Surgery Commons^™

Electrophysiological Signatures Of Spatial Boundaries In The Human Subiculum., Sang Ah Lee, Jonathan F. Miller, Andrew J. Watrous, Michael R. Sperling, Ashwini Sharan, Gregory A. Worrell, Brent M. Berry, Joshua P. Aronson, Kathryn A. Davis, Robert E. Gross, Bradley Lega, Sameer Sheth, Sandhitsu R. Das, Joel M. Stein, Richard Gorniak, Daniel S. Rizzuto, Joshua Jacobs

Department of Radiology Faculty Papers

Environmental boundaries play a crucial role in spatial navigation and memory across a wide range of distantly related species. In rodents, boundary representations have been identified at the single-cell level in the subiculum and entorhinal cortex of the hippocampal formation. Although studies of hippocampal function and spatial behavior suggest that similar representations might exist in humans, boundary-related neural activity has not been identified electrophysiologically in humans until now. To address this gap in the literature, we analyzed intracranial recordings from the hippocampal formation of surgical epilepsy patients (of both sexes) while they performed a virtual spatial navigation task and compared …

Transanal Drainage Of Coloanal Anastomotic Leaks., Bradley Sherman, Mark Arnold, Syed Husain

Surgery Articles

The conventional operative intervention for leaks following coloanal anastomoses has been proximal fecal diversion with or without take-down of anastomosis. A few of these cases are also amenable to percutaneous drainage. Ostomies created in this situation are often permanent, specifically in cases where coloanal anastomoses are taken down at the time of reoperation. We present two patients who developed perianastomotic pelvic abscesses that were treated with transanal large bore catheter drainage resulting in successful salvage of coloanal anastomoses without the need for a laparotomy or ostomy creation. We propose this to be an effective therapeutic approach to leaks involving low …

A New Mini-Navigation Tool Allows Accurate Component Placement During Anterior Total Hip Arthroplasty., Javad Parvizi Md, Jessica R. Benson, Jeffrey M. Muir

Department of Orthopaedic Surgery Faculty Papers

Introduction: Computer-assisted navigation systems have been explored in total hip arthroplasty (THA) to improve component positioning. While these systems traditionally rely on anterior pelvic plane registration, variances in soft tissue thickness overlying anatomical landmarks can lead to registration error, and the supine coronal plane has instead been proposed. The purpose of this study was to evaluate the accuracy of a novel navigation tool, using registration of the anterior pelvic plane or supine coronal plane during simulated anterior THA.

Methods: Measurements regarding the acetabular component position, and changes in leg length and offset were recorded. Benchtop phantoms and target measurement values …

Expression Of Carbonic Anhydrase Iii, A Nucleus Pulposus Phenotypic Marker, Is Hypoxia-Responsive And Confers Protection From Oxidative Stress-Induced Cell Death., Elizabeth S. Silagi, Philip Batista, Irving Shapiro, Makarand V. Risbud

Department of Stem Cell Biology and Regenerative Medicine Faculty Papers & Presentations

The integrity of the avascular nucleus pulposus (NP) phenotype plays a crucial role in the maintenance of intervertebral disc health. While advances have been made to define the molecular phenotype of healthy NP cells, the functional relevance of several of these markers remains unknown. In this study, we test the hypothesis that expression of Carbonic Anhydrase III (CAIII), a marker of the notochordal NP, is hypoxia-responsive and functions as a potent antioxidant without a significant contribution to pH homeostasis. NP, but not annulus fibrosus or end-plate cells, robustly expressed CAIII protein in skeletally mature animals. Although CAIII expression was hypoxia-inducible, …

Non-Retrieval Of Inferior Vena Cava Filters As A Patient Safety Concern: Evaluation Of A New Process Improvement Project To Increase Retrieval Rates In A Vascular And Interventional Radiology Clinic, Joshua Brown, Jeffery Talbert, Ryan Pennington, Qiong Han, Driss Raissi

Pharmacy Practice and Science Faculty Publications

Background: Retrieval of inferior vena cava filters (IVCFs) is important to decrease the long-term risk of complications associated with indwelling devices. Our hospital experienced low retrieval rates and implemented a low-cost intervention and evaluation for quality improvement. The working hypothesis was that a simple, mailed letter intervention could increase retrieval rates by increasing patient and primary care provider knowledge of the need for retrieval.

