Surgery Commons^™

Examining The Influence Of The General Surgery Resident Colorectal Experience On The Pursuit Of Colorectal Surgery Fellowship, Adam D. Price, Bilal W. Nasim, Frances Hu, Desmond Layne, Robyn Richmond, Zachary E. Hier, Antonela Muca, Alexander R. Cortez, Jonathan Abelson, Jitesh A. Patel

Conference Presentation Abstracts

Purpose/Background: Colon and Rectal Surgery (CRS) is a highly sought after and competitive fellowship following General Surgery (GS) residency. However, it has not been studied as to how a resident’s CRS experience during residency impacts their career choice and pursuit of CRS. This study aims to identify individual and program factors associated with matriculation into CRS fellowship. Methods/Interventions: An analysis of case logs and demographic data from graduates of 19 ACGME-accredited GS residency programs between 2010-2020 was completed utilizing the US Resident OPerative Experience (ROPE) Consortium. The demographics and operative experience of residents who pursued CRS fellowship were compared to …

Creating More Diversity, Equity, And Inclusion In The Swedish General Surgery Residency, Bruce Carman

2024 Swedish Learning and Celebration Day

No abstract provided.

A New Computed Tomography Score-Based Staging For Melioidosis Pneumonia To Predict Progression, Yang Chen, Dehuai He, Yehua Wu, Xiangying Li, Kaifu Yang, Yuefu Zhan, Jianqiang Chen, Xiaobo Zhou

Faculty, Staff and Student Publications

infectious disease prevalent in tropical regions. Chest computed tomography (CT) has emerged as a valuable tool for assessing the severity and progression of lung involvement in melioidosis pneumonia. However, there persists a need for the quantitative assessment of CT characteristics and staging methodologies to precisely anticipate disease progression. This study aimed to quantitatively extract CT features and evaluate a CT score-based staging system in predicting the progression of melioidosis pneumonia.

Methods: This study included 97 patients with culture-confirmed melioidosis pneumonia who presented between January 2002 and December 2021. Lung segmentation and annotation of lesions (consolidation, nodules, and cavity) were used …

Insights From Targeted Fecal Metabolomic Analysis Reveal Altered Metabolic Pathways In Treatment-Naive Pediatric Subjects With Crohn's Disease, Nadia Ashrafi, Ali Yilmaz, Nicolette Monacelli, Rose E. Callahan, Ilyas Ustun, Nathan M. Novotny, J W. Rattray, Kypros Nicolaides, Stewart Graham

Conference Presentation Abstracts

Crohn’s disease (CD) is a heterogeneous and multifactorial inflammatory bowel disease with a significant global health impact. Genetic and lifestyle factors contribute to its etiology, emphasizing dysregulation of intestinal and dietary habits. Our study aimed to identify fecal metabolites from treatment-naïve, pediatric sufferers of CD, which allowed us to investigate the underlying biochemical perturbations associated with the disease, highlighting potential, translational targets. Using a Waters Acquity UPLC coupled with a Xevo-TQ-S mass spectrometer, we quantified >500 metabolites in fecal samples (n=72) of pediatric CD sufferers. We developed diagnostic tests capable of accurately discriminating between children with CD and healthy individuals …

Development Of An Antioxidant-Rich Sugar-Free Plantain Candy And Assessment Of Its Shelf Life In A Flexible Laminate, Poulami Sarkar, Paramita Bhattacharjee, Bidhan Das

Faculty, Staff and Student Publications

RESEARCH BACKGROUND: Candy is a popular confection worldwide, and it would be beneficial to society if it were converted into a source of antioxidant molecules to eliminate its adverse health effects. The amount of antioxidants available even in fruit candies is questionable due to the high thermal processing losses they undergo and the presence of various food additives. Plantains (

EXPERIMENTAL APPROACH: To accomplish the first objective, lyophilized plantain powder, sorbitol and mannitol were used as base materials with minimal additives under minimal processing conditions to reduce processing loss. Sensory, proximate, physicochemical and phytochemical properties, including the antioxidant synergy among …

Trends In Shortages Of Lead Chelators From 2001 To 2022, James D Whitledge, Pelayia Soto, Kieran M Glowacki, Diane P Calello, Erin R Fox, Maryann Mazer-Amirshahi

Faculty, Staff and Student Publications

OBJECTIVE: The study aims to describe drug shortages affecting lead chelators in the United States from 2001 through 2022.

METHODS: Drug shortage data were retrieved from the University of Utah Drug Information Service from January 1, 2001, through December 31, 2022. Shortages of first- and second-line lead chelators were analyzed. Drug class, formulation, administration route, shortage reason, shortage duration, generic status, single-source status, and presence of temporally overlapping shortages were examined. Total shortage months, percentages of study period on shortage, and median shortage durations were calculated.

RESULTS: Thirteen lead chelator shortages were reported during the study period. Median duration was …

Open Tibial Shaft Fracture Fixation Strategies: Intramedullary Nailing, External Fixation, And Plating, Michelle Shen, Nirmal Tejwani

Faculty, Staff and Student Publications

Tibial shaft fractures are one of the most common orthopaedic injuries. Open tibial shaft fractures are relatively common because of the paucity of soft tissue surrounding the bone. Despite the prevalence of these injuries, the optimal fixation strategy is still a topic of debate. The purpose of this article was to review the current literature on open tibial shaft fracture fixation strategies including intramedullary nailing, external fixation, and plating.

Common Epilepsy Variants From The General Population Are Not Associated With Epilepsy Among Individuals With Tuberous Sclerosis Complex, Melissa A Richard, Philip J Lupo, Erik A Ehli, Mustafa Sahin, Darcy A Krueger, Joyce Y Wu, Elizabeth M Bebin, Kit Sing Au, Hope Northrup, Laura S Farach

Faculty, Staff and Student Publications

Common genetic variants identified in the general population have been found to increase phenotypic risks among individuals with certain genetic conditions. Up to 90% of individuals with tuberous sclerosis complex (TSC) are affected by some type of epilepsy, yet the common variants contributing to epilepsy risk in the general population have not been evaluated in the context of TSC-associated epilepsy. Such knowledge is important to help uncover the underlying pathogenesis of epilepsy in TSC which is not fully understood, and critical as uncontrolled epilepsy is a major problem in this population. To evaluate common genetic modifiers of epilepsy, our study …

Total Hip Arthroplasty With Subtrochanteric Osteotomy For Crowe Iv Dysplasia Using An Extensile Direct Anterior Approach: A Surgical Technique, Brian T Muffly, Erik M Hegeman, Braden E Hartline, Keerat Singh, Ajay Premkumar, George N Guild

Faculty, Staff and Student Publications

The direct anterior approach (DAA) has been increasing in popularity for primary total hip arthroplasty (THA). Despite previously documented anatomic limitations to its direct distal extension, alternative exposure methods have been described to safely access the femoral diaphysis and facilitate increasingly complex primary and revision THA scenarios. The DAA has several purported advantages compared to alternative approaches (eg, posterior and lateral-based), including its muscle-sparing nature, use of an internervous plane, and preservation of posterior stabilizing structures. Proponents of the DAA cite decreased postoperative pain, quicker recovery times, potentially lower dislocation rates, ease of intraoperative fluoroscopy, and improved implant placement/restoration of …

Glucagon-Like Peptide-1 Receptor Agonist Use And Residual Gastric Content Before Anesthesia, Sudipta Sen, Paul P Potnuru, Nadia Hernandez, Christina Goehl, Caroline Praestholm, Srikanth Sridhar, Omonele O Nwokolo

Faculty, Staff and Student Publications

Importance: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly increasing in the US, driven by its expanded approval for weight management in addition to hyperglycemia management in patients with type 2 diabetes. The perioperative safety of these medications, particularly with aspiration risk under anesthesia, is uncertain.

Objective: To assess the association between GLP-1 RA use and prevalence of increased residual gastric content (RGC), a major risk factor for aspiration under anesthesia, using gastric ultrasonography.

Design, setting, and participants: This cross-sectional study prospectively enrolled patients from a large, tertiary, university-affiliated hospital from June 6 through July 12, 2023. Participants followed …

Lymphovenous Anastomosis For The External And Internal Types Of Head And Neck Lymphedema: A Case Series And Preliminary Clinical Results, Ying-Sheng Lin, Chia-Ju Liu, Chen-Han Chou

Faculty, Staff and Student Publications

BACKGROUND: Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL.

METHODS: Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. …

Which North American Spine Society Disc Herniation Morphology Descriptors Are Most Associated With Improvements In Clinical Outcomes After Microdiscectomy?, Rajkishen Narayanan, Teeto Ezeonu, Jeremy C. Heard, Yunsoo A. Lee, Caleb M. Yeung, Tyler Henry, Alec Kellish, Meera Kohli, Jose A. Canseco, Mark F. Kurd, Alan S. Hilibrand, Alex R. Vaccaro, Gregory Schroeder, Christopher Kepler, Ian David Kaye

Rothman Institute Papers

BACKGROUND: The North American Spine Society (NASS) assembled the first ever comprehensive naming system for describing lumbar disc disease, including lumbar disc herniation. The objectives of this study were (1) to determine which NASS descriptors are most predictive of independent patient-reported outcomes after microdiscectomy and (2) to identify the inter-rater reliability of each NASS descriptor.

METHODS: Adult patients (≥18 years) who underwent a lumbar microdiscectomy from 2014-2021 were retrospectively identified. Patient-reported outcome measures (PROMs) were collected at preoperative, 3-month, and 1-year postoperative time points. Lumbar disc herniations were evaluated and classified on preoperative MRI using the NASS lumbar disc nomenclature …

Vascular Risk Profile And Changes Of Arterial Hypertension After Surgical Revascularization In Adult Moyamoya Patients, Patrick Haas, Lucas Moritz Wiggenhauser, Jonas Tellermann, Helene Hurth, Daniel Feucht, Marcos Tatagiba, Nadia Khan, Constantin Roder

Faculty, Staff and Student Publications

Moyamoya disease (MMD) is a rare stenoocclusive cerebral vasculopathy often treated by neurosurgical revascularization using extracranial-intracranial bypasses to prevent ischemic or hemorrhagic events. Little is known about the vascular risk profile of adult MMD patients compared to the general population. We therefore analyzed 133 adult MMD patients and compared them with data from more than 22,000 patients from the German Health Update database. Patients with MMD showed an age- and sex-adjusted increased prevalence of arterial hypertension, especially in women between 30 and 44 years and in patients of both sexes between 45 and 64 years. Diabetes mellitus was diagnosed significantly …

Utilization Of Indocyanine Green (Icg) Fluorescence In Patients With Pediatric Colorectal Diseases: The Current Applications And Reported Outcomes., Elizaveta Bokova, Ismael Elhalaby, Seth Saylors, Irene Isabel P. Lim, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

In pediatric colorectal surgery, achieving and visualizing adequate perfusion during complex reconstructive procedures are paramount to ensure postoperative success. However, intraoperative identification of proper perfusion remains a challeng. This review synthesizes findings from the literature spanning from January 2010 to March 2024, sourced from Medline/PubMed, EMBASE, and other databases, to evaluate the role of indocyanine green (ICG) fluorescence imaging in enhancing surgical outcomes. Specifically, it explores the use of ICG in surgeries related to Hirschsprung disease, anorectal malformations, cloacal reconstructions, vaginal agenesis, bladder augmentation, and the construction of antegrade continence channels. Preliminary evidence suggests that ICG fluorescence significantly aids in …

Development Of Takotsubo Cardiomyopathy In 46-Year-Old With Refractory Crohn's Disease, Margarita Pipinos, Andrea Klooz, Maria E. Tecos, Andrew Kamien

Graduate Medical Education Research Journal

Rampant autoimmune disease has the potential to ravage the entirety of the body in a systemic fashion. Rarely, it has been reported for Takotsubo cardiomyopathy develop as a result of refractory inflammatory bowel disease. Balancing the comprehensive cares required to support both the cardiovascular system and treat the underlying autoimmune condition care present unique challenges. Here, we describe a patient who developed late-onset Takotsubo cardiomyopathy after prolonged systemic stress as a result of uncontrolled Crohn’s disease. While this patient unfortunately did succumb to the disease process, it is our hope that highlighting these rare cases may progress care for future …

Spontaneous Spinal Cord Infarction: A Systematic Review, Maria Gharios, Vasilios Stenimahitis, Victor Gabriel El-Hajj, Omar Ali Mahdi, Alexander Fletcher-Sandersjöö, Pascal Jabbour, Magnus Andersson, Claes Hultling, Adrian Elmi-Terander, Erik Edström

Department of Neurosurgery Faculty Papers

BACKGROUND AND OBJECTIVES: Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes.

METHODS: The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted …

The Impact Of The Optn Policy Change On Patients With A Durable Left Ventricular Assist Device And Chronic Kidney Disease: Analysis Of The Unos Database, Eric D. Warner, Christopher Pritting, Sawan Dutta, Matt Bierowski, Waqas Ullah, Yevgeniy Brailovsky, Michelle Kittleson, René J. Alvarez, J. Eduardo Rame, Alexander Hajduczok, Vineeta Kumar, Danial Ahmad, Vakhtang Tchantchaleishvili, Indranee N. Rajapreyar

Division of Cardiology Faculty Papers

BACKGROUND: The Organ Procurement and Transplantation Network (OPTN) implemented modifications in 2018 to the adult heart transplant allocation system to better stratify the most medically urgent transplant candidates. We evaluated the impact of these changes on patients supported by a durable left ventricular assist device (LVAD) with chronic kidney disease (CKD).

OBJECTIVE: To evaluate the impact of the OPTN policy change on patients supported by durable left ventricular assist devices (LVAD) with chronic kidney disease (CKD).

METHODS: We performed an analysis of patients from the United Network of Organ Sharing Database supported by durable LVAD listed for a heart transplant …

Hemoadsorption With Cytosorb As Part Of A Strategy To Improve Outcomes In Patients On Extracorporeal Membrane Oxygenation, Ruzica Mrkonjic

The VAD Journal

The exposure of a patient’s blood to the non-endothelialized surface of the extracorporeal membrane oxygenation (ECMO) system results in the production of pro-inflammatory and anti-inflammatory cytokines. This imbalance in pro- and anti-inflammatory cytokines leads to inflammatory response syndrome, which contributes to edema, vasoplegia, and multiple organ failure among other complications. Hemoadsorption therapy, with the use of CytoSorb^® (CytoSorbents) has emerged as a well-accepted treatment option that helps control pro-inflammatory response and improve outcomes for patients on ECMO. However, studies have shown that the potential of hemoadsorption is controversial and that it is crucial for clinicians to weigh the pros …

Construct Length Analysis Of Type B And C Cervical And Thoracolumbar Fractures, Jeremy C. Heard, Mark J. Lambrechts, Yunsoo Lee, Teeto Ezeonu, Delano R. Trenchfield, Nicholas D. D'Antonio, Azra N. Dees, Bright M. Wiafe, John J. Mangan, Jose A. Canseco, Barrett I. Woods, Ian David Kaye, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Rothman Institute Papers

Objectives:

The purpose of this study is to identify if construct length affects the rate of surgical complications and instrumentation revision following surgical fixation of subaxial and thoracolumbar Type B and C fractures. This study evaluates the effect of ankylosing spondylitis/diffuse idiopathic skeletal hyperostosis (AS/DISH) within this population on outcomes.

Methods:

Retrospective review of 91 cervical and 89 thoracolumbar Type B and C fractures. Groups were divided by construct length for analysis: short-segment (constructs spanning two or less segments adjacent to the fracture) and long-segment (constructs spanning more than two segments adjacent to the vertebral fracture).

Results:

For cervical fractures, …

Poptosis Or Peptide-Induced Transmembrane Pore Formation: A Novel Way To Kill Cancer Cells Without Affecting Normal Cells, Matthew Pincus, Miriam Silberstein, Nitzan Zohar, Ehsan Sarafraz-Yazdi, Wilbur Bowne

Department of Surgery Faculty Papers

Recent advances in cancer treatment like personalized chemotherapy and immunotherapy are aimed at tumors that meet certain specifications. In this review, we describe a new approach to general cancer treatment, termed peptide-induced poptosis, in which specific peptides, e.g., PNC-27 and its shorter analogue, PNC-28, that contain the segment of the p53 transactivating 12-26 domain that bind to HDM-2 in its 1-109 domain, bind to HDM-2 in the membranes of cancer cells, resulting in transmembrane pore formation and the rapid extrusion of cancer cell contents, i.e., tumor cell necrosis. These peptides cause tumor cell necrosis of a wide variety of solid …