Surgery Commons^™

Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients, Farid Khan, Abdul Rehman, Muhammad Shahzad Shamim, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.
Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests …

Efficacy Of Transoral Fundoplication Vs Omeprazole For Treatment Of Regurgitation In A Randomized Controlled Trial., John G. Hunter, Peter J. Kahrilas, Reginald C.W. Bell, Erik B. Wilson, Karim S. Trad, James P. Dolan, Kyle A. Perry, Brant K. Oelschlager, Nathaniel J. Soper, Brad E. Snyder, Miguel A. Burch, William Scott Melvin, Kevin M. Reavis, Daniel G. Turgeon, Eric S. Hungness, Brian S. Diggs

Surgery Faculty Publications

Background

The aim of this randomized, crossover study was to determine if transoral fundoplication (TF) could further improve clinical outcomes in partial responders to high-dose (HD) proton-pump inhibitor (PPI) therapy and to evaluate durability of TF.

Methods

In seven United States centers, patients with hiatal hernia ≤2 cm and abnormal esophageal acid exposure (EAE) were randomized to TF (n = 40) or HD PPIs (n = 23) group. At 6-month follow-up, PPI patients underwent crossover. We assessed clinical outcomes 6-month post TF in crossover patients (COP), as compared to 6-month of HD PPI therapy, and 12-month outcomes in patients initially …

Department Of Surgery Update, February 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains note about Margaret M. Dunn, M.D., being appointed dean of the Boonshoft School of medicine, a message from the chair, a list of important dates, a call for abstracts, scholarly activity and more.

Francis Daniels Moore: One Of The Brightest Minds In The Surgical Field., Sara L. Low, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Ashesh P. Shah, Md

Department of Surgery Gibbon Society Historical Profiles

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties.

Vivien Thomas: Master Craftsman, Gifted Teacher, And Unsung Hero., Alisha Joyner, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

The field of pediatric cardiovascular surgery gained international recognition in 1944 with the first successful correction of a tetralogy of Fallot congenital anomaly in a 15-month-old patient. Dr. Helen Taussig (1898 to 1986), a pediatrician at Johns Hopkins Hospital, recognized the need for the procedure. Dr. Alfred Blalock (1899 to 1964), Chief of Surgery at Johns Hopkins Hospital, is credited with performing the surgery. However, there is an unsung hero who for many years did not receive a single mention in the medical literature. Vivien Thomas (1910 to 1985) was Dr. Blalock’s research assistant who is said to have stood …

Self-Perceived Barriers To Eye Care In A Hard-To-Reach Population: The Karachi Marine Fishing Communities Eye And General Health Survey, Khabir Ahmad, Anthony B. Zwi, Daniel J. M. Tarantola, Tanveer Anjum Chaudhry

Department of Surgery Docs

Abstract

Purpose.: We examined self-reported barriers to eye care among marginalized, hard-to-reach fishing communities in Karachi, Pakistan.

Methods.: The Karachi Marine Fishing Communities Eye and General Health Survey was a cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on seven islands and coastal areas were interviewed regarding sociodemographic background, experience of eye problems, eye care use, and barriers to access. They also were examined to determine visual acuity with a reduced logMAR chart and underwent a detailed eye examination.

Results.: …

Breast Cancer Screening: Early Detection Is Not Enough, Judy A. Tjoe

Journal of Patient-Centered Research and Reviews

N/A

Esophageal Fistula Complicating Thyroid Lobectomy, Nicholas D. Ward, Cortney Y. Lee, James T. Lee, David A. Sloan

Surgery Faculty Publications

Thyroidectomy is associated with low morbidity and mortality. Esophageal perforation following thyroidectomy has been reported only three times previously, with subsequent fistulization occurring in two of these cases. The authors present the first such case report in the English-speaking literature.

Endovascular Stroke Therapy Results Improve Over Time: The ‘Learning Curve’ At A New Comprehensive Stoke Center, Ethan A. Benardete, Anil K. Nair

Department of Neurosurgery Faculty Papers

Background: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of …

First-In-Human, Phase 1, Randomized, Dose-Escalation Trial With Recombinant Anti-Il-20 Monoclonal Antibody In Patients With Psoriasis, A. B. Gottlieb, J. G. Krueger, M. Sandberg Lundblad, M. Gothberg, B. E. Skolnick