Methods: For all prospective patients who received a retrievable IVCF during the intervention period from January 1, 2014 to February 29, 2016, patients and their primary care providers were mailed letters encouraging contact with the clinic …

Transabdominal Versus Transvaginal, Kyla Camille Gray

Grace Peterson Nursing Research Colloquium

Background: In the United States, there has been a 21% increase in the occurrence of premature births within the last two decades. These children are also more likely to require lifelong therapies, assistive technologies, mobility devices, and more supportive services throughout their time in school. Globally, preterm births, and their preventions, have become a topic of interest. One method that has had significant success rates is placing a cerclage to prevent cervical dilation; while simultaneously treating prophylactically for early delivery.

Objectives: The purpose of this integrative literature review was to focus on which placement of cerclages, transabdominal or transvaginal, …

Perioperative Gait Analysis After Total Hip Arthroplasty: Does Outpatient Surgery Compromise Patient Outcomes?, Bryn O. Zomar, Susan W. Hunter, Dianne Bryant, Brent A. Lanting, James L. Howard

Western Research Forum

Background: There has been a continuing trend towards decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). Outpatient procedures, discharging patients on the same day as surgery, have now become possible yet little research has been done to examine the impact this might have on patients during early recovery. We aimed to investigate the impact of discharge time on gait and patient-reported outcomes in the early post-operative period.

Methods: We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and two-, six- and 12-weeks postoperatively. Participants also completed …

Age Related Diffusion And Tractography Changes In Typically Developing Pediatric Cervical And Thoracic Spinal Cord, Mahdi Alizadeh, Joshua Fisher, Sona Saksena, Phd, Yusra Sultan, Chris Conklin, Phd, Devon Middleton, Laura Krisa, Phd, Jürgen Finsterbusch, Adam Flanders, Scott H. Faro, M. J. Mulcahey, Feroze Mohamed, Phd

Department of Radiology Faculty Papers

Background and objective: Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are two techniques that can measure white matter integrity of the spinal cord. Recently, DTI indices have been shown to change with age. The purpose of this study is (a) to evaluate the maturational states of the entire pediatric spinal cord using DTI and DTT indices including fractional anisotropy (FA), mean diffusivity (MD), mean length of white matter fiber tracts and tract density and (b) to analyze the DTI and DTT parameters along the entire spinal cord as a function of spinal cord levels and age. Method: A …

Use Of Preoperative Apparent Diffusion Coefficients To Predict Brain Tumor Grade, Aneela Darbar, Muhammad Waqas, Syed Faaiz Enam, Shaikh D. Mahmood

Section of Neurosurgery

Introduction: The apparent diffusion coefficient (ADC) sequence is based on the diffusion properties of water molecules within tissues and correlates with tissue cellularity. ADC may have a role in predicting tumor grade for gliomas, and may in turn assist in identifying tumor biopsy sites. The purpose of this investigation was to assess the competence of preoperative ADC values in predicting tumor grades.
Methods: This was a retrospective investigation. We calculated the ADC values in the areas of greatest restriction in solid tumor components, and we recorded the pattern of contrast enhancement. Pathology reports masked to the imaging results were reviewed …

Association Of Obesity And Thyroid Cancer At A Tertiary Care Hospital In Pakistan, Adnan Ali, Yumna Mirza, Urooj Faizan, Nida Zahid, Muhammad S. Awan

Section of General Surgery

Objective: Thyroid cancer (TC) is one of the most common endocrine malignancies with a rapidly increasing worldwide presence. In Pakistan, it is more prevalent in females than males and has an incidence rate of 2.1%. Obesity and excess body mass index (BMI) has been linked to several cancers and is thought to be a risk factor for TC. We aim to investigate the incidence of TC in our population and understand it's correlation with obesity.
Subjects: The study was a retrospective case series conducted in the years 2000 to 2014, at the Aga Khan University Hospital (AKUH), Karachi, Pakistan where …

Rare Case Of Diffuse Spinal Arachnoiditis Following A Complicated Vertebral Artery Dissection, Elias Atallah, Md, Sophia Dang, Sage Rahm, Nohra Chalouhi, Md, Stavropoula Tjoumakaris Md, Robert H. Rosenwasswer Md, Pascal Jabbour Md

Department of Neurosurgery Posters

Spinal arachnoiditis (SA) is an extremely rare and delayed complication of intracranial subarachnoid hemorrhage (SAH). SA is an inflammatory process leading to chronic fibrosis of the spinal cord. Possible pathophysiology is a two-staged disease of initial inflammatory reaction secondary to SAH, followed by a “free interval phase” prior to delayed adhesive phase (i.e. SA). The clinical course can be complicated and is the cause of major morbidity.

