Surgery Commons^™

Foam Sclerotherapy Augmented Phlebectomy (Sap) Procedure For Varicose Veins: Report Of A Novel Technique., Raghu Kolluri, Katherine U Hays, Manjit S Gohel

Surgery Articles

INTRODUCTION: While traditional ambulatory phlebectomy (AP) is a safe and effective procedure, few adverse effects such as hematoma, bleeding, bruising and nerve injury have been reported. To improve AP and to reduce some of these adverse events, herein we report a novel technique - Foam Sclerotherapy Assisted Phlebectomy (SAP).

REPORT: The details of the above technique, along with the potential advantages and limitations will be discussed.

DISCUSSION: Foam sclerotherapy and DUS act as valuable adjuncts to traditional AP. SAP increases precision and creates additional venospasm leading to reduced bruising, reduced nerve injury and sclerosis of residual vein segments.

The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., Robroy L Martin, John J Christoforetti, Ryan Mcgovern, Benjamin R Kivlan, Andrew B Wolff, Shane J Nho, John P Salvo, Thomas J Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S Carreira

Surgery Articles

BACKGROUND: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement.

HYPOTHESIS: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and …

Wound Closure After Posterior Multi-Level Lumbar Spine Surgery: An Anatomical Cadaver Study And Technical Note., Emre Yilmaz, Tamir Tawfik, Thomas M O'Lynnger, Joe Iwanaga, Ronen Blecher, Amir Abdul-Jabbar, R Shane Tubbs, Cameron K Schmidt, Rod J Oskouian, Jens R Chapman

Articles, Abstracts, and Reports

Meticulous attention to wound closure in posterior lumbar spine surgery is an important principle in reducing surgical site infections. We detail standardized wound closure used for posterior lumbar spine surgery at a tertiary care referral center and illustrate this as a step-by-step cadaveric dissection. The lumbar spine of a cadaveric specimen (male, 73 years at death) was used for dissection. Standardizing wound closure in posterior lumbar spine surgery may help limit wound complications and infection. Some key points of our technique, as demonstrated on a cadaveric specimen, include separating fascial compartments, avoiding suture abscesses, and creating a tension-free wound.

Anti-Aging Therapy: Can We Age Cancer Cells So They Stop Growing?, Jonathan R. Brody, Phd

Pancreatic Cancer & Related Diseases Patient Symposium

No abstract provided.

Update On Multimodal Therapy For Pancreatic Cancer, Harish Lavu, Md

Pancreatic Cancer & Related Diseases Patient Symposium

No abstract provided.

Precious Data: 2018 Interim Report From The Jefferson Pancreas Tumor Registry, Theresa Yeo, Phd, Mph, Msn, Aocnp

Pancreatic Cancer & Related Diseases Patient Symposium

No abstract provided.

Breakfast With The Experts, Tbd

Pancreatic Cancer & Related Diseases Patient Symposium

Continental Breakfast, Informational Tables & Scientific Poster Presentations

Validation Of Near Infrared Fluorescence (Nirf) Probes In Vivo With Dual Laser Nirf Endoscope, Manisha Shrivastav, Elias Gounaris, Mohammad W. Khan, Jeffrey Ko, Stacy H. Ryu, Matthew Bogyo, Andrew Larson, Terrence A. Barrett, David J. Bentrem

Internal Medicine Faculty Publications

Purpose

The development of NIRF cathepsin activity probes offered the ability to visualize tumor associated tumor reaction and act as a surrogate marker to delineate the dysplastic lesions. One major type is a NIRF substrate of cathepsins (SBP), which is involved in catalytic way to produce high levels of fluorescence emission. The other major type (ABP) reacts with active cathepsins in stoichiometric manner since they bind covalently with their active center. Little is known about the sensitivity and the specificity of the NIRF probes to detect autochthonous developed dysplastic lesions. Dual laser NIRF endoscope provides a good tool to determine …

Surgical Management Of Metastatic Lesions Of Proximal Femur And The Hip, Mujahid Jamil Khattak, Umair Ashraf, Zohaib Nawaz, Shahryar Noordin, Masood Umer

Section of Orthopaedic Surgery

Metastatic bony lesions involving proximal femur and hip joint pose a challenge to orthopedic surgeons. Lesions in this important weight-bearing zone of the femur weaken its ability to sustain load causing pain and impending pathologic fracture. These Patients warrant multidisciplinary approach including orthopedic surgeons, oncologist and medical specialties. Management of these lesions has evolved over the last 60 years from benign neglect to internal fixation and recently to prosthetic reconstruction for optimum function. Decision for surgical approach requires consideration for location of the lesion, presence of a fracture, tumor type, cortical destruction, patient's life expectancy, patient preferences and the expected …

