Surgery Commons^™

Placental Pathology In Spontaneous And Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features, Lucy T Brink, Drucilla J Roberts, Colleen A Wright, Daan G Nel, Pawel T Schubert, Theonia K Boyd, David R Hall, Hein Odendaal

Faculty, Staff and Student Publications

INTRODUCTION: Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The aim of this study was to investigate these relationships.

METHODS: Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13.

RESULTS: In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) …

Management Of Adrenocorticotropic Hormone-Secreting Neuroendocrine Tumors And The Role Of Bilateral Adrenalectomy In Ectopic Cushing Syndrome, Jace P Landry, Uriel Clemente-Gutierrez, Carolina R C Pieterman, Yi-Ju Chiang, Steven G Waguespack, Camilo Jimenez, Mouhammed A Habra, Daniel M Halperin, Sarah B Fisher, Paul H Graham, Nancy D Perrier

Faculty, Staff and Student Publications

BACKGROUND: Neuroendocrine tumors can cause ectopic Cushing syndrome, and most patients have metastatic disease at diagnosis. We identified risk factors for outcome, evaluated ectopic Cushing syndrome management, and explored the role of bilateral adrenalectomy in this population.

METHODS: This was a retrospective study including patients with diagnosis of ectopic Cushing Syndrome secondary to neuroendocrine tumors with adrenocorticotropic hormone secretion treated at our quaternary referral center over a 40-year period (1980-2020).

RESULTS: Seventy-six patients were included. Mean age at diagnosis was 46.3 ± 15.8 years. Most patients (N = 61, 80%) had metastases at ectopic Cushing syndrome diagnosis. Average follow-up was …

Association Of Gangrenous, Suppurative, And Exudative Findings With Outcomes And Resource Utilization In Children With Nonperforated Appendicitis, Shannon L Cramm, Aaron M Lipskar, Dionne A Graham, Shaun M Kunisaki, Cornelia L Griggs, Myron Allukian, Robert T Russell, Nicole M Chandler, Matthew T Santore, Danielle I Aronowitz, Martin L Blakely, Brendan Campbell, Devon T Collins, Sarah J Commander, Robert A Cowles, Jennifer R Defazio, Justice C Echols, Joseph R Esparaz, Christina Feng, Richard A Guyer, David N Hanna, Katherine He, Anastasia M Kahan, Olivia A Keane, Abdulraouf Lamoshi, Carla M Lopez, Sean E Mclean, Elizabeth Pace, Maia D Regan, Stefan Scholz, Elisabeth T Tracy, Sasha A Williams, Lucy Zhang, Shawn J Rangel

Faculty, Staff and Student Publications

IMPORTANCE: The clinical significance of gangrenous, suppurative, or exudative (GSE) findings is poorly characterized in children with nonperforated appendicitis.

OBJECTIVE: To evaluate whether GSE findings in children with nonperforated appendicitis are associated with increased risk of surgical site infections and resource utilization.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study used data from the Appendectomy Targeted Database of the American College of Surgeons Pediatric National Surgical Quality Improvement Program, which were augmented with operative report data obtained by supplemental medical record review. Data were obtained from 15 hospitals participating in the Eastern Pediatric Surgery Network (EPSN) research consortium. The study …

Association Of Changes In Antithrombin Activity Over Time With Responsiveness To Enoxaparin Prophylaxis And Risk Of Trauma-Related Venous Thromboembolism, Laura E Vincent, Michael M Talanker, Dakota D Butler, Xu Zhang, Jeanette M Podbielski, Yao-Wei W Wang, Amber Chen-Goodspeed, Selina L Hernandez Gonzalez, Erin E Fox, Bryan A Cotton, Charles E Wade, Jessica C Cardenas

Faculty, Staff and Student Publications

Importance: Venous thromboembolism (VTE) affects 2% to 20% of recovering trauma patients, despite aggressive prophylaxis with enoxaparin. Antithrombin is a primary circulating anticoagulant and crucial component of enoxaparin thromboprophylaxis. Approximately 20% of trauma patients present with antithrombin deficiency (antithrombin activity < 80%).

Objective: To examine time-dependent changes in antithrombin activity, responsiveness to enoxaparin, as measured by anti-factor Xa (anti-FXa) levels, and incidence of VTE after severe trauma and to assess the association of ex vivo antithrombin supplementation with patients' sensitivity to enoxaparin prophylaxis.