Tumorigenic Proteins Upregulated In The Mycn-Amplified Imr-32 Human Neuroblastoma Cells Promote Proliferation And Migration., Hayat Zaatiti, Jad Abdallah, Zeina Nasr, George Khazen, Anthony Sandler, Tamara J Abou-Antoun

Surgery Faculty Publications

Childhood neuroblastoma is one of the most common types of extra-cranial cancer affecting children with a clinical spectrum ranging from spontaneous regression to malignant and fatal progression. In order to improve the clinical outcomes of children with high-risk neuroblastoma, it is crucial to understand the tumorigenic mechanisms that govern its malignant behaviors. MYCN proto-oncogene, bHLH transcription factor (MYCN) amplification has been implicated in the malignant, treatment-evasive nature of aggressive, high-risk neuroblastoma. In this study, we used a SILAC approach to compare the proteomic signatures of MYCN-amplified IMR-32 and non-MYCN-amplified SK-N-SH human neuroblastoma cells. Tumorigenic proteins, including fatty-acid binding protein 5 …

Department Of Surgery Update, March 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Seasonal Influence On Postoperative Complications After Total Knee Arthroplasty, Azeem Tariq Malik, Muhammad Shahid Khan, Arif Ali M, Syed Hamza Mufarrih, Shahryar Noordin

Section of Orthopaedic Surgery

Purpose: This study is aimed at investigating whether inpatient complications and surgical site infections (SSIs) occurred more commonly in patients undergoing total knee arthroplasty (TKA) during the summer season.
Materials and Methods: A total of 725 patients who underwent unilateral or bilateral TKA were included in this study. A total of 241 patients (33.2%) underwent TKA between May and August. Our outcomes of interest were the incidence of postoperative complications and length of stay.
Result: May-August surgeries were associated with a higher risk of postoperative inpatient complications (p=0.003). May-August surgeries (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18 …

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

Gibbon Surgical Review

Table of Contents

• A First Year's Perspective on JeffMD, Somnath Das, MS1
• Spotlight on TJUH's Quality and Safety Group, Samantha L. Savitch, MS1
• Medical Student Involvement in Quality Improvement Research, Tyler M. Bauer, MS3
• Global Surgery: A Shift in the Global Health Paradigm, Myles S. Dworkin, MS3
• Thomas Jefferson University Design Vault, Victor B. Hsue, MS2
• Physician Spotlight: Ernest (Gary) L. Rosato, MD, FACS, Carrie E. Andrews, MS3
• The SCALPELS Program, Emily Papai, MS1

In-Hospital Mortality And Post-Surgical Complications Among Cancer Patients With Metabolic Syndrome, Tomi Akinyemiju, Swati Sakhuja, Neomi Vin-Raviv

Epidemiology and Environmental Health Faculty Publications

Background

Metabolic syndrome (MetS) is an important etiologic and prognostic factor for cancer, but few studies have assessed hospitalization outcomes among patients with both conditions.

Methods

Data was obtained from the Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS). Study variables were assessed using ICD-9 codes on adults aged 40 years and over admitted to a US hospital between 2007 and 2011 with primary diagnosis of either breast, colorectal, or prostate cancer. We examined in-hospital mortality, post-surgical complications, and discharge disposition among cancer patients with MetS and compared with non-MetS patients.

Results

Hospitalized breast (OR: 0.31, 95% CI: 0.20–0.46), …

Outcome Of Patients With Small Vessel Vasculitis After Renal Transplantation: National Database Analysis, Amr El-Husseini, Sherif Saleh, Omer Hamad, Xiaonan Mei, Ana L. Castellanos, Daniel L. Davenport, Roberto Gedaly, B. Peter Sawaya

Internal Medicine Faculty Publications

Background. Small vessel vasculitis commonly affects the kidney and can progress to end-stage renal disease. The goal of this study is to compare outcomes of patients who received a renal transplant as a result of small vessel vasculitis (group A) with those who received kidney transplants because of other causes (group B). Methods. This is a retrospective analysis of United Network for Organ Sharing registry data for adult primary kidney transplants from January 2000 to December 2014. Group A patients (N = 2196) were compared with a group B (N = 6588); groups were case matched for age, race, sex, …

Cough, Hemoptysis And Hair Expectoration: An Intrapulmonary Teratoma, Shanila Ahmed, Habib Kibzai, Talha Shahzad, Saulat Fatimi, Madiha Bilal L Qureshi

