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Jss Editorial Board & Credits

Jefferson Surgical Solutions

Jefferson Surgical Solutions is published by Thomas Jefferson University and Thomas Jefferson University Hospital. Jefferson Department of Surgery Curtis Building, Suite 620 1015 Walnut Street Philadelphia, PA 19107 www.JeffersonHospital.org/surgery Barry Gutman, Editor/Writer JeffGraphics, Design Editorial Board: Volume 1, Issue 1 Hwyda Arafat, MD, PhD Adam Berger, MD Cataldo Doria, MD Adam Frank, MD Gerald Isenberg, MD Robert Larson, MD John Moore, MD Scott Silvestry, MD Robert Solit, MD Thomas Tulenko, PhD Charles Yeo, MD Jennifer Brumbaugh Diane Calder Patricia McMorrow Flo Williams Information in Jefferson Surgical Solutions is not intended to provide advice on personal medical matters or to substitute …

Honoring Dr. Herbert Cohn

Jefferson Surgical Solutions

On March 28, Mae Gelb of Scranton, Pennsylvania, celebrated her 100th birthday with close friends and family, including her nephew, Herbert E. Cohn, MD, Anthony Narducci Professor and Vice Chair of Surgery, Jefferson. Mrs. Gelb's life has been nearly as healthy as it is long. Aside from giving birth, her only experience as an inpatient was when, in October 1993, at Thomas Jefferson University Hospital, she underwent a major operation performed by then-Samuel D. Gross Professor and Chair of Surgery Francis E. Rosato, MD, with moral support from Dr. Cohn. "So many physicians I know have been taught by Herb." …

News In Brief

Jefferson Surgical Solutions

Jefferson's Department of Surgery has been accepted to participate in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). The lead surgeon for this initiative is Herbert E. Cohn, MD. Developed by the United States Department of Veteran Affairs, NSQIP is one of the first outcomes-based, risk-adjusted, peer-controlled programs designed to measure and enhance the quality of surgical care. The program collects data on 133 variables, including preoperative risk factors, intraoperative variables and 30-day mortality and morbidity outcomes data – the latter entered by Kathleen Hartman, RN, BSN, the department's new Surgical Clinical Nurse Reviewer. It will enable …

On The Job

Jefferson Surgical Solutions

Patricia Kal Sauter, RN, MSN, ACNP, NCTMB, Gastrointestinal Surgery, Department of Surgery Since graduating from the University of Maryland School of Nursing, Pat Sauter had worked at the Johns Hopkins Hospital in Baltimore –the last 15 years with Charles J. Yeo, MD, whom she accompanied when he was appointed in 2005 as the Samuel D. Gross Professor and Chair of Surgery at Jefferson Medical College of Thomas Jefferson University and at Thomas Jefferson University Hospital. She works four days a week and spends the others on her farm near York, Pennsylvania, with children Kate, age 14, and Jack, 11. Describe …

Meet Our Surgical Interns

Jefferson Surgical Solutions

The staff of the Department of Surgery at Jefferson is currently assisted by an exceptional group of interns. Pictured left to right, they are: Hamid Abdollahi, MD, Jefferson Medical College (JMC), Class of 2005; Lisa Harris, MD, State University of New York (SUNY) Downstate Medical Center, Brooklyn, Class of 2005; Matthew Rosen, MD, JMC, Class of 2005; Jennifer Sullivan, MD, University of Maryland, College Park, Class of 2005; Nikolai Bildzukewicz, MD, JMC, Class of 2001 (followed by military service as a flight surgeon in the United States Navy); and Daniel Lefebvre, MD, SUNY Upstate Medical University, Syracuse, Class of 2005. …

Initiation Of A Critical Pathway For Pancreaticoduodenectomy At An Academic Institution -- The First Step In Multi-Disciplinary Team Building, Eugene P. Kennedy, Ernest L. Rosato, Patricia K. Sauter, Laura M. Rosenberg, Cataldo Doria, Ignazio R. Marino, Karen A. Chojnacki, Adam C. Berger, Charles Yeo

Department of Surgery Faculty Papers

Objective: This study was designed to identify quantifiable parameters to track performance improvements brought about by the implementation of a critical pathway for complex alimentary tract surgery.

