Surgery Commons^™

Regenerative Medicine Technologies Applied To Transplant Medicine An Update, Astgik Petrosyan, Filippo Montali, Andrea Peloso, Antonio Citro, Lori N Byers, Catherine La Pointe, Mara Suleiman, Alice Marchetti, Eoin P Mcneill, Allison L Speer, Wai Hoe Ng, Xi Ren, Benedetta Bussolati, Laura Perin, Paolo Di Nardo, Vincenzo Cardinale, Jerome Duisit, Alexandra Rose Monetti, John Richard Savino, Amish Asthana, Giuseppe Orlando

Faculty, Staff and Student Publications

Regenerative medicine (RM) is changing how we think and practice transplant medicine. In regenerative medicine, the aim is to develop and employ methods to regenerate, restore or replace damaged/diseased tissues or organs. Regenerative medicine investigates using tools such as novel technologies or techniques, extracellular vesicles, cell-based therapies, and tissue-engineered constructs to design effective patient-specific treatments. This review illustrates current advancements in regenerative medicine that may pertain to transplant medicine. We highlight progress made and various tools designed and employed specifically for each tissue or organ, such as the kidney, heart, liver, lung, vasculature, gastrointestinal tract, and pancreas. By combing both …

Palliative Endoscopic Salvage Of A Functionally Obstructed Gastrojejunostomy - Report Of Technique, Elias A Chamely, Bryan Hoang, Nadim S Jafri, Melissa M Felinski, Kulvinder S Bajwa, Peter A Walker, Jaideep Barge, Erik B Wilson, Putao Cen, Shinil K Shah

Faculty, Staff and Student Publications

BACKGROUND: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

CASE DESCRIPTION: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical …

Cushioned On The Way Up, Controlled On The Way Down During Resuscitative Endovascular Balloon Occlusion Of The Aorta (Reboa): Investigating A Novel Compliant Balloon Design For Optimizing Safe Overinflation Combined With Partial Reboa Ability, Adam Power, Asha Parekh, Neil Parry, Laura J Moore

Faculty, Staff and Student Publications

Background: There are a variety of devices capable of performing resuscitative endovascular balloon occlusion of the aorta (REBOA), with most containing compliant balloon material. While compliant material is ideal for balloon inflation due to its "cushioning" effect, it can be problematic to "control" during deflation. The COBRA-OS (Control Of Bleeding, Resuscitation, Arterial Occlusion System) was designed to optimize inflation and deflation of its compliant balloon and was tested in vitro and in vivo with respect to its overinflation and partial REBOA abilities.

Methods: For overinflation, the COBRA-OS was inflated in three differently sized inner diameter (ID) vinyl tubes until balloon …

Traumatized Triad Of Complementopathy, Endotheliopathy, And Coagulopathy – Impact On Clinical Outcomes In Severe Polytrauma Patients, Zhangsheng Yang, Tuan D Le, Milomir O Simovic, Bin Liu, Tamara L Fraker, Tomas S Cancio, Andrew P Cap, Charles E Wade, Jurandir J Dallelucca, Yansong Li

Faculty, Staff and Student Publications

Complementopathy, endotheliopathy, and coagulopathy following a traumatic injury are key pathophysiological mechanisms potentially associated with multiple-organ failure (MOF) and mortality. However, the heterogeneity in the responses of complementopathy, endotheliopathy, and coagulopathy to trauma, the nature and extent of their interplay, and their relationship to clinical outcomes remain unclear. Fifty-four poly-trauma patients were enrolled and divided into three subgroups based on their ISS. Biomarkers in blood plasma reflecting complement activation, endothelial damage, and coagulopathy were measured starting from admission to the emergency department and at 3, 6, 12, 24, and 120 hours after admission. Comparative analyses showed that severely injured patients …

Enhancing Mesenchymal Stromal Cell Potency: Inflammatory Licensing Via Mechanotransduction, Max A Skibber, Scott D Olson, Karthik S Prabhakara, Brijesh S Gill, Charles S Cox

