Surgery Commons^™

Hic1 (Hypermethylated In Cancer 1) Sumoylation Is Dispensable For Dna Repair But Is Essential For The Apoptotic Dna Damage Response (Ddr) To Irreparable Dna Double-Strand Breaks (Dsbs)., Sonia Paget, Marion Dubuissez, Vanessa Dehennaut, Joe Nassour, Brennan T Harmon, Nathalie Spruyt, Ingrid Loison, Corinne Abbadie, Brian R Rood, Dominique Leprince

Surgery Faculty Publications

The tumor suppressor gene HIC1 (Hypermethylated In Cancer 1) encodes a transcriptional repressor mediating the p53-dependent apoptotic response to irreparable DNA double-strand breaks (DSBs) through direct transcriptional repression of SIRT1. HIC1 is also essential for DSB repair as silencing of endogenous HIC1 in BJ-hTERT fibroblasts significantly delays DNA repair in functional Comet assays. HIC1 SUMOylation favours its interaction with MTA1, a component of NuRD complexes. In contrast with irreparable DSBs induced by 16-hours of etoposide treatment, we show that repairable DSBs induced by 1 h etoposide treatment do not increase HIC1 SUMOylation or its interaction with MTA1. Furthermore, HIC1 SUMOylation …

Disparities In Stage-Appropriate Therapy For Resectable Non-Small Cell Lung Cancer In Kentucky, Jeremiah T. Martin

Theses and Dissertations--Clinical Research Design

Lung cancer (NSCLC) is the leading cause of cancer related mortality. Lung cancer screening aims to detect treatable cancers, however survival advantage will only be seen with early and appropriate stage-directed therapy. This study aims to understand recent rates of therapy for early-stage lung cancer in Kentucky, and to explore potential sources of disparities in treatment and outcomes. A Kentucky Cancer Registry query was performed of all NSCLC cases treated in the state from 2005-2014. Of 39,763 lung cancer patients, 10,622 were clinically operable. Of these, overall 40% did not receive surgery, while 16% did not receive any stage-appropriate local …

Epidemiological Investigation Of Candida Species Causing Bloodstream Infection In Pediatric Small Bowel Transplant Recipients, Mallory J. Suhr, João Carlos Gomes-Neto, Nabaraj Banjara, Diana F. Florescu, David F. Mercer, Peter C. Iwen, Heather E. Hallen-Adams

Department of Food Science and Technology: Faculty Publications

Small bowel transplantation (SBT) can be a life-saving medical procedure. However, these recipients experience high risk of bloodstream infections caused by Candida. This research aims to characterize the SBT recipient gut microbiota over time following transplantation and investigate the epidemiology of candidemia in seven pediatric patients. Candida species from the recipients’ ileum and bloodstream were identified by internal transcribed spacer sequence and distinguished to strain by multilocus sequence typing and randomly amplified polymorphic DNA. Antifungal susceptibility of bloodstream isolates was determined against nine antifungals. Twenty-two ileostomy samples harbored at least one Candida species. Fungemia were caused by Candida parapsilosis …

The Surgical Infection Society Revised Guidelines On The Management Of Intra-Abdominal Infection, John E. Mazuski, Jeffrey M. Tessier, Addison K. May, Robert G. Sawyer, Evan P. Nadler, Matthew R. Rosengart, Phillip K. Chang, Patrick J. O'Neill, Kevin P. Mollen, Jared M. Huston, Jose J. Diaz Jr., Jose M. Prince

Surgery Faculty Publications

Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations.

Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published …

Department Of Surgery Update, January 2017, Wright State University Department Of Surgery

Department of Surgery Updates

A one page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Attenuation Of Postoperative Adhesions Using A Modeled Manual Therapy (Data Files), Geoffrey M. Bove, Susan L. Chapelle, Katherine E. Hanlon, Michael P. Diamond, David J. Mokler

Biomedical Sciences Faculty Publications

These files include data and figures utilized to research and communicate the following:

Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations, and represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. Based on the hypothesis that postoperative adhesions develop from a lack of movement of the abdominopelvic organs, we proposed a relatively simple treatment approach using a modified manual therapy technique that mobilizes abdominopelvic structures in the immediate postoperative period while they are otherwise rendered …

Role Of Epigenetic Modification And Immunomodulation In A Murine Prostate Cancer Model, Jay E. Sulek, Samuel P. Robinson, Albert A. Petrossian, Shaoqing Zhou, Ekaterine Goliadze, Masoud H. Manjili, Amir Toor, Georgi Guruli

Surgery Publications

INTRODUCTION. Decreased expression of highly immunogenic cancer-testis antigens (CTA) might help tumor to achieve low immunogenicity, escape immune surveillance and grow unimpeded. Our aim was to evaluate CTA expression in tumor and normal tissues and to investigate possible means of improving the immune response in a murine prostate cancer (CaP) model by using the combination of epigenetic modifier 5-azacitidine (5-AzaC) and immunomodulator lenalidomide. No study to date has examined the effect of this combination on the prostate cancer or its impact on antigen-presenting cells (APC).

MATERIALS AND METHODS. Gene microarrays were performed to compare expression of several CTA in murine …

Traumatic Laceration Of The Posterior Tibial Tendon Treated With Novel Technique, Nicholas Miladore, Robert Gorman

Research Day

Abstract Title: TRAUMATIC LACERATION OF THE POSTERIOR TIBIAL TENDON TREATED WITH NOVEL TECHNIQUE Abstract ID: 249 Abstract Category: Clinical Research INTRODUCTION: Posterior tibial tendon (PTT) insufficiency is a common entity, and can result in chronic tendon disruption. Acute disruption is a rare occurrence, but has been described in the literature. Most reported cases are associated with ipsilateral ankle fractures. Laceration of the posterior tibial tendon has also been described, typically in the operative setting as a result of iatrogenic injury. 
CASE REPORT: A 15 year old male presented to the clinic with complaints of right ankle pain and weakness. 2.5 …

Gallbladder Duplication: Case Report Of A Rare Congenital Anomaly Treated By Single-Incision Laparoscopic Cholecystectomy In A Pediatric Patient, Jairo Espinosa M.D., Peter White, Michael Leinwand M.D.

Research Day

Introduction: Gallbladder duplication is a rare congenital anomaly. Preoperative diagnosis is essential for prevention of intra operative complications. Based on our review of the literature, this is the first description of gallbladder duplication treated with single-incision laparoscopic surgery (SILS) in a pediatric patient.

Case Presentation: A 14 year-old girl presented to the pediatric surgery clinic with a 4-month history of right upper quadrant abdominal pain, nausea, and low- grade fevers. Preoperative imaging revealed gallbladder duplication. The single incision laparoscopic technique was employed. Intra operative ndings included two gallbladders that appeared to share a common wall. There were two parallel cystic …

Mixed Goblet Cell Carcinoid-Adenocarcinoma: A Case Series, Jairo Espinosa M.D., Timothy Truong, Julia Miladore M.D., John T. Collins, Saad Shebrain M.D., Gitonga Munene M.D.

Research Day

INTRODUCTION: Mixed goblet cell carcinoid-adenocarcinoma (GCC) tumors are a group of rare heterogenous neoplasms of the appendix accounting for < 5% of all primary appendiceal tumors. They are characterized as an intermediate between classic carcinoid tumors and appendiceal adenocarcinomas, exhibiting both neuroendocrine and glandular/mucinous morphology that most commonly presents in Caucasian females in the fifth and sixth decades. We present three cases of mixed GCC presenting as acute appendicitis. CASE PRESENTATION: Case #1 A 65-year-old male presented with RLQ pain, nausea, emesis, and leukocytosis. CT of the abdomen revealed perforated appendicitis. The patient underwent a laparoscopic appendectomy. Pathology revealed a high-grade adenocarcinoma ex goblet cell carcinoid, signet ring type extending through the muscularis propria into the mesoappendix measuring >3cm. The patient subsequently underwent a colonoscopy that revealed diverticulosis, but was otherwise normal. Patient then underwent a right hemicolectomy and partial omentectomy. Pathology revealed normal ileal, omental, and colonic tissue without evidence of carcinoma. 0/12 nodes were positive. Case #2 A 49-year-old male presented with periumbilical pain, nausea, emesis, and leukocytosis. CT of the abdomen revealed appendicitis. The patient underwent a laparoscopic appendectomy. Pathology revealed a high-grade, poorly differentiated, adenocarcinoma ex goblet cell carcinoid invading through the muscularis propria into …

Rare Presentation Of High Grade Retroperitoneal Angiosarcoma In A Patient Status Post Endovascular Aortic Repair (Evar), Jairo Espinosa M.D., Alan Hifko, Julia Miladore M.D., John T. Collins

Research Day

INTRODUCTION: Primary angiosarcoma of the aorta is a rare malignancy arising from the aorta’s endothelial lining. The most common presentation is claudication, however in the presence of an endograft a tumor originating in the aneurysmal sac may remain undetected and mimic common graft pathology. Diagnosis is typically delayed due to vague clinical presentation and imaging being indistinguishable from common complications of endografts such as leaks, infections or hematomas. We report a case of primary angiosarcoma of the aorta after endovascular repair of an abdominal aortic aneurysm. This case report describes the sixth case in the literature of primary angiosarcoma arising …

Pheochromocytoma With Ivc Invasion: Case Report & Systematic Review Of Literature, Jennifer Kim Bs, Ms2, Gitonga Munene M.D., David Schutter Md, Pgy3

Research Day

Surgical management and outcome of pheochromocytoma with invasion of the inferior vena cava (IVC) has not been thoroughly reported or widely available in the literature. As determining the malignancy of pheochromocytoma has yet to be clearly defined and the experience of surgical resection of this condition is underrepresented, we include a case report and a systematic literature review on this condition. A literature search in PubMed was performed based on a recent review article by Kassahun et al. (2016). The search yielded 13 case reports between 1988 and 2014 from which data was extracted based on the following variables: patient’s …

