Surgery Commons^™

A Decade Of Blood-Brain Barrier Permeability Assays: Revisiting Old Traumatic Brain Injury Rat Data For New Insights And Experimental Design, Chris T Bolden, Scott D Olson, Charles S Cox

Faculty, Staff and Student Publications

Increased microvascular permeability at the level of the blood-brain barrier (BBB) often leads to vasogenic brain edema following traumatic brain injury (TBI). These pathologic conditions compromise the integrity of the neurovascular unit resulting in severe brain dysfunction. To quantify this permeability and assess ionic equillibrium, preclinical researchers have relied on the use of various molecular weight permeable dyes such as Evans Blue that normally cannot enter the brain parenchyma under homeostatic conditions. Evans Blue, the most cited of the molecular weight dyes, has reported reproducibility issues because of harsh extraction processes, suboptimal detection via absorbance, and wide excitation fluorescence spectra …

Healthcare Utilization Among Infants Discharged From The Neonatal Intensive Care Unit: A Descriptive Cost Analysis, Nutan B Hebballi, Elenir Bc Avritscher, Elisa Garcia, Andrew Bain, Marisa A Bartz-Kurycki, Kuojen Tsao, Mary T Austin

Faculty, Staff and Student Publications

The cost of readmissions of neonatal intensive care unit (NICU) graduates within 6 months and a year of their life is well-studied. However, the cost of readmissions within 90 days of NICU discharge is unknown. This study's objective was to estimate the overall and mean cost of healthcare use for unplanned hospital visits of NICU graduates within 90 days of discharge A retrospective review of all infants discharged between 1/1/2017 and 03/31/2017 from a large hospital system NICUs was conducted. All unplanned hospital visits (readmissions or stand-alone emergency department (ED) visits) occurring within 90 days post NICU discharge were included. …

Robot-Assisted Resection Of Left Ventricular Papillary Fibroelastoma Arising From The Mitral Chordal Apparatus, Kyle G Mitchell, Blaz Podgorsek, Diego E Fiorito, Juan A Abreu, Danny Ramzy

Faculty, Staff and Student Publications

The application of robot-assisted thoracoscopy to cardiac surgery affords an opportunity to leverage the exceptional intraoperative exposure, visualization, and dexterity of the robotic platform. Here, we report the case of a 72-year-old woman who presented to our institution for evaluation of a left ventricular mass that was identified following workup for an embolic event. We present an intraoperative video that provides technical details of the robot-assisted resection of the lesion, which was found to be a left ventricular papillary fibroelastoma arising from the mitral chordal apparatus. This case highlights the advantages provided by the robotic platform, which permitted complete, minimally …

Addition Of Aspirin To Venous Thromboembolism Chemoprophylaxis Safely Decreases Venous Thromboembolism Rates In Trauma Patients, Daniel Lammers, Michelle Scerbo, Annamaria Davidson, Matthew Pommerening, Jeffrey Tomasek, Charles E Wade, Jessica Cardenas, Jan Jansen, Charles C Miller, John B Holcomb

Faculty, Staff and Student Publications

Background: Trauma patients exhibit a multifactorial hypercoagulable state and have increased risk of venous thromboembolism (VTE). Despite early and aggressive chemoprophylaxis (CP) with various heparin compounds ("standard" CP; sCP), VTE rates remain high. In high-quality studies, aspirin has been shown to decrease VTE in postoperative elective surgical and orthopedic trauma patients. We hypothesized that inhibiting platelet function with aspirin as an adjunct to sCP would reduce the risk of VTE in trauma patients.

Methods: We performed a retrospective observational study of prospectively collected data from all adult patients admitted to an American College of Surgeons Level I Trauma center from …

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy, Jennifer H Gross, Mihir R Patel, Jeffrey M Switchenko, Tyler G Chan, H M Baddour, Azeem Kaka, Brian J Boyce, Nabil F Saba, Jonathan J Beitler, Mark El-Deiry

Faculty, Staff and Student Publications

IMPORTANCE: Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy.

OBJECTIVE: To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with …

Trends Over Time In Incidence Of Bicuspid Aortic Valve Patients With Thoracic Aortic Aneurysms In New York, Sarah Marc, Jahnvi Bansal, Alexander Cove, Annet Kuruvilla, Joshua Helali, Ashutosh Yaligar, Junying Wang, Jie Yang, Jonathan Price, Thomas Bilfinger, Henry Tannous, Annie Laurie Shroyer, Allison Mclarty

Department of Surgery Faculty Publications

Aim: Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, with increased risk for early onset thoracic aortic aneurysms (TAA). This study aims to examine the trends over time in incidence of BAV patients with TAA, given imaging advancements and increased frequency of imaging.