Section of Haematology/Oncology

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary …

Migraine And Vascular Disease Biomarkers: A Population-Based Case-Control Study., Gretchen E. Tietjen, Jagdish Khubchandani, Nabeel Herial, Inge H. Palm-Meinders, Hille Koppen, Gisela M. Terwindt, Mark A. Van Buchem, Lenore J. Launer, Michel D. Ferrari, Mark C. Kruit

Department of Neurosurgery Faculty Papers

Background The underpinnings of the migraine-stroke association remain uncertain, but endothelial activation is a potential mechanism. We evaluated the association of migraine and vascular disease biomarkers in a community-based population. Methods Participants (300 women, 117 men) were recruited as a part of the Dutch CAMERA 1 (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) study. Participants were aged 30-60 (mean 48) years, 155 migraine had with aura (MA), 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared …

Cigarette Smoke Initiates Oxidative Stress-Induced Cellular Phenotypic Modulation Leading To Cerebral Aneurysm Pathogenesis., Robert M. Starke, John W. Thompson, Muhammad S. Ali, Crissey L. Pascale, Alejandra Martinez Lege, Dale Ding, Nohra Chalouhi, David M. Hasan, Pascal Jabbour, Gary K Owens, Michal Toborek, Joshua M. Hare, Aaron S. Dumont

Department of Neurosurgery Faculty Papers

OBJECTIVE: Cigarette smoke exposure (CSE) is a risk factor for cerebral aneurysm (CA) formation, but the molecular mechanisms are unclear. Although CSE is known to contribute to excess reactive oxygen species generation, the role of oxidative stress on vascular smooth muscle cell (VSMC) phenotypic modulation and pathogenesis of CAs is unknown. The goal of this study was to investigate whether CSE activates a NOX (NADPH oxidase)-dependent pathway leading to VSMC phenotypic modulation and CA formation and rupture.

APPROACH AND RESULTS: In cultured cerebral VSMCs, CSE increased expression of NOX1 and reactive oxygen species which preceded upregulation of proinflammatory/matrix remodeling genes …

Are Prophylactic Intravenous Antibiotics Required In Routine Shoulder Arthroscopic Surgery? A Systematic Review Of The Literature, Njalalle Baraza, Jordan Leith

General Surgery, East Africa

Purpose: The purpose of this study was to find out from the literature the difference in infection rates between patients who did and patients who did not receive prophylactic antibiotics in arthroscopic shoulder surgery.

Methods: We conducted a comprehensive search of the literature using Medline Ovid for prospective studies that looked at infection as the primary outcome following shoulder arthroscopy. The articles were then assessed for study design, outcome, and relevance to the specific question as part of the critical appraisal.

Results: Eight partially relevant articles were obtained from the search, but there were no prospective studies comparing infection in …

Out Of The Straitjacket., Michael Weinstein

Department of Surgery Faculty Papers

No abstract provided.

Treatment Options For Primary Cns Lymphoma, Abid Laghari, Syed Ijlal Ahmed, Adnan Jabbar, Muhammad Shahzad Shamim

Section of Haematology/Oncology

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Phosphaturic Mesenchymal Tumor Of The Nasal Cavity: Clinicopathologic Correlation Is Essential For Diagnosis, Aidan Kerr, Ryan Rimmer, Marc Rosen, James J. Evans, Madalina Tuluc, Stacey K. Mardekian

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm in which the tumor cells produce fibroblast growth factor 23 (FGF23), leading to oncogenic osteomalacia and thus a distinct clinical presentation. However, the pathologic findings of PMT are often non-specific and variable, especially in tumors occurring in the head and neck. We present a case of a 66-year-old female who presented with osteomalacia-related symptoms and was found to have a nasal cavity mass. Histopathologic examination was suggestive of PMT but certain characteristic features were lacking, requiring confirmation of the diagnosis by chromogenic in situ hybridization (CISH) assay for FGF23 mRNA. The patient's …

Tracheal Injury Detected Immediately After Median Sternotomy By Inexperienced Surgeons: Two Case Reports., Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, Suguru Ohira, Satoru Beppu, Nozomu Sasahashi, Nobuaki Shime

Department of Surgery Faculty Papers

BACKGROUND: Although median sternotomy is standard during cardiac surgery, the procedure is associated with a risk of injury to mediastinal organs. Here, we discuss two cases of tracheal injury following median sternotomy during cardiac surgery.

