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Thacker, Julie K. Marosky

Positions:

Associate Professor of Surgery

Surgery, Advanced Oncologic and Gastrointestinal Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1998

M.D. — Indiana University at Indianapolis

News:

Grants:

Technique to Standard Closure Techniques Plus Sylys Surgical Sealant

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Cohera Medical
Role
Principal Investigator
Start Date
March 07, 2017
End Date
February 29, 2020

Publications:

Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery.

To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.Postoperative ileus remains a major source of morbidity and costs in colorectal surgery. Alvimopan has been shown to reduce incidence of postoperative ileus in enhanced recovery colorectal surgery; however, data are equivocal regarding its benefit in reducing length of stay and costs.Patients undergoing major elective enhanced recovery colorectal surgery were identified from a prospectively-collected database (2010-2013). Multivariable analyses were employed to compare outcomes and hospital costs among patients who had alvimopan versus no alvimopan by adjusting for demographic, clinical, and treatment characteristics.A total of 660 patients were included; 197 patients received alvimopan and 463 patients had no alvimopan. In unadjusted analysis, the alvimopan group had a faster return of bowel function, shorter length of stay, and lower rates of ileus, Foley re-insertion, and urinary tract infection (all P < 0.01). After adjustment, alvimopan was associated with a faster return of bowel function by 0.6 day (P = 0.0006), and lower incidence of postoperative ileus (odds ratio 0.23, P = 0.0002). With adjustment, alvimopan was associated with a shorter length of stay by 1.6 days (P = 0.002), and a hospital cost savings of $1492 per patient (P = 0.01).Alvimopan administration as an element of enhanced recovery colorectal surgery is associated with faster return of bowel function, lower incidence of postoperative ileus, shorter hospitalization, and a significant cost savings. These results suggest that alvimopan is cost-effective in the setting of enhanced recovery colorectal surgery protocols, and should therefore be considered in these programs.

Authors
Adam, MA; Lee, LM; Kim, J; Shenoi, M; Mallipeddi, M; Aziz, H; Stinnett, S; Sun, Z; Mantyh, CR; Thacker, JKM
MLA Citation
Adam, MA, Lee, LM, Kim, J, Shenoi, M, Mallipeddi, M, Aziz, H, Stinnett, S, Sun, Z, Mantyh, CR, and Thacker, JKM. "Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery." July 2016.
PMID
26501697
Source
epmc
Published In
Annals of Surgery
Volume
264
Issue
1
Publish Date
2016
Start Page
141
End Page
146
DOI
10.1097/sla.0000000000001428

Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations.

To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States.An element of enhanced recovery care protocols, optimized perioperative fluid administration may be associated with improved outcomes; however, there is currently no consensus in the United States on fluid use or the effects on outcomes of this use.The study included all inpatients receiving colon, rectal, or primary hip or knee surgery, 18 years of age or older, who were discharged from a hospital between January 1, 2008 and June, 30 2012 in the Premier Research Database. Patient outcomes and intravenous fluid utilization on the day of surgery were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low day-of-surgery fluids with the likelihood of increased hospital length of stay (LOS), total costs, or postoperative ileus.The study showed significant associations between high fluid volume given on the day of surgery with both increased LOS (odds ratio 1.10-1.40) and increased total costs (odds ratio 1.10-1.50). High fluid utilization was associated with increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilization was also associated with worse outcomes.According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.

Authors
Thacker, JKM; Mountford, WK; Ernst, FR; Krukas, MR; Mythen, MMG
MLA Citation
Thacker, JKM, Mountford, WK, Ernst, FR, Krukas, MR, and Mythen, MMG. "Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations." Annals of surgery 263.3 (March 2016): 502-510.
PMID
26565138
Source
epmc
Published In
Annals of Surgery
Volume
263
Issue
3
Publish Date
2016
Start Page
502
End Page
510
DOI
10.1097/sla.0000000000001402

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.

BACKGROUND: The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presence of multiple standardized care programs provides additive benefit. STUDY DESIGN: Institutional ACS-NSQIP data were used to identify patients who underwent elective CRS from September 2006 to March 2013. The cohort was stratified into 3 groups relative to implementation of the ERP (February 1, 2010) and SSIB (July 1, 2011). Unadjusted characteristics and 30-day outcomes were assessed, and inverse proportional weighting was then used to determine the adjusted effect of these programs. RESULTS: There were 787 patients included: 337, 165, and 285 in the pre-ERP/SSIB, post-ERP/pre-SSIB, and post-ERP/SSIB periods, respectively. After inverse probability weighting (IPW) adjustment, groups were balanced with respect to patient and procedural characteristics considered. Compared with the pre-ERP/SSIB group, the post-ERP/pre-SSIB group had significantly reduced length of hospitalization (8.3 vs 6.6 days, p = 0.01) but did not differ with respect to postoperative wound complications and sepsis. Subsequent introduction of the SSIB then resulted in a significant decrease in superficial SSI (16.1% vs 6.3%, p < 0.01) and postoperative sepsis (11.2% vs 1.8%, p < 0.01). Finally, inflation-adjusted mean hospital cost for a CRS admission fell from $31,926 in 2008 to $22,044 in 2013 (p < 0.01). CONCLUSIONS: Sequential implementation of the ERP and SSIB provided incremental improvements in CRS outcomes while controlling hospital costs, supporting their combined use as an effective strategy toward improving the quality of patient care.

Authors
Keenan, JE; Speicher, PJ; Nussbaum, DP; Adam, MA; Miller, TE; Mantyh, CR; Thacker, JKM
MLA Citation
Keenan, JE, Speicher, PJ, Nussbaum, DP, Adam, MA, Miller, TE, Mantyh, CR, and Thacker, JKM. "Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs." Journal of the American College of Surgeons 221.2 (August 2015): 404-14.e1.
PMID
26206639
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
221
Issue
2
Publish Date
2015
Start Page
404
End Page
14.e1
DOI
10.1016/j.jamcollsurg.2015.04.008

Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost?

To identify differences in hospital course and hospitalization cost when comparing image-guided percutaneous drainage with surgical repair for gastrointestinal anastomotic leaks.A retrospective IRB-approved search using key words "leak" and/or "anastomotic" was performed on all adult CT reports from 2002 to 2011. CT examinations were reviewed for evidence of a postoperative gastrointestinal leak and assigned a confidence score of 1-5 (1 = no leak, 5 = definite leak). Patients with an average confidence score <4 were excluded. Type of surgery, patient data, method of leak management, number of hospital admissions, length of hospital stay, discharge disposition, number of CT examinations, number of drains, and hospitalization costs were collected.One hundred thirty-nine patients had radiographic evidence of a gastrointestinal anastomotic leak (esophageal, gastric, small bowel or colonic). Nine patients were excluded due to low confidence scores. Twenty-seven patients underwent surgical repair (Group A) and 103 were managed entirely with percutaneous image-guided drainage (Group B). There was no significant difference in patient demographics or number of hospital admissions. Patients in Group A had longer median hospital stays compared to Group B (48 vs. 32 days, p = 0.007). The median total hospitalization cost for Group A was more than twice that for Group B ($99,995 vs. $47,838, p = 0.001). Differences in hospital disposition, number of CT examinations, number of drains, and time between original surgery and first CT examination were statistically significant.Gastrointestinal anastomotic leaks managed by percutaneous drainage are associated with lower hospital cost and shorter hospital stays compared with surgical management.

Authors
Burke, LMB; Bashir, MR; Gardner, CS; Parsee, AA; Marin, D; Vermess, D; Bhattacharya, SD; Thacker, JK; Jaffe, TA
MLA Citation
Burke, LMB, Bashir, MR, Gardner, CS, Parsee, AA, Marin, D, Vermess, D, Bhattacharya, SD, Thacker, JK, and Jaffe, TA. "Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost?." Abdominal imaging 40.5 (June 2015): 1279-1284.
PMID
25294007
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
5
Publish Date
2015
Start Page
1279
End Page
1284
DOI
10.1007/s00261-014-0265-z

Contemporary surgical options for metastatic colorectal cancer.

The diagnosis of stage IV colorectal cancer was once associated with a uniformly grim prognosis. Over the last 20 years, advances in chemotherapeutics, surgical technique, and surgical adjuncts have dramatically broadened treatment options and improved outcomes. Among current treatment options, surgery remains the key component of any multidisciplinary approach with surgical data demonstrating the longest survivorship. This review will summarize current and developing surgical advances in the treatment of metastatic colorectal cancer. Specifically, we will discuss how surgical interventions fit within the greater context of a multi-modality approach, as well as, the specific, recent innovations in the surgical management of hepatic and extrahepatic metastases.

Authors
Sun, Z; Thacker, JM
MLA Citation
Sun, Z, and Thacker, JM. "Contemporary surgical options for metastatic colorectal cancer." Current oncology reports 17.4 (April 2015): 13-. (Review)
PMID
25708798
Source
epmc
Published In
Current Oncology Reports
Volume
17
Issue
4
Publish Date
2015
Start Page
13
DOI
10.1007/s11912-015-0437-1

In response

Authors
Thacker, JK; Miller, TE; Gan, TJ
MLA Citation
Thacker, JK, Miller, TE, and Gan, TJ. "In response." Anesthesia and analgesia 120.1 (January 1, 2015): 255-. (Letter)
Source
scopus
Published In
Anesthesia and Analgesia
Volume
120
Issue
1
Publish Date
2015
Start Page
255
DOI
10.1213/ANE.0000000000000502

In response

Authors
Miller, TE; Thacker, JK; Gan, TJ
MLA Citation
Miller, TE, Thacker, JK, and Gan, TJ. "In response." Anesthesia and analgesia 120.1 (January 1, 2015): 256-257. (Letter)
Source
scopus
Published In
Anesthesia and Analgesia
Volume
120
Issue
1
Publish Date
2015
Start Page
256
End Page
257
DOI
10.1213/ANE.0000000000000493

In response.

Authors
Thacker, JK; Miller, TE; Gan, TJ
MLA Citation
Thacker, JK, Miller, TE, and Gan, TJ. "In response." Anesthesia and analgesia 120.1 (January 2015): 255-.
PMID
25625269
Source
epmc
Published In
Anesthesia and Analgesia
Volume
120
Issue
1
Publish Date
2015
Start Page
255
DOI
10.1213/ane.0000000000000502

In response.

Authors
Miller, TE; Thacker, JK; Gan, TJ
MLA Citation
Miller, TE, Thacker, JK, and Gan, TJ. "In response." Anesthesia and analgesia 120.1 (January 2015): 256-257. (Letter)
PMID
25625271
Source
epmc
Published In
Anesthesia and Analgesia
Volume
120
Issue
1
Publish Date
2015
Start Page
256
End Page
257
DOI
10.1213/ane.0000000000000493

Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost?

© 2014, Springer Science+Business Media New York.Purpose: To identify differences in hospital course and hospitalization cost when comparing image-guided percutaneous drainage with surgical repair for gastrointestinal anastomotic leaks. Materials and methods: A retrospective IRB-approved search using key words “leak” and/or “anastomotic” was performed on all adult CT reports from 2002 to 2011. CT examinations were reviewed for evidence of a postoperative gastrointestinal leak and assigned a confidence score of 1–5 (1 = no leak, 5 = definite leak). Patients with an average confidence score <4 were excluded. Type of surgery, patient data, method of leak management, number of hospital admissions, length of hospital stay, discharge disposition, number of CT examinations, number of drains, and hospitalization costs were collected. Results: One hundred thirty-nine patients had radiographic evidence of a gastrointestinal anastomotic leak (esophageal, gastric, small bowel or colonic). Nine patients were excluded due to low confidence scores. Twenty-seven patients underwent surgical repair (Group A) and 103 were managed entirely with percutaneous image-guided drainage (Group B). There was no significant difference in patient demographics or number of hospital admissions. Patients in Group A had longer median hospital stays compared to Group B (48 vs. 32 days, p = 0.007). The median total hospitalization cost for Group A was more than twice that for Group B ($99,995 vs. $47,838, p = 0.001). Differences in hospital disposition, number of CT examinations, number of drains, and time between original surgery and first CT examination were statistically significant. Conclusion: Gastrointestinal anastomotic leaks managed by percutaneous drainage are associated with lower hospital cost and shorter hospital stays compared with surgical management.

Authors
Burke, LMB; Bashir, MR; Gardner, CS; Parsee, AA; Marin, D; Vermess, D; Bhattacharya, SD; Thacker, JK; Jaffe, TA
MLA Citation
Burke, LMB, Bashir, MR, Gardner, CS, Parsee, AA, Marin, D, Vermess, D, Bhattacharya, SD, Thacker, JK, and Jaffe, TA. "Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost?." Abdominal Imaging 40.5 (October 8, 2014): 1279-1284.
Source
scopus
Published In
Abdominal Imaging
Volume
40
Issue
5
Publish Date
2014
Start Page
1279
End Page
1284
DOI
10.1007/s00261-014-0265-z

The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.

IMPORTANCE: Surgical site infections (SSIs) in colorectal surgery are associated with increased morbidity and health care costs. OBJECTIVE: To determine the effect of a preventive SSI bundle (hereafter bundle) on SSI rates and costs in colorectal surgery. DESIGN: Retrospective study of institutional clinical and cost data. The study period was January 1, 2008, to December 31, 2012, and outcomes were assessed and compared before and after implementation of the bundle on July 1, 2011. SETTING AND PARTICIPANTS: Academic tertiary referral center among 559 patients who underwent major elective colorectal surgery. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of superficial SSIs before and after implementation of the bundle. Secondary outcomes included deep SSIs, organ-space SSIs, wound disruption, postoperative sepsis, length of stay, 30-day readmission, and variable direct costs of the index admission. RESULTS: Of 559 patients in the study, 346 (61.9%) and 213 (38.1%) underwent their operation before and after implementation of the bundle, respectively. Groups were matched on their propensity to be treated with the bundle to account for significant differences in the preimplementation and postimplementation characteristics. Comparison of the matched groups revealed that implementation of the bundle was associated with reduced superficial SSIs (19.3% vs 5.7%, P < .001) and postoperative sepsis (8.5% vs 2.4%, P = .009). No significant difference was observed in deep SSIs, organ-space SSIs, wound disruption, length of stay, 30-day readmission, or variable direct costs between the matched groups. However, in a subgroup analysis of the postbundle period, superficial SSI occurrence was associated with a 35.5% increase in variable direct costs ($13,253 vs $9779, P = .001) and a 71.7% increase in length of stay (7.9 vs 4.6 days, P < .001). CONCLUSIONS AND RELEVANCE: The preventive SSI bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs.

Authors
Keenan, JE; Speicher, PJ; Thacker, JKM; Walter, M; Kuchibhatla, M; Mantyh, CR
MLA Citation
Keenan, JE, Speicher, PJ, Thacker, JKM, Walter, M, Kuchibhatla, M, and Mantyh, CR. "The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings." JAMA surgery 149.10 (October 2014): 1045-1052.
PMID
25163027
Source
epmc
Published In
JAMA Surgery
Volume
149
Issue
10
Publish Date
2014
Start Page
1045
End Page
1052
DOI
10.1001/jamasurg.2014.346

A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients.

BACKGROUND: Goal-directed fluid therapy (GDFT) is associated with improved outcomes after surgery. The esophageal Doppler monitor (EDM) is widely used, but has several limitations. The NICOM, a completely noninvasive cardiac output monitor (Cheetah Medical), may be appropriate for guiding GDFT. No prospective studies have compared the NICOM and the EDM. We hypothesized that the NICOM is not significantly different from the EDM for monitoring during GDFT. METHODS: One hundred adult patients undergoing elective colorectal surgery participated in this study. Patients in phase I (n = 50) had intraoperative GDFT guided by the EDM while the NICOM was connected, and patients in phase II (n = 50) had intraoperative GDFT guided by the NICOM while the EDM was connected. Each patient's stroke volume was optimized using 250-mL colloid boluses. Agreement between the monitors was assessed, and patient outcomes (postoperative pain, nausea, and return of bowel function), complications (renal, pulmonary, infectious, and wound complications), and length of hospital stay (LOS) were compared. RESULTS: Using a 10% increase in stroke volume after fluid challenge, agreement between monitors was 60% at 5 minutes, 61% at 10 minutes, and 66% at 15 minutes, with no significant systematic disagreement (McNemar P > 0.05) at any time point. The EDM had significantly more missing data than the NICOM. No clinically significant differences were found in total LOS or other outcomes. The mean LOS was 6.56 ± 4.32 days in phase I and 6.07 ± 2.85 days in phase II, and 95% confidence limits for the difference were -0.96 to +1.95 days (P = 0.5016). CONCLUSIONS: The NICOM performs similarly to the EDM in guiding GDFT, with no clinically significant differences in outcomes, and offers increased ease of use as well as fewer missing data points. The NICOM may be a viable alternative monitor to guide GDFT.

Authors
Waldron, NH; Miller, TE; Thacker, JK; Manchester, AK; White, WD; Nardiello, J; Elgasim, MA; Moon, RE; Gan, TJ
MLA Citation
Waldron, NH, Miller, TE, Thacker, JK, Manchester, AK, White, WD, Nardiello, J, Elgasim, MA, Moon, RE, and Gan, TJ. "A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients." Anesthesia and analgesia 118.5 (May 2014): 966-975.
PMID
24681660
Source
epmc
Published In
Anesthesia and Analgesia
Volume
118
Issue
5
Publish Date
2014
Start Page
966
End Page
975
DOI
10.1213/ane.0000000000000182

Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Authors
Miller, TE; Thacker, JK; White, WD; Mantyh, C; Migaly, J; Jin, J; Roche, AM; Eisenstein, EL; Edwards, R; Anstrom, KJ; Moon, RE; Gan, TJ
MLA Citation
Miller, TE, Thacker, JK, White, WD, Mantyh, C, Migaly, J, Jin, J, Roche, AM, Eisenstein, EL, Edwards, R, Anstrom, KJ, Moon, RE, and Gan, TJ. "Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol." Anesthesia and analgesia 118.5 (May 2014): 1052-1061.
Website
http://hdl.handle.net/10161/8598
PMID
24781574
Source
epmc
Published In
Anesthesia and Analgesia
Volume
118
Issue
5
Publish Date
2014
Start Page
1052
End Page
1061
DOI
10.1213/ane.0000000000000206

A simple scoring system for risk-stratifying rectal cancer patients prior to radical resection.

BACKGROUND: Various predictors of perioperative risk for patients with rectal cancer undergoing radical resection have been well described, but no simple scoring system for surgeons to estimate this risk currently exists. The objective of this study was to develop a system for more accurate preoperative evaluations of competing risks and more informed shared decision-making with patients diagnosed with rectal cancer. METHODS: The National Surgical Quality Improvement Program-Participant Use Data File for 2005-2011 was used to retrospectively identify patients undergoing radical resection for rectal cancer. A forward-stepwise multivariable logistic regression model was used to create a dynamic scoring system to preoperatively estimate a patient's risk of major complications. RESULTS: A total of 6,847 patients met study inclusion criteria. Thirteen risk factors were identified, and using these predictive variables, a scoring system was derived to stratify major complication risk after radical resection. CONCLUSIONS: The risk of a major complication after radical resection for rectal cancer is dependent on multiple preoperative variables. This study provides surgeons with a simple but effective tool for estimating major complication risk in rectal cancer patients prior to radical resection. This risk-stratification score serves as a patient-centered resource for discussing perioperative risks and assisting with the shared decision-making of operative planning.

Authors
Speicher, PJ; Ligh, C; Scarborough, JE; Thacker, JK; Mantyh, CR; Turley, RS; Migaly, J
MLA Citation
Speicher, PJ, Ligh, C, Scarborough, JE, Thacker, JK, Mantyh, CR, Turley, RS, and Migaly, J. "A simple scoring system for risk-stratifying rectal cancer patients prior to radical resection." Tech Coloproctol 18.5 (May 2014): 459-465.
PMID
24085640
Source
pubmed
Published In
Techniques in Coloproctology
Volume
18
Issue
5
Publish Date
2014
Start Page
459
End Page
465
DOI
10.1007/s10151-013-1076-x

Is follow-up CT imaging of the chest and abdomen necessary after preoperative neoadjuvant therapy in rectal cancer patients without evidence of metastatic disease at diagnosis?

AIM: Patients with rectal cancer often undergo multiple CT scans prior to surgical resection. We propose that in patients with locally advanced rectal cancer without evidence of metastatic disease at presentation, CT imaging of the chest and abdomen after preoperative neoadjuvant therapy does not change clinical information or surgical management. METHOD: An institutional review board-approved medical record review identified patients with contrast enhanced CT of the chest, abdomen and pelvis alone or in conjunction with (18)F-fluoro-2-deoxy-d-glucose/positron emission tomography imaging for staging of rectal cancer prior to and after neoadjuvant therapy. Eighty-eight patients were included in the study. Scans were reviewed for the presence of metastatic disease on initial and follow-up imaging prior to surgical resection. RESULTS: Seventy-six (86%) of 88 patients had no evidence of metastasis at presentation. None of these patients developed metastatic disease after neoadjuvant therapy. Twelve (14%) had metastases at presentation. No study patient developed metastatic disease in a new organ. CONCLUSION: Imaging after preoperative neoadjuvant therapy in rectal cancer does not change the designation of metastatic disease. Patients with locally advanced rectal adenocarcinoma without evidence of metastases may not benefit from repeat imaging of the chest and abdomen after neoadjuvant therapy.

Authors
Jaffe, TA; Neville, AM; Bashir, MR; Uronis, HE; Thacker, JM
MLA Citation
Jaffe, TA, Neville, AM, Bashir, MR, Uronis, HE, and Thacker, JM. "Is follow-up CT imaging of the chest and abdomen necessary after preoperative neoadjuvant therapy in rectal cancer patients without evidence of metastatic disease at diagnosis?." Colorectal Dis 15.11 (November 2013): e654-e658.
PMID
23910050
Source
pubmed
Published In
Colorectal Disease
Volume
15
Issue
11
Publish Date
2013
Start Page
e654
End Page
e658
DOI
10.1111/codi.12372

Distant Harrington rod migration 35 years after implantation.

Harrington rods have been successfully implanted in thousands of patients for the correction of scoliotic deformity since the 1950s. An exceedingly rare complication of Harrington rod placement is loosening with resultant migration. The authors present a 50-year-old woman who had a single Harrington rod placed when she was 15 years old. Thirty-five years later, she presented with acute sensory changes in her lower extremities. Imaging revealed rod failure and migration of the hardware distally, resulting in penetration of the wall of the rectum. Due to the unique anatomical position of the migrated hardware, sigmoidoscopy was used to directly visualize and remove the rod. The patient ultimately made a full recovery. Rod migration is an exceedingly rare complication that has been described only a few times since the introduction of Harrington rods over 60 years ago. The case herein is particularly unique given the extensive period of time that passed before migration (35 years) and the use of sigmoidoscopy for hardware removal.

Authors
Lark, RK; Caputo, AM; Brown, CR; Michael, KW; Thacker, JK; Richardson, WJ
MLA Citation
Lark, RK, Caputo, AM, Brown, CR, Michael, KW, Thacker, JK, and Richardson, WJ. "Distant Harrington rod migration 35 years after implantation." J Clin Neurosci 20.10 (October 2013): 1452-1453.
PMID
23664127
Source
pubmed
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
10
Publish Date
2013
Start Page
1452
End Page
1453
DOI
10.1016/j.jocn.2012.08.019

Distant Harrington rod migration 35 years after implantation

Harrington rods have been successfully implanted in thousands of patients for the correction of scoliotic deformity since the 1950s. An exceedingly rare complication of Harrington rod placement is loosening with resultant migration. The authors present a 50-year-old woman who had a single Harrington rod placed when she was 15 years old. Thirty-five years later, she presented with acute sensory changes in her lower extremities. Imaging revealed rod failure and migration of the hardware distally, resulting in penetration of the wall of the rectum. Due to the unique anatomical position of the migrated hardware, sigmoidoscopy was used to directly visualize and remove the rod. The patient ultimately made a full recovery. Rod migration is an exceedingly rare complication that has been described only a few times since the introduction of Harrington rods over 60 years ago. The case herein is particularly unique given the extensive period of time that passed before migration (35 years) and the use of sigmoidoscopy for hardware removal. © 2013 Elsevier Ltd. All rights reserved.