Faculty, Staff and Student Publications

Mesenchymal stromal cells (MSC) undergo functional maturation upon their migration from bone marrow and introduction to a site of injury. This inflammatory licensing leads to heightened immune regulation via cell-to-cell interaction and the secretion of immunomodulatory molecules, such as anti-inflammatory mediators and antioxidants. Pro-inflammatory cytokines are a recognized catalyst of inflammatory licensing; however, biomechanical forces, such as fluid shear stress, are a second, distinct class of stimuli that incite functional maturation. Here we show mechanotransduction, achieved by exposing MSC to various grades of wall shear stress (WSS) within a scalable conditioning platform, enhances the immunomodulatory potential of MSC independent of …

Incidence Of Readmission Following Pediatric Hand Surgery: An Analysis Of 6600 Patients, Christopher J Goodenough, Cassie A Hartline, Shuyan Wei, Joseph K Moffitt, Alfredo Cepeda, Phuong D Nguyen, Matthew R Greives

Faculty, Staff and Student Publications

BACKGROUND: Quality in surgical outcomes is frequently assessed by the 30-day readmission rate. There are limited data available in the published literature regarding readmission rates following pediatric hand surgery. This study aims to identify factors associated with an increased risk of readmission following hand surgery in a pediatric population.

METHODS: The 2012-2017 National Surgical Quality Improvement Project - Pediatric (NSQIP-P) databases were queried for pediatric patients who underwent procedures with hand-specific current procedural terminology (CPT) codes. The primary outcome was readmission.

RESULTS: A total of 6600 pediatric patients were identified and included in the analysis. There were 45 patients who …

Dysphagia Is Associated With Worse Clinical Outcomes In Geriatric Trauma Patients, Heather R Kregel, Mina Attia, Claudia Pedroza, David E Meyer, Michael W Wandling, Shah-Jahan M Dodwad, Charles E Wade, John A Harvin, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

INTRODUCTION: Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.

METHODS: Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, …

Management Of Biliary Stones In Bariatric Surgery, Francisco Tustumi, João Emílio Lemos Pinheiro Filho, Lucas Cata Preta Stolzemburg, Leonardo Carvalho Serigiolle, Thiago Nogueira Costa, Denis Pajecki, Marco Aurélio Santo, Sérgio Carlos Nahas

Faculty, Staff and Student Publications

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.

Plain language summary: Management of biliary stones in …

Cross-Mentorship: A Unique Lens Into The Realities And Challenges Of Diversity In Surgery., Marina Affi Koprowski, Karen J Dickinson, Crystal N Johnson-Mann, Martha Godfrey, Emilia J Diego, Marie Crandall, Kevin Y. Pei Md, Mhsed

Other Specialties

Mentorship in surgery is a perennial topic of interest, as successful mentoring relationships are associated with improved career satisfaction, academic promotion, research productivity, and overall well-being. While it is true that certain minority groups in surgery find great personal and professional benefit in receiving and providing mentorship among “their own” (ie, a female academic surgeon mentoring a female resident), it is important to recognize that many mentoring relationships, whether intentionally or otherwise, extend across gender, sexuality, generations, race, ethnicity, and other differences. Lived examples of these include an Asian man hailing from the Northeast with no children mentoring a White …

Recurrent Hgnet-Mn1 Altered (Astroblastoma Mn1-Altered) Of The Foramen Magnum: Case Report And Molecular Classification, Sricharan Gopakumar, Malcolm F Mcdonald, Himanshu Sharma, Claudio E Tatsui, Gregory N Fuller, Ganesh Rao

Faculty, Staff and Student Publications

Background: Astroblastoma is a rare primary brain tumor of unclear origin, often occurring in young patients less than 30-years-old. It typically arises supratentorially and is diagnosed based on histological features including vascular hyalinization and perivascular pseudorosettes. Recent molecular characterization of primary CNS high-grade neuroepithelial tumors with meningioma I alteration (HGNET-MN1) found that HGNET-MN1 and tumors with morphological signatures of astroblastoma clustered together. Further analysis revealed such astroblastomas have MN1 alteration and the 2021 WHO classification of tumors of the CNS now recognizes astroblastoma MN1-altered as a new entity.