CASE PRESENTATION: Ventilation failure occurred in a 78-year-old Japanese man and a 71-year-old Japanese man after median sternotomy, and tracheal injury was identified. The sites of injury were directly repaired and covered with mediastinal fat tissue, following which ventilation was successful. The burn-like deposits observed at the site of tracheal injury and on the removed endotracheal tube support the notion that the injuries in our …

Injury Of The Radial Nerve In The Arm: A Review., Taroob J Latef, Muhammad Bilal, Marc Vetter, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Compression of the radial nerve is most commonly described at the supinator muscle (i.e., arcade of Frohse). However, radial nerve compression can occur in the arm. Therefore, the purpose of this article is to review both etiologies of radial nerve entrapment and the sites at which this can occur in the arm. The clinical presentation of radial nerve entrapment in the arm and how it differs from that of entrapment at other sites is reviewed and the conditions potentially predisposing to nerve entrapment are described. Particular attention is paid to the nerve's course and potential variants of the anatomical structures …

Muscle Activity During Maximal Isometric Forearm Rotation Using A Power Grip, Joseph Scott Bader, Michael R. Boland, Desney Greybe, Arthur J. Nitz, Timothy L. Uhl, David A. Pienkowski

Biomedical Engineering Faculty Publications

This study aimed to provide quantitative activation data for muscles of the forearm during pronation and supination while using a power grip. Electromyographic data was collected from 15 forearm muscles in 11 subjects while they performed maximal isometric pronating and supinating efforts in nine positions of forearm rotation. Biceps brachii was the only muscle with substantial activation in only one effort direction. It was significantly more active when supinating (µ = 52.1%, SD = 17.5%) than pronating (µ = 5.1%, SD = 4.8%, p < .001). All other muscles showed considerable muscle activity during both pronation and supination. Brachioradialis, flexor carpi radialis, palmaris longus, pronator quadratus and pronator teres were significantly more active when pronating the forearm. Abductor pollicis longus and biceps brachii were significantly more active when supinating. This data highlights the importance of including muscles additional to the primary forearm rotators in a biomechanical analysis of forearm rotation. Doing so will further our understanding of forearm function and lead to the improved treatment of forearm fractures, trauma-induced muscle dysfunction and joint replacements.

Closed-Loop Stimulation Of Temporal Cortex Rescues Functional Networks And Improves Memory., Youssef Ezzyat, Paul A. Wanda, Deborah F. Levy, Allison Kadel, Ada Aka, Isaac Pedisich, Michael R. Sperling, Ashwini Sharan, Bradley C. Lega, Alexis Burks, Robert E. Gross, Cory S. Inman, Barbara C. Jobst, Mark A. Gorenstein, Kathryn A. Davis, Gregory A. Worrell, Michal T. Kucewicz, Joel M. Stein, Richard Gorniak, Sandhitsu R. Das, Daniel S. Rizzuto, Michael J. Kahana

Department of Neurology Faculty Papers

Memory failures are frustrating and often the result of ineffective encoding. One approach to improving memory outcomes is through direct modulation of brain activity with electrical stimulation. Previous efforts, however, have reported inconsistent effects when using open-loop stimulation and often target the hippocampus and medial temporal lobes. Here we use a closed-loop system to monitor and decode neural activity from direct brain recordings in humans. We apply targeted stimulation to lateral temporal cortex and report that this stimulation rescues periods of poor memory encoding. This system also improves later recall, revealing that the lateral temporal cortex is a reliable target …

Partitioning Of Adipose Lipid Metabolism By Altered Expression And Function Of Ppar Isoforms After Bariatric Surgery, C Jahansouz, H Xu, A V. Hertzel, Kristin Ewing

Articles

BACKGROUND:

Bariatric surgery remains the most effective treatment for reducing adiposity and eliminating type 2 diabetes; however, the mechanism(s) responsible have remained elusive. Peroxisome proliferator-activated receptors (PPAR) encompass a family of nuclear hormone receptors that upon activation exert control of lipid metabolism, glucose regulation and inflammation. Their role in adipose tissue following bariatric surgery remains undefined.

RESULTS:

Within 7 days, bariatric surgery acutely drives a change in the activity and expression of PPARγ and PPARδ in subcutaneous adipose tissue thereby attenuating lipid storage, increasing lipolysis and potentiating lipid oxidation. This unique metabolic alteration leads to changes in downstream PPARγ/δ targets …

Improving Outcomes Of Emergency Bowel Surgery Using Nela Model, Rizwan Sultan, Hasnain Zafar

Section of General Surgery

Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA).
Study Design: An audit.
Place & Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014.
Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their …