Surgery Commons^™

Wses Classification And Guidelines For Liver Trauma, Federico Coccolini, Fausto Catena, Ernest E. Moore, Rao Ivatury, Walter Biffl, Andrew Peitzman, Raul Coimbra, Sandro Rizoli, Yoram Kluger, Fikri M. Abu-Zidan, Marco Ceresoli, Giulia Montori, Massimo Sartelli, Dieter Weber, Gustavo Fraga, Noel Naidoo, Frederick A. Moore, Nicola Zanini, Luca Ansaloni

Surgery Publications

The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines.

Wses Guidelines For The Management Of Acute Left Sided Colonic Diverticulitis In The Emergency Setting, Massimo Sartelli, Fausto Catena, Luca Ansaloni, Federico Coccolini, Ewen A. Griffiths, Fikri M. Abu-Zidan, Salomone Di Saverio, Jan Ulrych, Yoram Kluger, Ofir Ben-Ishay, Frederick A. Moore, Rao R. Ivatury, Raul Coimbra, Andrew B. Peitzman, Ari Leppaniemi, Gustavo P. Fraga, Ronald V. Maier, Osvaldo Chiara, Jeffry Kashuk, Boris Sakakushev, Dieter G. Weber, Rifat Latifi, Walter Biffl, Miklosh Bala, Aleksandar Karamarkovic, Kenji Inaba, Carlos A. Ordonez, Andreas Hecker, Goran Augustin, Zaza Demetrashvili, Renato Bessa Melo, Sanjay Marwah, Sanoop K. Zachariah, Vishal G. Shelat, Michael Mcfarlane, Miran Rems, Carlos Augusto Gomes, Mario Paulo Faro, Gerson Alves Pereira Júnior, Ionut Negoi, Yunfeng Cui, Norio Sato, Andras Vereczkei, Giovanni Bellanova, Arianna Birindelli, Isidoro Di Carlo, Kenneth Y. Kok, Mahir Gachabayov, Georgios Gkiokas, Konstantinos Bouliaris, Elif Çolak, Arda Isik, Daniel Rios-Cruz, Rodolfo Soto, Ernest E. Moore

Surgery Publications

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

Wses Jerusalem Guidelines For Diagnosis And Treatment Of Acute Appendicitis, Salomone Di Saverio, Arianna Birindelli, Micheal D. Kelly, Fausto Catena, Dieter G. Weber, Massimo Sartelli, Michael Sugrue, Mark De Moya, Carlos Augusto Gomes, Aneel Bhangu, Ferdinando Agresta, Ernest E. Moore, Kjetil Soreide, Ewen Griffiths, Steve De Castro, Jeffry Kashuk, Yoram Kluger, Ari Leppaniemi, Luca Ansaloni, Manne Andersson, Federico Coccolini, Raul Coimbra, Kurinchi S. Gurusamy, Fabio Cesare Campanile, Walter Biffl, Osvaldo Chiara, Fred Moore, Andrew B. Peitzman, Gustavo P. Fraga, David Costa, Ronald V. Maier, Sandro Rizoli, Zsolt J. Balogh, Cino Bendinelli, Roberto Cirocchi, Valeria Tonini, Alice Piccinini, Gregorio Tugnoli, Elio Jovine, Roberto Persiani, Antonio Biondi, Thomas Scalea, Philip Stahel, Rao Ivatury, George Velmahos, Roland Andersson

Surgery Publications

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the …

Bilayered, Non-Cross-Linked Collagen Matrix For Regeneration Of Facial Defects After Skin Cancer Removal: A New Perspective For Biomaterial-Based Tissue Reconstruction, Shahram Ghanaat, Adorjan Kovacs, Mike Barbeck, Jonas Lorenz, Anna Teiler, Nader Sadeghi, Charles Kirkpatrick, Robert Sader

Surgery Faculty Publications

Classically skin defects are covered by split thickness skin grafts or by means of local or regional skin flaps. In the presented case series for the first time a bilayered, non-crossed-linked collagen matrix has been used in an off-label fashion in order to reconstruct facial skin defects following different types of skin cancer resection. The material is of porcine origin and consists of a spongy and a compact layer. The ratio of the two layers is 1:3 in favour of the spongy layer. The aim of the study was to investigate the potential of this matrix for skin regeneration as …

Interleukin-6 Is A Risk Factor For Atrial Fibrillation In Chronic Kidney Disease: Findings From The Cric Study., Richard L. Amdur, Monica Mukherjee, Alan Go, Ian R Barrows, Ali Ramezani, Jun Shoji, Dominic S. Raj, +13 Additional Authors

Surgery Faculty Publications

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic kidney disease (CKD). In this study, we examined the association between inflammation and AF in 3,762 adults with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. AF was determined at baseline by self-report and electrocardiogram (ECG). Plasma concentrations of interleukin(IL)-1, IL-1 Receptor antagonist, IL-6, tumor necrosis factor (TNF)-α, transforming growth factor-β, high sensitivity C-Reactive protein, and fibrinogen, measured at baseline. At baseline, 642 subjects had history of AF, but only 44 had AF in ECG recording. During a mean follow-up of 3.7 years, 108 subjects …

Outcomes Of Recurrent Laryngeal Nerve Injury Following Congenital Heart Surgery: A Contemporary Experience., Fahad A Alfares, Conor F Hynes, Ghedak Ansari, Reginald Chounoune, Manelle Ramadan, Conner Shaughnessy, Brian K. Reilly, David Zurakowski, Richard A. Jonas, Dilip S. Nath

Surgery Faculty Publications

OBJECTIVE: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition.

DESIGN: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus.

RESULTS: The incidence of post-operative vocal cord paralysis was 1.1% (32 …

Mutational Profiles Reveal An Aberrant Tgf-Β-Cea Regulated Pathway In Colon Adenomas., Jian Chen, Gottumukkala S Raju, Wilma Jogunoori, Shoujun Gu, Lopa Mishra, + 27 More

Surgery Faculty Publications

Mutational processes and signatures that drive early tumorigenesis are centrally important for early cancer prevention. Yet, to date, biomarkers and risk factors for polyps (adenomas) that inordinately and rapidly develop into colon cancer remain poorly defined. Here, we describe surprisingly high mutational profiles through whole-genome sequence (WGS) analysis in 2 of 4 pairs of benign colorectal adenoma tissue samples. Unsupervised hierarchical clustered transcriptomic analysis of a further 7 pairs of adenomas reveals distinct mutational signatures regardless of adenoma size. Transitional single nucleotide substitutions of C:G>T:A predominate in the adenoma mutational spectrum. Strikingly, we observe mutations in the TGF-β pathway …

Vitamin D Deficiency Promotes Liver Tumor Growth In Transforming Growth Factor-Β/Smad3-Deficient Mice Through Wnt And Toll-Like Receptor 7 Pathway Modulation., Jian Chen, Lior H Katz, Nina M Muñoz, Shoujun Gu, Ji-Hyun Shin, Lopa Mishra, +13 Additional Authors

Surgery Faculty Publications

Disruption of the TGF-β pathway is associated with liver fibrosis and suppression of liver tumorigenesis, conditions associated with low Vitamin D (VD) levels. However, potential contributions of VD to liver tumor progression in the context of TGF-β signaling remain unexplored. Our analyses of VD deprivation (VDD) in in vivo models of liver tumor formation revealed striking three-fold increases in tumor burden in Smad3(+/-) mice, with a three-fold increase in TLR7 expression compared to controls. ChIP and transcriptional assays confirm Smad3 binding at two TLR7 promoter SBE sites. Molecular interactions between TGF-β pathway and VDD were validated clinically, where an absence …

Transoral Fundoplication Offers Durable Symptom Control For Chronic Gerd: 3-Year Report From The Tempo Randomized Trial With A Crossover Arm, Karim S. Trad, Mark Fox, Gilbert Simoni, Ahmad Shughoury, Peter Mavrelis, Mamoon Raza, Jeffrey Heise, William Barnes

Surgery Faculty Publications

Background

Four randomized controlled trials have demonstrated the short-term efficacy and safety of transoral esophagogastric fundoplication (TF) performed with the EsophyX® device in eliminating troublesome gastroesophageal reflux disease (GERD) symptoms in well-selected patient populations. The aim of this study was to assess the durability of these outcomes at 3 years post-procedure.

Methods

The TF EsophyX versus Medical PPI Open Label trial was conducted in seven US sites. Between June and August 2012, we enrolled patients with small (<2 cm) or absent hiatal hernias who suffered from troublesome GERD symptoms while on PPI therapy for at least 6 months and had abnormal esophageal acid exposure (EAE). Randomization was to TF group (n = 40) or to PPI group (n = 23). Following evaluation at 6 months, all remaining PPI patients (n …

Adult Gli2+/-;Gli3Δ699/+ Male And Female Mice Display A Spectrum Of Genital Malformation., Fei He, Pedram Akbari, Rong Mo, Jennifer J Zhang, Chi-Chung Hui, Peter C. Kim, Walid A Farhat

Surgery Faculty Publications

Disorders of sexual development (DSD) encompass a broad spectrum of urogenital malformations and are amongst the most common congenital birth defects. Although key genetic factors such as the hedgehog (Hh) family have been identified, a unifying postnatally viable model displaying the spectrum of male and female urogenital malformations has not yet been reported. Since human cases are diagnosed and treated at various stages postnatally, equivalent mouse models enabling analysis at similar stages are of significant interest. Additionally, all non-Hh based genetic models investigating DSD display normal females, leaving female urogenital development largely unknown. Here, we generated compound mutant mice, Gli2+/-;Gli3Δ699/+, …

Two Cases Of Monoclonal Nodular Pulmonary Amyloidosis And Review Of The Literature, Kendal Endicott, Conor Hynes, Cindy M. Hsieh, Edina Paal, Gregory D. Trachiotis

Surgery Faculty Publications

Nodular pulmonary amyloidosis (NPA) is an uncommon pathology of insoluble protein depositing in pulmonary parenchyma. This localized pulmonary form of amyloidosis is most often found to contain combinations of kappa and lambda immunoglobulin light chain and immunoglobulin heavy chain proteins with a polyclonal lymphoplasmacystic infiltrate. Herein we present two cases of NPA of the rarely reported monoclonal (light-chain restricted) form with review of the literature and discussion of the clinical, radiographic, and histologic features of NPA.

Surgeon's Guide To Anticoagulant And Antiplatelet Medications Part Two: Antiplatelet Agents And Perioperative Management Of Long-Term Anticoagulation., Louise Y Y Yeung, Babak Sarani, Jordan A Weinberg, Paul B Mcbeth, Addison K May

Surgery Faculty Publications

An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two part review, agents commonly encountered by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part one, we review warfarin and the new direct oral anticoagulants. In part two, we review …

Current And Desired Practice Patterns Of Trauma And Acute Care Surgeons (T/Acs), Nathan M. Droz, Melissa L. Whitmill, Priti Parikh, Kimberly M. Hendershot

Department of Surgery Faculty Publications

Resident hour restrictions and the addition of emergency general surgery (EGS) have changed how the T/ACS team functions and their work patterns. The purpose of our study is to report current practice patterns of T/ACS and compare those to desired practice patterns of the future workforce in the field (residents/fellows).

Radioresistance Of Brain Tumors, K. Kelley, J. Knisely, M. Symons, R. Ruggieri

Journal Articles

Radiation therapy (RT) is frequently used as part of the standard of care treatment of the majority of brain tumors. The efficacy of RT is limited by radioresistance and by normal tissue radiation tolerance. This is highlighted in pediatric brain tumors where the use of radiation is limited by the excessive toxicity to the developing brain. For these reasons, radiosensitization of tumor cells would be beneficial. In this review, we focus on radioresistance mechanisms intrinsic to tumor cells. We also evaluate existing approaches to induce radiosensitization and explore future avenues of investigation.