Ankle Arthrodesis Using Ilizarov Ring Fixator: A Primary Or Salvage Procedure?: An Analysis Of Twenty Cases, Obada Hasan, Shah Fahad, S. Sattar, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.
Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in …

Radiological And Clinical Outcomes In Patients Undergoing Anterior Cervical Discectomy And Fusion: Comparing Titanium And Peek (Polyetheretherketone) Cages, Muhammad Junaid, Mamoon Ur Rashid, Syed Sarmad Bukhari, Mamoon Ahmed

Section of Neurosurgery

Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.
Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical …

Tumour Treating Fields (Ttfs) For Paediatric Brain Tumours, Brain Metastases And Other Novel Applications, Farhan Arshad Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Tumour treating fields (TTFs) are now FDA approved for high grade glioma treatment. Novel application of this treatment modality is being assessed for paediatric brain tumours and intracranial metastatic disease. Clinical trials are being conducted to test the efficacy of this treatment modality as adjuvant therapy to current standard of care. Here we will discuss the existing literature on TTF its role in pathologies other than GBM. In addition, aspects of safety, compliance and cost are also discussed.

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 2, 2018

Gibbon Surgical Review

Table of Contents

• Forward by Charles J. Yeo, MD, FACS
• PERSPECTIVE - An Interview with Dr. Theresa Yeo, Co-Director of the Jefferson Pancreas Tumor Registry (JPTR)
• A PGY-1's Perspective: Conducting Pancreatic Cancer Research as a Medical Student
• INTERVIEW - Jonathan Brody, PhD - Pancreatic Cancer Specialist
• RESEARCH SPOTLIGHT - The Journal of Pancreatic Cancer
• Pancreatic Cancer Research at Jefferson: The Mary Halinski Pancreatic Cancer Research Fund
• The Gibbon Surgical Society
• Contributors
• Samuel D. Gross Professor of Surgery: Charles J. Yeo, MD, FACS

The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., Robroy L. Martin, John J. Christoforetti, Ryan Mcgovern, Benjamin R. Kivlan, Andrew B. Wolff, Shane J. Nho, John P. Salvo, Thomas J. Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S. Carreira

Department of Medicine Faculty Papers

Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement.

Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression.

Study Design: Cohort study; Level of evidence, 3.

Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and …

Inheritance Patterns, Challenges, And Outcomes Of Fracture Management In Osteopetrosis Patients. Case Series And Review Of Pertinent Literature, Obada Hussein Hasan, Aly Zaheer Pathan, Hammad Naqvi, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery Docs

Background: Osteopetrosis (OP) is a group of rare inheritable genetic disorders which show increased bone radiodensity on radiography. As no cure exists, careful symptomatic treatment is the mainstay in management due to brittle bone and frequent complications. We would like to present a case series of OP patients, their management, a review of literature about this rare disease and its genetic and inheritance patterns.
Materials and methods: Retrospective case series of 6 patients with OP seen at our institution from 2010 to January 2018. We searched PubMed and Google Scholar for articles using the following keywords: Osteopetrosis, Radiology, Fracture and …

Percutaneous Transhepatic Cholecysto-Cholangiography (Ptcc): An Alternative To Intraoperative Cholangiography In High Risk Infants Suspect For Biliary Atresia, Joseph Sujka, Katrina L. Weaver, Ashwini S. Poola, Douglas C. Rivard, Richard J. Hendrickson

Manuscripts, Articles, Book Chapters and Other Papers

Infants with cholestasis and conjugated hyperbilirubinemia persisting beyond two weeks of age must be evaluated promptly to exclude biliary atresia (BA). BA progresses to cirrhosis and liver failure if portoenterostomy (PE) is not performed in a timely fashion. The gold standard to diagnose BA is intraoperative cholangiography (IOC) via laparotomy. Neonates that are critically ill or have significant co-morbidities may be high-risk surgical candidates, and thus minimizing operative time or avoiding an operation may be beneficial. An additional modality for excluding BA is percutaneous transhepatic cholecysto-cholangiography (PTCC). We present three infants undergoing PTCC by interventional radiology (IR) revealing patency of …

Potential Role Of Csf Cytokine Profiles In Discriminating Infectious From Non-Infectious Cns Disorders., Danielle Fortuna, D. Craig Hooper, Amity L. Roberts, Larry A. Harshyne, Michelle Nagurney, Mark T. Curtis

