Surgery Commons^™

Fluorescence-Guided Surgical Debridement Of Chronic Osteomyelitis Utilizing Doxycycline Bone Labeling: A Technical Trick Revived, Garrhett G. Via, David A. Brueggeman, Grant M. Slack, James M. Danias, Jennifer L. Jerele

Medical Student Research Symposium Abstracts and Posters

The present manuscript discusses the concept of fluorescence-guided surgical debridement of chronic osteomyelitis in the orthopaedic patient based upon a two-fold mechanism, natural fluorescence of healthy bone combined with bone labeling by tetracyclines. The senior author prefers preoperative administration of oral doxycycline 100 mg twice daily for at least 1 month. The excitation source of choice is an ordinary blacklight, as this is both cost-effective and readily attainable. Intraoperatively, viable bone is noted to fluoresce a greenish hue which is then used to guide the debridement. Previous studies have demonstrated that bleeding bone is not a reliable indicator of a …

Local Wound Infiltration With Liposomal Bupivacaine Decreases Post-Cesarean Pain Scores, Avni Gupta, Justin Williams, Rose A. Maxwell, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

Surgical patients are routinely prescribed opioid analgesics that are strongly associated with drug overdose deaths. Liposomal bupivacaine is a long-acting local anesthetic that received FDA approval in 2011 for local surgical site infiltration to promote post-operative analgesia. This anesthetic has demonstrated an improvement in post-operative pain control in various surgical realms, indicating a decreased need for opiates and subsequently decreased risks. However, few studies have investigated its use at the time of cesarean delivery.

Staphylococcus Aureus Floating Biofilm Formation And Phenotype In Synovial Fluid Depends On Albumin, Fibrinogen, And Hyaluronic Acid, Samantha Knott, Dylan Curry, Neil Zhao, Pallavi Metgud, Sana Dastgheyb, Caroline Purtill, Marc I. Harwood, Md, Antonia F Chen, Thomas P Schaer, Michael Otto, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

Biofilms are typically studied in bacterial media that allow the study of important properties such as bacterial growth. However, the results obtained in such media cannot take into account the bacterial localization/clustering caused by bacteria–protein interactions in vivo and the accompanying alterations in phenotype, virulence factor production, and ultimately antibiotic tolerance. We and others have reported that methicillin-resistant or methicillin-susceptible Staphylococcus aureus (MRSA or MSSA, respectively) and other pathogens assemble a proteinaceous matrix in synovial fluid. This proteinaceous bacterial aggregate is coated by a polysaccharide matrix as is characteristic of biofilms. In this study, we identify proteins important for this …

The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen

Patient Experience Journal

The attrition of small volume surgical and maternity services in rural Canada over the past three decades has made access to these services especially challenging for rural citizens. While many of these closures have occurred as consequences of regionalization, a strategy to regionally centralize healthcare services, many studies investigating outcomes of regionalization have focused on costs and medical endpoints rather than the direct experiences of the rural patients affected. In this study, we aimed to understand and document the experiences of rural residents accessing procedural and maternity care both locally and away from home. This study is part of a …

Gray Matter Sampling Differences Between Subdural Electrodes And Stereoelectroencephalography Electrodes., Mohamed Tantawi, Jingya Miao, Caio Matias, Christopher T. Skidmore, Michael R. Sperling, Ashwini Sharan, Chengyuan Wu

Department of Neurosurgery Faculty Papers

Objective: Stereoelectroencephalography (SEEG) has seen a recent increase in popularity in North America; however, concerns regarding the spatial sampling capabilities of SEEG remain. We aimed to quantify and compare the spatial sampling of subdural electrode (SDE) and SEEG implants.

Methods: Patients with drug-resistant epilepsy who underwent invasive monitoring were included in this retrospective case-control study. Ten SEEG cases were compared with ten matched SDE cases based on clinical presentation and pre-implantation hypothesis. To quantify gray matter sampling, MR and CT images were coregistered and a 2.5mm radius sphere was superimposed over the center of each electrode contact. The estimated recording …

Disclosing Bad News Of Cancer Diagnosis: Patients' Preference For Communication, Sabah Uddin Saqib, K. M. Inam Pal

Section of General Surgery

The majority of relatives of cancer patients in Pakistan request their clinicians to adopt a "do not tell approach" while counselling the patients regarding their disease. The current study aimed to assess patients' understanding of their disease and how they would prefer the physicians to deliver news about cancer diagnosis and its management plan. This was a cross-sectional study in which both patients and their immediate relatives were interviewed. The study enrolled 55 patients with six different types of cancers. The study showed that 35 (65.5%) patients did not know the stage of their illness at the time of diagnosis, …

Perioperative Family Updates Reduce Anxiety And Improve Satisfaction: A Randomized Controlled Trial, Lindsay S. Howe, Daniel Wigmore, Nathaniel Nelms, Patrick Schottel, Craig Bartlett, David Halsey, Martin Krag, David Lunardini, Robert Monsey, Bruce Beynnon, Michael Blankstein

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to determine if standardized updates at specific perioperative events affect anxiety and satisfaction of the family members and if the length of surgical procedure affects the satisfaction with updates.

Methods: This study was a randomized control trial. In the control group, surgeons communicated with the family only once near the completion of the procedure. In the intervention group, families received electronic updates at 3 significant perioperative events during the procedure. A postoperative survey rating family member satisfaction and anxiety levels, using a Likert scale of 0–5, was administered.

Results: Mean level of overall satisfaction did not …

Proceedings Of The Eighth Annual Deep Brain Stimulation Think Tank: Advances In Optogenetics, Ethical Issues Affecting Dbs Research, Neuromodulatory Approaches For Depression, Adaptive Neurostimulation, And Emerging Dbs Technologies, Vinata Vedam-Mai, Karl Deisseroth, James Giordano, Gabriel Lazaro-Munoz, Winston Chiong, Nanthia Suthana, Jean-Philippe Langevin, Jay Gill, Wayne Goodman, Nicole R Provenza, Casey H Halpern, Rajat S Shivacharan, Tricia N Cunningham, Sameer A Sheth, Nader Pouratian, Katherine W Scangos, Helen S Mayberg, Andreas Horn, Kara A Johnson, Christopher R Butson, Ro'ee Gilron, Coralie De Hemptinne, Robert Wilt, Maria Yaroshinsky, Simon Little, Philip Starr, Greg Worrell, Prasad Shirvalkar, Edward Chang, Jens Volkmann, Muthuraman Muthuraman, Sergiu Groppa, Andrea A Kühn, Luming Li, Matthew Johnson, Kevin J Otto, Robert Raike, Steve Goetz, Chengyuan Wu, Peter Silburn, Binith Cheeran, Yagna J Pathak, Mahsa Malekmohammadi, Aysegul Gunduz, Joshua K Wong, Stephanie Cernera, Aparna Wagle Shukla, Adolfo Ramirez-Zamora, Wissam Deeb, Addie Patterson, Kelly D Foote, Michael S Okun

Department of Neurosurgery Faculty Papers

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS …

Preprocedure Covid-19 Testing In Early Phase Of Pandemic, Renuka Jain, Bradley Kruger, Robert Citronberg, Stacie Kroboth, Ana Cristina Perez Moreno, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

The COVID-19 pandemic led to a nationwide shutdown of elective medical procedures. Upon resumption of services, preprocedure nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was introduced for all patients requiring surgical or other aerosol-generating procedures. We investigated preprocedure COVID-19 testing in one of the largest U.S. health systems. Patients included in this retrospective, observational study were asymptomatic and scheduled for a procedure or surgery. All patients underwent a nasopharyngeal swab test for SARS-CoV-2 performed 24–72 hours prior to a planned procedure. Clinical demographics, type of procedure, test results, and subsequent procedure status were evaluated. Of 38,608 …

What Did We Learn About Vads In 2020?, Maya Guglin

The VAD Journal

This is our 7th annual literature review on mechanical circulatory support (MCS) devices.

Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, and 2019 are available online.

In this review, we summarized the most interesting and important, from our standpoint, publications covering MCS from 2020. There may be some slight overlap with the end of 2019 because some papers were published online first, and the year of the publication changed when they became available in print.

For the fourth time this year, we …

Reduction In Hospital System Opioid Prescribing For Acute Pain Through Default Prescription Preference Settings: Pre-Post Study, Benjamin Heritier Slovis, Jeffrey Riggio, Melanie Girondo, Cara Martino, Bracken Babula, Lindsey Roke, John C. Kairys

Department of Medicine Faculty Papers

BACKGROUND: The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence.

OBJECTIVE: The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system.

METHODS: We performed a quasi-experimental retrospective pre-post analysis of a 24-month period before and after modifications to our EHR's opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications …

Fears And Barriers: Problems In Breast Cancer Diagnosis And Treatment In Pakistan, Sidra Saeed, Muhammad Asim, Malik Muhammad Sohail

Community Health Sciences

Background: Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.
Methods: In this process 45 women (age = 18-50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.
Results: An inductive approach was …

Acute Presentation Of Cocoon Abdomen As Septic Peritonitis Mimicking With Strangulated Internal Herniation: A Case Report, Sabah Uddin Saqib, Rimsha Farooq, Omair Saleem, Sarosh Moeen, Tabish Umer Chawla

Section of General Surgery

Background: Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis.
Case presentation: A 35-year-old male with no known co-morbidity …

Implementation Of A Perioperative Pathway For Individuals With Or At High Risk For Obstructive Sleep Apnea, Kimberly Claude

Doctor of Nursing Practice Scholarly Projects

Background At the Veterans Affairs Boston, pre-operative screening for obstructive sleep apnea using the STOP-Bang questionnaire and referral to pulmonary service for those who fail screening is not reliably completed. For patients identified as having OSA or at high risk for OSA, advice on how to reduce postoperative risk may not be adequately communicated through the perioperative process. The project aim is to construct and implement a perioperative pathway to ensure surgical patients with OSA or suspected OSA receive evidence-based care throughout the perioperative period.

