Surgery Commons^™

A Case Report Of Successful Management Of Clostridium Difficile Colitis With Antegrade Fidaxomicin Through A Mucous Fistula Obviating The Need For Subtotal Colectomy., Suzanne Arnott, Matthew Skancke, Sheena Chen, Bruce Abell

Surgery Faculty Publications

Introduction

Clostridium difficile is the most common cause of healthcare-associated infections and can have devastating morbidity and mortality. Traditional treatment algorithms involve intravenous metronidazole and enteric metronidazole or vancomycin. Fidaxomicin (DificidR) targets “switch regions” within RNA polymerases and effectively kills clostridium difficile bacteria and is typically administered orally primarily or through a naso/oro-gastric conduit.

Presentation of case

55-year-old with a recent elective surgical procedure was hospitalized with multifocal pneumonia and subsequently developed clostridium difficile colitis. This patient failed the standard medical therapy for clostridium difficile colitis, decompensated and required surgical exploration, partial colectomy and mucous fistula creation. Following her surgery, …

Transcriptional Alterations In Hereditary And Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors According To Genotype., Xavier M Keutgen, Suresh Kumar, Sudheer Gara, Myriem Boufraqech, Sunita Agarwal, Ralph H Hruban, Naris Nilubol, Martha Quezado, Richard Finney, Maggie Cam, Electron Kebebew

Surgery Faculty Publications

BACKGROUND

Nonfunctioning pancreatic neuroendocrine tumors (NFPanNETs) may be sporadic or inherited because of germline mutations associated with von Hippel-Lindau disease (VHL) or multiple endocrine neoplasia type 1 (MEN1). The clinical behavior of NFPanNETs is difficult to predict, even in tumors of the same stage and grade. The authors analyzed genotype-specific patterns of transcriptional messenger RNA (mRNA) levels of NFPanNETs to understand the molecular features that determine PanNET phenotype.

METHODS

Thirty-two samples were included for genome-wide mRNA gene expression analysis (9 VHL-associated, 10 MEN1-associated, and 9 sporadic NFPanNETs and 4 purified normal islet cell [NIC] samples). Validation of genes was performed …

Comparison Of Outcomes Of Antibiotic Drugs And Appendectomy (Coda) Trial: A Protocol For The Pragmatic Randomised Study Of Appendicitis Treatment., Giana H Davidson, David R Flum, David A Talan, Larry G Kessler, Danielle C Lavallee, Bonnie J Bizzell, Farhood Farjah, Skye D Stewart, Anusha Krishnadasan, Erin E Carney, Erika M Wolff, Bryan A Comstock, Sarah E Monsell, Patrick J Heagerty, Annie P Ehlers, Daniel A Deugarte, Amy H Kaji, Heather L Evans, Julianna T Yu, Katherine Mandell, Ian C Doten, Kevin S Clive, Karen M Mcgrane, Brandon C Tudor, Careen S Foster, Darin J Saltzman, Richard C Thirlby, Erin O Lange, Amber K Sabbatini, Gregory J Moran

Articles, Abstracts, and Reports

INTRODUCTION: Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%-15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. A rigorous comparative effectiveness trial in the USA that is sufficiently large and pragmatic to incorporate usual variations in care and measures the patient experience is needed to determine whether antibiotics are as good as appendectomy.

OBJECTIVES: The Comparing Outcomes of …

Genetic And Genomic Characterization Of 462 Melanoma Patient-Derived Xenografts, Tumor Biopsies, And Cell Lines., Bradley Garman, Ioannis N. Anastopoulos, Clemens Krepler, Patricia Brafford, Katrin Sproesser, Yuchao Jiang, Bradley Wubbenhorst, Ravi Amaravadi, Joseph Bennett, Marilda Beqiri, David Elder, Keith T. Flaherty, Dennie T. Frederick, Tara C. Gangadhar, Michael Guarino, David Hoon, Giorgos Karakousis, Qin Liu, Nandita Mitra, Nicholas J. Petrelli, Lynn Schuchter, Batool Shannan, Carol L. Shields, Jennifer Wargo, Brandon Wenz, Melissa A. Wilson, Min Xiao, Wei Xu, Xaiowei Xu, Xiangfan Yin, Nancy R. Zhang, Michael A. Davies, Meenhard Herlyn, Katherine L. Nathanson

