Deron J Tessier

Washington University in St. Louis, San Luis, Missouri, United States

Are you Deron J Tessier?

Claim your profile

Publications (42)102.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Postoperative wound complications are minimized after laparoscopic ventral hernia repair (LVHR) while maintaining low recurrence rates and acceptable morbidity. The purpose of this study is to evaluate efficacy and safety of LVHR in patients after organ transplantation in comparison to a large cohort of nontransplantation patients after LVHR. A retrospective, institutional review board (IRB)-approved review was performed on 347 patients who underwent LVHR between July 2000 and December 2007. LVHR was successfully completed in 38/38 transplantation patients (n = 21 liver, n = 5 cardiac, n = 8 kidney, n = 1 lung/kidney, n = 2 kidney/pancreas, n = 1 double lung) without conversion and in 301/309 (97.4%) nontransplant patients. Previous hernia repairs were attempted in 5/38 (13.2%) of the transplant patients and 108/309 (35.0%) of nontransplantation patients. Mean defect size was 256 cm(2) (p < 0.00001) and mesh size 780 cm(2) (p < 0.00001) in the transplantation patients, and 140 cm(2) and 426 cm(2) in nontransplantation patients, respectively. Mean operating time was similar between the two groups (216.9 min versus 184.0 min). Perioperative complication rate was similar between groups (34.2% versus 34.3%, p = 1.0). There were three (1.0%) mesh infections and two (0.6%) mortalities in the nontransplantation patients and one mesh infection and no mortalities in the transplantation group. At mean follow-up of 20.0 (range 1.1-41) months in the transplantation group and 5.0 (range 1-38) months in the nontransplantation group, the hernia recurrence rate was 7.9% and 2.9%, respectively (p = 0.1330). Perioperative complication and hernia recurrence rates in transplant patients after LVHR are comparable to nontransplant patients, although the transplantation patients had significantly larger hernias. LVHR should be considered to manage ventral incisional hernias post transplantation.
    Surgical Endoscopy 02/2009; 23(8):1835-8. · 3.43 Impact Factor
  • Source
    Deron J Tessier
    The Permanente journal 01/2009; 13(1):30-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundSerious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described. MethodsThe records of five cases of adrenalectomy performed at outside hospitals were reviewed. Four cases were referred for management of complications and one for medical-legal review. The nature of the adrenal lesion, operative approach, complication(s), and subsequent clinical course and complication management were assessed. Both open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) cases were included. ResultsOperative indications were pheochromocytoma (N=3), aldosteronoma (N=1), and a nonfunctioning 6-cm hypervascular mass (N=1). Complications of adrenalectomy included: case 1—complete transection of the porta hepatitis during right LA resulting in hepatic failure requiring emergent liver transplantation; case 2—ligation of the hepatic artery during right OA resulting in recurrent cholangitis and bile duct sclerosis requiring liver transplantation; case 3—ligation of the left ureter during LA resulting in postoperative hydronephrosis and loss of renal function; case 4—loss of left kidney function after OA, likely secondary to renal artery ligation ultimately requiring laparoscopic nephrectomy; case 5—LA of a normal adrenal gland for a 6-cm hypervascular mass thought to be arising from the adrenal gland. Three-month postoperative imaging demonstrated a persistent mass and the patient underwent hand-assisted laparoscopic nephrectomy for a left upper pole renal cell carcinoma that was missed at the time of LA. ConclusionDespite the generally low morbidity of adrenalectomy, serious and potentially life-threatening complications can occur. Surgeon inexperience may be a factor in the occurrence of some of these complications which have not been previously described.
