Surgery Commons^™

Severe Lupus Enteritis Complicated By Intractable Gastrointestinal Hemorrhage, Austin Thomas, Clay Smithhart, Maneera Chopra, Athira Jayan, Faisal Ali, Karim Doughem, Asmeen Bhatt, Joanna Scoon, Scott Larson

Faculty, Staff and Student Publications

Lupus enteritis (LE) is a rare presentation of systemic lupus erythematosus manifesting with nonspecific symptoms, laboratory derangements, and imaging findings. Rarely, LE may progress to bowel perforation, hemorrhage, and even death. Treatment with systemic glucocorticoids often results in rapid clinical improvement, but patients may require further immunosuppression. We present a case of severe LE complicated by life-threatening intractable gastrointestinal hemorrhage and warm autoimmune hemolytic anemia refractory to glucocorticoids and ultimately requiring massive transfusions, intravenous immunoglobulin, and plasmapheresis. This case illustrates the importance of early specialist involvement and treatment with intravenous immunoglobulin and plasmapheresis for severe, life-threatening LE.

Review Of Generic Scenario Environmental Release And Occupational Exposure Models Used In Chemical Risk Assessment, William M Barrett, David E Meyer, Raymond L Smith, Sudhakar Takkellapati, Michael A Gonzalez

Faculty, Staff and Student Publications

Under the Toxic Substances Control Act (TSCA), the United States Environmental Protection Agency (USEPA) is required to determine whether a new chemical substance poses an unreasonable risk to human health or the environment before the chemical is manufactured in or imported into the United States. This manuscript provides a review of the process used to evaluate the risk associated with a chemical based on the scenarios and models used in the evaluation. Specifically, the Generic Scenarios and Emission Scenario Documents developed by the USEPA were reviewed, along with background documentation prepared by USEPA to identify the core elements of the …

Acaa2 Is A Novel Molecular Indicator For Cancers With Neuroendocrine Phenotype, Michelle Shen, Shiqin Liu, Angus Toland, En-Chi Hsu, Alifiani B Hartono, Busola R Alabi, Merve Aslan, Holly M Nguyen, Conner J Sessions, Rosalie Nolley, Chanjuan Shi, Jiaoti Huang, James D Brooks, Eva Corey, Tanya Stoyanova

Faculty, Staff and Student Publications

BACKGROUND: Neuroendocrine phenotype is commonly associated with therapy resistance and poor prognoses in small-cell neuroendocrine cancers (SCNCs), such as neuroendocrine prostate cancer (NEPC) and small-cell lung cancer (SCLC). Expression levels of current neuroendocrine markers exhibit high case-by-case variability, so multiple markers are used in combination to identify SCNCs. Here, we report that ACAA2 is elevated in SCNCs and is a potential molecular indicator for SCNCs.

METHODS: ACAA2 expressions in tumour xenografts, tissue microarrays (TMAs), and patient tissues from prostate and lung cancers were analysed via immunohistochemistry. ACAA2 mRNA levels in lung and prostate cancer (PC) patients were assessed in published …

Design And Development Of A Clot Burst Pressure Device To Investigate Resuscitation Strategies, Atharwa R Mankame, Jacob B Schriner, Max A Skibber, Mitchell J George, Jessica C Cardenas, Charles S Cox, Brijesh S Gill

Faculty, Staff and Student Publications

Introduction: A reduction in clot strength is a hallmark feature of trauma-induced coagulopathy. A better understanding of clot integrity can optimize resuscitation strategies. We designed a device to gauge clot strength by pressurizing fluids over a formed clot and measuring the pressure needed to dislodge the clot. We hypothesized that this device could distinguish between clots formed in hypocoagulable and hypercoagulable states by observing differences in the clot burst pressure.

Methods: Whole blood from healthy volunteers was collected into sodium citrate tubes and was treated with heparin or fibrinogen to generate clots in a hypocoagulable or hypercoagulable state, respectively. Small …

Hidroadenocarcinoma Mimicking Epidermal Inclusion Cyst Of The Palm, Connor L Zale, Sean Kelly, Kevin Krul

Faculty, Staff and Student Publications

Hidradenocarcinoma is a rare malignant tumor of sweat glands of the skin that has been reported several times in the hand. We report a case of hidradenocarcinoma of the palm in a 55-year-old woman that presented as a painless volar hand mass. A staged rotational forearm flap was used after resection.

Aortic Arch Reconstruction Using Nonvalved Femoral Vein Homograft In High-Risk Neonates, Kyle G Mitchell, Julija Dobrila, Blaz Podgorsek, Christopher Greenleaf, Peter Chen, Jorge D Salazar, Damien J Lapar

Faculty, Staff and Student Publications

Aortic arch obstruction is often present with complex concomitant congenital heart defects (CHDs). The use of nonvalved femoral vein homograft (FVH) to reconstruct the aortic arch has distinct surgical advantages, including simplified reconstruction. We present an intraoperative video of a Yasui procedure utilizing FVH for aortic reconstruction in a 12-day-old (2.2 kg) neonate with right ventricular outflow tract obstruction, malalignment ventricular septal defect, aortic valve atresia, aortic arch hypoplasia, atrial septal defect, and ductal dependent systemic circulation. Further, we report outcomes for a series of three additional neonatal patients with complex CHD and aortic arch obstruction who underwent FVH arch …

Changes In Renal-Mesenteric Duplex Ultrasound Velocities After Fenestrated And Branched Endovascular Aortic Aneurysm Repair, Titia A L Sulzer, Thanila A Macedo, Nicole Strissel, Gina K Hesley, Alexander Lekah, Tiziano Tallarita, Marina Dias-Neto, Ying Huang, Emanuel R Tenorio, Andrea Vacirca, Thomas Mesnard, Aidin Baghbani-Oskouei, Safa Savadi, Jorg L De Bruin, Hence J M Verhagen, Bernardo Mendes, Gustavo S Oderich

Faculty, Staff and Student Publications

Objective: Stenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms.

Methods: Patients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of …

Inflammation And Fibrosis In Orbital Inflammatory Disease: A Histopathologic Analysis., Rohan Verma, Allison J Chen, Dongseok Choi, David J Wilson, Hans E Grossniklaus, Roger A Dailey, John D Ng, Eric A Steele, Stephen R Planck, Craig N Czyz, Bobby S Korn, Don O Kikkawa, Jill A Foster, Michael Kazim, Gerald J Harris, Deepak P Edward, Azza Al Maktabi, James T Rosenbaum

Surgery Articles

PURPOSE: The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens.

METHODS: In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 …

Maternal And Perinatal Outcomes Of Women With Vaginal Birth After Cesarean Section Compared To Repeat Cesarean Birth In Select South Asian And Latin American Settings Of The Global Network For Women's And Children's Health Research, Lester Figueroa, Margo Harrison, Manolo Mazariegos, Shivaprasad Gouda, Avinash Kavi, Richard Derman, Archana Patel, Prabir Das, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Objective: Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.
Hypothesis: Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.
Methods: A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), …

Benefits Of The Enhanced Recovery After Surgery (Eras) Pathway With Quadratus Lumborum Blocks For Minimally Invasive Gynecologic Surgery Patients: A Retrospective Cohort Study, Paul S Lee, Laurie L Brunette, Intira Sriprasert, Mohamed Eloustaz, Rasika Deshpande, Crystal Adams, Laila Muderspach, Lynda Roman, Shane Dickerson, Michael P Kim

Faculty, Staff and Student Publications

STUDY OBJECTIVE: This study aimed to determine the effect of the implementation of the Enhanced Recovery After Surgery (ERAS) protocol among patients receiving minimally invasive gynecologic surgery.

DESIGN AND SETTING: This retrospective cohort study was performed in a tertiary care hospital.

PATIENTS: A total of 328 females who underwent minimally invasive gynecologic surgeries requiring at least one overnight stay at Keck Hospital of University of Southern California (USC), California, USA, from 2016 to 2020 were included in this study.

