Surgery Commons^™

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 …

Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques For Breast Conservation In A Patient With Moderate- To Large-Sized Breasts, Abhishek Chatterjee, Deniz Dayicioglu, Nazanin Khakpour, Brian J. Czerniecki

Surgery Faculty Publications

Oncoplastic surgery is an evolving field in breast surgery combining the strengths of breast surgical oncology with plastic surgery. It provides the surgeon the ability to excise large areas of the breast in the oncologic resection without compromising, and possibly improving, its aesthetic appearance. The purpose of this review is to provide a guide that could help a breast surgeon excise breast cancer in most areas of the breast using 5 oncoplastic techniques. These techniques would be used depending primarily on the location of the cancer in the breast and also on the size of the tumor.

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 …

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 …

Factors Influencing Preference For Surgical Choice Among Women With Early Stage Breast Cancer, Susan G. Yackzan

Theses and Dissertations--Nursing

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among …

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 …

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 …

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 Meta-Analysis Of Resuscitative Endovascular Balloon Occlusion Of The Aorta (Reboa) Or Open Aortic Cross-Clamping By Resuscitative Thoracotomy In Non-Compressible Torso Hemorrhage Patients, Ramiro Manzano Nunez, Maria Paula Naranjo, Esteban Foianini, Paula Ferrada, Erika Rincon, Herney Andrés García-Perdomo, Paola Burbano, Juan Pablo Herrera, Alberto F. García, Carlos A. Ordoñez

Surgery Publications

Background

The objective of this systematic review and meta-analysis was to determine the effect of REBOA, compared to resuscitative thoracotomy, on mortality and among non-compressible torso hemorrhage trauma patients.

Methods

Relevant articles were identified by a literature search in MEDLINE and EMBASE. We included studies involving trauma patients suffering non-compressible torso hemorrhage. Studies were eligible if they evaluated REBOA and compared it to resuscitative thoracotomy. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. We conducted meta-analysis using random effect models.

Results

We included three studies in our systematic review. These studies included …

Preoperative Immunonutrition And Elective Colorectal Resection Outcomes., Lucas W Thornblade, Thomas K Varghese, Xu Shi, Eric K Johnson, Amir Bastawrous, Richard P Billingham, Richard Thirlby, Alessandro Fichera, David R Flum

Articles, Abstracts, and Reports

BACKGROUND: Randomized controlled trials demonstrate the efficacy of arginine-enriched nutritional supplements (immunonutrition) in reducing complications after surgery. The effectiveness of preoperative immunonutrition has not been evaluated in a community setting.

OBJECTIVE: This study aims to determine whether immunonutrition before elective colorectal surgery improves outcomes in the community at large.

DESIGN: This is a prospective cohort study with a propensity score-matched comparative effectiveness evaluation.

SETTINGS: This study was conducted in Washington State hospitals in the Surgical Care Outcomes Assessment Program from 2012 to 2015.

PATIENTS: Adults undergoing elective colorectal surgery were selected.

INTERVENTIONS: Surgeons used a preoperative checklist that recommended that …

New Horizons In Spine Research: Intervertebral Disc Repair And Regeneration., James C Iatridis, James Kang, Rita Kandel, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Distal Interphalangeal Joint Arthrodesis Complicated By Postoperative Infection: A Rare Presentation Of Disseminated Herpes Simplex Virus., Meredith N. Osterman, Michael P. Gaspar

Department of Orthopaedic Surgery Faculty Papers

Postoperative infection after elective arthrodesis of the interphalangeal joint is an uncommon complication often necessitating urgent debridement. We present the rare case of a female patient with a history of oral herpetic lesions, who underwent elective arthrodesis of the middle and index fingers for treatment of erosive osteoarthritis and subsequently developed a postoperative herpetic infection at the surgical site.

Pain And Anxiety Levels Of Patients Undergoing Tissue Expansion After Mastectomies: A Case Series Study, Nicole K. Le, Carla García-Molina, Ambuj Kumar, Lisa Griffin, Deniz Dayicioglu

Surgery Faculty Publications

The tissue expansion process is done after mastectomies to increase the submuscular space in preparation for the placement of permanent breast implant. The process is often believed to be painful by patients who are often intimidated by the prospect of mechanically stretching out their skin and muscle. This study aims to quantify the pain experienced by patients and determine the different pain management techniques used. We used a case series approach, in which patients who were undergoing serial tissue expansion process were asked to rate their pain and anxiety on a scale from 1 to 10, using a questionnaire and …

In The Age Of Breast Augmentation, Breast Reconstruction Provides An Opportunity To Augment The Breast, Amanda L. Zimmerman, Bugra Tugertimur, Paul D. Smith, Ambuj Kumar, Deniz Dayicioglu

Surgery Faculty Publications

Background: Augmentation mammoplasty remains the most common cosmetic surgery procedure performed. The objective of this article is to evaluate the impact of augmented volume of the reconstructed breast in patients that undergo nipple-sparing mastectomy and patients previously augmented who undergo mastectomy with tissue expander/implant-based reconstruction.

Methods: Patients undergoing skin-sparing mastectomy, nipple-sparing mastectomy, and mastectomy after previous augmentation followed by tissue expander/implant-based reconstruction between June 2011 and April 2015 by 2 surgeons at the same institution were included. Retrospective chart review of the patients identified using these criteria was performed to record patient characteristics, complications, breast volume, implant volume, and percentage …

Disparities In Use And Access To Postmastectomy Breast Reconstruction Among African American Women: A Targeted Review Of The Literature, Sara E. Soni, M. Catherine Lee, Clement K. Gwede

Surgery Faculty Publications

Postmastectomy breast reconstruction is a therapy that has been shown to have positive psychological effects on its recipients. There is evidence that racial disparities in its use exist, particularly among African American (AA) women. The purpose of this targeted review of the literature was to examine the use of postmastectomy breast reconstruction among AA women and to explore factors that contribute to such disparities. Published literature that evaluated rates of breast reconstruction in AA women, as well as barriers to reconstruction in this population, was reviewed. All of the reviewed data consisted of retrospective studies. There are conflicting data in …

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.

Irreversible Electroporation Of Locally Recurrent Pancreatic Cancer With 5-Year Survival, Alyssa Deiters, Minia Hellan, Rebecca N. Tuttle, James R. Ouellette

Department of Surgery Faculty Publications

Background: Isolated local recurrence after surgical resection for pancreatic cancer is rare. Current common therapies for recurrence include chemotherapy or chemoradiation. There are few, if any, reports regarding surgical resection of local pancreatic cancer recurrence. This is the first report of using irreversible electroporation (IRE) to treat a pancreatic adenocarcinoma local recurrence and represents a true 5-year survivor and possible cure.

Case report: A 50-year-old female initially presented with 2.5 cm mass in the uncinate process of the pancreas suspicious for malignancy. Preoperative endoscopic guided fine needle aspirate (FNA) confirmed adenocarcinoma. She underwent pylorus preserving pancreaticoduodenectomy with the finding of …

Immunohistochemical P21 Expression In Breast Cancer: Association With Patient And Tumour Characteristics, Benjamin N. Njihia

Master of Medicine in General Surgery

Introduction: Molecular characterisation of the breast cancer has allowed for targeted therapies that are improving outcomes. The gains achieved by these treatments have fuelled the search for other targets, including cyclin-dependent kinase inhibitors such as p21. p21 expression in breast cancer has been shown to be variably associated with clinical and pathological parameters in different populations. It is possible that either methodological or biological differences underlie these variations. Objective: The current study sought to determine the association of p21 expression and clinico-pathological parameters in breast cancer patients at the Aga Khan University Hospital in Nairobi, Kenya. Methods: Clinically annotated tissue …

Biomechanical Evaluation Of A Growth-Friendly Rod Construct., Sarah Galvis, Josh Arnold, Erin Mannen, Benjamin Wong, Hadley Sis, Eileen Cadel, John Anderson, Dennis Anderson, Paul Arnold, Elizabeth Friis

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Distraction-type rods mechanically stabilize the thorax and improve lung growth and function by applying distraction forces at the rib, spine, pelvis, or a combination of locations. However, the amount of stability the rods provide and the amount the thorax needs is unknown.

METHODS: Five freshly frozen and thawed cadaveric thoracic spine specimens were tested for lateral bending, flexion/extension, and axial rotation in displacement control (1°/sec) to a load limit of ±5 Nm for five cycles after which a growth-friendly unilateral rod was placed in a simulated rib-to-lumbar attachment along the right side. The specimens were tested again in the …

Assessing Survival And Grading The Severity Of Complications In Octogenarians Undergoing Pulmonary Lobectomy., Andrew Feczko, Elizabeth Mckeown, Jennifer L Wilson, Brian E Louie, Ralph W Aye, Jed A Gorden, Eric Vallières, Alexander S Farivar

Articles, Abstracts, and Reports

No abstract provided.