    Surgical Endoscopy 01/2009; 23(1):97-102. · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionThe purpose of this study is to determine the incidence of residual common bile duct (CBD) stones after preoperative ERCP for choledocholithiasis and to evaluate the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) in this patient population. MethodsAll patients who underwent preoperative ERCP and interval LC with IOC from 5/96 to 12/05 were reviewed under an Institutional Review Board (IRB)-approved protocol. Data collected included all radiologic imaging, laboratory values, clinical and pathologic diagnoses, and results of preoperative ERCP and LC with IOC. Standard statistical analyses were used with significance set at p<0.05. ResultsA total of 227 patients (male:female 72:155, mean age 51.9years) underwent preoperative ERCP for suspicion of choledocholithiasis. One hundred and eighteen patients were found to have CBD stones on preoperative ERCP, and of these, 22 had choledocholithiasis diagnosed on IOC during LC. However, two patients had residual stones on completion cholangiogram after ERCP and were considered to have retained stones. Therefore, 20 patients overall were diagnosed with either interval passage of stones into the CBD or a false-negative preoperative ERCP. In the 109 patients without CBD stones on preoperative ERCP, nine patients had CBD stones on IOC during LC, an 8.3% incidence of interval passage of stones or false-negative preoperative ERCP. In both groups, there was no correlation (p>0.05) between an increased incidence of CBD stones on IOC and a longer time interval between ERCP and LC, performance of sphincterotomy, incidence of cystic duct stones, or pathologic diagnosis of cholelithiasis. ConclusionsThe overall incidence of retained or newly passed CBD stones on IOC during LC after a preoperative ERCP is 12.9%. Although the natural history of residual CBD stones after preoperative ERCP is not known, the routine use of IOC should be considered in patients with CBD stones on preoperative ERCP undergoing an interval LC.
    Surgical Endoscopy 10/2008; 22(11):2365-2372. · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is safe and effective. Retrospective medical record review. Tertiary referral center. Patients undergoing laparoscopic resection of gastric GISTs from April 1, 2000, to April 1, 2006. Demographic data, diagnostic workup, operative technique, tumor characteristics, morbidity, mortality, and follow-up. Thirty-three patients underwent attempted laparoscopic resection of gastric GISTs, with 31 operations completed laparoscopically. The mean patient age was 68 years (age range, 35-86 years). The female to male ratio was 18:15. Sixteen patients (49%) were asymptomatic, and their tumors were found incidentally. Of 24 patients (73%) who underwent preoperative endoscopic ultrasonography, the results of fine-needle aspiration verified the diagnosis in 13 patients (54%). The mean operative time was 124 minutes (range, 30-253 minutes). A combined endoscopic-laparoscopic approach was used in 11 patients (33%). The mean tumor size was 3.9 cm (range, 0.5-10.5 cm). Two patients (6%) underwent conversion to an open procedure. The median hospital stay duration was 3 days. The mean follow-up was 13 months (range, 3-64 months). There were no local recurrences. Three patients (9%) experienced complications, including 1 wound infection and 2 episodes of upper gastrointestinal tract bleeding. There were no mortalities. Although technically demanding, the laparoscopic approach to gastric GISTs is safe and effective, resulting in a short hospital stay duration and low morbidity.