INTERVENTIONS: The institutional ERAS protocol was implemented in late 2018. A total of 186 patients from 2016 to 2018 prior to …

Subungual Squamous Cell Carcinoma Leading To Arm Amputation, Ovidiu V. Fabian, Emilia Maria Pătruţ, Mădălina Șteţca, Radu Mircea Galasiu, Vlad Zolog, Adriana Zolog, Iacob Domşa, Ioan Șimon, Anca Mihailov, Olga Hilda Orăşan, Flaviu Mureşan

Journal of Mind and Medical Sciences

Although rare, subungual carcinoma is the most common malignant nail tumor. The symptomatology is not characteristic, being very similar to that of other nail and periungual diseases. For this reason, early diagnosis is usually established by performing a biopsy. With appropriate treatment, subungual carcinoma usually has a favorable prognosis. Metastatic cases are rarely encountered, but they usually have a poor therapeutic result. This article presents the case of a patient with subungual carcinoma (diagnosed by histopathological exam), initially treated by amputation of the distal and middle phalanges of the fourth finger. Two years after the operation, a recurrence in the …

Giant Renal Cell Carcinoma In A Patient With Ipsilateral Lower Limb Hypertrophic Lichen Planus; Case Report And Literature Review, Silvia Popescu, Dumitru Peța, Zoltan Janos Kövér, Dumitru Toma, Ioan-Teodor Cristea, Mihaela Anca Popescu, Oana-Denisa Bălălău, Romina-Marina Sima, Gabriel-Petre Gorecki, Călin Giurcăneanu

Journal of Mind and Medical Sciences

Renal cell carcinoma is the most common type of primary urogenital cancer, usually resistant to radiotherapy and chemotherapy. Hypertrophic lichen planus is an inflammatory dermatosis characterized by the presence of papulosquamous and intensely pruritic lesions. The association of these two conditions is unusual, being reported in the specialized literature only in a few rare cases with the onset of lichenoid lesions after patients have undergone various forms of treatment. The case of a 62-year-old male patient who was admitted for severe abdominal pain due to a giant renal tumor associated with a hypertrophic plaque located on the anterior part of …

Is Open Surgery Still Part Of The Current Treatment Of Inguinal Hernias?, Dan Bratu, Alin Mihetiu, Alexandra Sandu, Crenguta Serboiu, Corneliu Tudor, Laurentiu Simion, Dragos Cretoiu, Florin Bobirca, Dragos Davitoiu, Bogdan Serban, Claudiu Eduard Nistor

Journal of Mind and Medical Sciences

Inguinal hernia repair represents one of the most frequent pathologies with surgical addressability. From the multitude of surgical procedures, a limited number still keep their indication in the current treatment of hernias. Open surgery, the exclusive repair method until recently, is associated with laparoscopic techniques with benefits that are at least superposable on those in open repair. We conducted a study, analyzing several types of procedures in open surgery and comparing them to each other, but also with the TAPP approach, which is still at the beginning in our service. The non-mesh procedures scored poorly in terms of recurrence, the …

Revascularization Impact: Quality Of Life Enhancement In Chronic Limb-Threatening Ischemia, Cristian Traian Paius, Vlad Denis Constantin, Alexandru Carap, Andrei Tarus, Grigore Tinica

Journal of Mind and Medical Sciences

Introduction. Globally, over 230 million people have peripheral artery disease, often undiagnosed, leading to chronic limb-threatening ischemia. Revascularization is vital for preventing amputation and improving quality of life. While specific questionnaires for severe ischemia are lacking, the SF-36 questionnaire is widely used to assess quality of life, with variations like SF-12 and SF-8 for larger cohorts. Objectives. Our aim was to assess how different lower limb revascularization methods affect the postoperative quality of life in patients with chronic limb-threatening ischemia. Methods. This study was conducted at the St. Pantelimon Emergency Hospital of Bucharest, Romania. It included 166 adult patients with …

Follow-Up Care After Metabolic Surgery – A Prospective Study In The North-Eastern Region Of Romania, Sorina Boariu, Ana Maria Scutariu, Adrian Cureniuc, Anamaria Meuca, Roxana Adriana Stoica, Anca Mihaela Pantea Stoian, Delia Reurean Pintilei

Journal of Mind and Medical Sciences

Background. Anti-obesity therapeutic strategies are continuously evolving. Bariatric procedures or metabolic surgery are among the most effective and long-lasting therapies for obesity and its complications. Our objective was to investigate the clinical and biological evolution after metabolic surgery in a group of patients from North-Eastern Romania and to evaluate a nutritional intervention plan for this population. Materials and Methods. Our clinic surveyed 50 patients who received nutritional counselling before and after bariatric surgery. The patient's weight loss, metabolic markers, and lifestyle changes from January to December 2021 were recorded. SPSS Statistics v.18 was used for statistical analyses. Results and Discussions. …

