Surgery Commons^™

High-Intensity Focused Ultrasound: Past, Present, And Future In Neurosurgery, Syed A. Quadri,, Muhammad Waqas, Inamullah Khan, Muhammad Adnan Khan, Sajid S. Suriya, Mudassir Farooqui, Brian Fiani

Section of Neurosurgery

Since Lynn and colleagues first described the use of focused ultrasound (FUS) waves for intracranial ablation in 1942, many strides have been made toward the treatment of several brain pathologies using this novel technology. In the modern era of minimal invasiveness, high-intensity focused ultrasound (HIFU) promises therapeutic utility for multiple neurosurgical applications, including treatment of tumors, stroke, epilepsy, and functional disorders. Although the use of HIFU as a potential therapeutic modality in the brain has been under study for several decades, relatively few neuroscientists, neurologists, or even neurosurgeons are familiar with it. In this extensive review, the authors intend to …

Ureteral Tunnel Length Versus Ureteral Orifice Configuration In The Determination Of Ureterovesical Junction Competence: A Computer Simulation Model, Carlos A. Villanueva, J. Tong, Carl A. Nelson, Linxia Gu

Department of Mechanical and Materials Engineering: Faculty Publications

Introduction The long-held belief that a ureteral re-implant tunnel should be five times the diameter of the ureter, as proposed by Paquin in 1959, ignores the effect of the orifice on the occurrence of reflux. In 1969, Lyon proposed that the shape of the ureteral orifice (UO) is more important than the intravesical tunnel. However, both theories missed quantitative evidence from principles of physics. The goal of the current study was to test Lyon’s theory through numerical models (i.e. to quantify the sensitivity of ureterovesical junction (UVJ) competence to intravesical tunnel length and to the UO).

Materials and methods The …

Department Of Surgery Update, February 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.

Prognostic Significance Of Optic Nerve Sheath Diameter On Computed Tomography Scan With Severity Of Blunt Traumatic Brain Injury In The Emergency Department., Shahan Waheed, Muhamamd Akbar Baig, Emaduddin Siddiqui, Danyal Jamil, Asher Feroze

Department of Emergency Medicine

Optic nerve sheath diameter measurement (ONSD) has been associated with identifying the prognosis of traumatic brain injury (TBI) patients. The study was planned to evaluate the prognostic value of ONSD measured on the initial brain computed tomography (CT) scan performed on patients with blunt TBI in the emergency department(ED). This retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of moderate and severe TBI patients from January to December 2014. ONSD for each eye on the initial CT scan and Glasgow Coma Scale (GCS) was measured upon patient presentation. Correlation between presentation GCS and …

A Case Review Of A Morel Lavellee Lesion With Delayed Presentation, Ammar Qureshi, Pradeep Monoot

Marshall Journal of Medicine

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure.

Anatomical Study Of The Extreme Lateral Transpsoas Lumbar Interbody Fusion With Application To Minimizing Injury To The Kidney., Joe Iwanaga, Emre Yilmaz, Tamir Tawfik, Amir Abdul-Jabbar, Marc Vetter, Marc Moisi, Koichi Watanabe, Koh-Ichi Yamaki, R Shane Tubbs, Rod J Oskouian

Articles, Abstracts, and Reports

Objective Since the extreme lateral lumbar interbody fusion procedure was first reported by Ozgur in 2006, a large number of clinical studies have been published. Anatomical studies which explore methods to avoid visceral structures, such as the kidney, with this approach have not been examined in detail. We dissected the retroperitoneal space to analyze how the extreme lateral transpsoas approach to the lumbar spine could damage the kidney and related structures. Methods Eight sides from four fresh Caucasian cadavers were used for this study. The latissimus dorsi muscle and the thoracolumbar fascia were dissected to open the retroperitoneum. The fat …

Infection Of A Ventricular Septal Defect Patch With Acremonium Species, Nosheen Nasir, Kauser Jabeen, Joveria Farooqi, Binish Arif Sultan, Afia Zafar, Aamir Hameed Khan, Muneer Amanullah, Farheen Ali