    Archives of surgery (Chicago, Ill.: 1960) 07/2008; 143(6):587-90; discussion 591. · 4.32 Impact Factor
  • Deron J Tessier, J Chris Eagon
    Current problems in surgery 03/2008; 45(2):68-137. · 1.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate the perioperative outcomes and pathology of patients undergoing laparoscopic splenectomy for splenic masses. The records for 174 patients who underwent laparoscopic splenectomy from May 1994 to August 2006 were reviewed. Patient demographics, preoperative imaging, American Society of Anesthesiologists (ASA) score, body mass index (BMI), estimated blood loss (EBL), operative time, spleen size, complications, hospital length of stay (LOS), pathology, and mortality were extracted from the records. Data are expressed as means +/- standard deviation. Statistical significance (p < 0.05) was determined using a two-tailed t-test and Fisher's exact test. A splenic mass was diagnosed preoperatively for 18 patients (10.3%) (7 males and 11 females). The mean patient age was 51.4 +/- 13.7 years. The mean ASA was 2.3 +/- 0.8, and the mean BMI was 27.3 +/- 5.8 kg/m(2). Computed tomography scans demonstrated splenic masses in all the patients. The mean mass size was 4.3 +/- 3.3 cm (range, 1.0-11.0 cm), and the mean spleen length was 14.6 +/- 7.5 cm (range, 5.5-40.2 cm). Total laparoscopic splenectomy was completed for 15 patients, and hand-assisted splenectomy was performed for 3 patients (2 converted). The mean operative time was 128.3 +/- 38.5 min, and the mean EBL was 110 +/- 137.5 ml. There were no intraoperative complications or 30-day mortalities. The postoperative complication rate was 11.1%, and the mean LOS was 1.9 +/- 1.0 days. The pathology for six patients (33.3%) was malignant (5 lymphomas and 1 adenocarcinoma). There were three false-positive positron emission tomography (PET) scans. Compared with 73 patients undergoing laparoscopic splenectomy for idiopathic thrombocytopenic purpura, there was no significant difference in mean EBL, operative time, conversion rate, complication rate, LOS, or 30-day mortality rate (p > 0.05). Laparoscopic splenectomy is appropriate for patients whose indication for surgery is splenic mass. Suspicious splenic masses should be removed due to the relatively high incidence of malignant pathology, most commonly lymphoma.
    Surgical Endoscopy 02/2008; 22(9):2062-6. · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Iatrogenic colonic perforation is one of the most serious potential complications of colonoscopy. Standard management is surgical repair. No prospective data exist to clearly define the indications for laparoscopic repair. We report the largest case series to date of laparoscopic repair of colonoscopic perforations. A retrospective review was performed of all patients undergoing either exploratory laparoscopy with conversion to open repair, or laparoscopic repair of colonoscopic perforation. Exploratory laparoscopy for the attempted repair of colonoscopic perforations was performed in 11 patients at our institution. The mean colonic perforation size was 2.7 cm. Three cases were converted immediately to open laparotomy. A fourth patient that underwent primary laparoscopic repair of a 4-cm tear developed a leak at the repair site, necessitating reoperation. A fifth patient in whom exploratory laparoscopy was unrevealing underwent separate laparotomy for continued sepsis. Six patients underwent successful laparoscopic repair. Most perforations secondary to colonoscopy warrant rapid exploratory laparoscopy. Extensive inflammation or fecal soilage may require colonic diversion. Inability to laparoscopically localize the area of perforation or doubt regarding the security of the repair should prompt conversion to laparotomy. Laparoscopic repair of colonic perforations in experienced hands is a viable alternative to the open approach.
    Journal of Gastrointestinal Surgery 06/2007; 11(5):655-9. · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Apolipoprotein E (ApoE) genotype and aerobic fitness are each associated with cognitive performance in older adults. However, their potentially interactive effects on cognitive performance have not been examined. The primary purpose of this study was to determine whether ApoE genotype and aerobic fitness interact to uniquely impact memory performance and executive functioning. A secondary purpose was to examine the interactive effects on other measures of cognition to provide a more comprehensive assessment of cognitive abilities across a broad range of functions. Community-dwelling, cognitively normal older women (N = 90) provided blood samples to allow for assessment of ApoE genotype, completed cognitive tests, and performed a maximal aerobic fitness test. Primary outcome variables were the auditory verbal learning test (AVLT), the complex figures test (CFT), and the Wisconsin card-sorting task (WCST). Secondary outcome variables were the block design test and the paced auditory serial addition task (PASAT). Regression analyses indicated that aerobic fitness was associated with significantly better performance on measures of the AVLT, the CFT, and the PASAT for the ApoE-epsilon4 homozygotes. The preliminary findings from this study support the possibility that aerobic fitness is positively associated with the memory performance of those individuals at most genetic risk for Alzheimer disease.
