Surgery Commons^™

Profibrotic Behavior Of Fibroblasts Derived From Patients That Develop Posttraumatic Shoulder Stiffness, Benjamin A. Hendy, Jolanta Fertala, Thema Nicholson, Joseph A. Abboud, Surena Namdari, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND AND AIMS: Arthrofibrosis is a severe scarring condition characterized by joint stiffness and pain. Fundamental to developing arthrofibrotic scars is the accelerated production of procollagen I, a precursor of collagen I molecules that form fibrotic deposits in affected joints. The procollagen I production mechanism comprises numerous elements, including enzymes, protein chaperones, and growth factors. This study aimed to elucidate the differences in the production of vital elements of this mechanism in surgical patients who developed significant posttraumatic arthrofibrosis and those who did not.

METHODS: We studied a group of patients who underwent shoulder arthroscopic repair of the rotator cuff. …

Emerging Therapeutic Strategies For Diffuse Intrinsic Pontine Glioma: A Systematic Review, Shahrukh Farrukh, Shagufta Habib, Amna Rafaqat, Zouina Sarfraz, Azza Sarfraz, Muzna Sarfraz, Karla Robles-Velasco, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Of all central nervous systems tumors, 10-20% are located in the brainstem; diffuse intrinsic pontine glioma (DIPG) is diagnosed in 80% of them. With over five decades of clinical trial testing, there are no established therapeutic options for DIPG. This research article aims to collate recent clinical trial data and provide a landscape for the most promising therapies that have emerged in the past five years.
Methods: PubMed/MEDLINE, Web of Science, Scopus, and Cochrane were systematically searched using the following keywords: Diffuse intrinsic pontine glioma, Pontine, Glioma, Treatment, Therapy, Therapeutics, curative, and/or Management. Both adult and pediatric patients with …

Severe Ocular Alkali Injury Managed With An Externally Sutured Amniotic Membrane And Customized Symblepharon Ring, Sophia S. Lam, Bonnie Sklar, Marisa Schoen, Christopher J. Rapuano

Student Papers, Posters & Projects

Alkali injuries are ocular emergencies that require immediate evaluation and therapy to preserve vision. Severe alkali injuries can result in long‑term vision‑threatening sequelae including symblepharon, corneal ulceration, corneal scarring, limbal stem cell deficiency, xerophthalmia, cicatricial changes of the eyelid and adnexa, glaucoma, uveitis, and permanent vision loss. Treatment is aimed at neutralizing the pH, controlling inflammation, and restoring the ocular surface. Here, we present the case of a 35‑year‑old male who sustained direct ocular exposure to sodium hydroxide, resulting in significant corneal and conjunctival epithelial defects despite aggressive initial medical therapy. The patient subsequently received a large, externally sutured amniotic …

Variance In Management Of Extracorporeal Membrane Oxygenation-Associated Fibrin Sheaths At A Single Institution, Alexandra Tedesco Md, Monica Majumdar Md, Jamel P. Ortoleva Md, Christine Nayar Md, Masashi Kawabori Md, Payam Salehi Md, Ali Irshad Md

Abington Jefferson Health Papers

Objective: Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure has been increasingly used by advanced critical care practitioners. The thromboembolic complications of ECMO have been extensively discussed and researched; however, research and discussion on the development, risks, and management of cannulae-associated fibrin sheaths are lacking.

Methods: Institutional review board approval was not required. We have presented three cases detailing the identifi- cation and individualized management of ECMO-associated fibrin sheaths at our institution. The three patients provided written informed consent for the report of their case details and imaging studies.

Results: Of our three patients with ECMO-associated …

Sphenopalatine Artery Pseudoaneurysm Formation Following Facial Trauma: A Case Report And Literature Review, Kareem El Naamani, Stephen Capone, Ching-Jen Chen, Lisa Tartaglino, Marc Rosen, Rawad Abbas, Georgios S. Sioutas, Abdelaziz Amllay, Adam Hunt, Michael Reid Gooch, Nabeel Herial, Pascal Jabbour, Robert H. Rosenwasswer, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

Facial fractures, specifically orbitozygomatic and zygomaticomaxillary complex fractures, are well-documented and common injuries. Pseudoaneurysm formation following cerebrovascular blunt trauma is a rarely experienced complication with an incidence rate of less than 1% with only a few cases reported in the literature. Traumatic pseudoaneurysm formation of the sphenopalatine artery (SPA), the deepest branch of the maxillary artery, is extremely rare due to the deep location of the SPA and its protection from bony landmarks. In craniofacial trauma, pseudoaneurysm formation is not apparent on physical examination due to its deep location and usually presents as persistent nasal bleeding. SPA pseudoaneurysms can present …

Opioid Prescriptions In A Veteran Population Undergoing Lumbar Spine Surgery: What Are The Current Knowledge Gaps?, Mark J. Lambrechts, Hernan Roca, Brian A. Karamian

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Protocol: New York State Race, Ethnicity, And Insurance Disparities In Follow-Up Prostate Cancer Screening, Seth Greenspan, Mansi Chandra, Hyun Woo Joo, Netanel Sapir, Jonathan Gorman, Jie Yang, Xiaoning Li, Barghav Cavale, Allegra Fierro, Annie Laurie Laurie Shroyer, John P. Fitzgerald

Department of Urology Faculty Publications

Using de-identified reports from the Statewide Planning and Research Cooperative System (SPARCS) data, this descriptive study will identify the impact of socioeconomic status (SES) metrics on the follow-up prostate cancer screening care within 3 years of index prostate cancer screening test in NYS. The socioeconomic status metrics will be subclassified into race, insurance, and ethnicity and each of these sub-components will be evaluated for its impact on the follow-up cancer screening care. The exclusion criteria for this study includes patients records with unknown age, age <55 or >75, previous history of prostate cancer or radical prostatectomy, previous prostate biopsy, female sex, lives …

Peptides That Block Ras-P21 Protein-Induced Cell Transformation, Matthew R Pincus, Bo Lin, Purvi Patel, Elmer Gabutan, Nitzan Zohar, Wilbur Bowne

Department of Surgery Faculty Papers

This is a review of approaches to the design of peptides and small molecules that selectively block the oncogenic RAS-p21 protein in ras-induced cancers. Single amino acid substitutions in this protein, at critical positions such as at Gly 12 and Gln 61, cause the protein to become oncogenic. These mutant proteins cause over 90 percent of pancreatic cancers, 40-50 percent of colon cancers and about one third of non-small cell cancers of the lung (NSCCL). RAS-p21 is a G-protein that becomes activated when it exchanges GDP for GTP. Several promising approaches have been developed that target mutant (oncogenic) RAS-p21 proteins …

Hemiparkinsonism Caused By A Lateral Sphenoid Wing Meningioma, With Tractography Analysis: Illustrative Case, Attill Saemann, Stefan Busch, Ethan Taub, Birgit Westermann, Cristina Granziera, Raphael Guzman, Luigi Mariani, Jehuda Soleman, Jonathan Rychen

Faculty, Staff and Student Publications

BACKGROUND: The etiologies of parkinsonism are diverse. A possible and rare cause of hemiparkinsonism is mechanical compression of the basal ganglia and its connecting white matter tracts. The authors present a case of hemiparkinsonism caused by a lateral sphenoid wing meningioma, discuss the underlying pathophysiology based on tractography, and systematically review the existing literature.

OBSERVATIONS: A 59-year-old female was referred for a left-sided tremor of the hand, accompanied by a cogwheel rigidity of the left arm. Symptomatology appeared 1 year earlier and worsened in the previous 6 months, finally also showing involvement of the left leg. Magnetic resonance imaging (MRI) …

Supporting Cardiac Perfusion By Preboa With Reduced Visceral Ischemia Despite Extended Occlusion, Paige Deville, John Hunt, Alan B. Marr, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alison Smith

School of Medicine Faculty Publications

No abstract provided.

One-Stage Synovectomies Result In Improved Short-Term Outcomes Compared To Two-Stage Synovectomies Of Diffuse-Type Tenosynovial Giant Cell Tumor (D-Tgct) Of The Knee: A Multicenter, Retrospective, Cohort Study, Geert Spierenburg, Floortje G M Verspoor, Jay S Wunder, Anthony M Griffin, Peter C Ferguson, Matthew T Houdek, David M King, Richard Boyle, Robert Lor Randall, Steven W Thorpe, Jacob I Priester, Erik J Geiger, Lizz Van Der Heijden, Nicholas M Bernthal, Bart H W B Schreuder, Hans Gelderblom, Michiel A J Van De Sande

Rothman Institute Papers

Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion …

Clinical Outcomes With And Without Adherence To Evidence-Based Medicine Guidelines For Lumbar Degenerative Spondylolisthesis Fusion Patients, Glenn A Gonzalez, Guilherme Porto, Kevin Hines, Daniel Franco, Thiago S Montenegro, Aria Mahtabfar, Matthew O'Leary, J. Miao, Sara Thalheimer, Joshua Pelta-Heller, Ashwini Sharan, James Harrop

Department of Neurosurgery Faculty Papers

Introduction: Degenerative lumbar spondylolisthesis (DS) patients are treated with instrumented fusion, following EBM guidelines, and typically have excellent clinical outcomes. However, not all lumbar fusion procedures adhere to EBM guidelines, typically due to a lack of prospective data.

Objective: This retrospective study compared outcomes of DS lumbar fusion patients treated according to EBM guidelines (EBM concordant) to lumbar fused patients with procedures that did not have clear EBM literature that supported this treatment, the goal being to examine the value of present EBM to guide clinical care.

Methods: A total of 125 DS patients were considered EBM concordant, while 21 …

Spontaneous Large Volume Hemothorax Managed With A Small-Bore Chest Tube, Moiz Salahuddin, Samia Ayub

Department of Medicine

A 67-year-old male with metastatic lung cancer presented with acute shortness of breath and increasing oxygen requirements. He had a decreasing hemoglobin for which he required red blood cell transfusions. His chest x-ray showed near complete white-out of the left lung. Bedside ultrasound (Handheld Sonostar C4PL) showed a large pleural effusion with swirling echogenic material suggestive of plankton sign. The pleural effusion was aspirated and showed frank blood, after which a small-bore chest tube (SBCT) was inserted. A total of 3200ml of blood was drained with the SBCT. There was complete clearance of the pleural space, and no further blood …

Parent Satisfaction With Same Day Discharge After Laparoscopic Appendectomy For Non Perforated Appendicitis, Nelimar Cruz-Centeno, James Fraser, Shai Stewart Md, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Richard J. Hendrickson, Charles L. Snyder, Bhargava Mullapudi, Shawn D. St.Peter, Jason D. Fraser, Tolulope A. Oyetunji

Presentations

Background: Same-day discharge (SDD) after laparoscopic appendectomy for acute non-perforated appendicitis is safe, without an increased rate of postoperative complications, emergency department visits, or re-admissions. We aimed to evaluate caregiver satisfaction with this protocol. Materials and Methods: Patients discharged on the day of laparoscopic appendectomy for non-perforated acute appendicitis were identified between January 2022-August 2022. Surveys to evaluate satisfaction with the protocol were distributed to the caregivers via e-mail or text message 96 hours after discharge. Telephone surveys were conducted if there were no responses to the initial online survey. The surveys assessed comfort with SDD, post-operative pain control adequacy, …

Neighborhood Deprivation And Residential Property Values Do Not Affect Weight Loss At 1 Or 3 Years After Bariatric Surgery, Adam Drewnowski, Benjamin D Hong, Ernest Shen, Ming Ji, Silvia R Paz, Bhumi B Bhakta, Mayra Macias, Cecelia L Crawford, Kristina H Lewis, Jialuo Liu, Darren D Moore, Sameer B Murali, Deborah R Young, Karen J Coleman

Faculty, Staff and Student Publications

OBJECTIVE: This study examined the association between individual- and neighborhood-level sociodemographic factors and surgical weight loss at 1 year (short term) and 3 years (long term).

METHODS: Data were obtained from the baseline survey of the BELONG (Bariatric Experience Long Term) prospective longitudinal cohort study. Individual-level self-reported data on sex, race and ethnicity, education, and household income were obtained by survey. Data from the 2010 US Census were used to calculate area Neighborhood Deprivation Index score and median value of owner-occupied housing units at the census tract level.

RESULTS: Patients (N = 1341) had a mean age of 43.4 (SD …

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study, Nelimar Cruz-Centeno, James A. Fraser Md, Shai Stewart Md, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Richard J. Hendrickson, Charles L. Snyder, Shawn D. St.Peter, Jason D. Fraser, Tolulope A. Oyetunji

Presentations

Introduction: Initial management of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Here we describe the protocol and subsequent outcomes. Methods: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016-2020. All patients were managed per the protocol outlined in Figure 1. All were given formula or breast milk after the post-anesthesia care unit and discharged home after tolerating three consecutive feeds. Feedings were given every 2-3 …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla B. Briggs, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Tolulope A. Oyetunji, Jason D. Fraser