Background: Pancreaticoduodenectomy (PD) is a complex general surgical procedure performed in varying numbers at many academic institutions. Originally associated with significant perioperative morbidity and mortality, multiple studies have now shown that this operation can be performed quite safely at high volume institutions that develop a particular expertise. Critical pathways are one of the key tools used to achieve consistently excellent outcomes as these institutions. It remains to be determined if implementation …

Building A Better Bypass Graft

Jefferson Surgical Solutions

Jefferson vascular surgeon obtains three research grants. Vascular surgeon Paul DiMuzio, MD, FACS,Assistant Professor of Surgery and Radiology,Jefferson Medical College (JMC) of ThomasJefferson University, has been awarded grantsfrom the National Institutes of Health (NIH),American Vascular Association and AmericanHeart Association totaling $975,000. Thesefunds will further his team's research to usetissue engineering and stem cell technologyto develop a novel bypass graft for patientswho lack autogenous tissues for vascularprocedures such as coronary and peripheralartery bypass and hemodialysis access. "Today, the gold standard for creatingthese grafts is using the patient's saphenousvein or another artery," Dr. DiMuzio says."When those are unavailable because theyare diseased, too …

History Of Epilepsy Surgery, Ather Enam

Section of Neurosurgery

No abstract provided.

Impact Of Suture Choice On Stricture Formation Following Repair Of Esophageal Atresia, Shawn D. St Peter, Patricia A. Valusek, Charles L. Snyder, G W. Holcomb Iii, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

Background/ Purpose: The most common complication following repair of esophageal atresia is anastomotic stricture. Despite strong opinions of pediatric surgeons regarding the type of suture used for the anastomosis, these opinions remain unsubstantiated by any data present in the literature. Therefore, we investigated the rate and severity of stricture formation relative to the suture size and material.
Materials & Methods: A retrospective analysis of our most recent 20-year experience with repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) was performed. Stricture was defined as the need for dilation. Outcomes were analyzed based on absorbability, texture, and type of …

Postoperative Sore Throat After Elective Surgical Procedures, Aliya Ahmed, Shemaila Abbasi, Hasham Bin Ghafoor, Muhammad Ishaq

Department of Anaesthesia

Postoperative sore throat is a common complication of anaesthesia and can lead to dissatisfaction after surgery. Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management Methods: In this prospective observational study elective gynaecological and general surgical patients were interviewed 24 hours postoperatively to determine the presence of sore throat. Information collected included demographic data, surgical procedure, duration of surgery, airway device used and position of patient during surgery. This study was done over a period of 3 months. Results: 312 patients were interviewed. 81(26%) patients suffered with sore throat postoperatively. 28% …

Postoperative Wound Leak And Anterior Chamber Reaction In Patients Undergoing Phacoemulsification Cataract Surgery With Sutured And Sutureless Corneal Incisions, Tanveer Anjum Chaudhry, Muhammad Shahzad Shamim, Sameer Khan, Khabir Ahmad

Department of Surgery Docs

Purpose: To compare the rates of significant post operative wound leak and anterior chamber (AC) reaction in patients undergoing phacoemulsification cataract surgery with sutured and sutureless corneal incisions. Material and Methods: All eyes scheduled to have phacoemulsification surgery by two surgeons at two centers were selected. The first group of eyes underwent phacoemulsification surgery with 3.25 mm superior and superior-temporal clear corneal incisions. The incision was sutured using a single 10/0 nylon suture. The second group of eyes underwent an identical surgery, but the incision was not sutured. Patients were followed up at 24 hours, and 1 week and evaluated …

Total Parotidectomy Under Local Anesthesia: A Novel Technique, Kamran Shahid, Bilal Karim Siddiqui, Muhammad Hammad Tahir, Salman Bin Ayub, Ghulam Murtaza Memon, Adnan Yousuf, Arif Hussain, Osmani, Abdul Karim Siddiqui

Department of Biological & Biomedical Sciences

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. …

Mediastinal Parathyroid Adenoma Causing Primary Hyperparathyroidism, Farhat Abbas, Syed Raziuddin Biyabani, Amanullah Memon, Jamsheer Jehangir Talati

