Surgery
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Item Open Access Immediate Impact of Coronary Artery Bypass Graft Surgery on Regional Myocardial Perfusion: Results from the Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity(2022-12) Ferguson, T. Bruce, Jr.; Buch, Ashesh N.; et alItem Open Access Surgical Management of Paratesticular Rhabdomyosarcoma: A Consensus Opinion from the Children’s Oncology Group, European paediatric Soft tissue sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe(2021-04) Rodeberg, David A.; Rogers, Timothy N.; Seitz, Guido; Fuchs, Jörg; Martelli, Helene; Dasgupta, Roshni; Routh, Jonathan C.; Hawkins, Douglas S.; Koscielniak, Ewa; Bisogno, GianniItem Open Access Development and Assessment of a Systematic Approach for Detecting Disparities in Surgical Access(2021) Wong, Jan H.; Vohra, Nasreen A.; Akram, Warqaa; Irish, William D.; DeMaria, Eric J.; Pories, Walter J.; Brownstein, Michelle R.; Altieri, Maria S.; Haisch, Carl E.; Leeser, David B.; Tuttle, Janet E.Item Open Access Benefit of Delayed Primary Excision in Rhabdomyosarcoma: A Report from the Children’s Oncology Group (COG)(2021-01-15) Rodeberg, David A.; Lautz, Timothy B.; Chi, Yueh-Yun; Li, Minjie; Wolden, Suzanne L.; Casey, Dana L.; Routh, Jonathan C.; Granberg, Candace F.; Binite, Odion; Rudzinski, Erin R.; Hawkins, Douglas S.; Venkatramani, RajkumarItem Open Access Health-Related Quality of Life in Weight Loss Interventions: Results from the OPTIWIN Trial(2021-02-12) Matarese, Laura E.; Pories, Walter J.; Dainelli, Livia; Luo, Dan Roberto; Cohen, Sarah S.; Marczewska, Agnieszka; Ard, Jamy D.; Coburn, Sally L.; Lewis, Kristina H.; Loper, Judy; Rothberg, Amy E.Item Open Access Contraception and Conception After Bariatric Surgery(2017-11-01) Pories, Walter J.Item Open Access Validity and Reliability of Telephone Administration of the Patient-Specific Functional Scale for the Assessment of Recovery from Snakebite Envenomation(2019-12-13) Toschlog, Eric; Bush, Sean P.Item Open Access The Shirt Off His Back(2015-11) Pories, Walter J.Item Open Access Bariatric Surgery among Medicare Subgroups: Short- and LongTerm Outcomes(2019-11) Pories, Walter J.Item Open Access Insurance Status Differences in Weight Loss and Regain Over 5 Years Following Bariatric Surgery(2018) Pories, Walter J.Item Open Access Alcohol and Other Substance Use after Bariatric Surgery: Prospective Evidence from a US Multicenter Cohort Study(2017-08) Pories, Walter J.Item Open Access Time course metabolome of Roux-en-Y gastric bypass confirms correlation between leptin, body weight and the microbiome(2018-05-31) Seridi, Loqmane; Leo, Gregory C.; Dohm, G. Lynis; Pories, Walter J.; Lenhard, JamesRoux-en-Y gastric bypass (RYGB) is an effective way to lose weight and reverse type 2 dia- betes. We profiled the metabolome of 18 obese patients (nine euglycemic and nine diabet- ics) that underwent RYGB surgery and seven lean subjects. Plasma samples from the obese patients were collected before the surgery and one week and three months after the surgery. We analyzed the metabolome in association to five hormones (Adiponectin, Insulin, Ghrelin, Leptin, and Resistin), four peptide hormones (GIP, Glucagon, GLP1, and PYY), and two cytokines (IL-6 and TNF). PCA showed samples cluster by surgery time and many microbially driven metabolites (indoles in particular) correlated with the three months after the surgery. Network analysis of metabolites revealed a connection between carbohydrate (mannosamine and glucosamine) and glyoxylate and confirms glyoxylate association to dia- betes. Only leptin and IL-6 had a significant association with the measured metabolites. Lep- tin decreased immediately after RYGB (before significant weight loss), whereas IL-6 showed no consistent response to RYGB. Moreover, leptin associated with tryptophan in support of the possible role of leptin in the regulation of serotonin synthesis pathways in the gut. These results suggest a potential link between gastric leptin and microbial-derived metabolites in the context of obesity and diabetes.Item Open Access Systems, methods and computer program products for creating and maintaining electronic medical records(2002-07-04) Pories, Walter J.; Tabrizi, MohammadSystems, methods, and computer program products that generate electronic clinical medical records from patient encounters are provided. An illness for a particular patient is entered into a data processing system via an input device. Next, a defined retrievable clinical lexicon for that illness is displayed via the input device. The defined retrievable clinical lexicon comprises words and phrases associated with the illness. After the lexicon is displayed, a subset of words and phrases is selected from the lexicon for that patient encounter. A clinical medical record is then generated from the selected subset of words and phrases. A clinical medical record may be stored with like records for that patient and other patients, and associated with demographic records, fiscal records, drug administration records and the like for the patient. The collection of clinical records so created may be readily searched due to the enhanced uniformity of the records so created.Item Open Access Trends in esophageal cancer and body mass index by race and gender in the state of Michigan(East