Section of Internal Medicine

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Surgical Interventions For Advanced Parameningeal Rhabdomyosarcoma Of Children And Adolescents., Paul J Choi, Joe Iwanaga, R Shane Tubbs, Emre Yilmaz

Articles, Abstracts, and Reports

Owing to its rarity, rhabdomyosarcoma of the head and neck (HNRMS) has seldom been discussed in the literature. As most of the data is based only on the retrospective experiences of tertiary healthcare centers, there are difficulties in formulating a standard treatment protocol. Moreover, the disease is poorly understood at its pathological, genetic, and molecular levels. For instance, 20% of all histological assessment is inaccurate; even an experienced pathologist can confuse rhabdomyosarcoma (RMS) with neuroblastoma, Ewing's sarcoma, and lymphoma. RMS can occur sporadically or in association with genetic syndromes associated with predisposition to other cancers such as Li-Fraumeni syndrome and …

Development Of An Objective Assessment Tool For Total Laparoscopic Hysterectomy: A Delphi Method Among Experts And Evaluation On A Virtual Reality Simulator., Sophie Knight, Rajesh Aggarwal, Md, Phd, Frcs, Facs, Aubert Agostini, Anderson Loundou, Stéphane Berdah, Patrice Crochet

Department of Surgery Faculty Papers

INTRODUCTION: Total Laparoscopic hysterectomy (LH) requires an advanced level of operative skills and training. The aim of this study was to develop an objective scale specific for the assessment of technical skills for LH (H-OSATS) and to demonstrate feasibility of use and validity in a virtual reality setting.

MATERIAL AND METHODS: The scale was developed using a hierarchical task analysis and a panel of international experts. A Delphi method obtained consensus among experts on relevant steps that should be included into the H-OSATS scale for assessment of operative performances. Feasibility of use and validity of the scale were evaluated by …

I.D.E.A.L. Transition Plan, Colleen Porwoll

Nursing Posters

The purpose of this evidence-based practice project is to increase the number of discharges prior to noon by using the IDEAL discharge planning tool with noncomplex total joint replacement patients and maintaining score of discharge phone call follow up. "Were you aware of the discharge plans and felt prepared?"

Joint Representation Of Spatial And Phonetic Features In The Human Core Auditory Cortex, P. Patel, L. K. Long, J. L. Herrero, A. D. Mehta, N. Mesgarani

Journal Articles

No abstract provided.

Predicting The Incidence And Timing Of Central Nervous System Disease In Metastatic Melanoma: Implications For Surveillance And Preventative Therapy, G. B. Deutsch, R. Tyrell, S. Yost, M. B. Deutsch, G. Barkhoudarian, D. F. Kelly, M. B. Faries

Journal Articles

No abstract provided.

Obesity In The Workplace: Impact, Outcomes, And Recommendations, C. M. Yarborough, S. Brethauer, W. N. Burton, R. J. Fabius, P. Hymel, S. Kothari, R. F. Kushner, J. M. Morton, M. S. Roslin, J. Ording, +8 Additional Authors

Journal Articles

Copyright © 2017 American College of Occupational and Environmental Medicine. Objective: To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. Methods: We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. Results: A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and …

Combining Autologous Breast Reconstruction And Vascularized Lymph Node Transfer, E. I. Chang, J. Masià, M. L. Smith

Journal Articles

© 2018 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Breast cancer patients are at risk for developing postmastectomy lymphedema syndrome of the ipsilateral upper extremity following treatment for breast cancer in the setting of an axillary dissection, postoperative radiation, and chemotherapy. For patients suffering from lymphedema who are also seeking breast reconstruction, combining an autologous abdominal free flap with a vascularized inguinal lymph node transfer provides patients the opportunity to have an aesthetic breast reconstruction as well as the potential to improve their lymphedema in a single operation. The present article aims to provide …