Section of Urology

An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explorations, an ectopically placed parathyroid adenoma should be considered …

An Unusual Abdominal Mass: Case Report, H. Saidi, U. Mohammed, M. Machoki

General Surgery, East Africa

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze.The case illustrates the fallibility of the men and women in the operating theatres and the vital role of …

Post-Operative Extended Volume External Beam Radiation Therapy Is Safe For High Risk Esophageal Cancer Patients, Edward Yu, Patricia Tai, Jawaid Younus, Richard Malthaner, Larry Stitt, Pauline Truong, George Rodrigues, Robert Ash, Rashid Dar, Anna Tomiak, Mark Vincent, Walter Kocha, Brian Dingle, Richard Inculet

Oncology Presentations

Post-operative radiation therapy (RT) (1) and post-operative chemoradiation (2) have been used for esophageal cancer patients deemed high risk for recurrence after esophagectomy.

Defining opitmal RT target volume after esophagectomy is difficult due to significant changes in patient anatomy and function.

Some radiationon cologists advocated the inclusion of the anastomotic site within the irradiation volume due to concerns for potential increased relapse risk, while others did not subscribe to this practice due to concerns for increased treatment related toxicity.

We have previously reported patient outcome benefit using extended volume RT In management with high risk esophageal cancer patients underwent esopagectomy(3). …

Cholecystectomy Deferral In Patients With Endoscopic Sphincterotomy, Vivian Mcalister, Eric Davenport, Elizabeth Renouf

Surgery Publications

BACKGROUND: Cholecystectomy is not required in up to 64% of patients who adopt a wait-and-see policy after endoscopic clearance of common bile duct stones. Although reports of retrospective cohort series have shown a higher mortality among patients who defer cholecystectomy, it is not known if this is due to the patients' premorbid health status or due to the deferral of cholecystectomy. Randomised clinical trials of prophylactic cholecystectomy versus wait-and-see have not had sufficient power to demonstrate differences in survival.

OBJECTIVES: To evaluate the beneficial and harmful effects of cholecystectomy deferral (wait-and-see) versus elective (prophylactic) cholecystectomy in patients who have had …

Non-Cardiac Surgery In Patients With Prosthetic Heart Valves: A 12 Years Experience, Raja Parvez Akhtar, Abdul Rehman Abid, Hasnain Zafar, Syed Javed Raza Gardezi, Abdul Waheed, Jawad Sajid Khan

Section of General Surgery

Objective: To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures.
Study Design: It was a cohort study.
Place and Duration of Study : The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006.
Patients and Methods: Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded.
Results: In this study, 507 consecutive patients with a mechanical …

Spectrum Of Intracranial Pathology: Tumors Versus Infections At A Tertiary Care Hospital, Muhib Alam Khan, Sukaina Aijazali Panju, Ather Enam

Section of Neurosurgery

Introduction: Aga Khan University Hospital Neurosurgery Department has evolved into a high-volume centre for treatment of neurosurgical diseases. We aimed to compare the relative outcomes of intracranial tumors and CNS infections seen at our facility.
Methods: Hospital records of patients admitted under the neurosurgery service between 1994-2003 were evaluated. Cases with a principal diagnosis of an intracranial lesion were identified for further study. Demographic, clinical,and surgical variables were extracted from the medical record. Length of hospital stay, ICU utilization, and in-hospital mortality were the primary outcome indicators. Data were analyzed through descriptive statistics and comparisons of meansand proportions. …

Neurosurgeons And Electrocautery, S. Ather Enam

Section of Neurosurgery

Abstract are not provided by the author/publisher

Idiopathic Granulomatous Mastitis Masquerading As Carcinoma Of The Breast: A Case Report And Review Of The Literature., Richard Tuli, Brian J O'Hara, Janet Hines, Anne L Rosenberg

Department of Surgery Faculty Papers

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options …

Gastroesophageal Reflux Disease And Fundoplication In Infants And Children, Shawn D. St Peter, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