Wills Eye Hospital Papers

Tumor-sequencing studies have revealed the widespread genetic diversity of melanoma. Sequencing of 108 genes previously implicated in melanomagenesis was performed on 462 patient-derived xenografts (PDXs), cell lines, and tumors to identify mutational and copy number aberrations. Samples came from 371 unique individuals: 263 were naive to treatment, and 108 were previously treated with targeted therapy (34), immunotherapy (54), or both (20). Models of all previously reported major melanoma subtypes (BRAF, NRAS, NF1, KIT, and WT/WT/WT) were identified. Multiple minor melanoma subtypes were also recapitulated, including melanomas with multiple activating mutations in the MAPK-signaling pathway and chromatin-remodeling gene mutations. These well-characterized …

Diverticulitis Resulting In Brain Abscess: A Case Report (Poster)., Sean J. Wallace Md, David Deisher Do, Thomas Daniel Harrison Do

Department of Surgery

No abstract provided.

Piercing Of The Lumbocostal Ligament By The Subcostal Nerve: A Previously Unreported Case., Marc Vetter, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

As lateral approaches gain popularity in lumbar spine surgery, detailed discussions regarding anatomical variations in the innervation of the thoracolumbar region are of increasing importance. Damage to intercostal or subcostal nerves can lead to post-operative complications including regional loss of sensitivity, motor function, or abdominal wall hernias. More specifically, the subcostal nerve has been identified in the literature as one of the more vulnerable structures during such procedures. A clear understanding of the position of the subcostal nerve relative to nearby anatomical structures is therefore important for medical professionals. We herein report a rare anatomical variation in which the subcostal …

Extra-Pleural Dermal Solitary Fibrous Tumor On The Posterior Shoulder: A Case Report., Sean J. Wallace Md, Robert Teixeira Md, Nathan F. Miller, Hina A. Sheikh, Genevieve Guzman, Rohit Sharma Md

Department of Surgery

No abstract provided.

Differential Impact Of Serial Measurement Of Nonplatelet Thromboxane Generation On Long-Term Outcome After Cardiac Surgery., Nikolaos Kakouros, Tyler J Gluckman, John V Conte, Thomas S Kickler, Katherine Laws, Bruce A Barton, Jeffrey J Rade

Articles, Abstracts, and Reports

BACKGROUND: Systemic thromboxane generation, not suppressible by standard aspirin therapy and likely arising from nonplatelet sources, increases the risk of atherothrombosis and death in patients with cardiovascular disease. In the RIGOR (Reduction in Graft Occlusion Rates) study, greater nonplatelet thromboxane generation occurred early compared with late after coronary artery bypass graft surgery, although only the latter correlated with graft failure. We hypothesize that a similar differential association exists between nonplatelet thromboxane generation and long-term clinical outcome.

METHODS AND RESULTS: Five-year outcome data were analyzed for 290 RIGOR subjects taking aspirin with suppressed platelet thromboxane generation. Multivariable modeling was performed to …

Thyroid Cancer: Is It All In The Genes?, Electron Kebebew

Surgery Faculty Publications

No abstract provided.

Reading Between The Joints-Using Spinal Magnetic Resonance Imaging For Evaluation Of Instability, Komal Naeem, S. Ather Enam

Section of Neurosurgery

No abstract provided.

Laparoscopic Harvest Of The Rectus Abdominis For Perineal Reconstruction, Nneamaka Agochukwu, Alisha Bonaroti, Sandra Beck, James Liau

Surgery Faculty Publications

The rectus abdominis is a workhorse flap for perineal reconstruction, in particular after abdominoperineal resection (APR). Laparoscopic and robotic techniques for abdominoperineal surgery are becoming more common. The open harvest of the rectus abdominis negates the advantages of these minimally invasive approaches. (Sentence relating to advantages of laparoscopic rectus deleted here.) We present our early experience with laparoscopic harvest of the rectus muscle for perineal reconstruction. Three laparoscopic unilateral rectus abdominis muscle harvests were performed for perineal reconstruction following minimally invasive colorectal and urological procedures. The 2 patients who underwent APR also had planned external perineal skin reconstruction with local …

Retinitis Pigmentosa Genes Implicated In South Asian Populations: A Systematic Review, Sidra Zafar, Khabir Ahmed, Azam Ali, Rashid Baig