Carolina University, 2009-06-23) Kort, Eric J.; Sevensma, Eric; Fitzgerald, Timothy L.Background: Adenocarcinoma of the esophagus has been increasing in incidence in the U.S. over the past several decades, particularly among white males. The factors driving the racial disparity in adenocarcinomas rates are not well understood. Methods: Here we examine trends in both esophageal cancer incidence and body mass index (BMI) in a geographically defined cohort by gender and race. Age-adjusted esophageal cancer incidence rates from 1985 to 2005 were calculated from data collected by the Michigan state cancer registry. Trends were analyzed along with trends in BMI data obtained from the Behavioral Risk Factor Survey administered by the Centers for Disease Control. Results: Overall, age adjusted incidence rates in esophageal carcinoma increased from 4.49 to 4.72 cases/100,000 persons per year in Michigan from 1985 to 2005. Among white males, the rate of adenocarcinomas increased by 0.21 cases/100,000 per year to a maximum of 6.40 cases/100,000 in 1999, after which these rates remained constant. There was a slight but non-significant increase in the rate of adenocarcinomas among African American males, for whom the average incidence rate was 8 times lower than that for white males (0.58 vs 4.72 cases/100,000 person years). While average BMI is rising in Michigan (from 26.68 in 1988 to 30.33 in 2005), average BMI was slightly higher among African Americans on average, and the rates of increase in BMI were not different between African American males and white males. Conclusion: The disparity between African American males and white males is not explained by ecological-level trends in BMI. Further research to identify the factors responsible for this disparity, possibly including anatomic fat distribution, are required. Originally published BMC Gastroenterology, Vol. 9, No. 47, June 2009Item Open Access Physical Activity Levels of Patients Undergoing Bariatric Surgery in the Longitudinal Assessment of Bariatric Surgery (LABS) Study(East Carolina University, 2008) King, Wendy C.; Belle, S. H.; Eid, G. M.; Dakin, G. F.; Inabnet, W. B.; Mitchell, James E.; Patterson, E. J.; Courcoulas, A. P.; Flum, David; Chapman, William H. H.; Wolfe, B. M.Background- Bariatric surgery candidates' physical activity (PA) level may contribute to the variability of weight loss and body composition changes following bariatric surgery. However, there is little research describing the PA of patients undergoing bariatric surgery to inform PA recommendations in preparation for, and following, surgery. Objectives- Describe PA assessment in the LABS-2 study and report pre-surgery PA level. Examine relationships between objectively determined PA level and 1) BMI and 2) self-reported purposeful exercise. Setting- Six sites in the U.S. Methods- Participants wore an accelerometer and completed a PA diary. Standardized measures of height and weight were obtained. Results- Of 757 participants, 20% were sedentary (<5000 steps/day), 34% low active (5000-7499 steps/day), 27% somewhat active (7500-9999 steps/day), 14% active (10000-12499 steps/day), and 6% were highly active (greater than or equal to 12500 steps/day). BMI was inversely related to mean steps/day and mean steps/minute during the most active 30 minutes each day. The most commonly reported activities were walking, 44%; gardening, 11%; playing with children, 10%; and stretching, 7%. Self-report of minutes of exercise accounted for 2% of the variance in objectively determined steps. Conclusion- Patients present for bariatric surgery with a wide range of PA levels, with almost half categorized as somewhat active or active. BMI is inversely related to total amount and intensity of PA. Few patients report a regular pre-operative exercise regimen suggesting most PA is accumulated from activities of daily living. Patient report of daily minutes of walking or exercise may not be a reliable indication of their PA level. Originally published Surgery for Obesity and Related Diseases, Vol. 4, No. 6, Nov-Dec 2008Item Open Access Robotic Surgical Training in an Academic Institution(East Carolina University, 2001-10) Chitwood, W. Randolph; Nifong, L. Wiley; Chapman, William H. H.; Felger, Jason E.; Bailey, B. Marcus; Ballint, Tara; Mendleson, Kim G.; Kim, Victor B.; Young, James A.; Albrecht, Robert A.Objective To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background Data Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Methods Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Results Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Conclusion Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely. Originally published Annals of Surgery, Vol. 234, No. 4, Oct 2001Item Open Access Bariatric Surgery: Risks and Rewards(East Carolina University, 2008-11) Pories, Walter J.Context: Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis. Objective: Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations. Interventions: Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. Positions: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United Statesâ similar to the complication rates after cholecystectomy. Conclusions: Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity. Originally published J Clin Endocrinol Metab 93: S89â S96, 2008