Surgery Commons^™

Removal Of Impella In The Setting Of Left Ventricular Thrombus: A Potential Indication For Cerebral Embolic Protection Devices, Miro Asadourian, Avinash Sharma, Richard Kiel, Felice Lin, Manminder Bhullar

The VAD Journal

Successful percutaneous mechanical circulatory support (MCS) has been used for acute stabilization of cardiogenic shock (CS). Improved survival outcomes have been observed in patients with CS from an acute myocardial infarction (AMI) who undergo implantation of left ventricular (LV) to ascending aorta rotodynamic pumps, such as the Impella® device (Abiomed). However, thrombotic events are a known complication of such devices in poor flow states such as CS. There is limited evidence regarding the management of patients who develop an LV thrombus after Impella insertion. Currently, the Sentinel cerebral protection system (SCPS, Boston Scientific) is the only FDA-approved device for cerebral …

Intradural Extramedullary Primary Central Nervous System Melanoma Of The Craniovertebral Junction During Pregnancy: Observations And Outcomes, Fabiola Valenzuela, Sohum Desai

School of Medicine Publications

Background: Primary central nervous system (CNS) melanoma is a rare lesion derived from neural crest precursors. While its management is analogous to metastatic spinal melanoma, the literature does not describe this entity clearly in pregnant patients and the unique implications it presents. Here, we describe the case of a pregnant patient who presented with primary CNS melanoma of the cervical spine.

Case Description: A 27-year-old pregnant patient presented with a 3-month history of neck and interscapular pain. MRI of the cervical spine demonstrated a ventral intradural extramedullary mass adjacent to the C2-C3 vertebral bodies causing severe cord compression. The patient …

Long-Term Patient-Reported Outcomes And Patient-Reported Outcome Measures After Injury: The National Trauma Research Action Plan (Ntrap) Scoping Review, Juan P. Herrera-Escobar, Samia Y. Osman, Sophiya Das, Alexander Toppo, Claudia P. Orlas, Manuel Castillo-Angele, Angel Rosario, Mahin B. Janjua, Muhammad Abdullah Arain, Adil H. Haider

Section of General Surgery

Background: The aim of this scoping review is to identify and summarize patient-reported outcome measures (PROMs) that are being used to track long-term patient-reported outcomes (PROs) after injury and can potentially be included in trauma registries.
Methods: Online databases were used to identify studies published between 2013 and 2019, from which we selected 747 articles that involved survivors of acute physical traumatic injury aged 18 years or older at time of injury and used PROMs to evaluate recovery between 6 months and 10 years postinjury. Data were extracted and summarized using descriptive statistics and a narrative synthesis of the results. …

Role Of Intra-Operative Ultrasound In Brain Tumour Surgeries, Mohammad Hamza Bajwa, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

The use of intra-operative ultrasound remains a largely underutilized option in brain tumour surgeries. The widespread availability of neuronavigation may be the reason why such a useful modality has become less popular even though recent advances in ultrasound technology have greatly improved its utility. The available literature also clearly shows that it offers additional advantages especially when used with neuronavigation. Herein the authors have briefly touched upon the available literature on the role of intraoperative ultrasound in brain tumour surgeries.

Temporal Trends And Predictors Of Surgical Ablation For Atrial Fibrillation In A Large Western Us Healthcare System, Scott Brancato, Mansen Wang, Kateri Spinelli, Alison Leiataua, James Brevig, Zachary M Deboard, Torin P. Fitton, Maheer Gandhavadi, Jonathan P. Piccini, Neil Worrall, Tyler J Gluckman

Articles, Abstracts, and Reports

No abstract provided.