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Current laboratory testing of cerebrospinal fluid (CSF) does not consistently discriminate between different central nervous system (CNS) disease states. Rapidly distinguishing CNS infections from other brain and spinal cord disorders that share a similar clinical presentation is critical. New approaches focusing on aspects of disease biology, such as immune response profiles that can have stimulus-specific attributes, may be helpful. We undertook this preliminary proof-of-concept study using multiplex ELISA to measure CSF cytokine levels in various CNS disorders (infections, autoimmune/demyelinating diseases, lymphomas, and gliomas) to determine the potential utility of cytokine patterns in differentiating CNS infections from other CNS diseases. Both …

Surgeon's Perspective On Short Bowel Syndrome: Where Are We?, Ignazio R. Marino, Augusto Lauro

Department of Surgery Faculty Papers

Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented …

"It's A Precious Gift, Not To Waste": Is Routine Cross Matching Necessary In Orthopedics Surgery?: Retrospective Study Of 699 Patients In 9 Different Procedures, Obada Hasan, Eraj Khurshid Khan, Moiz Ali, Sadaf Sheikh, Anum Fatima, Haroon Ur Rashid

Section of Orthopaedic Surgery

Background: Orthopedic surgeries are usually associated with excessive blood loss which leads surgeons to overestimate need for blood transfusions and over ordering of blood. The cross matched blood, when not used, leads to the wastage of blood bank resources in terms of time, money and manpower. The objective of this study was to investigate the compliance to previously proposed MSBOS and to provide updated recommendations for all orthopedic procedures.
Methods: A retrospective analysis was conducted between 1st June 2015 and 31st May 2016. Patients admitted to the orthopedic surgery service for whom blood products were requested were included. Cross Match/Transfusion …

P-21 Activated Kinase As A Molecular Target For Chemoprevention In Diabetes, Kyle Dammann, Vineeta Khare, Clyde Coleman, Henrik Berdel, Christoph Gasche

Surgery Faculty Publications

Hypothesis: Anti-diabetic drugs modulate p-21 activated kinase (PAK) signaling. Introduction: Type 2 diabetes mellitus (T2DM) is a chronic inflammatory disease associated with increased cancer risk. PAK signaling is implicated in cellular homeostasis when regulated, and cancer when unrestrained. Recent reports provided a role for PAK signaling in glucose homeostasis, but the role of PAKs in the pathogenesis of T2DM is unknown. Here, we performed a mini-meta-analysis to explore if anti-diabetic drugs modify PAK signaling pathways, and provide insight regarding modulation of these pathways, to potentially reduce diabetes-associated cancer risk. Methods: PAK interacting partners in T2DM were identified using the online …

Cd133 Expression In Glioblastoma Multiforme: A Literature Review, Syed Ijlal Ahmed, Gohar Javed, Altaf Ali Laghari, Syeda Beenish Bareeqa, Saba Farrukh, Shajeeah Zahid, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

Glioblastoma, also known as glioblastoma multiforme (GBM), is the most common primary brain tumor. Extensive research has been carried out to discover the factors associated with the course and progression of GBM. CD133 is a glycoprotein antigen found in normal and malignant tissues. CD133 has been recognized as a marker for the growth of cancer cells. The association between this tissue marker and GBM is being investigated. The aim of this review was to evaluate the role of CD133 as a tumor marker for the prognosis of GBM.

Metformin Clinical Trial In Hpv+ And Hpv- Head And Neck Squamous Cell Carcinoma: Impact On Cancer Cell Apoptosis And Immune Infiltrate., Joseph M. Curry, Jennifer Johnson, Mehri Mollaee, Patrick Tassone, Dev Amin, Alexander Knops, Diana Whitaker Menezes, My Mahoney, Andrew P. South, Ulrich Rodeck, Tingting Zhan, Larry A. Harshyne, Nancy Philp, Adam J. Luginbuhl, David Cognetti, Madalina Tuluc, Ubaldo E. Martinez-Outshoorn, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Metformin, an oral anti-hyperglycemic drug which inhibits mitochondrial complex I and oxidative phosphorylation has been reported to correlate with improved outcomes in head and neck squamous cell carcinoma (HNSCC) and other cancers. This effect is postulated to occur through disruption of tumor-driven metabolic and immune dysregulation in the tumor microenvironment (TME). We report new findings on the impact of metformin on the tumor and immune elements of the TME from a clinical trial of metformin in HNSCC. Methods: Human papilloma virus-(HPV-) tobacco+ mucosal HNSCC samples (n = 12) were compared to HPV+ oropharyngeal squamous cell carcinoma (OPSCC) samples (n …

