Surgery Commons^™

Current Principles For The Surgical Treatment Of Intrahepatic Cholangiocarcinoma, Catalin Savin, Luiza Tarca, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Gabriel Petre Gorecki, Cristina Martac, Marilena Stoian, Cristian Balalau, Nicolae Bacalbasa

Journal of Mind and Medical Sciences

Intrahepatic cholangiocarcinoma is one of the most aggressive forms of cancer. It is usually diagnosed in advanced stages of the disease, mainly because it is asymptomatic for a long time after the onset. Consequently, intrahepatic cholangiocarcinoma still represents an important problem of diagnosis and treatment. In the multidisciplinary treatment of these patients, oncological surgery is essential, as the accuracy of resection is one of the most important prognostic factors for the long-term results of these patients. Therefore, there has been a continuing concern to improve surgical techniques, with the aim of maximizing the chances of achieving the best possible long-term …

Pancreatic Cancer; From Effective Prevention And Early Diagnosis To Personalized Therapy, Adrian Silaghi, Dragos Serban, Bogdan Gaspar, Valentin Verlas, Dragos Epistatu, Cristian Paius, Roxana Sfetea, Liliana Andronache, Ioana Paunica, Irina Ruxandra Strambu, Daniela Gabriela Bălan, Alexandru Florin Motofei, Vlad Denis Constantin

Journal of Mind and Medical Sciences

Despite substantial improvements in survival rates for most cancers, pancreatic cancer still remains a leading cause of death from malignancy. The disease has no symptoms in the initial stages, it can early invade the surrounding organs, and treatment methods have poor long-term prognosis. In addition, this neoplasia is starting to be diagnosed more and more frequently in young people. High incidences have been found in developed regions such as Europe, North America, Australia, but recent data show that this condition is increasing in other regions as well. Pancreatic cancer involves multiple factors such as cigarette smoking, obesity, diabetes, alcohol consumption, …

Artificial Intelligence In Ovarian Cancers- From Diagnosis To Treatment; A Literature Review, Cristina Bucur, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Marilena Stoian, Cristian Balalau, Nicolae Bacalbasa

Journal of Mind and Medical Sciences

Ovarian cancer remains the most lethal gynecological malignancy due to challenges in early detection stemming from a lack of reliable biomarkers. Despite this, various laboratory tests are commonly employed in clinical practice, some showing diagnostic and prognostic promise for ovarian cancer. This review aims to synthesize current literature to delineate the role of artificial intelligence (AI) in both the diagnosis—from laboratory tests to imaging—and treatment of ovarian cancers. Thus, the epidemiology, risk factors, pathology, screening methods, as well as the integration of AI in the diagnosis of ovarian cancer (AI based on both blood biomarkers and imaging-based ovarian cancer detection) …

Nutritional Indicators Of Bone Nonunion: A Systematic Review, Eleanor Christianson, Margaret Thomas, Sheila Sprague, Jessica Rivera, Andrew Chapple, Robert Zura

School of Medicine Faculty Publications

Background/Objectives: Bone nonunion remains a clinical challenge in orthopedic surgery with significant impacts on mental and physical wellbeing for patients. There are several previously established risk factors of nonunion that are connected to nutrition, but this has yet to be substantially explored. This review seeks to assess all studies that present associations between nutrition and nonunion to understand the potential for clinical relevance in nonunion prevention. Methods: Case–control and cohort studies comparing nonunion risk based on nutritional factors were gathered through PubMed in July 2024. Data were extracted with dual verification through Covidence and assessed for bias using the Newcastle–Ottawa …

An Evaluation Of The Safety Of Half-Dose Direct Oral Anticoagulants Following Total Joint Arthroplasty: A Pilot Study., Harrison A Patrizio, Rex W Lutz, Stephanie A Kwan, Adam Lencer, Gregory K Deirmengian

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background Total joint arthroplasty (TJA) patients on preoperative anticoagulation therapy present a challenge for adult reconstruction surgeons. The goal in managing such patients is to limit bleeding complications associated with administering the medications while preventing medical complications from withholding them. At our institution, we began a protocol in 2017 that utilizes a half-dose direct oral anticoagulant (DOAC) regimen for one week followed by resuming of the full-dose regimen in select patients who underwent TJA. This study investigated the 90-day safety profile associated with this protocol compared to previous literature. Methodology A retrospective review of 898 patients from a single institution …

Editorial Review Of The Validation Of Thoracolumbar Injury Classification And Severity Score In The Management Of Acute And Subacute Osteoporotic Vertebral Compression Fractures, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Trends In Gaps Of Care For Patients With Congenital Heart Disease: Implications For Social Determinants Of Health And Child Opportunity Index, Abbas H. Zaidi, Adam Alberts, Devyani Chowdhury, Claude Beaty, Benjamin Brewer, Ming Hui Chen, Sarah D. De Ferranti

Department of Surgery Faculty Papers

BACKGROUND: Lifelong continuity of care is essential for patients with congenital heart disease (CHD) to maximize health outcomes; unfortunately, gaps in care (GIC) are common. Trends in GIC and of social determinants of health factors contributing to GIC are poorly understood.

METHODS AND RESULTS: This retrospective cohort study included patients with CHD, aged 0 to 34 years, who underwent surgery between January 2003 and May 2020, followed up at a pediatric subspeciality hospital. Patients were categorized as having simple, moderate, and complex CHD based on 2018 American Heart Association and American College of Cardiology guidelines. Social determinants of health, such …

“It Is What It Is” – The Lived Experience Of Women With Breast Cancer Undergoing Axillary Lymph Node Dissection, Eva Vikhe Patil, Anna Forsberg, Carina Wennerholm, Jenny Drott

Journal of Patient-Centered Research and Reviews

Purpose: The lived experience of women undergoing axillary procedures as part of their breast cancer (BC) treatment remains unexplored. This lack of in-depth understanding could hamper implementation of person-centred care, which is concerning because BC is the most common form of cancer in women. The aim of this study was therefore to explore the lived experiences of women undergoing axillary lymph node dissection (ALND) due to BC.

Methods: Twelve women with a mean age of 59 years were interviewed about their lived experiences of axillary procedures as part of their BC treatment. The interviews were recorded, transcribed verbatim, and analysed …

Why Do Early-Career Adult Reconstruction Surgeons Change Jobs? An American Association Of Hip And Knee Surgeons Young Arthroplasty Group Survey Study, Matan Ozery, Elizabeth G. Lieberman, Jenna A. Bernstein, Jesse I. Wolfstadt, David C. Landy, Claudia Leonardi, Anna Cohen-Rosenblum

School of Medicine Faculty Publications

Background: There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change. Methods: An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and …

Regular Nonsteroidal Anti-Inflammatory Drug Use Increases Stress Fracture Risk In The General Population: A Retrospective Case-Control Study, Alexandra Ciuciu, Chris Mulholland, Michael A. Bozzi, Chris C. Frymoyer, Leonardo Cavinatto, David Yaron, Marc I. Harwood, Jeremy D. Close, Christopher J. Mehallo, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Previous studies have shown that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased stress fracture risk. This phenomenon has been studied predominantly in high-activity individuals, so data regarding the general population are limited despite the substantial economic and resource burden of stress fracture injuries within the general US population. Furthermore, our preclinical studies demonstrate that regular use of NSAIDs also diminishes the intrinsic ability of bone to resist fracture. To determine the association of regular NSAID use with stress fractures in the general population, we surveyed subjects presenting with either stress fracture or uncomplicated ankle sprain to …

Outcomes Of Alcohol-Associated Hepatitis In Hospitalized Patients With Prior Bariatric Surgery: A Nationwide Analysis, 2016-2020, Sarpong Boateng, Prince A. Ameyaw, Karthik Mathialagan, Basile Njei

Posters

Alcohol-associated hepatitis (AAH) is a severe liver condition often necessitating hospitalization and has a one-year mortality of 40%. The increasing prevalence of obesity has led to a rise in bariatric surgery (BS), which can alter the outcomes of various comorbid conditions. There are some concerns about possible increased risk and severity of alcohol related disorders in patients with a history of BS due to alteration in alcohol metabolism after surgery.