Recipient Criteria Predictive Of Graft Failure In Kidney Transplantation, E. P. Molmenti, A. Alex, L. Rosen, M. Alexander, J. Nicastro, E. Siskind, L. Alex, E. Sameyah, M. Bhaskaran, N. Ali, A. Basu, M. Sachdeva, S. Agorastos, P. Rajendran, P. Krishnan, P. Ramadas, L. Amodu, J. Cagliani, S. Rehman, A. Kressel, C. B. Sethna, R. Schwarz, S. Fishbane, A. Bellucci, G. Coppa, H. Rilo, C. L. Molmenti, +4 Additional Authors

Journal Articles

Several classifications systems have been developed to predict outcomes of kidney transplantation based on donor variables. This study aims to identify kidney transplant recipient variables that would predict graft outcome irrespective of donor characteristics. All U.S. kidney transplant recipients between October 25,1999 and January 1, 2007 were reviewed. Cox proportional hazards regression was used to model time until graft failure. Death-censored and nondeath-censored graft survival models were generated for recipients of live and deceased donor organs. Recipient age, gender, body mass index (BMI), presence of cardiac risk factors, peripheral vascular disease, pulmonary disease, diabetes, cerebrovascular disease, history of malignancy, hepatitis …

Milk Fat Globule-Epidermal Growth Factor-Factor Viii Downregulates Interleukin-17 Expression In Sepsis By Modulating Stat3 Activation, C. Cen, M. Aziz, W.L. Yang, J. Nicastro, G. F. Coppa, P. Wang

Journal Articles

BACKGROUND: Milk fat globule-epidermal growth factor-factor VIII (MFG-E8) is a secretory glycoprotein with a known role in inflammation. In sepsis, interleukin (IL)-17 acts as a proinflammatory cytokine to exaggerate systemic inflammation. We hypothesize that MFG-E8 downregulates IL-17 expression in sepsis. METHODS: Sepsis was induced in 8-week-old male C57BL/6 mice by cecal ligation and puncture (CLP). Recombinant mouse MFG-E8 (rmMFG-E8) at a dosage of 20 mug/kg body weight or phosphate-buffered saline was concurrently injected. After 10 hours, blood and spleen samples were harvested for analysis. For in vitro studies, splenocytes isolated from healthy mice pretreated with rmMFG-E8 and splenocytes from MFG-E8 …

Inhibition Of Lipogenesis Reduces Inflammation And Organ Injury In Sepsis, J. P. Idrovo, W.L. Yang, A. Jacob, L. Corbo, Jeffrey Nicastro, Gene Coppa, P. Wang

Journal Articles

BACKGROUND: Sepsis is a life-threatening acute inflammatory condition associated with metabolic complications. Accumulation of free fatty acids (FFAs) induces inflammation and causes lipotoxic effects in the liver. Because fatty acid metabolism plays a role in the inflammatory response, we hypothesized that the administration of C75, a fatty acid synthase inhibitor, could alleviate the injury caused by sepsis. METHODS: Male mice were subjected to sepsis by cecal ligation and puncture (CLP). At 4 h after CLP, different doses of C75 (1- or 5-mg/kg body weight) or vehicle (20% dimethyl sulfoxide in saline) were injected intraperitoneally. Blood and liver tissues were collected …

Inhibition Of Fatty Acid Synthase With C75 Decreases Organ Injury After Hemorrhagic Shock, M. Kuncewitch, W.L. Yang, A. Jacob, A. Khader, M. Giangola, J. Nicastro, G.F. Coppa, P. Wang

Journal Articles

BACKGROUND: Hemorrhagic shock is the primary cause of morbidity and mortality in the intensive care units in patients under the age of 35. Several organs, including the lungs, are seriously affected by hemorrhagic shock and inadequate resuscitation. Excess free fatty acids have shown to trigger inflammation in various disease conditions. C75 is a small compound that inhibits fatty acid synthase, a key enzyme in the control of fatty acid metabolism that also stimulates fatty acid oxidation. We hypothesized that C75 treatment would be protective against hemorrhagic shock. METHODS: Adult male Sprague-Dawley rats were cannulated with a femoral artery catheter and …

Type Vi Choledochal Cyst—An Unusual Presentation Of Jaundice, L. Nambiar, E. Siskind, A. W. Shen, C. Fan, G. Grimaldi, C. Choy, J. Madariaga, J. Nicastro, E. P. Molmenti, G. Coppa, +1 Additional Author

Journal Articles

No abstract provided.

Combined Endoscopic And Laparoscopic Management Of Postcholecystectomy Mirizzi Syndrome From A Remnant Cystic Duct Stone: Case Report And Review Of The Literature, Arpit Amin, Yuriy Zhurov, George Ibrahim, Anthony Maffei, Jonathan Giannone, Thomas Cerabona, Ashutosh Kaul

NYMC Faculty Publications

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant …