Surgery Commons^™

Sirtuin 6 Activation Rescues The Age-Related Decline In Dna Damage Repair In Primary Human Chondrocytes, Michaela E. Copp, Jacqueline Shine, Hannon L. Brown, Kirti R. Nimmala, Oliver B. Hansen, Susan Chubinskaya, John A. Collins, Richard F. Loeser, Brian O. Diekman

Department of Orthopaedic Surgery Faculty Papers

While advanced age is widely recognized as the greatest risk factor for osteoarthritis (OA), the biological mechanisms behind this connection remain unclear. Previous work has demonstrated that chondrocytes from older cadaveric donors have elevated levels of DNA damage as compared to chondrocytes from younger donors. The purpose of this study was to determine whether a decline in DNA repair efficiency is one explanation for the accumulation of DNA damage with age, and to quantify the improvement in repair with activation of Sirtuin 6 (SIRT6). After acute damage with irradiation, DNA repair was shown to be more efficient in chondrocytes from …

C-Case 2023: Promoting Excellence In Surgical Education: Canadian Conference For The Advancement Of Surgical Education, Oct. 12-13, 2023, Montréal, Quebec, Jeffrey Sioufi, Brandon Hall, Ryan Antel, Sarah Moussa, Mathushan Subasri, Mustafa Fakih, Nehal Islam, Reggie C. Hamdy, Sonaina Chopra, Karim Damji

Department of Ophthalmology & Visual Sciences

No abstract provided.

Alt Free Flap Coverage After Carotid Endarterectomy In The Setting Of Severe Radiation Changes, Richard F. Guidry, Hannah E. Doran, Mark W. Stalder

School of Medicine Faculty Publications

Carotid endarterectomy with patch angioplasty is commonly performed for severe atherosclerotic disease to reduce stroke risk. After neck radiation, loss of tissue planes; reactive fibrosis of skin; contraction; and rarely, necrosis of skin may occur, leading to severe wound complications and possible exposure of carotid artery reconstruction. Historically, local myocutaneous flaps have been performed to provide soft tissue coverage; however, these procedures may be associated with increased donor site morbidity and can be affected by radiation changes. This report describes the novel use of a fasciocutaneous free flap for durable vascularized soft tissue, and the associated secondary benefit of improved …

Exploring The Uncommon: A Case Report On Localized Peritonitis Caused By Ingested Toothpick, Narmeen Asif, Salva Shariq, Abdul Rehman Alvi

Department of Surgery

Introduction: Bowel perforation is a serious emergency. Occasionally, sharp objects like toothpicks can get stuck in narrow parts of the small intestine, potentially resulting in impaction, obstruction, or perforation.
Presentation of case: A 20-year-old male arrived at our hospital's emergency department with sudden, severe abdominal pain persisting for 24 h. On examination, his abdomen showed tenderness, and bowel sounds were reduced. Contrast-enhanced computed tomography (CECT) indicated possible small intestine inflammation due to a foreign object and a diagnostic laparoscopy revealed a hyperemic terminal ileum.
Discussion: This case involves ileal perforation from an unnoticed toothpick ingestion. Detecting foreign object perforations is …

Correction Of Spinal Sagittal Alignment After Posterior Lumbar Decompression: Does Severity Of Central Canal Stenosis Matter?, Delano Trenchfield, Yunsoo Lee, Mark J. Lambrechts, Nicholas D'Antonio, Jeremy Heard, John Paulik, Sydney Somers, Jeffrey Rihn, Mark Kurd, David Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Christopher K Kepler, Gregory Schroeder

Rothman Institute Faculty Papers

STUDY DESIGN: This study adopted a retrospective study design.

PURPOSE: Our study aimed to investigate the impact of central canal stenosis severity on surgical outcomes and lumbar sagittal correction after lumbar decompression.

OVERVIEW OF LITERATURE: Studies have evaluated sagittal correction in patients with central canal stenosis after lumbar decompression and the association of stenosis severity with worse preoperative sagittal alignment. However, none have evaluated the impact of spinal stenosis severity on sagittal correction.

METHODS: Patients undergoing posterior lumbar decompression (PLD) of ≤4 levels were divided into severe and non-severe central canal stenosis groups based on the Lee magnetic resonance imaging …

Inhibition Of Neurogenic Inflammatory Pathways Associated With The Reduction In Discogenic Back Pain, Jose A. Canseco, Hannah A. Levy, Brian A. Karamian, Olivia Blaber, Michael Chang, Neil Patel, John G. Curran, Alan S. Hilibrand, Gregory D. Schroeder, Alex R. Vaccaro, Dessislava Z. Markova, David E. Surrey, Christopher K. Kepler

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: This study aimed to determine whether the initiation of anti-calcitonin gene-related peptide (CGRP inhibitor) medication therapy for migraines was also associated with improvements in back/neck pain, mobility, and function in a patient population with comorbid degenerative spinal disease and migraine.

OVERVIEW OF LITERATURE: CGRP upregulates pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-6, brain-derived neurotrophic factor, and nerve growth factor in spinal spondylotic disease, which results in disc degeneration and sensitization of nociceptive neurons. Although CGRP inhibitors can quell neurogenic inflammation in migraines, their off-site efficacy as a therapeutic target for discogenic back/neck pain …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Women, Power, And Cancer: A Lancet Commission, Ophira Ginsburg, Verna Vanderpuye, Ann Marie Beddoe, Nirmala Bhoo-Pathy, Freddie Bray, Carlo Caduf, Narjust Florez, Ibtihal Fadhil, Nazik Hammad, Miriam Mutebi

General Surgery, East Africa

Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention and screening activities, as individuals living with and beyond a cancer diagnosis, as caregivers for family members and friends, as patient advocates, as health workers and healthcare professionals, and as cancer researchers and policy makers. The topic of women and cancer spans broad terrain, beyond women’s cancers and the biomedical aspects of any type of cancer that women in all their diversities might experience. It is inclusive of the ways in which sex and gender influence exposures to cancer risk factors, interactions with the cancer health …

Advanced Breast Cancer Care: The Current Situation And Global Disparities, Aruni Ghose, Susannah Stanway, Bhawna Sirohi, Miriam Mutebi, Sarah Adomah

General Surgery, East Africa

Objectives: Advanced breast cancer (ABC) is an incurable disease. The number of people living with ABC has increased globally. Disparities in ABC care exist at both individual and system levels. ABC cases in most low- and middle-income countries (LMICs) are underreported due to a lack of national cancer registries. Harmonized guidelines for resource stratification and capacity building in LMICs are under way.

Data sources: MEDLINE, Cochrane, and Google Scholar databases were used.

Conclusion: To improve ABC outcomes and resolve disparities, more robust health systems or pathways need to be developed across the cancer continuum in addition to social education.

Implications …

The Impact Of Neighborhood Socioeconomic Disadvantage On Operative Outcomes After Single-Level Lumbar Fusion, Grace Y. Ng, Ritesh Karsalia, Ryan S. Gallagher, Austin J. Borja, Jianbo Na, Scott Mcclintock, Neil R. Malhotra

Mathematics Faculty Publications

INTRODUCTION: The relationship between socioeconomic status and neurosurgical outcomes has been investigated with respect to insurance status or median household income, but few studies have considered more comprehensive measures of socioeconomic status. This study examines the relationship between Area Deprivation Index (ADI), a comprehensive measure of neighborhood socioeconomic disadvantage, and short-term postoperative outcomes after lumbar fusion surgery. METHODS: 1861 adult patients undergoing single-level, posterior-only lumbar fusion at a single, multihospital academic medical center were retrospectively enrolled. An ADI matching protocol was used to identify each patient's 9-digit zip code and the zip code-associated ADI data. Primary outcomes included 30- and …

From The Borders Edge To The Brink Of Death: A Case Of A Traumatic Pancreatic Injury And Whipple Procedure In The Rio Grande Valley, Valentine S. Alia, Ed W. Alvarado, Edward M. Diaz, Daniel Albo, Roger Galindo