Development Of Normal And Cleft Palate: A Central Role For Connective Tissue Growth Factor (Ctgf)/Ccn2, J. T. Tarr, A. G. Lambi, J. P. Bradley, M. F. Barbe, S. N. Popoff

Journal Articles

© 2018 by the authors. Development of the palate is the result of an organized series of events that require exquisite spatial and temporal regulation at the cellular level. There are a myriad of growth factors, receptors and signaling pathways that have been shown to play an important role in growth, elevation and/or fusion of the palatal shelves. Altered expression or activation of a number of these factors, receptors and signaling pathways have been shown to cause cleft palate in humans or mice with varying degrees of penetrance. This review will focus on connective tissue growth factor (CTGF) or CCN2, …

Improving Oratory Skills: An "American Idol" Presentation Competition For Residents., D. A. Hill, J. Jimenez, M. R. Price, S. M. Cohn

Journal Articles

Background It is essential for physicians to master the ability to deliver high-quality oral presentations. Despite this, little time is dedicated throughout residency for training and refining this important skill. In order to solve this issue, we set out to design and implement a course which will improve the oratory skills of the resident physicians. Methods Senior surgical residents (postgraduate years three and four) were involved in a single-elimination tournament with the audience voting for the top presenters. Faculty provided feedback on oration, slide layout and overall presentation format throughout the course. Baseline and post-course survey responses were evaluated to …

Natural History Of Isolated Skull Fractures In Children., S. Hassan, A. Q. Alarhayema, S. M. Cohn, J. C. Wiersch, M. R. Price

Journal Articles

Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between January 1, 2006 and December 31, 2014. We also analyzed the National Trauma Data Bank (NTDB) research data set for the years 2012-2014 using the same metrics. During this study period, our center admitted …

Wses Worldwide Emergency General Surgery Formation And Evaluation Project, Federico Coccolini, Yoram Kluger, Luca Ansaloni, Ernest E. Moore, Raul Coimbra, Gustavo P. Fraga, Andrew Kirkpatrick, Andrew Peitzman, Ron Maier, Gianluca Baiocchi, Vanni Agnoletti, Emiliano Gamberini, Ari Leppaniemi, Rao Ivatury, Michael Sugrue, Massimo Sartelli, Salomone Di Saverio, Walt Biffl, Fausto Catena

Surgery Publications

Optimal management of emergency surgical patients represents one of the major health challenges worldwide. Emergency general surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and nontraumatic acute conditions during the same admission in the hospital. EGS represents the easiest viable way to provide affordable and high-quality level of care to emergency surgical and trauma patients. It may result from the association of different physicians with other specialties in a cooperative model. The World Society of Emergency Surgery (WSES) has been working on the EGS organization and implementation since its foundation believing in the need of common benchmarks for …

Reduction Of Endothelial Nitric Oxide Increases The Adhesiveness Of Constitutive Endothelial Membrane Icam-1 Through Src-Mediated Phosphorylation, Feng Gao, Brandon P. Lucke-Wold, Xiang Li, Aric F. Logsdon, Li-Chong Xu, Sulei Xu, Kyle B. Lapenna, Huaqi Wang, M.A. Hassan Talukder, Christopher A. Siedlecki, Jason D. Huber, Charles L. Rosen, Pingnian He

Faculty & Staff Scholarship

Nitric oxide (NO) is a known anti-adhesive molecule that prevents platelet aggregation and leukocyte adhesion to endothelial cells (ECs). The mechanism has been attributed to its role in the regulation of adhesion molecules on leukocytes and the adhesive properties of platelets. Our previous study conducted in rat venules found that reduction of EC basal NO synthesis caused EC ICAM-1-mediated firm adhesion of leukocytes within 10–30min. This quick response occurred in the absence of alterations of adhesion molecules on leukocytes and also opposes the classical pattern of ICAM-1-mediated leukocyte adhesion that requires protein synthesis and occurs hours after stimulation. The objective …