Authors
Lark, RK; Caputo, AM; Brown, CR; Michael, KW; Thacker, JK; Richardson, WJ
MLA Citation
Lark, RK, Caputo, AM, Brown, CR, Michael, KW, Thacker, JK, and Richardson, WJ. "Distant Harrington rod migration 35 years after implantation." Journal of Clinical Neuroscience 20.10 (2013): 1452-1453.
Source
scival
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
10
Publish Date
2013
Start Page
1452
End Page
1453
DOI
10.1016/j.jocn.2012.08.019

Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced recovery after surgery (ERAS®) society recommendations

Background: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. Methods: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate). Conclusions: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery. © 2012 Société Internationale de Chirurgie.

Authors
Nygren, J; Thacker, J; Carli, F; Fearon, KCH; Norderval, S; Lobo, DN; Ljungqvist, O; Soop, M; Ramirez, J
MLA Citation
Nygren, J, Thacker, J, Carli, F, Fearon, KCH, Norderval, S, Lobo, DN, Ljungqvist, O, Soop, M, and Ramirez, J. "Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced recovery after surgery (ERAS®) society recommendations." World Journal of Surgery 37.2 (2013): 285-305.
PMID
23052796
Source
scival
Published In
World Journal of Surgery
Volume
37
Issue
2
Publish Date
2013
Start Page
285
End Page
305
DOI
10.1007/s00268-012-1787-6

Exploring predictors of complication in older surgical patients: a deficit accumulation index and the Braden Scale.

OBJECTIVES: To determine whether readily collected perioperative information might identify older surgical patients at higher risk of complications. DESIGN: Retrospective cohort study. SETTING: Medical chart review at a single academic institution. PARTICIPANTS: One hundred two individuals aged 65 and older who underwent abdominal surgery between January 2007 and December 2009. MEASUREMENTS: Primary predictor variables were first postoperative Braden Scale score (within 24 hours of surgery) and a Deficit Accumulation Index (DAI) constructed based on 39 available preoperative variables. The primary outcome was presence or absence of complication within 30 days of surgery. RESULTS: Of 102 patients, 64 experienced at least one complication, with wound infection being the most common. In models adjusted for age, race, sex, and open versus laparoscopic surgery, lower Braden Scale scores were predictive of 30-day postoperative complication (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.06-1.60), longer length of stay (β = 1.44 (0.25) days; P ≤ .001), and discharge to an institution rather than home (OR = 1.23, 95% CI = 1.02-1.48). The cut-off value for the Braden score with the highest predictive value for complication was ≤ 18 (OR = 3.63, 95% CI = 1.43-9.19; c statistic 0.744). The DAI and several traditional surgical risk factors were not significantly associated with 30-day postoperative complications. CONCLUSION: This is the first study to identify the perioperative Braden Scale score, a widely used risk-stratifier for pressure ulcers, as an independent predictor of other adverse outcomes in geriatric surgical patients. Further studies are needed to confirm this finding and to investigate other uses for this tool, which correlates well to phenotypic models of frailty.

Authors
Cohen, R-R; Lagoo-Deenadayalan, SA; Heflin, MT; Sloane, R; Eisen, I; Thacker, JM; Whitson, HE
MLA Citation
Cohen, R-R, Lagoo-Deenadayalan, SA, Heflin, MT, Sloane, R, Eisen, I, Thacker, JM, and Whitson, HE. "Exploring predictors of complication in older surgical patients: a deficit accumulation index and the Braden Scale." J Am Geriatr Soc 60.9 (September 2012): 1609-1615.
PMID
22906222
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
9
Publish Date
2012
Start Page
1609
End Page
1615
DOI
10.1111/j.1532-5415.2012.04109.x

Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis.

BACKGROUND: The objectives of our study were to determine the association between age and postoperative outcomes after emergency surgery for diverticulitis and to identify risk factors for postoperative mortality among elderly patients. METHODS: All patients from the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 Participant User Files undergoing emergent surgery for diverticulitis were included. Multivariate logistic regression was used to determine the association between age and postoperative morbidity and mortality after adjustment for perioperative variables. A separate regression model was used to determine risk factors for postoperative mortality among elderly patients, with specific postoperative complications being included as potential predictors. RESULTS: We included 2,264 patients for analysis, of whom 1,267 (56%) were <65 years old (nonelderly), 648 (28.6%) were 65-79 years old (elderly), and 349 (15.4%) were ≥80 years old (super-elderly). Advanced age was a significant predictor of 30-day postoperative mortality, and to a lesser extent postoperative morbidity. Among those patients ≥65 years old, super-elderly age classification remained a significant predictor of mortality after adjustment for the presence or absence of postoperative complications. Mortality among elderly and super-elderly patients was greatest in the setting of specific complications, such as septic shock, prolonged postoperative mechanical ventilation, and acute renal failure. CONCLUSION: Advanced age is an independent risk factor for death after emergency surgery for diverticulitis, with mortality being greatest among elderly patients who experience certain postoperative complications. Prevention of these complications should form the cornerstone of initiatives designed to lower the mortality associated with emergency surgery in elderly patients.