Are Patients With Mash- Or Alcohol-Associated Cirrhosis More Likely To Develop Hepatic Hydrothorax? A National Transplant Database Analysis, Sarpong Boateng

Posters

Hepatic hydrothorax (HH) is a complication of end-stage liver disease involving the accumulation of pleural fluid in patients with cirrhosis, in the absence of other cardiopulmonary disease. HH occurs in 10% of patients with decompensated cirrhosis, conferring a 5-fold increased risk of mortality.¹ Alcohol-associated liver disease (ALD) and metabolic dysfunction associated steatohepatitis (MASH), which accounts for 80% of liver cirrhosis in the US are known risk factors for HH. ²

REFERENCES

1. Asrani, Sumeet K., et al. "Burden of liver diseases in the world." Journal of hepatology 70.1 (2019): 151-171.

2. Banini, Bubu A., et al. "Multidisciplinary management of …

Radiographic Outcomes And Subsidence Rate In Hyperlordotic Versus Standard Lordotic Interbody Spacers In Patients Undergoing Anterior Cervical Discectomy And Fusion, Rajkishen Narayanan, Nicholas Pohl, Jonathan Dalton, Yunsoo Lee, Anthony Labarbiera, Meryem Guler, Emilie Sawicki, Sebastian Fras, Mark Kurd, John Mangan, I David Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder, Joseph Lee

Rothman Institute Papers

Background: Anterior cervical discectomy and fusion (ACDF) is a common surgery for patients with degenerative cervical disease and current interbody spacers utilized vary based on material composition, structure, and angle of lordosis. Currently, there is a lack of literature comparing subsidence rates or long-term radiographic outcomes with hyperlordotic and standard lordotic spacers. This study compares long-term radiographic outcomes, subsidence rate, and rate of fusion in patients who underwent ACDF with hyperlordotic or standard interbody placement. Materials and Methods: Patients who underwent 1-3-level ACDF with either a standard lordosis or hyperlordotic interbody were included. Standard radiographs were evaluated for C2-7 lordosis …

Congenital Diaphragmatic Hernia And Cleft Lip And Palate: Looking For A Common Genetic Etiology, Petra Nord, Ashley H Ebanks, Petra Peterson, Erik Iwarsson, Matthew T Harting, Carmen Mesas Burgos

Faculty, Staff and Student Publications

Purpose: Congenital diaphragmatic hernia (CDH) and cleft lip and/or palate (CL/P) are inborn closure defects. Genetic factors in and outcomes for patients with both anomalies (CDH+CL/P) remain unclear. We aimed to investigate associated genetic aberrations, prevalence of, and outcomes for, CDH+CL/P.

Methods: Data from Congenital Diaphragmatic Hernia Study Group (CDHSG) registry were collected. CL/P prevalence in CDH patients was determined. Genetic abnormalities and additional malformations in CDH+CL/P were explored. Patient characteristics and outcomes were compared between CDH+CL/P and isolated CDH (CDH-) using Fisher's Exact Test for categorical, and t-test or Mann-Whitney U-test for continuous, data. p < 0.05 was considered statistically significant.

Results: Genetic anomalies in …

Unusual Metastatic Pathways: A Case Of Colorectal Adenocarcinoma Presenting As A Cervical Neck Mass, Taha Al Hassan, Jessica Flores, Adam Bender-Heine, Rachel A. Giese

School of Medicine Publications

Head and neck metastasis of colorectal adenocarcinoma is exceedingly rare with most cases presenting in the liver, lungs, or peritoneum. This report describes the case of a 53-year-old female patient with a past medical history significant for mucinous adenocarcinoma of the colon treated with a right hemicolectomy. She was thought to be in remission but presented a few years later with a new, isolated left cervical neck mass and symptoms of left eye ptosis and dryness. Diagnostic imaging and biopsy confirmed the neck mass to be a metastatic lesion from her prior mucinous adenocarcinoma, with immunohistochemical findings specific for colorectal …

Broad Applicability Of The Goldspire™ Platform For The Treatment Of Solid Tumors, Jenny Zilberberg, Christopher Uhl, Charles B Scott, David W. Andrews, Mark A Exley

Department of Neurosurgery Faculty Papers

Goldspire™ is a personalized immunotherapy platform that combines whole tumor-derived cells with antisense oligonucleotide (IMV-001) against Insulin-Like Growth Factor-1 Receptor (IGF-1R) in biodiffusion chambers (BDCs; 0.1 μm pore). BDCs are exposed to 5-6 Gy and implanted at abdominal sites for ∼48 h to deliver an antigenic payload and immunostimulatory factors to train the immune system. Lead product IGV-001 was evaluated in newly diagnosed glioblastoma (ndGBM) patients in Phase 1a and 1b trials (NCT02507583). A Phase 2b study (NCT04485949) recently completed enrollment. Preventative treatment with tumor-specific products manufactured with Goldspire limited tumor progression and extended overall survival in mice challenged with …

Ao Spine-Dgou Osteoporotic Fracture Classification System: Internal Validation By The Ao Spine Knowledge Forum Trauma, Julian Scherer, Andrei Joaquim, Alex Vaccaro, Rishi Kanna, Mohammad El-Sharkawi, Masahiko Takahata, Mohamed M. Aly, Gaston Camino-Willhuber, Ulrich Spiegl, Cumhur Oner, Jose A. Canseco, Ratko Yurac, Lorin Michael Benneker, Eugen Cezar Popescu, Richard Bransford, Harvinder Cezar Chhabra, Frank Kandziora, Marko H. Neva, Klaus John Schnake

Rothman Institute Papers

Study Design: Cross-sectional survey.

Objectives: Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system.

Methods: 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic(κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The …

Management Strategies Of Cesarean Section Ectopic Pregnancy: A Case Report, Hannah E. Daley, Ava R. Hansen, Priyanka Raju Md, Jonathan Buerger Md

Transformative Medicine

Introduction:

Cesarean scar ectopic pregnancy is a rare form of pregnancy with potential life-threatening complications such as severe hemorrhage, uterine rupture, and emergency hysterectomy Currently, there is no consensus regarding a standardized treatment algorithm for this specific variant of ectopic pregnancies.

Case Description:

This case describes a 28-year-old female with history of two prior cesarean sections who was diagnosed with cesarean section scar ectopic pregnancy. Initial management with intramuscular methotrexate was unsuccessful in the setting of inadequate decrease in β-hCG level. The patient ultimately underwent surgical management with dilation and suction evacuation under ultrasound guidance for removal of the ectopic …

Effect Of An In-Home Palivizumab Administration Program For Children With Medical Complexity, Hina Emanuel, Aravind Yadav, Julie C Eapan, Maria Caldas-Vasquez, Tomika S Harris, Katrina Mcbeth, Fatima Boricha, Janice John, Ivan G Magana Ceballos, Giuseppe N Colasurdo, Maria E Tellez, Tina Reddy, Wilfredo De Jesús-Rojas, Ricardo A Mosquera

Faculty, Staff and Student Publications

Background: In-home palivizumab administration programs (PH) have shown promise in reducing RSV-associated infections. These programs may be particularly beneficial for children with medical complexity (CMC) by limiting their exposure to healthcare-associated infections (HAIs) from non-RSV-related pathogens during transportation and visits to medical facilities.

Methods: In this prospective study, 41 children with CMC less than 2 years of age were randomized by their health insurance to receive PH or in the clinic (PC) during the RSV season (October 2018-April 2019). Patients were stratified by home ventilation. The primary outcome was the total number of face-to-face encounters. Secondary outcomes were unscheduled clinic …

Surgical Technique For Glenoid Bone Defect In Revision Shoulder Arthroplasty: Distal Clavicle Excision And Grafting For 1-Stage Reverse Total Shoulder Prosthesis, Ryan Bialaszewski, Ross Chapel, Frank Gerold

Research Colloquium

Introduction: Reverse shoulder arthroplasty (RSA) has expanded its indications and use in North America since the early 1990s. Because of this, the prevalence of revision reverse total shoulder arthroplasty cases has continued to rise. On occasion, the need for revision of RSA can be due to and is complicated by glenoid bone loss defects, making this one of the most challenging cases for arthroplasty surgeons to perform. Historically, iliac crest or tibial grafts are most commonly used for these defects, although this comes with the disadvantage of requiring two surgical sites to be prepped and draped. The purpose of this …