Interleukin (Il)-18 Binding Protein Deficiency Disrupts Natural Killer Cell Maturation And Diminishes Circulating Il-18., Robert Z. Harms, Austin J. Creer, Kristina M. Lorenzo-Arteaga, Katie R. Ostlund, Nora Sarvetnick

Journal Articles: Surgery

The cytokine interleukin (IL)-18 is a crucial amplifier of natural killer (NK) cell function. IL-18 signaling is regulated by the inhibitory effects of IL-18 binding protein (IL-18BP). Using mice deficient in IL-18BP (IL-18BPKO), we investigated the impact of mismanaged IL-18 signaling on NK cells. We found an overall reduced abundance of splenic NK cells in the absence of IL-18BP. Closer examination of NK cell subsets in spleen and bone marrow using CD27 and CD11b expression revealed that immature NK cells were increased in abundance, while the mature population of NK cells was reduced. Also, NK cells were polarized to greater …

History Of The Innovation Of Damage Control For Management Of Trauma Patients: 1902-2016, Derek J. Roberts, Chad G. Ball, David V. Feliciano, Ernest E. Moore, Rao R. Ivatury, Charles E. Lucas, Timothy C. Fabian, David A. Zygun, Andrew W. Kirkpatrick, Henry T. Stelfox

Surgery Publications

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients.

Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation.

Methods: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation.

Results: The "innovation'' of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II …

A Pilot Study To Measure Dynamic Elasticity Of The Bladder During Urodynamics, Andrew F. Colhoun, Adam P. Klausner, Anna S. Nagle, Ashley W. Carroll, Robert W. Barbee, Paul H. Ratz, John E. Speich

Surgery Publications

AIMS: Previous studies using isolated strips of human detrusor muscle identified adjustable preload tension, a novel mechanism that acutely regulates detrusor wall tension. The purpose of this investigation was to develop a method to identify a correlate measure of adjustable preload tension during urodynamics.

METHODS: Patients reporting urgency most or all of the time based on ICIq-OAB survey scores were prospectively enrolled in an extended repeat fill-and-empty urodynamics study designed to identify a correlate of adjustable preload tension which we now call dynamic elasticity. Cystometric capacity was determined during initial fill. Repeat fills to defined percentages of capacity with passive …

Safety And Effectiveness Of Propranolol In Severely Burned Patients: Systematic Review And Meta-Analysis, Ramiro Manzano-Nunez, Herney Andrés García-Perdomo, Paula Ferrada, Carlos Alberto Ordoñez Delgado, Diego Andrés Gomez, Jorge Esteban Foianini

Surgery Publications

Background

The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA >20%).

Methods

Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (>20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We …

Characterization Of Lower Urinary Tract Symptoms In Patients With Idiopathic Normal Pressure Hydrocephalus, Sarah C. Krzastek, William M. Bruch, Samuel P. Robinson, Harold F. Young, Adam P. Klausner

Surgery Publications

AIMS: The purpose of this study was to evaluate lower urinary tract symptoms (LUTS) in idiopathic normal pressure hydrocephalus (iNPH).

METHODS: Patients with new-onset iNPH were prospectively evaluated for LUTS via detailed history and physical, and administration of questionnaires from the International Consultation on Incontinence to assess incontinence (ICIq-UI), overactive bladder (ICIq-OAB), and quality of life (ICIq-LUTqol), as well as the American Urological Association Symptom Score bother scale. All patients with moderate-to-severe LUTS were offered urodynamic testing. Sub-analysis was performed based on gender, medical comorbidities, and age.

RESULTS: Fifty-five consecutive patients with iNPH completed the initial evaluation and surveys. Total …

Pelvic Trauma: Wses Classification And Guidelines, Federico Coccolini, Philip F. Stahel, Giulia Montori, Walter Biffl, Tal M. Horer, Fausto Catena, Yoram Kluger, Ernest E. Moore, Andrew B. Peitzman, Rao Ivatury, Raul Coimbra, Gustavo Pereira Fraga, Bruno Pereira, Sandro Rizoli, Andrew Kirkpatrick, Ari Leppaniemi, Roberto Manfredi, Stefano Magnone, Osvaldo Chiara, Leonardo Solaini, Marco Ceresoli, Niccolò Allievi, Catherine Arvieux, George Velmahos, Zsolt Balogh, Noel Naidoo, Dieter Weber, Fikri Abu-Zidan, Massimo Sartelli, Luca Ansaloni

Surgery Publications

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be …

Scedosporium Prolificans Septic Arthritis, Collier S. Pace, Jessica A. Frankenhoff, Jonathan E. Isaacs

Surgery Publications

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did …

Operative And Nonoperative Management Of Blunt Liver Injuries, Jill Peysha, Paula Ferrada

Surgery Publications

Purpose of Review

The purpose of this review is to discuss the indications for operative and nonoperative management in patients with blunt liver injuries.

Recent Findings

Over the past several years, research has begun to show that nonoperative management in blunt liver injuries is feasible and has favorable outcomes over immediate operations in patients who are hemodynamically stable. This includes high-grade injuries who were previously taken to the operating room, in the absence of peritoneal signs or instability, for washout and packing. This trend in management is likely multifactorial and includes improved quality of critical care medicine, advances in imaging …