Case description: Here, we present the case of …

National Trends And Survival Outcomes Of Performing Immediate Breast Reconstruction For Male Breast Cancer Patients, Neha Sarvepalli, Nayana Dekhne, Mohamad Sebai, Patrick Karabon

Conference Presentation Abstracts

INTRODUCTION: Immediate breast reconstruction after a mastectomy was reported in 43.3% of female patients in 2014; and has been associated with improved quality of life and adherence to adjuvant therapies. While there are many studies regarding immediate breast reconstruction in women, little has been reported about reconstruction rates and outcomes in male breast cancer. The purpose of this study is to examine the trends and outcomes of performing Immediate Breast Reconstruction (IBR) in male breast cancer (MBC) patients following a mastectomy. METHODS: The National Cancer Database (NCDB) registry from 2004 to 2014 was used to identify non-metastatic MBC patients who …

Load Sharing Assessment Of Osseoligamentous Structures Within A Thoracic Spine Segment During Surgical Release, Michael Polanco, James Bennett, Austin Tapp, Michel Audette, Stacie Ringleb, Sebastian Bawab

Electrical & Computer Engineering Faculty Publications

Spinal surgical procedures often require release of intervertebral discs and ligaments to optimally achieve postural correction on a patient-specific basis. In this paper, a T7-T8 Finite Element (FE) model is utilized to examine internal load sharing during resection steps performed in a Ponte osteotomy. The FE model was rotated bidirectionally along three anatomical planes using an externally applied moment. In each step, the Ranges of Motion (RoM), Instantaneous Centers of Rotation (ICR), and forces from ligaments, discs, facet, and costovertebral joints were calculated. The product of each component’s force and the distance between the ICR and their position were used …

Jacuzzi-Induced Pneumoperitoneum: Case Report And Literature Review, Obteene Azimi-Ghomi, Dieter Brummund, Vasiliy Ovakimyan, Gerardo Kahane

HCA Healthcare Journal of Medicine

Radiographically-detected pneumoperitoneum in the setting of acute onset abdominal pain is a classic case among surgical emergencies. The spectrum of etiology ranges from benign to catastrophic, and the ability to differentiate depends in large part on the history and physical exam findings. Included among non-surgical types of pneumoperitoneum are (1) post-operative, (2) diagnostic/experimental, (3) gynecologic tract air entry, (4) the difference in intra- and extra-alveolar pressures, pneumothorax-associated and (5) miscellaneous. Jacuzzi-induced pneumoperitoneum is an extremely rare form of non-surgical pneumoperitoneum. We discuss a case of a 32-year-old female presenting with pneumoperitoneum and acute onset abdominal pain secondary to vaginal insertion …

Consequential Surgeries Limit Recurrence Of Skin Malignancies In Xeroderma Pigmentosum: A Case Report, Ahmad Kurnia, Diani Kartini, Novinda Herwirastri, Zoya M. Adyasa

The New Ropanasuri Journal of Surgery

Xeroderma Pigmentosum (XP) is a rare inherited skin malignancy with no causative treatment options. Reporting a 23-year-old woman with xeroderma pigmentosum who underwent several surgical tumor removals followed by further five procedures to apply tissue expander, facial resurfacing using full-thickness skin grafts with a donor from abdominal. The next series was tumor resection in the chin, forehead, nasal reconstruction, tumor removal on bilateral third digits, and defect closure. No recurrence after nine years of postoperative monitoring with an aesthetically acceptable result.

