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ABSTRACT: ABSTRACT: Annals of Surgical Innovation and Research enters its fourth year as an open access, fully on-line journal. In the last few years we witnessed dramatic changes in the world of science, clinically and from a research point of view. Social media and the ever growing world wide web became an integral part of science groups and discussion forums. These new technologies allow for a wide and fast dissemination of cutting edge research, clinical findings and are capable of incorporating audio-visual content unlike any other form of scientific publication, in our fast paced environment an important point not to underestimate. Its big advantage is the open access policy which allows everyone to see your research and dynamic manuscript immediately upon acceptance. With incorporating an unlimited number of dynamic manuscripts we take the forefront in 'multimedia-publishing'. This new concept is especially useful in the field of minimally invasive surgery, robotic surgery and newer technologies, like NOTES, involving endoscopic devices where visual content is more important than a plain manuscript. Scientists still fear to publish open access because of its costs and still not wide acceptance.
Annals of Surgical Innovation and Research 06/2011; 5:3.
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ABSTRACT: Minimally Invasive Surgical Oncology: State-of-the-Art Cancer Management offers a unique compendium of the current knowledge and applied techniques in treating cancer with a minimally invasive approach. It is a comprehensive text trying to cover all fields in oncology where minimally invasive surgery is currently used. The book is divided into two sections. Section one covers general topics ranging from historical aspects of the field to research in oncology, covering topics like residency training and includes contributions special to oncology like immunology and changes in elderly patients. Section two is subdivided into 25 chapters, organ-based, covering all aspects of minimally invasive surgery in the cancer patient in a unique way. At the end of each chapter the reader will find a section about future trends and a quick ref- erence guide to the specific topic and procedure. More so, the accompanying DVD offers tips and tricks by experts in the field explaining their surgical approach in a step-by-step fashion.
The ever growing field of minimally invasive surgery in combination with a better understanding of the consequent immunological and pathophysiologic changes has led to applications of minimally invasive approaches to maximally invasive disease processes. Over almost 2 decades, this field has rapidly evolved and there is almost no disease process and organ which has not been addressed. Despite this, oncologic diseases have always been addressed with great reservation and, for a long time, it was thought that cure could only be safely achieved with traditional open surgery.
When we first talked about the concept of the book we quickly realized that there is no existing book focused on the topic. All that was available were surgical atlases, case reports, and some randomized studies, particularly for covering colorectal malig- nancies. There was no clear guide of how to apply these techniques with maximal short- and long-term benefit to cancer patients. Our goal was to give the reader a bet- ter understanding of how the proven advantages of minimally invasive surgery could factor into an individualized surgical treatment plan, understanding that management of cancer is always multidisciplinary.
Minimally Invasive Surgical Oncology: State-of-the-Art Cancer Management
brings together the expertise of not only experts but true leaders and pioneers in the field. It provides clear explanations of all surgical procedures as outlined in the table of contents but is, by far, more than just another surgical atlas. Current nonsurgical therapies, future trends, and alternative procedures are discussed with a quick refer- ence guide and a multimedia section. We hope that the unique structure of this book will particularly be helpful to those engaged in treating oncological patients, contrib- ute to a wider acceptance of the application of minimally invasive techniques in malignancies and might open up new avenues for future research.
Philadelphia, PA, USA Ronald Matteotti Boston, MA, USA Stanley W. Ashley
1 edited by Ronald Matteotti, 06/2011; http://www.springer.com/medicine/surgery/book/978-3-540-45018-4., ISBN: 978-3-540-45021-4
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ABSTRACT: The amount and content of medical student teaching in the operating room and its alignment with clerkship goals was unknown.
A qualitative research design using field observations, followed by qualitative and quantitative data coding and analysis.
A mean of 9.8% of the total case time (range 1.6%-20.2%) was spent teaching clerkship goals. Teaching strategies based on basic principles of learning were used during a mean of 66% of the total case time (range 30%-99%). The most common teaching strategy was active student participation (28%) followed by command (14%) and lecture (13%). Educational experience in the OR was rated 4.0 (out of 5) by faculty and 3.3 by students. No correlation existed between student satisfaction and time actively participating in the operation or time spent teaching to clerkship goals (P = .66, P = .95, respectively).
Teaching in the OR is more focused on technical aspects of the operation than the goals of a core surgery clerkship.
American journal of surgery 07/2010; 200(1):167-72. · 2.36 Impact Factor
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ABSTRACT: Intestinal drug efflux proteins play a major role in the pharmacokinetics of many drugs. We assessed diurnal rhythmicity in the expression of ten major drug transporters. We acquired male Sprague-Dawley rats and harvested jejunal mucosa at 3-h intervals across a 24-h period. qPCR was performed for ten transporters: Mdr1, Mdr3, Mrp1 - 3, Mct1, Brcp, Pept1, Octn2, and Oatp-b. Rhythmicity was assessed with the cosinor procedure. Diurnal rhythmicity was observed for Mdr1, Mct1, Mrp2, Pept1, and Bcrp (1.6 - 5.4-fold-changes). Acrophases occurred during fasting hours. We conclude that many drug transporters display profound diurnal rhythms in transcription, which may underlie diurnal rhythms in drug pharmacokinetics.
Journal of Pharmacological Sciences 10/2008; 108(1):144-8. · 2.08 Impact Factor
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Journal of Gastrointestinal Surgery 10/2008; · 2.83 Impact Factor
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ABSTRACT: To evaluate the indications for and the outcomes from distal pancreatectomy.
Retrospective chart review of 171 patients who underwent distal pancreatectomy at Brigham and Women's Hospital between January 1996 and August 2005.
Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor. Fifty-six percent of the patients underwent a standard distal pancreatectomy +/- splenectomy (group 1), whereas 44% of distal pancreatic resections included additional organs or contiguous intraperitoneal or retroperitoneal tumor (group 2). The overall post-operative complication rate was 37%; the most common complication was pancreatic duct leak (23%). When compared to patients undergoing standard distal pancreatectomy, those with a more extensive resection including multiple viscera and/or metastatic or contiguous tumor resection had no significant difference in overall complication rate (35% v. 39%, p = 0.75), leak rate (25% v. 20%, p = 0.47), new-onset insulin-dependent diabetes mellitus (3% v. 4%, p = 1.0), and mortality (2% v. 4%, p = 0.656).
This series includes a large number of patients in whom distal pancreatectomy was performed as part of a multivisceral resection or with en bloc resection of contiguous tumor. Complications were no different in these patients when compared to patients undergoing straightforward distal pancreatectomy.
Journal of Gastrointestinal Surgery 09/2008; 12(12):2177-82. · 2.83 Impact Factor
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ABSTRACT: The surgical management of gastrointestinal stromal tumors (GISTs) has been impacted by the development of tyrosine kinase inhibitors (TKIs), advances in surgical technique, and a better understanding of the natural history of this unique disease. In this article, we review the technical aspects of the operations, the expanding role of laparoscopy, and the indications for neoadjuvant and neoadjuvant TKI therapy in primary GIST. Furthermore, we explore the rationale for and incorporation of surgery in the multidisciplinary management of advanced GIST.
Journal of Gastrointestinal Surgery 04/2008; 12(9):1592-9. · 2.83 Impact Factor
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Evan Matros,
Flavio Rocha,
Michael Zinner,
John Wang, Stanley Ashley,
Elizabeth Breen,
David Soybel,
Brent Shoji,
Anne Burgess,
Ronald Bleday,
Richard Kuntz,
Edward Whang
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ABSTRACT: A preliminary report has been interpreted to suggest that gum chewing reduces duration of postcolectomy ileus.
We rigorously tested this hypothesis in a prospective, randomized, placebo-controlled study. Patients undergoing open colectomy (n = 66) were randomized to receive 1 of 3 postoperative regimens beginning on postoperative day 1: sips (control, n = 21); sips and accupressure wrist bracelet (placebo, n = 23); and sips and gum chewing (treatment, n = 22). Patients were unaware of which regimen constituted placebo or treatment; end points were assessed by blinded investigators. Power was set a priori at 85% to detect a 0.75-day difference in time to first postoperative passage of flatus between placebo and treatment groups. Groups were compared using the log-rank test.