3,3'-Diindolylmethane Enhances Apoptosis In Docetaxel-Treated Breast Cancer Cells By Generation Of Reactive Oxygen Species., Susan Lanza-Jacoby, Guanjun Cheng

Department of Surgery Faculty Papers

CONTEXT: A major problem in the treatment of cancer is the development of toxic side effects and resistance to chemotherapy. The use of plant compounds to overcome resistance and prevent toxicity is a potential strategy for treatment.

OBJECTIVE: We evaluated whether 3,3'-diindolylmethane (DIM) enhanced the sensitivity of breast cancer cells to docetaxel (DOC).

MATERIALS AND METHODS: MDA-MB231 and Sk-BR-3 cells were treated with and without 25 or 50 µM of DIM and 1 nM of DOC for 48 and 72 h, respectively. MTT assay was used to measure cell survival. Apoptosis and intracellular reactive oxygen species (ROS) were determined by …

Early And Late Complications Of Bariatric Operation., Robert Lim, Alec Beekley, Dirk C. Johnson, Kimberly A. Davis

Department of Surgery Faculty Papers

Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient's anatomy, which can lead to complications at any …

Third Ventricular Tumors: A Comprehensive Literature Review, Syed Ijlal Ahmed, Gohar Javed, Altaf Ali Laghari, Syeda Benish Bareeqa, Kashif Aziz, Mehreen Khan, Syeda Sana Samar, Raja Azhar Humera, Alizay Rashid Khan, Muhammad Osama Farooqui, Amir Shahbaz

Section of Neurosurgery

Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple …

Functional Radical Cervical Dissection For Differentiated Thyroid Cancer: The Experience Of A Single Center, Tulin Adrian, Lucian Alecu, Catalina Poiana, Luminita Tomescu, Iulian Slavu, Raluca Tulin, Silviu Pituru, Cristina Orlov, Radu Jecan, Balalau Cristian, Anca Pantea Stoian, Razvan Hainarosie, Cornelia Nitipir

Journal of Mind and Medical Sciences

There is ongoing debate regarding the role of neck dissection in differentiated thyroid cancer, about its usefulness in elective settings, and the increased costs regarding morbidity and operative time. This retrospective study aimed to determine the rate of metastases in cervical lymph nodes, to examine the morbidity of this surgery, and to assess whether a pattern of distribution of tumor cells concerning neck lymphatic compartments exists. The most frequent type of cancer to metastasize was papillary cancer, the majority of patients were young with a median of 30 years, predominantly females. Differentiated thyroid cancer frequently metastasizes to the central and …

A Proposed Therapeutic Algorithm For Colorectal Cancer Prevention, Based On Endoscopic Polypectomies In Patients With Multiple Colonic Polyps, Septimiu Alexandru, Florin D. Ungureanu, Reka Incze Kutasi, Cosmin Alec Moldovan

Journal of Mind and Medical Sciences

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare.

Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania.

Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found.

Discussions. After …

Can Non-Small Cell Lung Cancer Histologic Subtypes Predict Survival? A Single Institution Experience, Cornelia Nitipir, Cristina Orlov, Ana-Maria Popa, Mihaela Olaru, Iulian Slavu, Iaciu Cristian, Razvan Hainarosie, Anca Pantea Stoian, Balalau Cristian

Journal of Mind and Medical Sciences

Introduction. The latest histological classification of lung adenocarcinoma includes lepidic, acinar, papillary, micropapillary, and solid as subtypes. Testing these subtypes for their prognostic and predictive value is an ongoing scientific challenge. The present research article aims to describe the influence this classification has on patient survival.

Materials and Methods. Thirty-three patients were included in the trial. The most important enrollment criterion was the clear specification of the adenocarcinoma subtype in the pathology report. Patients were stratified into three groups which included the adenocarcinoma pathological subtypes as follows: lepidic (LEP), acinar and papillary (ACN/PAP), and micropapillary/solid (MIP/SOL). The primary endpoint was …

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous …

Sentinel Lymph Node In Early Stage Ovarian Cancer; A Literature Review, Irina Balescu, Nicolae Bacalbasa, Mihaela Vilcu, Vladislav Brasoveanu, Iulian Brezean

Journal of Mind and Medical Sciences

Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method.

Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems …