Surgery Commons^™

An Unusual Case Of Bilateral Upper And Lower Oral Cavity Cysts In A Newborn, Frances Rodriguez Lara, Jillian L. Chen, Jennifer N. Shehan, Jessica R. Levi

HCA Healthcare Journal of Medicine

Background

Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management.

Case Presentation

A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days’ …

Using Mohs Micrographic Surgery To Treat A Large, Pedunculated Trichoblastoma On The Upper Cutaneous Lip, Richard G. Bindernagel Jr., Addie Walker, Richard Miller

HCA Healthcare Journal of Medicine

Trichoblastomas are uncommon adnexal tumors that usually occur on the face. We report a case of a 62-year-old White man with a large, asymptomatic, slow-growing lesion that had been on his right upper cutaneous lip for 15 years. A 2 cm pink, pedunculated nodule with telangiectasia was seen on examination. A shave biopsy was consistent with trichoblastoma: a circumscribed-appearing dermal tumor of basaloid cells arranged in cords and islands within a cellular stroma, focal epidermal connection, and papillary mesenchymal bodies. The patient elected for treatment with Mohs micrographic surgery (MMS) given the length of time that the tumor had been …

Effect Of Androgen Receptor Polymorphism On Hypogonadism Severity And Efficacy Of Testosterone Replacement Therapy, Nelson W Mills, Beatriz S Hernandez, Peyton J Coady, Arnaav Walia, Gal Saffati, Daniela Orozco Rendon, Dalia Khera, Nadia Khera, Weitao Song, Mohit Khera

Faculty, Staff and Students Publications

Background: The preferred treatment for hypogonadism, testosterone replacement therapy (TRT), has a varying efficacy that is currently not fully understood. This observation may be explained by polymorphism of the androgen receptor (AR), a ligand-binding transcription factor whose polyglutamine tract length affects various health conditions and androgen sensitivity. It has been theorized that this polymorphism may also affect the severity of hypogonadism. This study sought to determine a correlation between hypogonadism severity, TRT efficacy, and number of CAG trinucleotide repeats in the AR gene.

Methods: One hundred sixty-two males presenting to a single institution with symptoms of hypogonadism were recruited for …

Self-Perceived Burden And Mental Health Outcomes In Adults With Osteogenesis Imperfecta, Emily R Strouphauer, Camille Villar, Ryan J Mccarty, Danqi Li, Gianna M Colombo, Brendan Lee, Chaya N Murali, Dianne Nguyen, Sarah Sadek, Marie-Eve Robinson, Jocelyn Gomez, Michelle Fynan, V Reid Sutton, Andrew D Wiese, Eric A Storch

Faculty, Staff and Students Publications

Osteogenesis Imperfecta (OI) is a rare disorder causing bone fragility, pain, and functional impairment that causes substantial psychosocial burden. This study examined how self-perceived burden (SPB), or distress from feelings of dependence on caregivers, relates to depression, anxiety, and suicidality in adults with OI. A total of 208 adults (M age = 42.9, predominately White and female) with OI were recruited to complete a cross-sectional survey assessing SPB, psychological symptoms, health, and sociodemographics. Results indicated that SPB was significantly higher among younger individuals, those not living with a partner, those living with adult family members, lower-income groups, and individuals …

Protocol For Lentiviral Generation And Transduction Of Human-Derived Endometrial Epithelial Organoids To Study Uterine Function And Pathologies, Sydney E Parks, Diana Monsivais

Faculty, Staff and Students Publications

The use of patient-derived endometrial epithelial organoids has revolutionized the field of uterine biology. Here, we present a protocol for generating lentivirus and transducing human-derived endometrial epithelial organoids for the study of endometrial function and pathologies. We describe steps for lentiviral production, lentiviral transduction of endometrial epithelial organoids, and endometrial epithelial organoid passaging. We then detail procedures for validating lentiviral transduction. This protocol allows for knocking down or overexpressing genes of interest, enabling investigation of specific targets in a patient-centric model.

Protocol For Purifying And Sequencing Cell Subpopulations Based On Rna Fish Signal In Planaria, Mary Cathleen Mckinney, Jason A Morrison, Frederick G Mann, Dung M Vuu, Carolyn E Brewster, Kate E Hall, Blair W Benham-Pyle, Alejandro Sánchez Alvarado

Faculty, Staff and Students Publications

Isolation and characterization of rare cell types in non-model organisms present a challenge. Here, we provide a protocol to purify specific cells from planaria for downstream RNA sequencing. We employ a one-step dissociation and fixation method that avoids RNA-degrading formaldehyde. We label cells using RNA fluorescence in situ hybridization (RNA FISH) and flow sort to enrich sequencing reads from cells of interest for deeper biological insight.

For complete details on the use and execution of this protocol, please refer to Mann et al.1

Targeted Inhibition Of Atr Kinase Promotes Antitumor Immunity In Hnscc Through Enhanced Sting Activation And T Cell Function, Fabio Hb Da Costa, Mutsuki Kawabe, Tsung-You Tsai, Kento Okamoto, Mason D Bartels, Sofia Cortes, Ratna Veeramachaneni, Roberto Rangel, Mitchell J Frederick, Vlad C Sandulache, Andrew G Sikora, Jeffrey N Myers, Abdullah A Osman

Faculty, Staff and Students Publications

Objectives: Oral cavity head and neck squamous cell carcinoma (HNSCC) represents a major global health burden, with over 40,000 new cases annually in the United States and >500,000 worldwide. Despite advances in surgery, radiation therapy, chemotherapy, and immunotherapy, overall survival rates have remained largely stagnant over the past three decades, and over half of patients ultimately die from the disease. Although immune checkpoint inhibitors (ICIs) have improved outcomes for a subset of patients with recurrent or metastatic HNSCC, the majority gain limited benefit. Thus, novel therapeutic strategies that enhance responses to immunotherapy are urgently needed. The ATR-CHK1 signaling pathway has …

Management Algorithm For Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration, Subhasis Chatterjee, Jamel Ortoleva, Rakesh C Arora, Kelci R Dalton, Daniel T Engelman, Natalia Ivascu Girardi, Michael C Grant, Travis J Miles, Marc R Moon, Orlando R Suero, Erica Wittwer, Patrick M Wieruszewski

Faculty, Staff and Students Publications

Background: Vasoplegic shock is distributive shock that follows cardiopulmonary bypass, characterized by hypotension, low systemic vascular resistance, and catecholamine resistance despite preserved or elevated cardiac output. Reported incidence ranges from 5% to 50%. Associated adverse outcomes include acute kidney injury, prolonged intensive care unit stay, and mortality. A single, universally accepted consensus definition is lacking, and few evidence-based best-practice management strategies exist.

Methods: A panel of 12 clinicians-cardiac surgeons, anesthesiologists, intensivists, and pharmacists-from 6 institutions conducted a structured expert review. PubMed and Embase were searched for research studies, including clinical trials, retrospective analyses, and mechanistic studies covering epidemiology, risk factors, …

Apolipoprotein B100 Predicts Cardiovascular And Limb Events In Type 2 Diabetes Patients With Chronic Limb-Threatening Ischemia, Federico Biscetti, Maria Margherita Rando, Maria Anna Nicolazzi, Flavia Angelini, Roberto Iezzi, Luis H. Eraso, Paul J. Dimuzio, Dario Pitocco, Massimo Massetti, Antonio Gasbarrini, Andrea Flex

Department of Surgery Faculty Papers

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) and chronic limb-threatening ischemia (CLTI) undergoing lower extremity revascularization (LER) face high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), despite guideline-directed lipid-lowering therapy. Apolipoprotein B100 (ApoB100), reflecting total atherogenic particle number, may identify residual risk beyond LDL-cholesterol (LDL-C). Therefore, we investigated whether baseline ApoB100 levels independently predict MACE and MALE beyond conventional risk factors in this high-risk population.

METHODS: In this prospective cohort study, 167 T2DM patients with CLTI undergoing LER were followed for 12 months with visits at 1, 3, 6, and 12 months post-procedure. …

Financial Implications Of Vascular Surgery Conference Fees, Alexandra Kats, Gerard M. Martin, Sanath Patil, Joshua R. Chen, Paul J. Dimuzio, Dawn Salvatore, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

BACKGROUND: Conferences are an important venue for trainees and students to engage in scholarly activities and networking. However, cost presents a significant consideration for students looking to attend conferences as institutional funding varies. In this study, we analyze the attendance costs of vascular conferences.