School of Medicine Publications and Presentations

The traumatic pancreatoduodenectomy, also known as the traumatic Whipple, is a specialized surgical procedure often reserved for extreme cases in which an individual suffers traumatic injuries to the pancreas, duodenum, or periampullary structures. Traditionally, a Whipple procedure is a complex surgery involving the removal of the head of the pancreas, duodenum, and a portion of both the bile duct and stomach, for the management of pancreatic head cancer. In underserved communities where limited access to healthcare is coupled with a higher incidence of trauma, the lack of specialized and supportive care for patients suffering from pancreatic injuries may lead to …

Characteristic Dynamic Functional Connectivity During Sevoflurane-Induced General Anesthesia, J. Miao, M. Tantawi, Mahdi Alizadeh, Sara Thalheimer, Faezeh Vedaei, Victor Romo, Feroze B. Mohamed, Chengyuan Wu

Department of Neurosurgery Faculty Papers

General anesthesia (GA) during surgery is commonly maintained by inhalational sevoflurane. Previous resting state functional MRI (rs-fMRI) studies have demonstrated suppressed functional connectivity (FC) of the entire brain networks, especially the default mode networks, transitioning from the awake to GA condition. However, accuracy and reliability were limited by previous administration methods (e.g. face mask) and short rs-fMRI scans. Therefore, in this study, a clinical scenario of epilepsy patients undergoing laser interstitial thermal therapy was leveraged to acquire 15 min of rs-fMRI while under general endotracheal anesthesia to maximize the accuracy of sevoflurane level. Nine recruited patients had fMRI acquired during …

Prevalence Of Central Venous Stenosis Among Black And White Eskd Patients With Dysfunctional Dialysis Access, Vipul Chitalia Md, Jonathan Ravid, Arinze Nkiruka, Kristina Yamkovoy, Matthew Diamond, Rohit Pillai, Tyler J. Ryan, Saran Lotfollahzadeh, Janice Weinberg, Alik Farber, Rajendran Vivendhan, Jean Francis, Nathanael Fillmore, Najia Idrees

Journal of Health Disparities Research and Practice

In the United States, significant racial and ethnic disparities exist in chronic kidney disease (CKD) and its management. Hemodialysis constitutes the main stay of renal replacement therapy for end-stage kidney disease (ESKD), which is initiated using central venous catheters (CVC) in most CKD patients in the United States. Black ESKD patients have higher usage and greater time on CVC for hemodialysis compared to White patients. This trend places Black patients at a potentially higher risk for CVC-related complications such as central venous stenosis (CVS). We posited that Black patients would have a higher prevalence and a greater risk of CVS. …

Treatment Of Refractory Ventricular Tachycardia With Radiofrequency Ablation And Temporary Mechanical Circulatory Support, Som P. Singh, Alejandro Vidal Margenat, David L. Boone, Ellen Condoure, Ramesh Hariharan

The VAD Journal

Catheter-based radiofrequency ablation has long been recognized as an effective treatment for refractory ventricular tachycardia (VT). A 57-year-old male with severe coronary artery disease underwent percutaneous mechanical circulatory support because of worsening cardiogenic shock after failed revascularization attempts. Despite aggressive medical management, the patient experienced refractory VT episodes, leading to the decision to proceed with radiofrequency catheter ablation. Notably, the Impella 5.5 device (Abiomed) provided critical left ventricular support during the ablation procedure. This case underscores the potential benefits of Impella support during radiofrequency ablation of complex ventricular arrhythmias.

Large Right Lower Quadrant Abdominal Mass, Isheeta Madeka, Cannon Greco-Hiranaka, Ozlem Kulak, Wilbur Bowne

Jefferson Hospital Staff Papers and Presentations

No abstract provided.