    Medicine &amp Science in Sports &amp Exercise 02/2007; 39(1):199-207. · 4.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Numerous studies have found no clinically significant benefit to the perioperative use of pulmonary artery catheters (PACs), and peripherally inserted central venous catheters (PICCs) have been reported to measure central venous pressure (CVP) accurately. The objective of this study was to determine whether the dynamic shifts in preload associated with elective reconstruction of abdominal aortic aneurysms (AAAs) are accurately reflected by CVP measurements from open-ended PICCs compared to CVP measurements from concomitant indwelling PACs. This is a retrospective review of prospectively collected data. PICCs and PACs were placed preoperatively in five patients undergoing elective AAA reconstruction. CVP measurements were recorded every 15 min during the operation. Bland-Altman statistical analysis was used to determine the degree of agreement in data collected by the two measurement devices. Seventy-three paired measurements of CVP from concomitant indwelling PICCs and PACs obtained from five patients undergoing elective AAA reconstruction revealed PICC measurements to be higher than PAC measurements by 0.6 mm Hg (overall correlation coefficient 0.92). The difference between the two measurement devices was expected to be <3.4 mm Hg at least 95% of the time. The findings of this pilot study indicate that PICCs are an effective method for CVP monitoring in situations of dynamic systemic compliance and preload, such as those observed during elective AAA reconstruction.
    Annals of Vascular Surgery 09/2006; 20(5):577-81. · 0.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the in vivo effect of short-term, moderate dosage synthetic dl-alpha-tocopherol acetate supplementation on platelet aggregation, coagulation profile, and simulated bleeding time in healthy individuals. alpha-tocopherol is the most biologically active isomer of Vitamin E, traditionally promoted as an antioxidant and therapeutic agent in cardiovascular disease. In vitro studies have suggested that alpha-tocopherol plays a role in the inhibition of platelet aggregation. However, further investigations into the effect of alpha-tocopherol on bleeding in vivo have not duplicated these findings. A total of 42 healthy volunteers complied with a 2-week abstinence period from the use of anti-platelet agents followed by determination of baseline platelet aggregation properties and coagulation studies using citrated whole blood. Moderate dosage Vitamin E (800 IU of dl-alpha-tocopherol acetate) was then self-administered for 14 days with reevaluation of platelet aggregation and coagulation profile, and simulated bleeding time after 14 days of Vitamin E supplementation. Forty subjects completed the 4-week study period. All 40 subjects demonstrated normal baseline coagulation studies and all had collagen-stimulated platelet aggregation assessment performed in triplicate. After Vitamin E supplementation, no significant difference was demonstrated in any study parameter. Dietary supplementation with moderate dosage synthetic dl-alpha-tocopherol acetate did not significantly prolong bleeding or platelet aggregation in vivo. The affect of Vitamin E on platelet aggregation in vitro does not appear to be reproducible in vivo. Therefore, peri-operative discontinuation of Vitamin E may not be necessary.
    Journal of Surgical Research 06/2006; 132(1):121-9. · 2.02 Impact Factor
  • Deron J Tessier, James M Swain, Kristi L Harold
    [Show abstract] [Hide abstract]
    ABSTRACT: The published recurrence rate after laparoscopic ventral hernia repair is much less than the rate of recurrence via the open approach. Studies have demonstrated the safety and efficacy of this procedure but have had relatively young patient populations. We present our experience in a significantly older population. A retrospective chart review of all patients undergoing a laparoscopic ventral hernia repair at our institution from May 2000 to September 2004 was performed. Data extracted from charts included demographics, number and type of previous abdominal operations, number of previous hernia repairs, defect and mesh size, postoperative complications, and follow-up. Ninety-seven patients underwent laparoscopic ventral hernia repair (50 men and 47 women). The mean age was 68.5 years (37-85 years) with 78% of patients over the age of 60. Patients had undergone a mean of 2.1 prior abdominal operations. Thirty-five (36%) patients had undergone a mean of 1.8 previous open hernia repairs; 54% with mesh. The mean length of stay was 3.4 days (0-31 days). Thirty-three minor complications occurred in 27 patients. Six major complications occurred in five patients. Three patients required reoperation. Thirty-one percent of patients complained of pain at a transabdominal suture site 6 weeks after surgery. Nine percent of patients had seromas lasting longer than 6 weeks. Two recurrences occurred during follow-up and two patients required mesh removal. There were no deaths. Laparoscopic ventral hernia repair can be performed safely in patients regardless of age. Length of stay and overall complications are not affected by age. Long-term follow-up is necessary to evaluate the effectiveness of LVHR in this patient population.
    Hernia 04/2006; 10(1):53-7. · 1.69 Impact Factor
  • Deron J Tessier, Kristi L Harold
    [Show abstract] [Hide abstract]
    ABSTRACT: Synchronous gastrointestinal lesions of the abdomen are uncommon. Although laparoscopic gastric resection and colonic resection have been previously described, the combined laparoscopic resection of these 2 organs is unique. We report a case of a 72-year-old man with in situ gastric cancer and high-grade dysplasia of a colon polyp who underwent successful laparoscopic resection of both lesions. This report highlights the importance of preoperative planning and port placement in combined laparoscopic procedures.
    Surgical laparoscopy, endoscopy & percutaneous techniques 10/2005; 15(5):290-3. · 0.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P< 0.001 and P = 0.002). Comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.
    Annals of Surgery 10/2005; 242(4):576-81; discussion 581-3. · 6.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vasospasm occurs in conduits used for vascular reconstructions. The small heat shock proteins, HSP20 and HSP27, coordinately regulate vascular smooth muscle tone. Phosphorylated HSP20 is associated with vasorelaxation, and phosphorylated HSP27 inhibits the phosphorylation of HSP20 and relaxation. We hypothesized that the relationship between the phosphorylated states of these two proteins might dictate the tone of a vessel and may contribute to vasospasm. Sodium nitroprusside relaxation of vascular smooth muscle was recorded using pig coronary artery and human saphenous vein. Segments were frozen and homogenized, and extracted proteins were separated by one- and two-dimensional gel electrophoresis, transferred to Immobilon (Millipore), and probed with anti-cGMP-dependent protein kinase (anti-PKG), -HSP20, -HSP27, and -phosphoHSP27 antibodies. Band intensity was estimated using densitometry. Pig coronary artery completely relaxed (100%) with SNP (10(-7)M), but human saphenous vein only partially relaxed (20%). The levels of cGMP-dependent protein kinase and HSP20 were similar in the two tissue types. Human saphenous vein had significantly higher levels of HSP27 versus pig coronary artery (30.14 +/- 0.8 versus 6.62 +/- 0.2 pixels/mg; p < or = 0.001) and phosphoHSP27 (8.29 +/- 3.43 versus 0.012 +/- 0.008 pixels/mg; p < or = 0.001). Human saphenous vein contained significantly higher levels of HSP27 and pHSP27. Increased levels of phosphorylated HSP27 might contribute to vasospasm in human saphenous vein.