Different Approaches Of Suspected Unilateral And Bilateral Maxillary Sinus Myxoma, Two Rare Cases Report, Marlinda Adham, Ferucha Moulanda

The New Ropanasuri Journal of Surgery

Maxillary sinus myxoma is a rare benign tumor with locally aggressive behavior and can infiltrate surrounding structures. Surgical intervention is considered the primary procedure with several approaches for wider tumor exposure, complete tumor removal, and better wound healing. In this article, two cases of suspected unilateral and bilateral maxillary sinus myxoma were presented with different approaches applied for both cases. We managed two patients, a 37-year-old male with mass at right maxilla and a 60-year-old male with mass at both maxillae. Physical examination, radiology imaging, and pre-operative histopathology examination showed maxillary sinus myxoma. The total maxillectomy procedure with Weber Ferguson …

Factors Affecting Renal Function On Ileostomy In Dr. Cipto Mangunkusumo General Hospital: A Cross-Sectional Study, Lam Sihardo, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Every year, about 30—60 ileostomy with various underlying diseases and indications were created in Dr. Cipto Mangunkusumo General Hospital (CMGH). There were a lot of complications attributable to these creations; one is the decline of renal function. The study goal was to find out factors influencing the renal function of ileostomy in CMGH.

Method. A cross-sectional study was conducted using medical records in April – May 2021. Samples were taken using the purposive sampling method. Inclusion criteria include male or female patients who underwent ileostomy closure in CMGH in the last four years with complete BMI, ileostomy creation and …

Survival Rate Of Critically Ill Coronavirus Disease 2019 Patients On Tracheostomy In Indonesia, Aris Ramdhani, Dita Aditianingsih, Raihanita Zahra, Muhammad A. Putra, Wuryantoro Soeharto, Melvin D.B. Kwa

The New Ropanasuri Journal of Surgery

Introduction. During COVID-19 global pandemic, tracheostomy is often performed on critically ill COVID-19 patients. There is no available data on the survival rate of critically ill COVID-19 patients on tracheostomy in Indonesia. This study aimed to find the survival rate of critically ill COVID-19 patients on tracheostomy in Indonesia.

Methods. A descriptive survival analysis study enrolled critically ill COVID-19 patients in RSUI who underwent a tracheostomy procedure. Baseline data, including clinical characteristics and laboratory findings before tracheostomy, were recorded. Survival analysis was conducted using the Kaplan-Meier plot.

Results. Forty-two subjects were enrolled in the study: 25 males (59.5%) and 17 …

The New Version Of Accreditation For Higher Education In Health, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

No abstract provided.

Prognostic And Predictive Factors Of Mortality In Burn Patients At Dr. Cipto Mangunkusumo General Hospital, Indonesia, Muhamad Irfan A. Hasibuan, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Introduction. Some prognostic– and predictive factors in burn have never been investigated in Indonesian specific characteristics, which is delayed treatment. A study was conducted to determine prognostic and predictive factors in this specific characteristic.

Method. A retrospective cohort focused on burn mortality in extensive burns managed in CMGH from 1998–2010. Some known prognostic– and predictive factors and unknown ones were the variables of interest. Bivariate and multivariate using logistic regression analysis proceeded to find out these factors.

Results. Out of all factors investigated, the variables that showed a significant correlation were: TBSA, inhalation injury, Baux score, revised …

Cutaneous Horn On The Right Supraclavicular Region In An Adolescent Female, A Rare Case Report, Rohit Gupta, Manoj Kumar, Ruchi Sinha, Reva Shankar Sahu

The New Ropanasuri Journal of Surgery

Cutaneous horn (CH) is an outgrowth from the skin surface, composed of keratin, and associated with benign to malignant skin lesions. We report a case of CH in a 15-year-old female associated with Keratoacanthoma. It is uncommon in young people and is associated with a good prognosis because of its benign nature. This case needs to be reported as it highlights the rare occurrence of this condition in the younger age group and its good prognosis. Surgical excision is the treatment of choice, with histopathologic diagnosis playing a critical role in determining the nature and further treatment of this condition …