Design, setting, and participants: This single-center, prospective cohort study was performed at a level 1 trauma center between January …

Pharmacological Interventions For The Treatment And Control Of Shivering In Adult Patients Undergoing Elective Surgery Under Regional Anaesthesia: A Systematic Review And Meta-Analysis, Malika Hameed, Naureen Akber Ali, Khalid Ahsan, Mohsin Nazir

Department of Anaesthesia

Intraoperative shivering is quite common after regional anaesthesia, which not only increases the total body oxygen requirement but also causes discomfort to the patients. The aim of this systematic review is to determine the effectiveness of pharmacological agents administered intra-operatively for treating shivering in adult patients who are undergoing elective surgery under regional (i.e., central neuraxial) anaesthesia so that an optimal choice of an agent can be recommended for clinical application. A literature search was carried out using PubMed, Cochrane Library, CINAHL databases, and hand searches to identify relevant studies. After literature screening and information extraction, a systematic review was …

Utilization Of Finite Element Analysis Techniques For Adolescent Idiopathic Scoliosis Surgical Planning, Michael A. Polanco

Mechanical & Aerospace Engineering Theses & Dissertations

Adolescent Idiopathic Scoliosis, a three-dimensional deformity of the thoracolumbar spine, affects approximately 1-3% of patients ages 10-18. Surgical correction and treatment of the spinal column is a costly and high-risk task that is consistently complicated by factors such as patient-specific spinal deformities, curve flexibility, and surgeon experience. The following dissertation utilizes finite element analysis to develop a cost-effective, building-block approach by which surgical procedures and kinematic evaluations may be investigated. All studies conducted are based off a volumetric, thoracolumbar finite element (FE) model developed from computer-aided design (CAD) anatomy whose components are kinematically validated with in-vitro data. Spinal ligament stiffness …

Case Report: Axilla Fibroadenoma - An Atypical Presentation, Safna Naozer Virji, Lubna Mushtaque Vohra, Syeda Sakina Abidi, Romana Idress

Department of Surgery Docs

No abstract provided.

Longitudinal Reduction In Diversity Of Maternal Gut Microbiota During Pregnancy Is Observed In Multiple Low-Resource Settings: Results From The Women First Trial, Minghua Tang, Nicholas E. Weaver, Daniel N. Frank, Diana Ir, Charles E. Robertson, Jennifer F. Kemp, Jamie Westcott, Kartik Shankar, Sumera Aziz Ali, Sarah Saleem

Community Health Sciences

Objective: To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala).
Methods: Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm …

Giant Gastroduodenal Duplication Cyst With Juxta-Pancreatic Communication, Jhon F. Martinez Paredes, Daniel G. Plata-Diaz, Adriana Pinilla

School of Medicine Publications

Enteric duplication cysts are rare congenital malformations with a low incidence and there are only a few reports in the literature. Their clinical presentation varies according to the location and the type of duplication. T heir overall prognosis is good if early surgical intervention is provided. We report a 2-month-old boy who presented with a case of a giant gastroduodenal duplication cyst with a juxta-pancreatic communication and was successfully treated surgically. It is imperative to be aware of this rare congenital malformation that can present clinically with a wide range of non-specific symptoms that can cause significant morbidity and mortality …

Radiation Therapy For Older Women With Early Breast Cancer: An Unnecessary Hardship, Lauren E. Shawver

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial [published correction appears in Lancet Oncol. 2015 Mar;16(3):e105]. Lancet Oncol. 2015;16(3):266-273. https://doi.org/10.1016/S1470-2045(14)71221-5

for an older patient seeking treatment for Stage 1 Ductal Breast Carcinoma

Enhanced Recovery After Surgery (Eras) Protocols Decrease Length Of Hospital Stay And Maintain Functional Independence In Elderly Patients Undergoing Colorectal Surgery, Kristen Hawes

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Ostermann S, Morel P, Chalé JJ, et al. Randomized controlled trial of enhanced recovery program dedicated to elderly patients after colorectal surgery. Dis Colon Rectum. 2019;62(9):1105-1116. https://doi.org/10.1097/DCR.0000000000001442

for an elderly patient undergoing colorectal surgery.

A Retrospective Analysis Of Endocrine Disease In Sphingosine-1-Phosphate Lyase Insufficiency: Case Series And Literature Review, Avinaash Maharaj, Ruth Kwong, Jack Williams, Christopher Smith, Helen Storr, Ruth Krone, Debora Braslavsky, Maria Clemente, Nanik Ram, Indraneel Banerjee

Section of Diabetes, Endocrinology and Metabolism

Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional …

The Rsph4a Gene In Primary Ciliary Dyskinesia, Ron Nates, Mattan Arazi, Liza Grosman-Rimon, Roy Israel, Jacob Gohari, Leonid Sternik, Erez Kachel

Faculty, Staff and Student Publications

INTRODUCTION: There is no consensus as to which patients should undergo Non-Contrast Chest Computerized Tomography (NCCCT) and carotid arteries Doppler (CD) prior to cardiac surgery. The objective of this study was to examine whether preoperative imaging modalities provide clinical benefits and a change in surgical strategy.