    Journal of the American College of Surgeons 07/2005; 201(1):30-6. · 4.50 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Activation of cyclic nucleotide-dependent signaling pathways inhibits agonist-induced contraction of most vascular smooth muscles except human umbilical artery smooth muscle (HUASM). This impaired vasorelaxation may contribute to complications associated with preeclampsia, intrauterine growth restriction, and preterm delivery. Cyclic nucleotide-dependent signaling pathways converge at the phosphorylation of the small heat shock-related protein HSP20, causing relaxation of vascular smooth muscle. We produced recombinant proteins containing a protein transduction domain linked to HSP20 (rTAT-HSP20). Pretreatment of HUASM with in vitro phosphorylated rTAT-HSP20 (rTAT-pHSP20) significantly inhibited serotonin-induced contraction, without a decrease in myosin light chain phosphorylation. rTAT-pHSP20 remained phosphorylated upon transduction into isolated HUASM as demonstrated by two-dimensional gel electrophoresis. Transduction of peptide analogs of phospho-HSP20 containing the phosphorylation site on HSP20 and phosphatase-resistant mimics of the phosphorylation site (S16E) also inhibited HUASM contraction. These data suggest that impaired relaxation of HUASM may result from decreased levels of phosphorylated HSP20. Protein transduction can be used to restore intracellular expression levels and the associated physiological response. Transduction of posttranslationally modified substrate proteins represents a proteomic-based therapeutic approach that may be particularly useful when the expression of downstream substrate proteins is downregulated.
    Journal of Applied Physiology 06/2005; 98(5):1836-45. · 3.48 Impact Factor
  • D J Tessier, L McMahon, K L Harold
    Journal of Minimal Access Surgery 06/2005; 1(2):82-3.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Malignant fistula of the colon to the small bowel is rare and is most often due to adenocarcinoma. Colonic lymphoma is unusual, representing only 0.5 percent of all colonic malignancies. We report a case of intestinal lymphoma presenting with diarrhea and malnutrition. A colojejunal fistula was discovered during colonoscopy by biopsy of small bowel through a fistula in the sigmoid colon. Celiotomy revealed a 12 cm mass in the sigmoid colon with a fistula to the jejunum. Pathology was consistent with T-cell lymphoma. This is a rare entity in a nonimmunocompromised host and has not been described in the English literature.
    Diseases of the Colon & Rectum 02/2005; 48(1):158-61. · 3.34 Impact Factor
  • Medicine and Science in Sports and Exercise - MED SCI SPORT EXERCISE. 01/2005; 37.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A regression model based on computed tomographic (CT) findings alone can accurately predict the histologic severity of acute appendicitis in patients who have a high disease likelihood. Retrospective study. Mayo Clinic in Scottsdale, Ariz. Consecutive sample of 105 patients (50 women and 55 men, aged 15-89 years) undergoing nonincidental appendectomy within 3 days of nonfocused abdominal CT. Computed tomographic scans and histologic features were retrospectively reinterpreted. Each patient's histologic and CT findings were scored by standardized criteria. An ordinal logistic regression model was constructed with a subset of CT findings that statistically correlated best with the final histologic features. Predicted severity values were then generated from the model. Agreement between predicted and actual histologic severity, using weighted kappa measurement. Computed tomography variables used in the model were fat stranding, appendix diameter, dependent fluid, appendolithiasis, extraluminal air, and the radiologist's overall confidence score. The weighted kappa measurement of agreement between predicted and actual histologic severity was 0.75, with a 95% confidence interval between the values of 0.59 and 0.90. Computed tomographic findings, when used with the regression model developed from this pilot study, can accurately predict the histologic severity of acute appendicitis in patients initially seen with a high clinical suspicion of the disease. These findings provide a platform from which to prospectively test the model.
    Archives of Surgery 01/2005; 139(12):1304-8. · 4.10 Impact Factor

Publication Stats

738 Citations
102.41 Total Impact Points

Institutions

  • 2008–2009
    • Washington University in St. Louis
      • Department of Surgery
      San Luis, Missouri, United States
    • Kaiser Permanente
      Oakland, California, United States
    • University of Washington Seattle
      • Department of Surgery
      Seattle, WA, United States
  • 2002–2008
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
  • 2003–2005
    • Mayo Foundation for Medical Education and Research
      • Department of Surgery
      Scottsdale, AZ, United States
  • 2003–2004
    • Arizona State University
      • • School of Nutrition and Health Promotion
      • • Department of Engineering
      Mesa, AZ, United States