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Distraction enterogenesis may provide a novel therapy for short bowel syndrome. Previously described methods have relied on isolated intestinal segments or transmural fixation because of ineffective endoluminal attachment. We hypothesized that a novel approach of geometric coupling between a tapering device and the mesenteric curvature would allow trans-stomal distraction enterogenesis.A catheter...
Trauma centers commonly administer tetanus prophylaxis to patients sustaining open wounds. In the United States, there are different vaccinations available for adult administration: tetanus/diphtheria toxoid (Td) or tetanus/reduced diphtheria and acellular pertussis (Tdap). The importance of the Tdap preparation lies in its vaccination against pertussis while providing tetanus immunity. Vaccination...
Practice administration education and experience during surgery residency are variable among residency programs. To better understand these issues, a survey of recent General Surgery residency (GS) graduates was compared with the results from a survey of GS program directors (PD).All GS graduates completing residency from 2009 to 2013 (n = 5,512) were surveyed to assess opinions regarding the desire...
We hypothesized that most contralateral breast cancers (CBCs) develop ≥5 years after the primary breast cancer (PBC) and that CBCs have more favorable tumor characteristics.This is a single-institution retrospective review of 323 patients who were diagnosed with CBC from 1990 to 2014. CBCs were diagnosed at least 1 year after the diagnosis of PBC. Χ2 tests and one-way analysis of variance were used...
Progressive hemorrhagic injury (PHI) in traumatic brain injury (TBI) patients is associated with poor outcomes. Early prediction of PHI is difficult yet vital. We hypothesize that TBI subtype and coagulation would be predictors of PHI.This was a retrospective analysis of highest level activation adult trauma patients with evidence of TBI (head Abbreviated Injury Scale ≥3). Coagulopathy was determined...
Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable...
The majority of patients with primary hyperparathyroidism (PHPT) are diagnosed without the classic signs of renal or osseous complications. Vague and subjective symptoms have been attributed to PHPT but have been difficult to measure during the medical encounter. The Patient-Reported Outcomes Measurement Information System (PROMIS) of the National Institutes of Health contains validated measures of...
A diverting stoma is often performed at the time of low anterior resection (LAR) for rectal cancer after neoadjuvant chemoradiation (nCRT) to protect the anastomosis. The aim of this study was to compare surgical outcomes in large cohorts of mid-high rectal cancer patients undergoing LAR after nCRT with and without a diverting stoma.Patients undergoing LAR for rectal cancer (ICD-9 diagnosis code 154...
Every experienced surgeon has a patient whose life was saved by a blood transfusion (the “good”). In contrast, an overwhelming amount of evidence suggests that perioperative blood transfusion can be associated with adverse surgical outcomes (the “bad”). We wondered what patient characteristics, if any, can explain this clinical dichotomy with certain patients benefiting from transfusion, whereas others...
Our whole-body computed tomography protocol (WBCT), used to image patients with polytrauma, consists of a noncontrast head computed tomography (CT) followed by a multidetector computed tomography (40- or 64- slice) that includes an intravenous, contrast-enhanced scan from the face through the pelvis. WBCT is used to screen for blunt cerebrovascular injury (BCVI) during initial CT imaging of the patient...
The role of percutaneous cholecystostomy (PC) in the management of patients with acute calculous cholecystitis (ACC) remains controversial. The aim of this study is to report operative outcomes in a large cohort of patients undergoing PC before their delayed laparoscopic cholecystectomy (DLC).All patients who underwent DLC because of ACC between 2003 and 2012 were included. Outcomes of patients with...
MYCN amplification is a key molecular hallmark of high-risk neuroblastoma. Previously considered an “undruggable” target, MYCN transcription can be disrupted by inhibiting the bromodomain and the extraterminal (BET) domain family of proteins that regulates MYCN transcription epigenetically. JQ1 is a potent, small-molecule BET inhibitor that induces cell-cycle arrest and initiates apoptosis in neuroblastoma...
Propranolol has been shown previously to decrease the mobilization of hematopoietic progenitor cells (HPCs) after acute injury in rodent models; however, this acute injury model does not reflect the prolonged period of critical illness after severe trauma. Using our novel lung contusion/hemorrhagic shock/chronic restraint stress model, we hypothesize that daily administration of propranolol will decrease...
Patients with advanced cancer and an abdominal surgical emergency pose a dilemma, because rescue surgery may be futile. This study defines morbidity and mortality rates and identifies preoperative risk factors that may predict outcome.The National Surgical Quality Improvement Program database was queried for patients with disseminated cancer undergoing emergent abdominal surgery (2005–2012). Preoperative...
Reactive oxygen species (ROS) contribute to adult tumorigenesis; however, their roles in pediatric solid tumors are unknown. Here, we sought to define the steady-state ROS levels in neuroblastoma and to examine whether aggressive cellular behavior, which may predict treatment failure, is regulated by ROS.Neuroblastoma sections were assessed for 4-hydroxynonenal (4-HNE), a marker of intracellular lipid...
Noncommunicable diseases, including those requiring surgical care, are increasingly straining low- and middle-income countries. Globally, 11% of all disability-adjusted life-years lost result from conditions requiring surgery; however, little is known about country-specific burden. We piloted a household-based survey in a periurban district of Uganda to estimate the prevalence of surgical conditions...
Sentinel lymph node biopsy (SNB) as a staging and therapeutic procedure in melanomas 1–4 mm in thickness has been investigated extensively, however, the clinical value of SNB in thick melanomas is poorly understood.Patients undergoing operation for clinically node-negative melanoma >4 mm in depth between 2003 and 2010 were identified in the Surveillance Epidemiology and End Results registry. Two...
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