Section of Ophthalmology

Retinitis pigmentosa is one of the most prevalent causes of inherited retinal dystrophies worldwide. The widespread custom of consanguineous marriages in South Asian countries puts the population at risk for autosomal recessive disorders including retinitis pigmentosa. This systematic review was done between May and December 2015.A comprehensive literature search was carried out using MEDLINE and CINAHL databases and all relevant articles on causative mutations for non-syndromic Retinitis pigmentosa from 1999 till 2015 were included. Overall, 41 articles were identified involving 66 families; 28(68%)from Pakistan, 12(29%) from India and 1(2.4%) from Bangladesh. No data was available from the rest of countries …

Comparison Between Endoscopic And Microscopic Approaches For Surgery Of Pituitary Tumours, Inamullah Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Surgical techniques for resection of pituitary tumours have come a long way since it was first introduced in late 18th century. Nowadays, most pituitary surgeries are performed through trans-nasal trans-sphenoidal approach either using a microscope, or an endoscope. Herein the authors review the literature and compare these two instruments with regards to their outcomes when used for resection of pituitary tumours. .

Distal Humeral Fractures-Current Concepts, James C. Beazley, Njalalle Baraza, Robert Jordan, Chetan S. Modi

General Surgery, East Africa

Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.

Methods: A literature search was performed and the authors' personal experiences are reported.

Results: This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.

Conclusion: Distal humeral …

Allergic Contact Dermatitis To 2-Octyl Cyanoacrylate After Surgical Repair: Humidity As A Potential Factor, Avi Bitterman, Karanjit Sandhu

Student Papers, Posters & Projects

Allergic contact dermatitis to 2-octyl cyanoacrylate (Dermabond; Ethicon, Somerville, NJ) after surgical repair is an extremely rare condition with few reported cases. In recent years, contact dermatitis to Dermabond has been reported with increasing frequency.Cyanoacrylates are the most commonly used surgical adhesives and rely on their rapid polymerization to prevent sensitization from antigen presenting cells (APCs), because APCs are only capable of monomeric recognition of cyanoacrylates. It is thought that arid climates may contribute to increased sensitization of cyanoacrylates because water drives the polymerization reaction, decreasing the number of monomers capable of recognition by APCs. With less water present in …

Airway Stent Complications: The Role Of Follow-Up Bronchoscopy As A Surveillance Method., Hans J Lee, Wassim Labaki, Diana H Yu, Benjamin Salwen, Christopher R Gilbert, Andrea L C Schneider, Ricardo Ortiz, David Feller-Kopman, Sixto Arias, Lonny Yarmus

Articles, Abstracts, and Reports

Background: Airway stenting has become an integral part of the therapeutic endoscopic management of obstructive benign and malignant central airway diseases. Despite increased use of airway stents and frequent stent-associated complications, no clear guidelines for surveillance and maintenance exist. This study aim is to elucidate predictive factors associated with development of stent complications, as well as an optimal surveillance period for follow-up bronchoscopy for early detection and possible prevention of stent-associated complications.

Methods: Retrospective cohort study of all patients who underwent airway stent placements at our institution from April 2010 to December 2013 for benign and malignant airway diseases. Metallic, …

Early Stage Small Cell Lung Cancer: Very Rare, But A Surgical Disease!, Eric Vallières

Articles, Abstracts, and Reports

No abstract provided.

Hidden Blood Loss Between Pccp And Pfna In Elderly Femoral Intertrochanteric Fracture, Tao Ding, Huilin Yang, James Harrop, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Fan Zhan Zhang, Yuntao Xue

Department of Neurosurgery Faculty Papers

To compare perioperative hidden blood loss in the treatment of femoral intertrochanteric fractures with percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) in elderly patients, and analyse its influencing factors in order to provide the necessary data support for clinical perioperative treatment, and choice of appropriate internal fixation method. Retrospective analyses was carried out on data obtained from 158 patients with intertrochanteric fracture treated with PCCP or PFNA from January 2010 to May 2017. Data were obtained from variables such as age, gender, height, weight, operative bleeding and postoperative drainage, operation time, etc. Upon blood routine examination before …

Absence Of The Lumbosacral Trunk., Cameron K Schmidt, Joe Iwanaga, Emre Yilmaz, Charlotte Wilson, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The lumbosacral trunk, typically comprised of part of the fourth lumbar ventral rami and the entirety of the fifth lumbar ventral rami, serves as a connection between the lumbar and sacral plexuses. Developmental differences underlie the variable relative contributions of L4 and L5 to the lumbosacral trunk. Herein, we report a rare case in which dissection of an adult male cadaver revealed no L4 contribution to the lumbosacral plexus. We discuss the surgical and clinical implications of such an anatomic variation.

The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria

Marshall Journal of Medicine

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an …