Sex As A Moderator In The Relationship Between Post-Operative Pain And Analgesics Administered In Children Undergoing Elective Surgery, Amber M. Osorno, Michelle A. Fortier, Zeev N. Kain, Brooke N. Jenkins

Student Scholar Symposium Abstracts and Posters

About 85% of children who undergo elective surgery experience pain post-operatively and many do not receive proper pain management care after discharge. Most parents lack an understanding of proper pain care management using analgesics upon discharge. Research reveals that adults rate girls as more sensitive to pain and that they display a greater amount of pain in a pediatric post-operative environment. In adulthood, women report more sensations of pain and have a higher pain tolerance, which can be attributed to physiological characteristics. Nonetheless, the social differences by which boys and girls experience pain and express their pain cannot be denied. …

The Evolving Effectiveness Of Biologics In Avoiding Surgery In Children With Ulcerative Colitis., Mohineesh Kumar, Samuel K. Osei, Ayesha Fatima, Rachel N. Harvey, Alexander Menning, Anthony Stallion, Nathan Novotny

Conference Presentation Abstracts

Purpose

Pediatric ulcerative colitis (UC) treatment has changed dramatically with the introduction of multiple biologics in recent years. The purpose of this study was to assess effectiveness of biologic agents in achieving remission and incidence of surgery.

Methods

We retrospectively analyzed UC patients that were seen at gastroenterology clinic between January 2012-August 2020. We analyzed demographic characteristics, colonoscopy, clinic and hospital records. Patients were divided into four groups: 1) patients treated medically without biologics or surgery; 2) patients treated with one biologic; 3) patients treated with multiple biologics; and 4) patients that underwent colectomy. Pearson Chi-square test was used to …

Evaluation Of Surgical Antibiotic Prophylaxis Compliance At A Large, Tertiary Medical Center, Meagan Greckel, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High Risk Patients: A Diagnostic Accuracy Study, Brian Kiplagat Misoi

Master of Medicine in General Surgery

Introduction; Preoperative evaluation and optimization is conducted to prepare a sound perioperative management plan and limit complications. The standard of assessment is by the anesthesiologist based on ASA recommendations, and can be conducted early in the PAC or on the operative day. Reviews in the PAC have been shown to allay anxiety and reduce day of surgery cancellation. While it is ideal for all patients to be evaluated preoperatively by the physician anesthesiologist in the PAC, there are very few anaesthesiologist's in low and middle income countries meaning this may be unachievable. This creates a demand for innovative ways to …

Survival Outcomes And Prognostic Factors Affecting Survival In Patients With Metastatic Breast Cancer, Mwongeli Matheka

Master of Medicine in General Surgery

Introduction: There is an increase in breast cancer in Africa with up to 77% of patients diagnosed with advanced disease. Late diagnosis, aggressive tumor biology and inadequate or incomplete treatments contribute to high mortality rates. However, there is little data on survival outcomes and prognostic factors affecting survival in patients with metastatic breast cancer (MBC) in Africa. The study objective was to establish the survival of patients with MBC at a single tertiary health facility and to outline the clinical and pathological characteristic of the patients and their relation to survival outcomes. Methods: This was a retrospective descriptive study conducted …

Outcomes Of Cardiac Surgery At The Aga Khan University Hospital Nairobi – A One Year Review, Nelly Joseph Kahamba

Master of Medicine in General Surgery

Background: Cardiovascular diseases are the number one cause of death worldwide where an estimated 17.9 million people die yearly, according to WHO. Most of this disease burden lies in the low and middle-income countries. Management of cardiovascular diseases can be medical and/or surgical. Open heart surgery is one among the major surgeries performed worldwide. It is well established in high income countries where up to 200,000 cardiac surgeries can be performed yearly. In low-income countries particularly sub-Saharan Africa where most of the disease burden is, there are about 22 centres that cater to this growing need for cardiac surgery. There …

Developing A 2-Week Surgery Bootcamp: A Needs Assessment Of Aspiring General Surgeons, Darci C. Foote, Victoria A. Roach

Conference Presentation Abstracts

No abstract provided.