METHODS: We routinely performed NCCCT and CD in all non-urgent cardiac surgery patients. Major NCCCT/CD findings related to cardiovascular findings (aortic calcification/atherosclerosis, carotid artery plaque/stenosis), or other incidental findings (lung kidney, thyroid, adrenal, gastrointestinal sites etc.) were documented. The results were divided into 3 categories: (A) findings requiring both changes in surgical strategy and …

Use Of Autoreactive Antibodies In Blood Of Patients With Pancreatic Intraductal Papillary Mucinous Neoplasms (Ipmn) For Grade Distinction And Detection Of Malignancy, Niall Brindl, Henning Boekhoff, Andrea S Bauer, Matthias M Gaida, Hien Dang, Jörg Kaiser, Jörg D Hoheisel, Klaus Felix

Department of Surgery Faculty Papers

(1) Background: A reliable non-invasive distinction between low- and high-risk pancreatic intraductal papillary mucinous neoplasms (IPMN) is needed to effectively detect IPMN with malignant potential. This would improve preventative care and reduce the risk of developing pancreatic cancer and overtreatment. The present study aimed at exploring the presence of autoreactive antibodies in the blood of patients with IPMN of various grades of dysplasia. (2) Methods: A single-center cohort was studied composed of 378 serum samples from patients with low-grade IPMN (n = 91), high-grade IPMN (n = 66), IPMN with associated invasive cancer (n = 30), pancreatic …

Association Of U.S. Birth, Duration Of Residence In The U.S., And Atherosclerotic Cardiovascular Disease Risk Factors Among Asian Adults, Mahmoud Al Rifai, Sina Kianoush, Vardhmaan Jain, Parag H. Joshi, Miguel Cainzos-Achirica, Khurram Nasir, Anwar T. Merchant, Sunita Dodani, Zainab Samad, Salim S. Virani

Section of Cardiology

Introduction: Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans.
Methods: We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S.
Results: The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean …

The Virtual Peripheral Nerve Academy: Education For The Identification And Treatment Of Peripheral Nerve Disorders, Erica B. Lee, Allison Podsednik, Kimberly Khoo, Amal Cheema, Raysa Cabrejo, Chen Shen, Joseph Rosen, A Lee Dellon

School of Medicine Publications

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders. However, medical school curricula are profoundly deficient in peripheral nerve education. This lack of knowledge within the healthcare profession may cause inadequate patient care. We developed the Virtual Peripheral Nerve Academy (VPNA) as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system (PNS). Students are introduced to the PNS through virtual 3D rendering of the human body, wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve. PNS …

Endoscopic Outcomes In Patients With Aerd Treated With Topical Antibiotics And Intranasal Corticosteroids, Jhon F. Martinez Paredes, Garret Choby, Michael Marino, Devyani Lal, Osarenoma Olomu, Razan Alfakir, Janalee K. Stokken, Erin O’Brien, Angela M. Donaldson

School of Medicine Publications

Background: Identifying effective therapy for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP) is a major challenge; and subtypes such as aspirin-exacerbated respiratory disease (AERD) are even more difficult to treat. Evidence on topical antibiotics use in (CRSwNP) is lacking. Current consensus guidelines recommend against its routine use, but recent reviews show some benefit when managing recalcitrant disease after endoscopic sinus surgery (ESS).

Objective: Evaluate the effect of culture-directed topical antibiotics on sinonasal outcomes in AERD patients with a positive perioperative sinonasal bacterial culture who have undergone ESS.

Methods: A retrospective cohort study of AERD patients with positive sinonasal culture, who …

Advanced-Stage Melanoma At Presentation Following The Peak Of The Pandemic: A Covid-19 Cancer Canary In A Coal Mine, Ryan Lamm, Md, Walker Lyons, Md, Winnie So, Rn, Alliric I. Willis, Md, Facs, Msph

Department of Surgery Faculty Papers

Background: For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline.

Methods: Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: "pre-pandemic" from May 2019 to May 2020 and "pandemic," after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables …

Return To Work And Driving After Robotic Arm-Assisted Total Knee Arthroplasty, Manoshi Bhowmik-Stoker, Kevin K Mathew, Zhongming Chen, Antonia F Chen, William J Hozack, Ormonde Mahoney, Fabio R Orozco, Michael A Mont

Rothman Institute Papers

Background: Robotic arm-assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working.

Methods: A total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work.

Results: A total of 48 patients (96%) were discharged home with self-care or …

Cardiac Metastasis After Curative Treatment Of Hepatocellular Carcinoma: Risk Factors, Treatment Options, And Prognosis, Gaurav Jain, Mathew Otto, Mubeen Khan Mohammed Abdul, Manpreet Chadha, Ajay Sahajpal

Journal of Patient-Centered Research and Reviews

Hepatocellular carcinoma (HCC) is primary hepatic malignancy with a high incidence of recurrence. The risk of recurrence directly correlates to patient’s overall prognosis. Management of advanced HCC involves a combination of surgical resection, locoregional therapy, and systemic treatment. Distant metastases are rare, and intraventricular cardiac metastases are even more infrequent. This brief review details an illustrative case of cardiac metastasis after curative treatment of primary HCC and then summarizes the literature on risk factors, treatment options, and patient prognosis in the setting of distant metastases from HCC. Prognosis of metastasis to the heart is generally poor, and available evidence emphasizes …