Methods: Using administrative billing codes, this retrospective cohort study analyzed New York Statewide Planning and Research Cooperative System records from January 2007- December 2018, evaluating BAV+TAA incidence trends. Subgroups based on index admission were evaluated with a pre-identified 2014 inflection time point using an interrupted time series (ITS) analysis.

Results: Using a …

Advances In Upper Gastrointestinal Surgery: Management And Diagnostic Techniques, Gregory L. Falk

Theses

Upper gastrointestinal surgery has progressively moved from the surgically open abdomen to minimally invasive surgery, largely due to technological improvements in instrumentation. A direct result of this Gestalt has been improved patient comfort, rapid recovery and significantly less length of stay in the hospital and therefore significant cost-savings. This was the key impetus to my development of many of the skills in minimally invasive surgery and the subsequent dissemination to other surgeons in an organized and well-recognized teaching system. Many of the novel techniques of this type of surgery led to several publications both in the English and French oncological …

Clinical Parameters Affecting Survival Outcomes In Patients With Low-Grade Serous Ovarian Carcinoma: An International Multicentre Analysis, Taymaa May, Marcus Bernardini, Stephanie Lheureux, Katja K H Aben, Elisa V Bandera, Matthias W Beckmann, Javier Benitez, Andrew Berchuck, Line Bjørge, Michael E Carney, Daniel W Cramer, Anna Defazio, Thilo Dörk, Diana M Eccles, Michael Friedlander, María Jose García, Ellen L Goode, Alexander Hein, Claus K Høgdall, Allan Jensen, Sharon Johnatty, Catherine J Kennedy, Lambertus A Kiemeney, Susanne K Kjær, Jolanta Kupryjańczyk, Keitaro Matsuo, Valerie Mcguire, Francesmary Modugno, Lisa E Paddock, Tanja Pejovic, Catherine M Phelan, Marjorie J Riggan, Cristina Rodriguez-Antona, Joseph H Rothstein, Weiva Sieh, Honglin Song, Kathryn L Terry, Anne M Van Altena, Adriaan Vanderstichele, Ignace Vergote, Liv Cecilie Vestrheim Thomsen, Penelope M Webb, Nicolas Wentzensen, Lynne R Wilkens, Argyrios Ziogas, Haiyan Jiang, Alicia Tone, Ovarian Cancer Association And The Australian Ovarian Cancer Study Group

Faculty, Staff and Student Publications

BACKGROUND: Women with low-grade ovarian serous carcinoma (LGSC) benefit from surgical treatment; however, the role of chemotherapy is controversial. We examined an international database through the Ovarian Cancer Association Consortium to identify factors that affect survival in LGSC.

METHODS: We performed a retrospective cohort analysis of patients with LGSC who had had primary surgery and had overall survival data available. We performed univariate and multivariate analyses of progression-free survival and overall survival, and generated Kaplan-Meier survival curves.

RESULTS: Of the 707 patients with LGSC, 680 (96.2%) had available overall survival data. The patients' median age overall was 54 years. Of …

A Rare Case Of Metaplastic Carcinoma Breast: Challenges In Diagnosis And Management, Prajwal Chandrashekhara, Rohith Holla

Manipal Journal of Medical Sciences

Background
Metaplastic breast carcinoma (MBC) is a rare and aggressive subtype of breast cancer, characterized by a heterogeneous combination of epithelial and mesenchymal components. It is often challenging to diagnose due to its distinct clinical and histological features, and it generally carries a poor prognosis due to its rapid progression and limited response to conventional therapies.

Case Presentation
We present the case of a 43-year-old female who presented with a rapidly enlarging right breast lump, which increased from 3 x 4 cm to 10 x 10 cm in 4 months. Clinical examination revealed a fixed, pigmented lump in the upper …

Challenging The Endovascular Era: Open Bypass From Distal Sfa To Pta Using Ipsilateral Reversed Saphenous Vein For Critical Limb Ischemia, Suraj Pai, Suresh Pai, Sanya Mukhida, Aditya Nair

Manipal Journal of Medical Sciences

Open surgical revascularization remains a vital option in select patients with critical limb ischemia (CLI), especially when endovascular interventions are not feasible. We present a case of a 69 -year-old diabetic male with Rutherford class 5 CLI, initially planned for above-knee amputation due to extensive arterial occlusion and severe rest pain. The disease was attributed to his very significant smoking history which was stopped only recently. His CT Angiogram study revealed occlusion of distal superficial femoral artery with suboptimal distal reformation. Given the absence of endovascular options, he underwent successful open bypass from the distal superficial femoral artery (SFA) to …

Perioperative Outcomes Of Patients With Bleeding Disorders Undergoing Major Surgery At An Academic Hemophilia Treatment Center, Ruben Rhoades, Zachary French, Amy Yang, Karen Walsh, Douglass A. Drelich, Steven E. Mckenzie

Department of Medicine Faculty Papers

Persons with bleeding disorders (PwBD) are at high risk for bleeding with invasive procedures. However, the risk of bleeding in PwBD undergoing major surgery and outcomes of patients managed perioperatively at a hemophilia treatment center (HTC) are not well described. We performed a retrospective review of surgical outcomes among PwBD undergoing major surgery between January 1st, 2017 and December 31st, 2019 at the Cardeza Foundation Hemophilia and Thrombosis Center in Philadelphia, PA. The primary outcome was postoperative bleeding, assessed according to the ISTH-SSC's 2010 definition. Secondary outcomes included use of unplanned postoperative hemostatic therapy, LOS, and 30-day readmission rate. Results …

Virtual Surgical Planning In Craniomaxillofacial Surgery: A Structured Review, Kaye Verlarde, Rentor Cafino, Armando Isla Jr., Karen Mae Ty, Xavier-Lewis Palmer, Lucas Potter, Larry Nadorra, Luchin Valrian Pueblos, Lemuel Clark Velasco

Electrical & Computer Engineering Faculty Publications

Craniomaxillofacial (CMF) surgery is a challenging and very demanding field that involves the treatment of congenital and acquired conditions of the face and head. Due to the complexity of the head and facial region, various tools and techniques were developed and utilized to aid surgical procedures and optimize results. Virtual Surgical Planning (VSP) has revolutionized the way craniomaxillofacial surgeries are planned and executed. It uses 3D imaging computer software to visualize and simulate a surgical procedure. Numerous studies were published on the usage of VSP in craniomaxillofacial surgery. However, the researchers found inconsistency in the previous literature which prompted the …

Synchronous Gastrointestinal Metastatic Large Cell Neuroendocrine Tumor And Metastatic Colon Adenocarcinoma: Case Report, Hari Movva, Giri Movva, Christian Pena, Vijian Dhevan

School of Medicine Publications

This article reports a case involving a synchronous silent metastatic rectal adenocarcinoma and metastatic large cell neuroendocrine tumor of the cecum and ascending colon. The patient presented with left sided abdominal pain and hematochezia with a noncontributory family, social, and medical history. This case presents a rare pathology not only due to the low incidence of synchronous gastrointestinal malignancies, but due to the unusual silent patient presentation.

Pertussis And Influenza Immunization: Perceived Attitude And Decision Of Postpartum Patients, Nutan B Hebballi, Tayler Parker, Elisa I Garcia, Dalya M Ferguson, Susan Lesser, Kuojen Tsao, Maryam Broussard, Susan H Wootton

Faculty, Staff and Student Publications

BACKGROUND: Vaccination of pregnant patients with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccine during influenza season can reduce maternal and fetal morbidity and mortality; nevertheless, vaccination rates remain suboptimal in this patient population. To investigate the effect of a brief educational counseling session on maternal Tdap and influenza vaccination and determine factors influencing women's decision in regards to receiving Tdap and or influenza vaccine during their pregnancy.

METHODS: A face-to-face semi-structured cross-sectional survey was administered to postpartum patients on their anticipated day of discharge (June 11-August 21, 2018). A brief educational counseling session about maternal …

Unsupervised Machine Learning Using K-Means Identifies Radiomic Subgroups Of Pediatric Low-Grade Gliomas That Correlate With Key Molecular Markers, Debanjan Haldar, Anahita Fathi Kazerooni, Sherjeel Arif, Ariana Familiar, Rachel Madhogarhia, Nastaran Khalili, Sina Bagheri, Hannah Anderson, Ibraheem Salman Shaikh, Aria Mahtabfar, Meen Chul Kim, Wenxin Tu, Jefferey Ware, Arastoo Vossough, Christos Davatzikos, Phillip B Storm, Adam Resnick, Ali Nabavizadeh

Department of Neurosurgery Faculty Papers

Introduction: Despite advancements in molecular and histopathologic characterization of pediatric low-grade gliomas (pLGGs), there remains significant phenotypic heterogeneity among tumors with similar categorizations. We hypothesized that an unsupervised machine learning approach based on radiomic features may reveal distinct pLGG imaging subtypes.