Gastroesophageal reflux disease (GERD) can be one of the most distressing conditions developing at different ages in infants and children. The disease itself is a complex process along with ongoing dynamic anatomic and physiologic changes occurring during normal development. Therefore among referring physicians, considerations regarding the role of surgery for GERD in children varies widely depending on individual experiences in managing these patients. These varied opinions result in discrepancies in the operative experience with fundoplication among pediatric surgeons. It is unclear how much of the current opinions stem from published evidence, particularly with regard to the safety and efficacy of …

Solitary Infantile Myofibromatosis Of The Skull, Farah Naz, Zafar Nazir, Khalid Chishti, Nadeem Aslam, Salman Siddiqui

Department of Surgery Docs

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal region, associated with lysis of local bone. Investigations lead to a diagnosis of infantile myofibromatosis (IM). Wide local excision was performed. At one year follow-up, no recurrence was noted.

Pancreatic Operations In Children, An Institutional Experience And Review Of Literature, Varun Puri, Lisa Martin, Shawn D. St Peter, G W. Holcomb Iii, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

Pancreatic operations are not commonly performed in the pediatric age group. Tumors, chronic pancreatitis, trauma and hyperinsulinemic hypoglycemia are the main diseases leading to pancreatic resections in children. Excluding patients with acute pancreatitis and pseudocysts, over the last 5 years we have performed operations in 11 children for pancreaticoduodenal pathology. The diagnoses encountered were tumors or tumor like conditions (four), angiodysplasia (one), chronic pancreatitis (one), traumatic pancreatic transection (three), traumatic pseudocyst, and neonatal hyperinsulinemic hypoglycemia (one). Operations performed were: pancreaticoduodenectomy (PD) in three patients, subtotal or distal pancreatectomy in six patients, distal pancreaticojejunostomy with oversewing of the proximal pancreatic duct …

Reduction Of Astrogliosis And Microgliosis By Cerebrospinal Fluid Shunting In Experimental Hydrocephalus, Janet M. Miller, James P. Mcallister Ii

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Reactive gliosis has the potential to alter biomechanical properties of the brain, impede neuronal regeneration and affect plasticity. Determining the onset and progression of reactive astrogliosis and microgliosis due to hydrocephalus is important for designing better clinical treatments.

Methods

Reactive astrogliosis and microgliosis were evaluated as the severity of hydrocephalus increased with age in hydrocephalic H-Tx rats and control littermates. Previous studies have suggested that gliosis may persist after short-term drainage (shunt treatment) of the cerebrospinal fluid. Therefore shunts were placed in 15d hydrocephalic rats that were sacrificed after 6d (21d of age) or after 21d (36d of …

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …

Reverse Sural Island Flap In Coverage Of Defects Lower Third Of Leg: A Series Of Nine Cases, S. O. Khainga, B. Githae, V. M. Mutiso, Ronald Wasike

General Surgery, East Africa

The distally based sural island flap was first described by Masquelet, et al, in 1992. It is a skin island flap supplied by the vascular axis of the sural nerve. lhe aim of this paper is to demonstrate that it can be applied in coverage of difficult wound in the lower third of the leg. We treated nine patients with nine distally based sural island flaps. All the flaps survived, most of the flaps had venous congestion. The largest flap was 10 x 8 em and Doppler was used in only one flap. This technique is easy and quick to …

Fracture Of The Scapula With Intrathoracic Penetration In A Skeletally Mature Patient, Cary C. Schwartzbach, Hani Seoudi, Amy E. Ross, Kimberly M. Hendershot, Linda Robinson, Alireza Maekzadeh

Department of Surgery Faculty Publications

To our knowledge, intrathoracic displacement of a fractured scapula has only been described in two reports involving adolescents^1,2. We present the case of a skeletally mature adult with a scapular fracture that penetrated the thoracic cage without causing a pneumothorax. We speculate as to how the adult scapula can deform in a manner consistent with this rare injury. As the patient had advanced Alzheimer disease, the family consented to the publication of data concerning this case.

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery Docs

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Neck Recurrence In Early Carcinoma Tongue, Mubasher Ikram, Sadaf Fatima Jafferbhoy, Maisam Abbas Shiraz Onali

Section of Otolaryngology, Head & Neck Surgery

Objective: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck.

Methods: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years.

Results: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were …