The Role Of Tgf-Β/Smad4 Signaling In Cancer, M Zhao, Lopa Mishra, C Deng

Surgery Faculty Publications

Transforming growth factor β (TGF-β) signaling pathway plays important roles in many biological processes, including cell growth, differentiation, apoptosis, migration, as well as cancer initiation and progression. SMAD4, which serves as the central mediator of TGF-β signaling, is specifically inactivated in over half of pancreatic duct adenocarcinoma, and varying degrees in many other types of cancers. In the past two decades, multiple studies have revealed that SMAD4 loss on its own does not initiate tumor formation, but can promote tumor progression initiated by other genes, such as KRAS activation in pancreatic duct adenocarcinoma and APC inactivation in colorectal cancer. In …

Surgical Management Of Symptomatic Intraluminal Duodenal Diverticulum In An Adolescent, Vivian Lam Saavedra, Timothy D. Kane, Stefany Garrity

Surgery Faculty Publications

No abstract provided.

A Primer On The Acute Management Of Intravenous Extravasation Injuries For The Plastic Surgeon, Connor Maly, Kenneth Fan, Gary F. Rogers, Benjamin Mitchell, June Amling, Kara Johnson, Laura Welch, Albert K. Oh, Jerry Chao

Surgery Faculty Publications

Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and …

Same Day Discharge For Non-Perforated Appendicitis In Children: An Updated Institutional Protocol, Tolulope A. Oyetunji Md Mph

Presentations

No abstract provided.

Relationship Of Transmural Variations In Myofiber Contractility To Left Ventricular Ejection Fraction: Implications For Modeling Heart Failure Phenotype With Preserved Ejection Fraction, Yanghoub Dabiri, Kevin L. Sack, Semion Shaul, Partho P. Sengupta, Julius M. Guccione

Faculty & Staff Scholarship

The pathophysiological mechanisms underlying preserved left ventricular (LV) ejection fraction (EF) in patients with heart failure and preserved ejection fraction (HFpEF) remain incompletely understood. We hypothesized that transmural variations in myofiber contractility with existence of subendocardial dysfunction and compensatory increased subepicardial contractility may underlie preservation of LVEF in patients with HFpEF. We quantified alterations in myocardial function in a mathematical model of the human LV that is based on the finite element method. The fiber-reinforced material formulation of the myocardium included passive and active properties. The passive material properties were determined such that the diastolic pressure-volume behavior of the LV …

Quantum Confined Peptide Assemblies With Tunable Visible To Near-Infrared Spectral Range, Kai Tao, Zhen Fan, Leming Sun, Pandeeswar Makam, Zhen Tian, Mark Ruegsegger, Shira Shaham-Niv, Derek Hansford, Ruth Aizen, Zui Pan, Scott Galster, Jianjie Ma, Fan Yuan, Mingsu Si, Songnan Qu, Mingjun Zhang, Ehud Gazit, Junbai Li

Faculty & Staff Scholarship

Quantum confined materials have been extensively studied for photoluminescent applica- tions. Due to intrinsic limitations of low biocompatibility and challenging modulation, the utilization of conventional inorganic quantum confined photoluminescent materials in bio- imaging and bio-machine interface faces critical restrictions. Here, we present aromatic cyclo-dipeptides that dimerize into quantum dots, which serve as building blocks to further self-assemble into quantum confined supramolecular structures with diverse morphologies and photoluminescence properties. Especially, the emission can be tuned from the visible region to the near-infrared region (420 nm to 820 nm) by modulating the self-assembly process. Moreover, no obvious cytotoxic effect is observed for …

Mucinous Adenocarcinoma Of The Scalp: Primary Cutaneous Neoplasm Versus Underlying Metastatic Disease, Ciara A. Brown, Michael C. Lynch, Cristiane M. Ueno