Best Therapeutic Practices In The Management Of Obstetric Sepsis, Gabriel Petre Gorecki, Oana Denisa Balalau, Diana Elena Comandasu, Anca Daniela Stanescu, Dana Rodica Tomescu

Journal of Mind and Medical Sciences

Background. Physiological changes that occur during pregnancy make maternal sepsis a difficult condition to diagnose and treat, still having a fairly high mortality rate. Consequently, an early diagnosis and prompt therapeutic management of sepsis can significantly decrease mortality. The purpose of this study is to review literature data that present current practices in the management of obstetric sepsis. Methods. To collect the data required for the study, we performed a search of published articles in the PubMed and Google Scholar databases related to obstetric sepsis. Research paper articles from the period 2012-2022 were included in the analysis. In addition, 145 …

Endoscopic Approach To Recurrent Inguinal Hernia After Previous Open Surgery, Doru Moga, Dragos Serban, Bogdan Geavlete, Crenguta Serboiu, Bogdan Serban, Ana Maria Dascalu, Valentin Oprea

Journal of Mind and Medical Sciences

Background. The management of a recurrent inguinal hernia varies depending on multiple factors. In the case of recurrent inguinal hernias after open anterior repair, the laparoscopic approach is recommended. TEP and TAPP procedures are considered to have similar results. The purpose of the study is to evaluate on our sample if there are differences between primary inguinal hernia cases and recurrent hernia after laparoscopic TAPP and TEP procedures. Materials and Methods. We retrospectively reviewed the medical records of 300 patients who underwent laparoscopic inguinal hernia repairs at our hospital from March 2013 to March 2023. Results. Of the 300 patients, …

Sentinel Node Biopsy For Personalized Breast Cancer Management; Advances And Controversies, Rahim Al Moushaly, Daniel Ion, Octavian Andronic, Bogdan Socea, Alexandru Cosmin Palcau, Dan Nicolae Paduraru

Journal of Mind and Medical Sciences

Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary lymph node staging, providing valuable prognostic information while minimizing complications compared to axillary lymph node dissection. However, there are ongoing debates and controversies surrounding SLNB in specific cases. Studies have explored the use of SLNB in neoadjuvant chemotherapy, emphasizing the need for customized therapy decisions. Factors such as age, tumor characteristics, and treatment response influence the selection of SLNB or axillary lymph node dissection. Additionally, the presence of extranodal extension, micrometastases, and isolated tumor cells has been evaluated to determine the need for lymphadenectomy. The importance of accurate …

Diabetes Mellitus: Interdisciplinary Medical, Surgical And Psychological Therapeutic Approach, Bogdan Socea, Adrian Silaghi, Laura Florentina Rebegea, Daniela Gabriela Balan, Cristian Balalau, Tiberiu Ștefăniță Tenea-Cojan, Doina Andrada Mihai, Ioana Paunica

Journal of Mind and Medical Sciences

Diabetes mellitus is a complex and widespread metabolic disease, having extremely complex implications (biological, psychological, social) for patients. Understanding the pathophysiology of diabetes (majorly influenced by various factors such as genetic predisposition, age, lifestyle choices, etc.) is essential for the prevention of this condition and the establishment of effective treatment strategies. The latest and relevant literature data related to the epidemiology, pathophysiology, and treatment of diabetes are presented, after an exhaustive review of the articles published on this topic and indexed in the WOS, PubMed, Scopus and Google Scholar databases. Preventing or delaying the onset of diabetes can be achieved …

Gastric Cancer; Actualities And Perspectives Of Early Diagnosis And Targeted Therapy, Adrian Silaghi, Laura Florentina Rebegea, Daniela Gabriela Balan, Anca Dumitriu, Stana Paunica, Cristian Balalau, Stefăniță Tenea Cojan, Dragos Epistatu, Vlad Denis Constantin

Journal of Mind and Medical Sciences

Gastric cancer is an extremely aggressive form of malignancy that, if left untreated, is life-threatening. Improved survival rates depend on early detection of the disease, as well as on the combination of different forms of treatment (surgery, chemotherapy, radiotherapy, immunotherapy, etc.). Screening methods have brought real benefit in early detection of malignancies, but many cases are still diagnosed at advanced stages. The current study is a review related to actualities and perspectives of early diagnosis and targeted therapy of gastric cancer. After an extensive review of the literature, epidemiological, diagnostic and treatment data are presented. The open surgical approach is …