Surgery Commons^™

Critical Assessment Of Outcomes In Acute Aortic Dissection (Type A) At A Community Hospital: A 10 Year Review, Timothy S. Misselbeck, James K. Wu Md, Stephen Deturk Ba, Michael F. Szwerc Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Surgery

No abstract provided.

Mirizzi's Syndrome Masquerading As Cholangiocarcinoma: A Case Report, Muhammad Rizwan Khan, Sameer Ur Rehman

Department of Surgery Docs

Introduction: Mirizzi's syndrome is a rarely observed disorder that presents with obstructive jaundice. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar clinical and imaging findings, and a pre-operative diagnosis may be a serious challenge.CASE PRESENTATION: We present the case of a 44-year-old Asian man with Mirizzi's syndrome who was initially diagnosed as having cholangiocarcinoma based on his clinical presentation, raised cancer antigen …

Sigmoid Volvulus In Pregnancy And Puerperium: A Surgical And Obstetric Catastrophe Report Of A Case And Review Of The World Literature, Muhammad R. Khan, Sameer Ur Rehman

Department of Surgery Docs

Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6days history …

Challenging Cases In Pediatric Trauma: Management Of The Open Abdomen, Firas Madbak Md, William D. Hardin Jr, Md, Facs, Faap

Department of Surgery

No abstract provided.

Facial Fracture Management: Operative Trends, Ramon Garza, Iii Md, Joshua M. Adkinson Md, Jarom N. Gilstrap Md, Sherrine Eid Mph, Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Increase In Renal Transplantation Of Sensitized Recipients Following The Introduction Of Virtual Crossmatching: One Center’S Experience, Michael J. Moritz Md, Lynsey S. Biondi Md, Patricia Kimble Bs, Robert Cirocco Phd

Department of Surgery

No abstract provided.

Is Placement Of An Intra-Abdominal Drain Necessary After Hartmann’S Procedure For Perforated Diverticulitis?, Mychailo Fulmes Md, Phd, Avi S. Galler, David S. Bub, Robert J. Sinnott, John S. Park, Matthew M. Philp Md

Department of Surgery

No abstract provided.

Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of melanoma is dramatically increasing worldwide. We hypothesized that the ratio of metastatic to examined lymph node ratio (LNR) would be the most important prognostic factor for stage III patients.

METHODS: We retrospectively reviewed our institutional database of melanoma patients and identified 168 patients who underwent lymph node dissection (LND) for stage III disease between 1993 and 2007. Patients were divided into three groups based on LNR (≤10%, n = 93; 10-≤25%, n = 45; and >25%, n = 30). Univariate and multivariate analysis was performed using Cox proportional hazards model.

RESULTS: The median survival time of …

A Novel Survival-Based Tissue Microarray Of Pancreatic Cancer Validates Muc1 And Mesothelin As Biomarkers., Jordan M Winter, Laura H Tang, David S Klimstra, Murray F Brennan, Jonathan R Brody, Flavio G Rocha, Xiaoyu Jia, Li-Xuan Qin, Michael I D'Angelica, Ronald P Dematteo, Yuman Fong, William R Jarnagin, Eileen M O'Reilly, Peter J Allen

Department of Surgery Faculty Papers

BACKGROUND: One-fifth of patients with seemingly 'curable' pancreatic ductal adenocarcinoma (PDA) experience an early recurrence and death, receiving no definable benefit from a major operation. Some patients with advanced stage tumors are deemed 'unresectable' by conventional staging criteria (e.g. liver metastasis), yet progress slowly. Effective biomarkers that stratify PDA based on biologic behavior are needed. To help researchers sort through the maze of biomarker data, a compendium of ∼2500 published candidate biomarkers in PDA was compiled (PLoS Med, 2009. 6(4) p. e1000046).

METHODS AND FINDINGS: Building on this compendium, we constructed a survival tissue microarray (termed s-TMA) comprised of short-term …

Right Ventricular Rupture And Tamponade Caused By Malposition Of The Avalon Cannula For Venovenous Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Kentaro Yamane, Gregary D. Marhefka, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for …

Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C. Berger, Jeffrey M Farma

Department of Surgery Faculty Papers

The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …

Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C Berger, Jeffrey M Farma

Department of Surgery Faculty Papers

The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …

The Burden Of Breast Cancer In Italy: Mastectomies And Quadrantectomies Performed Between 2001 And 2008 Based On Nationwide Hospital Discharge Records., Prisco Piscitelli, Maddalena Barba, Massimo Crespi, Massimo Di Maio, Antonio Santoriello, Massiliamo D'Aiuto, Alfredo Fucito, Arturo Losco, Francesca Pentimalli, Pasquale Maranta, Giovanna Chitano, Alberto Argentiero, Cosimo Neglia, Alessandro Distante, Gian Luca Di Tanna, Maria Luisa Brandi, Alfredo Mazza, Ignazio R Marino, Antonio Giordano

Department of Surgery Faculty Papers

BACKGROUND: Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy.

METHODS: We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately …

Macrophage Imbalance (M1 Vs. M2) And Upregulation Of Mast Cells In Wall Of Ruptured Human Cerebral Aneurysms: Preliminary Results., David Hasan, Nohra Chalouhi, Pascal Jabbour, Tomoki Hashimoto

Department of Neurosurgery Faculty Papers

BACKGROUND: M1 and M2 cells are two major subsets of human macrophages that exert opposite effects on the inflammatory response. This study aims to investigate the role of macrophage M1/M2 imbalance and mast cells in the progression of human cerebral aneurysms to rupture.

METHODS: Ten patients with cerebral aneurysms (five ruptured and five unruptured) underwent microsurgical clipping. During the procedure, a segment of the aneurysm dome was resected and immunostained with monoclonal antibodies for M1 cells (anti-HLA DR), M2 cells (anti-CD 163), and mast cells (anti-tryptase clone AA). A segment of the superficial temporal artery (STA) was also removed and …

A Networkwide, Multidisciplinary Approach To Improving Perioperative Medication Safety, Diane Kimsey Rn, Ms, Cnor, Jeanne P. Luke Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

Use Of Colour Duplex Ultrasound As A First Line Surveillance Tool Following Evar Is Associated With A Reduction In Cost Without Compromising Accuracy, C. Gray, Patrick J. Goodman, C. C. Herron, L. P. Lawler, M. K. O'Malley, M. K. O'Donohoe, C. O. Mc. Donnell

Articles

CT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy. Patients & methods: Postoperative surveillance CTs and CDUS scans in the 145 patients who have undergone EVAR from 1st June 2003 to 1st July 2010 were compared …

The Genetics Of Neuroendocrine Prostate Cancers: A Review Of Current And Emerging Candidates, M Hammad Ather, Tahmeena Siddiqui

Department of Surgery Docs

Prostate cancer (PC) displays a strong familial link and genetic factors; genes regulating inflammation may have a pivotal role in the disease. Epigenetic changes control chromosomal integrity, gene functions, and, ultimately, carcinogenesis. The most widely studied epigenetic event in PC is aberrant DNA methylation (hypo- and hypermethylation); besides this, chromatin remodeling and micro RNA (miRNA) are other studied alterations in PC. These all lead to genomic instability and inappropriate gene expression. Causative dysfunction of histone modifying enzymes results in generic and locus-specific changes in chromatin remodeling. miRNA deregulation also contributes to prostate carcinogenesis, including interference with androgen-receptor signaling and apoptosis. …

Infectious Intracranial Aneurysms: Collaboration For Treatment Success, Erin M. Conahan Rn, Bsn, Cnrn

Patient Care Services / Nursing

No abstract provided.

An Analysis Of Quality Outcomes In Patients Having A Hysterectomy: Robotics Vs The Vaginal Approach, Martin A. Martino Md, Jocelyn Shubella, Elizabeth A. Berger Do

Department of Obstetrics & Gynecology

No abstract provided.

Benchmarking Quality Metrics For Endometrial Cancer Patients: Robotics Vs. Laparoscopy, Martin A. Martino Md, Jocelyn Shubella, Shamol Williams Msii, Rachel Morcrette Pa-C, Jeremy Patriarco, Hai-Yen Nguyen Md, Amy Hordendorf, M Bijoy Thomas Md, Richard Boulay Md

Department of Obstetrics & Gynecology

No abstract provided.