Methods: Multi-parametric MR images (T1 pre- and post-contrast, T2, and T2 FLAIR) from 157 patients with pLGGs were collected and 881 quantitative radiomic features were extracted from tumorous region. Clustering was performed using K-means after applying principal component analysis (PCA) for feature dimensionality reduction. Molecular and demographic data was obtained from the PedCBioportal and compared between imaging subtypes.

Results: …

Prognostic Factors For Mortality Of Pediatric Burn Injury In A National Tertiary Referral Center, Heru Angkoso, Aria Kekalih

The New Ropanasuri Journal of Surgery

Introduction. In Indonesia, burn injuries cause about 195,000 deaths annually. Data from the Ministry of the Health Republic of Indonesia showed the incidence of burns predominated at 1-4 years old. The mortality of pediatric burn patients in a tertiary hospital was 37.26%. This study aimed to find an association between known and unknown prognostic factors of mortality in Indonesian-specific characteristics.

Method. A retrospective analytical study included all pediatric burns admitted to Dr. Cipto Mangunkusumo General Hospital (CMGH) from 1998 to 2010. Variables within a period of the first 72 hours of admission were the focus of interest and were extracted …

Quality Of Life And Its Associated Factors In Patients After Esophagectomy At A Single National Referral Center, Dogma H. Sirirui, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Esophagectomy is the standard surgical treatment for resectable esophageal cancer patients. However, the success rate for this procedure was about 25–35% and was associated with a severe risk of postoperative complications. In addition, patients after esophagectomy have decreased their quality of life (QOL), but no research has been done in Indonesia. Therefore, this study was conducted to determine the quality of life after esophagectomy in Indonesia based on the patient population at Dr. Cipto Mangunkusumo General Hospital (CMGH).

Method. A retrospective study was conducted using quality–of–life instruments issued by the European Organization for Research and Treatment of Cancer (EORTC). …

Surgical Intervention For Endobronchial Tuberculosis With Total Bronchial Occlusion: A Case Report, Muhammad A. Putra, Matthew Billy, Radhyaksa Ardaya, Rut Hp Ekasiwi, Sari Rahmawati, Karel Hs Sumarsudi

The New Ropanasuri Journal of Surgery

Introduction. Endobronchial Tuberculosis (EBTB) is a specific TB form affecting the tracheobronchial tree with microbial and histopathological evidence. Early diagnosis is essential to provide timely treatment and prevent complications but also proves difficult due to the low positive rate of acid–fast bacilli (AFB) staining of sputum smears and non–specific clinical and radiological findings.

Case Illustration. We reported a 19–year–old man with a productive cough suspected of pulmonary tuberculosis, with a positive GeneXpert test and negative AFB smear. He received anti–tuberculosis drugs for six months. Although the symptoms initially seemed to improve, the patient complained of dyspnea during moderate activities in …

Potential Of Tumor Cell Seeding And Clinical Impact On Percutaneous Breast Biopsy Tracks: A Literature Review, I G.N. Gunawan Wibisana, Muhammad Mirwan

The New Ropanasuri Journal of Surgery

Introduction. Based on its effectiveness, a percutaneous breast biopsy was chosen because it has minimum side effects and fewer complications, does not distort the breast tissue architecture, and can be performed on an outpatient basis. However, the biopsy can damage the integrity of tumor cells, creating seeding at the site of the track made. Therefore, core biopsy is the method of choice for breast lesion sampling using a 14G needle that provides greater sensitivity. This study aims to explain whether the percutaneous biopsy track has the potential for the formation of tumor cell seeding and its clinical impact.

Methods …

Transplantation In Pediatrics Liver Failure Associated With Acute Hepatitis Of Unknown Etiology, Afid B. Putra, Agi S. Putranto, Muftah Risyaldi, Luthfian A. Nurachman

The New Ropanasuri Journal of Surgery

Introduction. On 5^th April 2022, some cases of severe acute hepatitis of unknown etiology in children were reported in the United Kingdom. Since then, the number has increased rapidly, with 650 probable cases identified worldwide. This review focuses on available information about managing acute liver failure (ALF) in pediatrics with acute hepatitis of unknown etiology through the perspective of hepatobiliary surgery.

Method. A literature review proceeded on some databases, namely PubMed and Google Scholar. Epidemiological data and technical policy were obtained from World Health Organization and some government institutions.

Results. Severe acute hepatitis can progressively develop into acute liver …