Temporary Intravascular Shunts After Civilian Arterial Injury: A Prospective Multicenter Eastern Association For The Surgery Of Trauma Study, Lily Tung, Jennifer Leonard, Ryan A. Lawless, Alexis Cralley, Richard Betzold, Jason D. Pasley, Kenji Inaba, Jennie S. Kim, Dennis Y. Kim, Kwang Kim, Bradley M. Dennis, Michael C. Smith, Margaret Moore, Christina Tran, Joshua P. Hazelton, Atlee Melillo, Tejal S. Brahmbhatt, Stephanie Talutis, Noelle N. Saillant, Jae Moo Lee, Mark J. Seamon

School of Medicine Faculty Publications

Introduction: We sought to determine the impact of the indication for shunt placement on shunt-related outcomes after major arterial injuries. We hypothesized that a shunt placed for damage control indications would be associated with an increase in shunt-related complications including shunt dislodgement, thrombosis, or distal ischemia. Patients & methods: A prospective, multicenter study (eleven level one US trauma centers) of all adult trauma patients undergoing temporary intravascular shunts (TIVS) after arterial injury was undertaken (January 2017-May 2019). Exclusion criteria included age <15years, shunt placement distal to popliteal/brachial arteries, isolated venous shunts, and death before shunt removal. Clinical variables were compared by indication and shunt-related complications. The primary endpoint was TIVS complications (thrombosis, migration, distal ischemia). Results: The 66 patients who underwent TIVS were primarily young (30years [IQR 22-36]) men (85%), severely injured (ISS 17 [10-25]) by penetrating mechanisms (59%), and had their shunts placed for damage control (41%). After a median SDT of 198min [89-622], 9% experienced shunt-related complications. Compared by shunt placement indication (damage control shunts [n=27] compared to non-damage control shunts [n=39]), there were no differences in gender, mechanism, extremity AIS, MESS score, fractures, or surgeon specialty between the two groups (all p>0.05). Patients with shunts placed for damage control indications had more severe injuries (ISS 23.5 compared to 13; SBP …

Pegloprastide-Based Ratiometric Fluorescence Imaging Detects Intraoperative Positive Margins In Real-Time, Sarah A. Mclaughlin, M Catherine Lee, Sheldon M. Feldman, Barry Rosen, Valerie P. Grignol, Anne M. Wallace, Nayana S. Dekhne

Conference Presentation Abstracts

Background/Objective: Positive margins detected after breast conservation surgery can result in the need for a re-excision or completion mastectomy. We hypothesized that pegloprastide combined with a ratiometric fluorescence imaging system would allow surgeons to detect positive margins in real time. Methods: Pegloprastide (AVB-620) was to be administered to patients 3-20 hours before the start of surgery. During the operation, initial primary tumor removal was performed unaided. Following primary resection, a fluorescence imaging system optimized for use with pegloprastide was used to assess the primary specimen and the cavity. Cavity shaves were taken when fluorescence above pre-specified thresholds were noted. Additional …

Trends Contributing To Disparities In Inflammatory Breast Cancer, Anna Lehrberg, Nayana Dekhne, Amita Desai, Sayee Kiran

Conference Presentation Abstracts

Background/Objective: Breast cancer overall survival rate in Black American (BA) women is lower compared to White American (WA) women. Inflammatory breast cancer (IBC) is a rare but aggressive subtype of breast cancer that is found at higher incidence in the BA patients. The objective of this study was to evaluate trends and identify factors that contribute to racial disparities in outcomes of women with IBC. Methods: The National Cancer Database (NCDB) was used to evaluate patients with Stage III IBC from 2004 to 2014. Patient demographics, tumor characteristics, treatments and survival trends were stratified by race for comparison. Results: A …

Development Of Malignancies And Their Outcomes In Patients Supported On Continuous-Flow Left Ventricular Assist Devices-A Systematic Review., Elizabeth J. Maynes, Jonathan S. Gordon, Matthew P. Weber, Thomas J. O'Malley, Tyler M. Bauer, Chelsey T. Wood, Rohinton J. Morris, Louis E. Samuels, John W. Entwistle, H. Todd Massey, Vakhtang Tchantchaleishvili

Department of Surgery Faculty Papers

Background: With increased use of continuous-flow left ventricular assist devices (CF-LVAD), development of malignant tumors in this population is not uncommon. We sought to evaluate malignancies in CF-LVAD patients and evaluate the outcomes of treatment strategies.