Faculty & Staff Scholarship

Primary cutaneous mucinous carcinoma (PCMC) is a rare mucin-pro- ducing malignancy derived from epithelial glandular structures. The literature re- garding this topic is mostly in the form of case reports and case series. PCMC tends to present in the elderly with predilection for the head and neck and on initial assessment it can be easily mistaken for a simple inclusion cyst. Although PCMC is often indolent in nature, in rare instances it can metastasize and should remain a differential diagnosis in a selected population. The significance in identifying PCMC is reliably differentiating it from metastatic mucinous adenocarcinoma. We present a …

Isolated Inferior Rectus Muscle Entrapment Following Endoscopic Sinus Surgery, Scott Shapiro, Jamie L. Schaefer, Sumeet Gupta, John Nguyen, Brian Kellerymeyer

Faculty & Staff Scholarship

Orbital complications are known risks of endoscopic sinus surgery (ESS). The lamina papyracea and medial rectus muscle are the most commonly injured structures during ESS. Inferior rectus injury is more rare, with only one reported case of isolated inferior rectus injury in the literature. Guidelines for managing ESS-induced inferior rectus injury do not exist, and delayed intervention and management of adjacent sinuses may affect long-term outcomes such as persistent diplopia and disfigurement. In this report, we present a case of a 67-year-old man with diplopia due to isolated left inferior rectus muscle entrapment and injury from violation of the orbital …

Pseudomonas Aeruginosa Algr Phosphorylation Status Differentially Regulates Pyocyanin And Pyoverdine Production, Alexander S. Little, Yuta Okkotsu, Alexandria A. Reinhart, Heath Damron, Mariette Barbier, Brandon Barrett, Amanda G. Ogledby-Sherrouse, Joanna B. Goldberg, William L. Cody, Michael J. Schurr, Michael L. Vasil

Faculty & Staff Scholarship

Pseudomonas aeruginosa employs numerous, complex regulatory ele- ments to control expression of its many virulence systems. The P. aeruginosa AlgZR two-component regulatory system controls the expression of several crucial viru- lence phenotypes. We recently determined, through transcriptomic profiling of a PAO1 ΔalgR mutant strain compared to wild-type PAO1, that algZR and hemCD are cotranscribed and show differential iron-dependent gene expression. Previous ex- pression profiling was performed in strains without algR and revealed that AlgR acts as either an activator or repressor, depending on the gene. Thus, examination of P. aeruginosa gene expression from cells locked into different AlgR phosphorylation states …

Tracheocutaneous Sinus Following Tracheocutaneous Fistula Repair: Management Strategies In A Pediatric Patient, Adam Bender-Heine, Habib G. Zalzal, Nainika Nanda, Hassan Ramadan

Faculty & Staff Scholarship

Objective. To present a rare case of a pediatric tracheocutaneous sinus years after repair of a tracheocutaneous fistula and to review management strategies. Background. A tracheocutaneous fistula is a common sequela of pediatric tracheostomy and can occur in as many as one in three pediatric patients. There is debate in the literature regarding optimal surgical management. Case Presentation. An 8-year-old girl presented to the emergency department with swelling and erythema over the anterior neck. Clinical exam and diagnostic imaging revealed an underlying tracheocutaneous sinus. Discussion. Complications following pediatric tracheostomy are common and range in complexity from stomal granulation to tracheocutaneous …

Hyperspectral Imaging And K-Means Classification For Histologic Evaluation Of Ductal Carcinoma In Situ, Yasser Khouj, Jeremy Dawson, James Coad, Linda Vona-Davis

Faculty & Staff Scholarship

Hyperspectral imaging (HSI) is a non-invasive optical imaging modality that shows the potential to aid pathologists in breast cancer diagnoses cases. In this study, breast cancer tissues from different patients were imaged by a hyperspectral system to detect spectral differences between normal and breast cancer tissues. Tissue samples mounted on slides were identified from 10 different patients. Samples from each patient included both normal and ductal carcinoma tissue, both stained with hematoxylin and eosin stain and unstained. Slides were imaged using a snapshot HSI system, and the spec- tral reflectance differences were evaluated. Analysis of the spectral reflectance values indicated …