Hong, Vicente Orozco-Sevilla, Jose G Diez, Joseph S Coselli

Faculty, Staff and Students Publications

Transcatheter aortic valve replacement is a well-established procedure for older patients with symptomatic, severe aortic stenosis. However, data are lacking on its durability and long-term complications, particularly in young patients and patients treated for aortic valve regurgitation. This article describes the case of a 27-year-old woman with complex congenital cardiovascular disease who, after 4 previous aortic valve replacement procedures, presented with structural deterioration of her most recent replacement valve, which had been placed by transcatheter aortic valve replacement inside a failed aortic root homograft 6 years earlier. After the patient had undergone this transcatheter aortic valve replacement procedure to treat …

Juvenile-Type Granulosa Cell Tumor In Pregnancy Presenting As A Ruptured Abdominal Mass, Odinaka Mogor, Steven Feinstein, Glen Friedman, Jose Salvador Saldivar, Melissa Mendez

HCA Healthcare Journal of Medicine

Introduction

Granulosa cell tumors (GCTs) are part of the sex cord-stromal tumors occurring with a rare incidence rate that only makes up about 2-5% of all ovarian malignancies.

Case Presentation

A 28-year-old woman, gravida 2, para 1, presented with a juvenile-type granulosa cell tumor at 31 weeks gestation, which appeared as a rapidly growing mass with rupture. She underwent an exploratory laparotomy with unilateral salpingo-oophorectomy, and consequently had a successful vaginal delivery. Post-operatively she was treated with paclitaxel and carboplatin chemotherapy regimen with no evidence of recurrence after one year.

Conclusion

Radical surgical management is recommended for these tumors due …

Complications Of Cardiopulmonary Bypass From An Anesthesia Perspective: A Clinical Review, Alex Roberts, Elizabeth C. Duncan, Paul Hargrave, David Redding Kingery, Josh Barnes, Derek L. Horstemeyer, Russell F. Stahl

HCA Healthcare Journal of Medicine

Cardiopulmonary bypass (CPB) is frequently used for open heart surgery and other procedures that utilize temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications. CPB can be seen as the ultimate “team sport” as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. In this clinical review paper, we examine possible complications of CPB, primarily from the perspective of the anesthesiologist, and how to troubleshoot them if they arise, which often requires …

Approximating Scaffold Printability Utilizing Computational Methods, Ashkan Sedigh, Pejman Ghelich, Jacob Quint, Evelyn C Mollocana-Lara, Mohamadmahdi Samandari, Ali Tamayol, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Bioprinting facilitates the generation of complex, three-dimensional (3D), cell-based constructs for various applications. Although multiple bioprinting technologies have been developed, extrusion-based systems have become the dominant technology due to the diversity of materials (bioinks) that can be utilized, either individually or in combination. However, each bioink has unique material properties and extrusion characteristics that affect bioprinting utility, accuracy, and precision. Here, we have extended our previous work to achieve high precision (i.e. repeatability) and printability across samples by optimizing bioink-specific printing parameters. Specifically, we hypothesized that a fuzzy inference system (FIS) could be used as a computational method to address …