Protracted Respiratory Failure In A Case Of Global Spinal Syringomyelia And Chiari Malformation Following Administration Of Diazepam: Illustrative Case, Luke Bauerle, Brandon Rogowski, Aakash Shingala, Habib Emil Rafka, Timothy Webb, Brian F. Saway, Edward F. Kilb, Julio A. Chalela, Nathan C. Rowland

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam.

OBSERVATIONS: A 31-year-old female presented with malnutrition, a 1-month history of right-sided weakness, and normal respiratory dynamics. After administration of diazepam prior to magnetic resonance imaging (MRI), she suddenly developed …

Durable Responses At 24 Months With High-Frequency Spinal Cord Stimulation For Nonsurgical Refractory Back Pain, Naresh P. Patel, Jessica Jameson, Curtis Johnson, Daniel Kloster, Aaron Calodney, Peter Kosek, Julie Pilitsis, Markus Bendel, Erika Petersen, Chengyuan Wu, Taissa Cherry, Shivanand Lad, Cong Yu, Dawood Sayed, Johnathan Goree, Mark K. Lyons, Andrew Sack, Diana Bruce, Manish Bharara, Rose Province-Azalde, David Caraway, Leonardo Kapural

Department of Neurosurgery Faculty Papers

OBJECTIVE: The objective of this study was to evaluate the 24-month durability of pain relief, function, quality of life, and safety outcomes for patients with nonsurgical refractory back pain (NSRBP) treated with high-frequency spinal cord stimulation (SCS) within a large, national, multicenter randomized controlled trial (RCT).

METHODS: Following the completion of an RCT comparing high-frequency SCS plus CMM with CMM alone for the treatment of NSRBP, patients gave additional consent for a follow-up extension to 24 months. Presented is the cohort analysis of all patients treated with high-frequency SCS following the optional crossover at 6 months. The outcomes assessed to …

Impact Of Climate Change On Surgery: A Scoping Review To Define Existing Knowledge And Identify Gaps, Tina Bharani, Rebecca Achey, Harris Jamal, Alexis Cherry, Malcolm K. Robinson, Guy J. Maddern, Deirdre K. Tobias, Divyansh Agarwal

Department of Surgery Faculty Papers

With climate change accelerated at a worrisome rate, global warming also will have implications for surgery and surgical practice. The goal of this current study was to systematically survey the literature and better understand how climate change has affected surgical disease burden, surgical care delivery, and surgical outcomes. We performed a comprehensive scoping review, screening 3334 unique citations from three databases – 1766 from Embase, 1329 from Pubmed and 239 from Scopus – to identify studies that had associated climate change with surgery. After systematic searching, quality appraisal, and data extraction, we synthesized findings from qualitative and quantitative studies. Twenty-six …

Editorial: Resilience, Quality Of Life And Psychosocial Outcomes Of Cancer Patients And Their Caregivers, Nida Zahid, Nargis Asad, Ashraf El-Metwally

Department of Surgery

No abstract provided.

Cavernous Malformations Of The Central Nervous System: An International Consensus Statement, Anastasia Tasiou, Alexandros G. Brotis, Adamantios Kalogeras, Christos Tzerefos, Cargill H. Alleyne, Alexandros Andreou, Andreas K. Demetriades, Nikolaos Foroglou, Robert M. Friedlander, Bengt Karlsson, Neil Kitchen, Torstein R. Meling, Aristotelis Mitsos, Vasilios Panagiotopoulos, Themistoklis Papasilekas, Giacomo Pavesi, Lukas Rasulic, Alejandro N. Santos, Robert F. Spetxler, Ulrich Sure, Stavropoula Tjoumakaris, Christos M. Tolias, Peter Vajkoczy, Kostas N. Fountas

Department of Neurosurgery Faculty Papers

Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial.

Research question: A consensus may navigate neurosurgeons through the decision-making process of selecting the optimal treatment for asymptomatic and symptomatic CMs.

Material and methods: A 17-item questionnaire was developed to address controversial issues in relation to aspects of the treatment, surgical planning, optimal surgical strategy for specific age groups, the role of stereotactic radiosurgery, as well as a follow-up pattern. …