Groups were equivalent with respect to demographic and surgical characteristics. Median times to first postoperative passage of flatus were as follows: sips, 67 hours; bracelet and sips, 72 hours; gum and sips, 60 hours (p = 0.384). There were no significant differences in time to passage of first bowel movement, time until patients were ready for discharge, or time until actual discharge among the three groups. Inpatient and 30-day followup demonstrated no difference in frequency or distribution of postoperative complications.
In contrast to findings of a preliminary study, our clinical trial suggests that gum chewing, although safe, does not reduce duration of postcolectomy ileus.
Journal of the American College of Surgeons 06/2006; 202(5):773-8. · 4.55 Impact Factor
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ABSTRACT: Cytokeratins are markers of epithelial cell differentiation useful in determining histogenesis for malignancies with an unknown primary. Application of this principle to a single malignancy may identify cancer subtypes with altered developmental programs. Herein, we investigate the relevance of two widely used cytokeratins (CKs), 7 and 20, to subtype pancreas cancer and identify associations with clinical features.
A tissue microarray was constructed using tumor specimens from 103 patients who underwent resection for pancreatic adenocarcinoma with curative intent. A subset of resection specimens was evaluated for pancreatic intraepithelial neoplasia (PanIN) lesions. Tissues were immunostained by using specific anticytokeratin 7 and 20 monoclonal antibodies.
CK 7 and 20 expression was present in 96% and 63% cases of pancreatic adenocarcinoma, respectively. Ubiquitous CK 7 expression precluded further analysis. Tumoral CK 20 expression was not associated with any histopathologic parameter but correlated with worse prognosis when considered as either a dichotomous (P=0.0098) or continuous (P=0.007) variable. In a multivariate model, tumoral CK 20 expression remained a significant independent prognosticator. CK 20 expression was absent in all PanIN lesions from eight resection specimens in which the tumor component was negative for CK 20. In contrast, presence of tumoral CK 20 was highly concordant with its expression in corresponding PanINs.
CK 20 expression defines a subtype of pancreas cancer with important biologic properties. When present, CK 20 expression is an early event in pancreatic carcinogenesis identifiable in precursor lesions. Further studies to identify the underlying genetic changes associated with this altered developmental pathway are warranted.
Cancer 03/2006; 106(3):693-702. · 4.77 Impact Factor
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ABSTRACT: The traditional scope of general surgery (GS) has been broadly encompassing. Although it is generally accepted that we need a more defined curriculum for GS training, the criteria for limiting its scope remain controversial. One approach is to perform a needs assessment, defined based on an analysis of current GS practice. The purpose of this study was to use such a needs assessment to model a subset of the GS curriculum in colon and rectal surgery.
The numbers of colon and anorectal procedures performed in the prior 24 months by 982 GS taking the 2004 ABS Recertification Examination in Surgery were examined to determine the mean number of procedures per surgeon along with the percentage of surgeons who had performed at least 1 of the identified procedures. The impact of using these numbers to define a general surgical curriculum was then examined.
Procedures performed frequently and by >60% GS included appendectomies, colostomies, colectomies, hemorrhoidectomies, and anorectal abscess procedures. Procedures performed infrequently, yet performed by >30% of surgeons at least once, included subtotal colectomies, abdominoperineal resections, transanal excisions, sphincterotomies, and anorectal fistulotomies. The procedures performed rarely included ileoanal pouch anastomoses and procedures for incontinence and rectal prolapse.
Based on this analysis, a colorectal surgical curriculum would include the treatment of diseases that led to commonly performed operations such as colon cancer, diverticular disease, lower gastrointestinal bleeding, mesenteric ischemia, inflammatory bowel disease (IBD), hemorrhoids, and anorectal diseases. The management of low rectal cancer, complex IBD, rectal prolapse, and fecal incontinence might not be essential content. A curriculum based on needs assessment would deemphasize or even eliminate some areas traditionally considered within the realm of GS. Although this might appropriately serve as a basis for defining the scope of GS, the indirect consequences will need to be defined.
Journal of Surgical Education 64(6):324-7. · 1.38 Impact Factor