Methods The intervention for this quality improvement project was an evidence-based perioperative pathway which includes …

An Assessment Of The Impact Of Flow Disruptions On Mental Workload And Performance Of Surgeons During Percutaneous Nephrolithotomy, Sana Hussain, Syed Muhammad Nazim, Basit Salam, Nida Zahid, Hammad Ather

Section of Urology

Objective: The aim of this study was to assess the impact of intraoperative disruptions on surgeons’ workload and performance during percutaneous nephrolithotomy (PCNL).
Materials and methods: A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons’ workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating …

Efficacy Of Weight Reduction On Pediatric Nonalcoholic Fatty Liver Disease: Opportunities To Improve Treatment Outcomes Through Pharmacotherapy., Chance S. Friesen, Chelsea Hosey-Cojocari, Sherwin S. Chan, Iván L. Csanaky, Jonathan B. Wagner, Brooke Sweeney, Alec Friesen, Jason D. Fraser, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

Obesity is the single greatest risk factor for nonalcoholic fatty liver disease (NAFLD). Without intervention, most pediatric patients with NAFLD continue to gain excessive weight, making early, effective weight loss intervention key for disease treatment and prevention of NAFLD progression. Unfortunately, outside of a closely monitored research setting, which is not representative of the real world, lifestyle modification success for weight loss in children is low. Bariatric surgery, though effective, is invasive and can worsen NAFLD postoperatively. Thus, there is an evolving and underutilized role for pharmacotherapy in children, both for weight reduction and NAFLD management. In this perspective article, …

A Pedunculated Esophageal Chondromatous Hamartoma In A Child, Dan-Alexandru Iozsa, Maria Puscasu, Catalin Gabriel Cirstoveanu, Vlad Denis Constantin, Anca Silvia Dumitriu, Stana Paunica, Nicolae Sebastian Ionescu

Journal of Mind and Medical Sciences

Esophageal tumors are uncommon in pediatric population and most of them are benign. Esophageal hamartomas have been reported extremely rare in children. These can present as intramural tumors of the esophageal wall or as polyps. Dysphagia is the main symptom described in their case, but other specific symptoms are also reported. Such symptoms encountered in clinical practice are represented by obstructive apnea episodes and bradycardia, poor weight gain, epigastric or retrosternal pain, hematemesis or melena, dysphonia or tracheal sounds. Diagnosis can be delayed due to the insidious onset and non-specific symptoms, therefore patient’s compliance to follow-up and broad, careful evaluation …

Postoperative Complicated Appendectomy Revealing Crohn’S Disease In A Pediatric Patient, Augustina Enculescu, Mircea Denis Lupusoru, Catalin Cirstoveanu, Andra-Iulia Suceveanu, Liliana Florina Andronache, Adrian-Paul Suceveanu, Felix Voinea, Maria Puscasu

Journal of Mind and Medical Sciences

Granulomatous appendicitis is a very rare entity in children. It is related to Crohn’s disease in only 5-10% of the cases. The diagnosis of Crohn’s disease is a real challenge in the pediatric population, especially when its initial manifestation is acute appendicitis. Herein, we present a 13-year-old boy admitted for acute appendicitis. The histopathological examination was conclusive for acute granulomatous appendicitis. The development of an entero-cutaneous fistula has complicated the postoperative evolution. The failure of the conservative management required ileocecal resection. The pathological examination revealed Crohn’s disease. The one-year follow-up on the patient din not reveal any complications. We strongly …

Acute Chylous Peritonitis Due To Idiopathic Pancreatitis Mimicking Acute Appendicitis, Dan Bratu, Alin Mihetiu, Dragoș Virgil Davițoiu, Vlad Dumitru Băleanu, Liliana Florina Andronache, Oana Popescu

Journal of Mind and Medical Sciences

The acute development and the accumulation of chyle into the peritoneal space is a rare condition and one needs to be able to distinguish it from chylous ascites, which is most commonly chronic and associated with related diseases. It is frequently idiopathic and additionally, clinical and imaging findings are nonspecific. In almost all cases, the diagnosis is made intraoperatively during laparoscopy or laparotomy, most diagnostic procedures being indicated by acute complaints pertaining to the abdomen. A 23-year-old man was admitted to the Emergency Department with abdominal pain, with right iliac fossa tenderness and peritonism. Laparoscopy was performed due to acute …

Role Of Ampk And Akt In Triple Negative Breast Cancer Lung Colonization, Jeremy Johnson, Zeta Chow, Eun Young Lee, Heidi L. Weiss, B. Mark Evers, Piotr G. Rychahou

Pathology and Laboratory Medicine Faculty Publications

Triple negative breast cancer (TNBC) is an aggressive disease with a 5-y relative survival rate of 11% after distant metastasis. To survive the metastatic cascade, tumor cells remodel their signaling pathways by regulating energy production and upregulating survival pathways. AMP-activated protein kinase (AMPK) and Akt regulate energy homeostasis and survival, however, the individual or synergistic role of AMPK and Akt isoforms during lung colonization by TNBC cells is unknown. The purpose of this study was to establish whether targeting Akt, AMPKα or both Akt and AMPKα isoforms in circulating cancer cells can suppress TNBC lung colonization. Transient silencing of Akt1 …