METHODS: Thirty-one vascular surgery conferences were identified with 12 regional and 6 national, and 13 international. Invitation-only conferences were excluded from the analysis. Cost of attendance was stratified by early and regular registration timing and attending, trainee, and student status. Additionally, conference websites were queried individually for scholarship opportunities. Data was presented descriptively and compared using …

Whole-Genome Variant Detection In Long-Read Sequencing Data From Ultra-Low Input Patient Samples, Katherine Wang, Cera J Aex, Hayan Lee, Lucas Finot, Kevin Zhu, Julianna R Chang, Aaron M Horning, William J Rowell, Philip Li, Sarah B Kingan, Michael P Snyder, Graham Scott Erwin

Faculty, Staff and Students Publications

Long-read sequencing provides a more complete view of the genome than short-read sequencing, with improved detection of structural variants, tandem repeats, and small variants (single nucleotide variants and insertions and deletions) in difficult-to-map regions. One limitation of long-read sequencing has been high input DNA requirements, with several micrograms required per sample. Here, we evaluate two methods of amplification-based long-read, whole-genome sequencing: ultra-low input HiFi (ULI-HiFi) sequencing and droplet multiple displacement amplification (dMDA) sequencing. When benchmarked against the Genome in a Bottle reference set (NA24385), we observe high precision and recall of single nucleotide variants (SNVs) with ULI-HiFi compared to the …

Outcomes In Single Versus Two-Stage Surgical Stabilization Of Complex Bilateral Chest Wall Injury: A Single-Center Experience., Alexis A Schweibinz, Jaya S Varre, Anna Graham, William B Devoe

Surgery Articles

INTRODUCTION: Surgical stabilization of rib fractures (SSRF) continues to show benefit for severe chest wall injury (CWI) with improvement in morbidity and mortality following stabilization. Complex bilateral injuries pose a clinical and technical challenge. Currently, there is no formal recommendation for an approach to repair such injuries, whether that be bilateral SSRF within the index case or staged repair. We sought to describe our institutional experience with this subset of patients, identify factors that may influence the decision to pursue single- versus two-stage procedures, and assess the potential benefit of combined bilateral SSRF during the index operation.

METHODS: A retrospective, …

Notch1 Acts As A Tumor Suppressor That Induces Early Differentiation In Head And Neck Cancer, Chenfei Huang, Shhyam Moorthy, Qiuli Li, Kazi M Ahmed, Kalil Saab, Defeng Deng, Jiping Wang, Xiayu Rao, Jiexin Zhang, Yuanxin Xi, Jing Wang, Zhiyi Liu, Noriaki Tanaka, David A Wheeler, Eve Shinbrot, Rami Saade, Curtis R Pickering, Tong-Xin Xie, Adel K El-Naggar, Abdullah A Osman, Kunal Rai, Patrick A Zweidler-Mckay, John V Heymach, Lauren A Byers, Faye M Johnson, Vlad C Sandulache, Jeffrey N Myers, Pedram Yadollahi, Mitchell J Frederick

Faculty, Staff and Students Publications

Inactivating NOTCH1 mutations in head and neck squamous cell carcinoma (HNSCC) were described over a decade ago, suggesting a tumor suppressor function - unlike its oncogenic role in other tumors. Today, much debate persists regarding a putative oncogenic role in HNSCC as well, with reports that NOTCH1 signaling drives tumor growth and a cancer stem cell (CSC) phenotype. In this work, comprehensive experiments unequivocally demonstrate that NOTCH1 is a tumor suppressor in HNSCC regardless of mutation or activation status and that it reduces CSC frequency. We developed a signature of NOTCH1 activation showing the pathway is associated with very early …

Impact Of Lumen Origin And Gap Distance On Target Vessel Outcomes Following Fenestrated-Branched Endovascular Aortic Repair Of Postdissection Thoracoabdominal Aortic Aneurysms, Armin Tabiei, Jesse Chait, Andrea Vacirca, Randall R Demartino, Emanuel R Tenorio, Fahad Shuja, Dora Babocs, Guilherme B B Lima, Naveed Saqib, Gustavo S Oderich, Bernardo C Mendes

Faculty, Staff and Students Publications

Background: This study evaluated the role of target vessel (TV) lumen origin and fenestration gap (FG) distance between the endograft and the aortic wall on TV outcomes following fenestrated-branched endovascular aortic repair (FB-EVAR) for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs).

Methods: A multicenter review of prospectively and retrospectively collected data of patients undergoing FB-EVAR for PD-TAAAs between 2013 and 2023 was performed. Lumen origin was retrospectively analyzed on preoperative imaging studies and classified as true lumen (TL) only, false lumen (FL) only, or both TL and FL. The FG distance was retrospectively measured on postoperative imaging studies and included as a …

Beyond Regulation: Why Europe Must Lead Ai Stewardship In Health, Luca Saba, Ignazio R. Marino

Department of Surgery Faculty Papers

No abstract available

Robotic-Assisted Pedicle Screw Placement Achieves High Accuracy And Narrows The Experience Gap: A Preclinical Evaluation, Anna T. Reza, Matthias Walper, Mitchell K. Ng, Paul G. Mastrokostas, Andrew S. Lee, Rafael G. Rafael, Kornelis A. Poelstra, Ratliff K. John, Rajiv K. Sethi, Michael A. Mont

Rothman Institute Papers

To assess a robotic-assisted system versus open manual techniques to: (1) compare pedicle screw accuracy between fellows and attendings with and without robotic assistance, and (2) evaluate executed versus planned trajectory fidelity relative to prior reports. Robotic-assisted spine systems aim to improve the accuracy, reproducibility, and safety of pedicle screw placement. Limited evidence compares outcomes across differing surgeon experience levels. A total of 255 thoracolumbar pedicle screws were placed in synthetic torsos simulating adult degenerative anatomy. Four surgeons (two fellows, two attendings) each placed half their screws using open fluoroscopy-guided techniques and half using a minimally invasive percutaneous approach with …

Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery At Swedish Cherry Hill, Jacinta Smith

All Podium Presentations

No abstract provided.

Silk Vista Baby Versus Pipeline Embolization Device For Unruptured Distal Anterior Cerebral Artery Aneurysms: A Multicenter Propensity-Weighted Comparative Study., Valerio Da Ros, Frédéric Clarençon, Adam A. Dmytriw, Pascal Jabbour Md, Marios Psychogios, Peter Sporns, Ajit S. Puri, Ameer E. Hassan, Oktay Algin, Markus A. Möhlenbruch, Mauro Bergui, Oded Goren, Gregoire Boulouis, Takeshi Morimoto, Raoul Pop, Joanna Wk Ho, Virginia Pujol Lereis, Jared Cooper, Giancarlo Salsano, Alessandro Sgreccia, Arturo Consoli, Eytan Raz, Julien Burel, Khawaja Muhammad Baqir Hassan, Zhe Ji, Riitta Rautio, Maria Ruggiero, Federico Sabuzi, Stefania Proietti, Joseph Domenico Gabrieli, Michael Levitt, Antonio Armando Caragliano, Christophe Cognard, Gaultier Marnat, Nicola Limbucci, Mariangela Piano, Alexis Guedon, Andrea Romi, Fortunato Di Caterino, Mykola Vyval, Adrien Guenego, Mohamad Abdalkader, Thanh Nguyen, Vitor Mendes Pereira, Ocilio Ribeiro Goncalves, Erwah Kalsoum, Alessandro Pedicelli, Andrea M Alexandre, Luca Scarcia

Department of Neurosurgery Faculty Papers

BACKGROUND: Flow diversion is effective for unruptured distal anterior cerebral artery (DACA) aneurysms, yet comparative data between the Silk Vista Baby (SVB) and Pipeline Embolization Device (PED) in this challenging territory remain scarce.

METHODS: We conducted a retrospective multicenter study using the CRETA Registry, including consecutive patients with unruptured DACA aneurysms treated with SVB or PED. The primary endpoint was complete angiographic occlusion (O'Kelly-Marotta grade D). Secondary outcomes included procedural characteristics, clinical outcome (modified Rankin Scale), and complications. Overlap weighting was applied to account for non-randomized treatment allocation. Predictors of occlusion were explored using penalized logistic regression. A sensitivity analysis …

Cancer Workforce-A Global Crisis: A Lancet Oncology Commission, Hedvig Hricak, Zachary Ward, Fabio Moraes, Andrew Scott, Farouk Dako, Wilfred Ngwa, Cynthia Villarreal-Garza, May Abdel-Wahab, Stephen Avery, Miriam Mutebi

General Surgery, East Africa

No abstract provided.

Artelon Graft Augmentation In Revision Anterior Cruciate Ligament Reconstruction: Surgical Technique Guide., Taylor Manes, Morgan Turnow, Trent Davis, Anthony Perugini, Michael Anderson, Benjamin Taylor

Surgery Articles

INTRODUCTION: Revision anterior cruciate ligament (ACL) procedures are becoming more prevalent. Variable grafts for ACL reconstruction are available, including autograft, allograft, and synthetic graft options. Various augmentation techniques are also available and typically consist of synthetic material such as Artelon graft. This type of synthetic material has been used and shown to produce safe and reliable augmentation in ligament injuries. The purpose of this study was to describe our unique revision ACL reconstruction technique utilizing Artelon graft augmentation and report our short-term results.

MATERIALS AND METHODS: We retrospectively reviewed patients undergoing revision ACL reconstruction with Artelon graft augmentation, a Flexband …