Journal Articles

BACKGROUND: The current trial was a first-in-human clinical trial evaluating the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary efficacy of the recombinant monoclonal anti-interleukin-20 (IL-20) antibody, NNC0109-0012, which targets the inflammatory cytokine IL-20. METHODS: In total, 48 patients aged 18 to 75 years with moderate to severe stable chronic plaque psoriasis with affected body surface area >/=15% and physician global assessment score >/=3 were enrolled in this randomized, double-blind, multicenter, placebo-controlled, phase 1 dose-escalation trial. Patients were randomized within each single dose cohort (0.01, 0.05, 0.2, 0.6, 1.5, or 3.0 mg/kg) or multiple dose cohort (0.05, 0.2, 0.5, 1.0, or 2.0 …

Interest In Bariatric Surgery Among Obese Patients With Obstructive Sleep Apnea, K. A. Dudley, A. Tavakkoli, R. A. Andrews, A. N. Seiger, J. P. Bakker, S. R. Patel

Journal Articles

BACKGROUND: Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. OBJECTIVES: Determine the proportion of OSA patients who would be interested in bariatric surgery. SETTING: Sleep clinics, United States. METHODS: Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m2 were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. RESULTS: Of 767 eligible patients, 230 (30.0%) …

Prothrombin Time And Activated Partial Thromboplastin Time Testing: A Comparative Effectiveness Study In A Million-Patient Sample, M. N. Capoor, J. L. Stonemetz, J. C. Baird, F. S. Ahmed, A. Awan, C. Birkenmaier, M. A. Inchiosa, S. K. Magid, K. Mcgoldrick, E. Molmenti, S. Naqvi, S. D. Parker, S. M. Pothula, A. Shander, R. G. Steen, M. K. Urban, J. Wall, V. A. Fischetti

Journal Articles

Background A substantial fraction of all American healthcare expenditures are potentially wasted, and practices that are not evidence-based could contribute to such waste. We sought to characterize whether Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) tests of preoperative patients are used in a way unsupported by evidence and potentially wasteful. Methods and Findings We evaluated prospectively-collected patient data from 19 major teaching hospitals and 8 hospital-affiliated surgical centers in 7 states (Delaware, Florida, Maryland, Massachusetts, New Jersey, New York, Pennsylvania) and the District of Columbia. A total of 1,053,472 consecutive patients represented every patient admitted for elective surgery …

Surgeon Motivations Behind The Timing Of Breast Reconstruction In Patients Requiring Postmastectomy Radiation Therapy, M. Lee, E. Reinertsen, E. Mcclure, S. Liu, L. Kruper, N. Tanna, J. Brian Boyd, J. W. Granzow

Journal Articles

OBJECTIVES: Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. METHODS: Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were …

Geriatric Telemedicine: Background And Evidence For Telemedicine As A Way To Address The Challenges Of Geriatrics, Ronald C. Merrell

Surgery Publications

Objectives

The global population of elderly people is increasing at a remarkable rate, which may be expected to continue for some time. Older patients require more care, and with the current model of care delivery, the costs may be expected to rise, although higher cost is unsustainable. For this reason, a new pattern of practice is needed. Telemedicine will be presented as a highly effective and necessary tool in geriatrics.

Methods

This review will present some of the background and evidence for telemedicine as a way to address the challenges of geriatrics through geriatric telemedicine. Some of the evidence for …

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitro for adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

An Unusual Case Of Bony Styloid Processes That Extend To The Hyoid Bone, Shekhar K. Gadkaree, Christopher G. Hyppolite, Aisha Harun, Ryan H. Sobel, Young Kim

Surgery Publications

The embryological origin of the hyoid bone is a point of uncertainty, with controversy surrounding the relative contribution of the second pharyngeal arch to hyoid development. We encountered a 52-year-old male with bilateral bony styloid extension to the lesser cornu of the hyoid bone during the workup of a patient with laryngeal cancer. This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological …

Penetrating Cardiac Trauma And The Use Of Emergent Extracorporeal Membrane Oxygenation And Therapeutic Hypothermia: When Cooler Heads Prevail, Nathaniel Lee, Daniel Tang, Sudha Jayaraman

Surgery Publications

This is a case of penetrating chest trauma with traumatic arrest from cardiac tamponade, right and left ventriculotomies, mitral valve injury and ventricular septal defect. Patient underwent resuscitative thoracotomy converted to clamshell thoracotomy for haemorrhage control. Ventriculotomies were repaired on initial damage control operation. Extracorporeal membrane oxygenation cannulation and therapeutic cooling bridged to definitive cardiac repair several days later. Patient was discharged to an inpatient rehabilitation facility in 16 days.

Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients, Massimo Sartelli, Mark A. Malangoni, Fikri M. Abu-Zidan, Ewen A. Griffiths, Stefano Di Bella, Lynne V. Mcfarland, Ian Eltringham, Vishal G. Shelat, George C. Velmahos, Ciarán P. Kelly, Sahil Khanna, Zaid M. Abdelsattar, Layan Alrahmani, Luca Ansaloni, Goran Augustin, Miklosh Bala, Frédéric Barbut, Offir Ben-Ishay, Aneel Bhangu, Walter L. Biffl, Stephen M. Brecher, Adrián Camacho-Ortiz, Miguel A. Caínzos, Laura A. Canterbury, Fausto Catena, Shirley Chan, Jill R. Cherry-Bukowiec, Jesse Clanton, Federico Coccolini, Maria Elena Cocuz, Raul Coimbra, Charles H. Cook, Yunfeng Cui, Jacek Czepiel, Koray Das, Zaza Demetrashvili, Isidoro Di Carlo, Salomone Di Saverio, Irina Magdalena Dumitru, Catherine Eckert, Christian Eckmann, Edward H. Eiland, Mushira Abdulaziz Enani, Mario Faro, Paula Ferrada, Joseph Derek Forrester, Gustavo P. Fraga, Jean Louis Frossard, Rita Galeiras, Wagih Ghnnam, Carlos Augusto Gomes, Venkata Gorrepati, Mohamed Hassan Ahmed, Torsten Herzog, Felicia Humphrey, Jae Il Kim, Arda Isik, Rao Ivatury, Yeong Yeh Lee, Paul Juang, Luis Furuya-Kanamori, Aleksandar Karamarkovic, Peter K. Kim, Yoram Kluger, Wen Chien Ko, Francis D. Labarbera, Jae Gil Lee, Ari Leppaniemi, Varut Lohsiriwat, Sanjay Marwah, John E. Mazuski, Gokhan Metan, Ernest E. Moore, Frederick Alan Moore, Carl Erik Nord, Carlos A. Ordoñez, Gerson Alves Pereira Júnior, Nicola Petrosillo, Francisco Portella, Basant K. Puri, Arnab Ray, Mansoor Raza, Miran Rems, Boris E. Sakakushev, Gabriele Sganga, Patrizia Spigaglia, David B. Stewart, Pierre Tattevin, Jean Francois Timsit, Kathleen B. To, Cristian Tranà, Waldemar Uhl, Libor Urbánek, Harry Van Goor, Angela Vassallo, Jean Ralph Zahar, Emanuele Caproli, Pierluigi Viale

Surgery Publications

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficileinfection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

Single Center Experience On Dosing And Adverse Events Of Recombinant Factor Seven Use For Bleeding After Congenital Heart Surgery, Mustafa Kurkluoglu, Alyson M. Engle, John P. Costello, Narutoshi Hibino, David Zurakowski, Richard A. Jonas, John T. Berger, Dilip S. Nath

Surgery Faculty Publications

There are limited data on the relationship between the administered dose of recombinant factor seven (rFVIIa) and the development of adverse clinical outcomes after congenital heart surgery. This single institution case series reports on dosing, adverse events, and blood product usage after the administration of rFVIIa in the congenital heart surgery patient population. A retrospective review identified 16 consecutive pediatric patients at an academic, free-standing, children’s hospital who received rFVIIa to curtail bleeding following congenital heart surgery between April 2004 and June 2012. Patients were assessed for survival to hospital discharge versus in-hospital mortality and the presence or absence of …

Pneumonectomy In A Patient With Swyer-James-Macleod Syndrome, Mariana Vignola Cruz, Gregory D. Trachiotis

Surgery Faculty Publications

Swyer-James-MacLeod syndrome is a rare disease that results in parenchymal damage believed to be caused by recurrent lung infections in childhood. We report a case of a previously healthy young woman that presented with insidious progression of exertional dyspnea with restrictive lung physiology. Axial imaging demonstrated a hyperinflated emphysematous right lung with lower lobe fibrosis, nodules and air-fluid filled cysts, with a small right pulmonary artery and contralateral shifting of the mediastinum. She underwent right pneumonectomy ultimately resulting in improvement of her symptoms, with surgical pathology indicating extensive emphysema, bronchiectasis, fibrosis with osseous metaplasia, and placental transmogrification of alveolar septa, …