Presentations

Introduction: Our institution previously reported on outcomes of children with untreated and not spontaneously draining breast abscesses. This study aimed to evaluate the outcomes of all patients with breast abscesses who were evaluated at our institution. Methods: Following IRB approval, all patients < 18-years-old with breast abscesses were included. A total of 145 patients treated from January 2008-December 2018 were identified. Patients were divided into 2 groups; Group 1 included patients initially evaluated at our institution and Group 2 included patients who were initially evaluated at referring centers. The primary outcome was disease persistence. Secondary outcomes were antibiotic utilization, number and type of procedures performed, and risk factors for recurrence. Statistical analysis was performed using STATA® 17 with a p-value of <0.05 indicating significance. Results: A total of 145 patients were identified: 111 (76.6%) in Group 1 and 34 (23.4%) in Group 2. Demographics were similar between groups. Of the 111 patients in Group 1, 2 (1.8%)) were treated with observation alone, 58 (52.3%) were treated with antibiotics alone, 26 (23.4%) were treated with aspiration, and 25 (22.5%) were treated with incision and drainage. Of the 34 patients in Group 2, 4 (11.8%) were treated initially with observation, 22 (64.7%) with antibiotics alone, 5 (14.7%) with manual expression, 2 (5.9%) with incision and drainage, and 1 (2.9%) with warm compresses. Patients in Group 1 were more likely to receive needle aspiration (23.4% vs. 0%; p<0.001) or incision and drainage (22.5.% vs. 5.9%; p<0.001) as initial treatment. Compared to Group 2, patients in Group 1 were more likely to be prescribed clindamycin when treated with antibiotics alone (69.9% vs 18.2%; p<0.001). They also had a 12.6% persistent disease rate (n=14). Second treatment in those with persistent disease included aspiration in 50% (n=7), incision and drainage 45.5% (n=5), antibiotics 7.1% (n=1), and manual expression 7.1% (n=1). No patients had persistent disease following second treatment. Patients in Group 2 were more likely to be treated with antibiotics alone (64.7% vs. 52.3%; p<0.001), with trimethoprim/sulfamethoxazole being the most commonly prescribed antibiotic (54.6%). In patients with persistent disease treated at our institution following initial evaluation at a referring center, 50.0% were treated with antibiotics alone, 26.5% with aspiration, 17.7% with incision and drainage, and 5.9% with manual expression. Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%;). Conclusions: Persistent breast abscesses may be treated with antibiotics alone in community and tertiary care centers. Disease persistence is similar regardless of the initial treatment setting.

Caesarean Section For Placenta Previa: A Retrospective Cohort Study Of Anaesthesia Techniques, Samina Ismail, Saima Rashid

Department of Anaesthesia

Objective: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.
Methods: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.
Results: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, …

Does Mainstream Brca Testing Affect Surgical Decision-Making In Newly-Diagnosed Breast Cancer Patients?, Quratul Ain, Caroline Richardson, Miriam Mutebi, Angela George, Zoe Kemp, Jennifer E. Rusby

General Surgery, East Africa

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making.

Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively.

Results: 580 eligible women had mainstream genetic testing. …

Sex-Related Differences In Acuity And Postoperative Complications, Mortality And Failure To Rescue, Qi Yan, Jeongsoo Kim, Daniel E Hall, Myrick C Shinall, Katherine Moll Reitz, Karyn B Stitzenberg, Lillian S Kao, Chen-Pin Wang, Zhu Wang, Susanne Schmidt, Bradley B Brimhall, Laura S Manuel, Michael A Jacobs, Paula K Shireman

Faculty, Staff and Student Publications

INTRODUCTION: Yentl syndrome describing sex-related disparities has been extensively studied in medical conditions but not after surgery. This retrospective cohort study assessed the association of sex, frailty, presenting with preoperative acute serious conditions (PASC), and the expanded Operative Stress Score (OSS) with postoperative complications, mortality, and failure-to-rescue.

METHODS: The National Surgical Quality Improvement Program from 2015 to 2019 evaluating 30-d complications, mortality, and failure-to-rescue.

RESULTS: Of 4,860,308 cases (43% were male; mean [standard deviation] age of 56 [17] y), 6.0 and 0.8% were frail and very frail, respectively. Frailty score distribution was higher in men versus women (P < 0.001). Most cases were low-stress OSS2 (44.9%) or moderate-stress OSS3 (44.5%) surgeries. While unadjusted 30-d mortality rates were higher (P < 0.001) in males (1.1%) versus females (0.8%), males had lower odds of mortality (adjusted odds ratio (aOR) = 0.92, 95% confidence interval [CI] = 0.90-0.94, P < 0.001) after adjusting for frailty, OSS, case status, PASC, and Clavien-Dindo IV (CDIV) complications. Males have higher odds of PASC (aOR = 1.33, CI = 1.31-1.35, P < 0.001) and CDIV complications (aOR = 1.13, CI = 1.12-1.15, P < 0.001). Male-PASC (aOR = 0.76, CI = 0.72-0.80, P < 0.001) and male-CDIV (aOR = 0.87, CI = 0.83-0.91, P < 0.001) interaction terms demonstrated that the increased odds of mortality associated with PASC or CDIV complications/failure-to-rescue were lower in males versus females.

CONCLUSIONS: Our …