Methods: Overall, 18 articles consisting of 28 patients were identified who developed malignancies after CF-LVAD placement. Patient-level data were extracted for systematic review.

Results: Median patient age was 60 years [59-67] and 85.7% (24/28) were male. CF-LVAD was placed as bridge-to-transplant (BTT) in 60.9% (14/23) of patients. The three most common malignancy types were GI in 35.7% (10/28) of patients, lung in 21.4% (6/28) …

Forward-Thinking Design Solutions For Mechanical Circulatory Support: Multifunctional Hybrid Continuous-Flow Ventricular Assist Device Technology., Amy Throckmorton, Ellen Garven, Matthew Hirschhorn, Steven Day, Randy Stevens, Vakhtang Tchantchaleishvili

Department of Surgery Faculty Papers

No abstract provided.

Holding Traction During Ct: Simple Tricks To Maintain Reduction In The Lower Extremity, Garrhett G. Via, David A. Brueggeman, Alexander Chase, Jennifer L. Jerele, Kyle S. Mobley

Medical Student Research Symposium Abstracts and Posters

Traction is one of the pillars of orthopaedic injury management, as it can provide both temporizing and definitive treatment for anatomic malalignment associated with joint dislocations and fractures. In the realm of modern orthopaedic care, post-traction imaging provides the surgeon with information about resting fracture position and the overall effects of traction that are critical to preoperative planning. However, there are often circumstances in which an orthopaedic surgery provider is faced with the discrepancy between the proper sequence of orthopaedic care and the need for emergent, advanced imaging to evaluate other organ systems. In other words, they are often forced …

The Role Of Implantable Cardioverter Defibrillators For The Prevention Of Ventricular Arrhythmia In Left Ventricular Assist Device Recipients, Nikhil Reddy, Cristina Ortiz, Toshimasa Okabe, Muhammad Afzal, Mohamed H. Derbala, Asvin Ganapathi, Sakima Smith

Medical Student Research Symposium Abstracts and Posters

Advanced heart failure represents a significant strain on our health care system and is associated with increased morbidity and mortality. New device therapies, including left ventricular assist device (LVAD) implantation, have transformed management as both a destination therapy and as a bridge to transplantation. Although LVADs have improved patient outcomes, arrhythmias represent a significant and costly complication of this therapy. In recent years, implantable cardioverter-defibrillators (ICDs) have been developed to reduce the incidence of lethal arrhythmia. However, a gap in the literature exists for both guidelines in prevention of early ventricular arrhythmia (VA) in LVAD recipients and the effectiveness of …

Is Microscopic Colitis Associated With Increased Risk For Other Gastrointestinal Diseases?, Tanner Graves, Paul Koles

Medical Student Research Symposium Abstracts and Posters

Microscopic colitis is clinically suspected in patients with recurrent watery diarrhea and the absence of gross pathologic changes in the colon by endoscopic examination. The diagnosis is established only by microscopic evaluation of colonic biopsies. Microscopic colitis is currently classified into three subgroups: collagenous colitis (CC), lymphocytic colitis (LC), and combined CC and LC. The incidence rates are 4.14 per 100,000 person-years and 4.85 per 100,000 person-years for CC and LC, respectfully.

Diagnosis is typically made without measuring the exact thickness of the subepithelial collagen band or by counting the number of lymphocytes in the epithelium. There is little research …