Authors
Lidsky, ME; Thacker, JKM; Lagoo-Deenadayalan, SA; Scarborough, JE
MLA Citation
Lidsky, ME, Thacker, JKM, Lagoo-Deenadayalan, SA, and Scarborough, JE. "Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis." Surgery 152.3 (September 2012): 465-472.
PMID
22938905
Source
epmc
Published In
Surgery
Volume
152
Issue
3
Publish Date
2012
Start Page
465
End Page
472
DOI
10.1016/j.surg.2012.06.038

Diagnosis and management of ileocolic pseudoaneurysms.

Ileocolic pseudoaneurysmal disease is a rare splanchnic aneurysm that affects 3 out of 100 000 patients, and only 7 cases have been described in the past 40 years in patients without preexisting connective tissue disorders. Abdominal pain is the most common presenting symptom and nearly 30% of patients present with hemorrhage. Ileocolic pseudoaneurysms are diagnosed by contrasted computed tomography scans and verified by arteriography. We present a case report and review of the literature in which a patient was initially managed by coil embolization, followed by laparotomy and suture ligation due to pseudoaneurysm rupture.

Authors
Desai, SS; Dua, A; Shortell, CK; Thacker, JK
MLA Citation
Desai, SS, Dua, A, Shortell, CK, and Thacker, JK. "Diagnosis and management of ileocolic pseudoaneurysms." Perspect Vasc Surg Endovasc Ther 24.3 (September 2012): 141-145. (Review)
PMID
23334533
Source
pubmed
Published In
Perspectives in Vascular Surgery and Endovascular Therapy
Volume
24
Issue
3
Publish Date
2012
Start Page
141
End Page
145
DOI
10.1177/1531003512472240

Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients.

HYPOTHESIS: Among patients undergoing urgent surgery for left-sided diverticulitis, those admitted on weekends vs weekdays have higher rates of Hartmann procedure and adverse outcomes. DESIGN: Analysis of data from the Nationwide Inpatient Sample between January 2002 and December 2008. Unadjusted and risk-adjusted generalized linear regression models were used. SETTING: Academic research. PATIENTS: Data on patients undergoing urgent surgery for acute diverticulitis. MAIN OUTCOME MEASURES: Rates of Hartmann procedure vs primary anastomosis, complications, length of hospital stay, and total hospital charges. RESULTS: In total, 31 832 patients were included; 7066 (22.2%) were admitted on weekends, and 24 766 (77.8%) were admitted on weekdays. The mean (SD) age of patients was 60.8 (15.3) years, and 16 830 (52.9%) were female. A Hartmann procedure was performed in 4580 patients (64.8%) admitted on weekends compared with 13 351 patients (53.9%) admitted on weekdays (risk-adjusted odds ratio [OR], 1.57; P < .001). In risk-adjusted analyses, patients admitted on weekends had significantly higher risk for any postoperative complication (OR, 1.10; P = .005) and nonroutine hospital discharge (OR, 1.33; P < .001) compared with patients admitted on weekdays, as well as a median length of hospital stay that was 0.5 days longer and median total hospital charges that were $3734 higher (P < .001 for both). CONCLUSIONS: Patients undergoing urgent surgery for left-sided diverticulitis who are admitted on a weekend have a higher risk for undergoing a Hartmann procedure and worse short-term outcomes compared with patients who are admitted on a weekday. Further research is warranted to investigate possible underlying mechanisms and to develop strategies for reducing this substantial weekend effect.

Authors
Worni, M; Schudel, IM; Østbye, T; Shah, A; Khare, A; Pietrobon, R; Thacker, JKM; Guller, U
MLA Citation
Worni, M, Schudel, IM, Østbye, T, Shah, A, Khare, A, Pietrobon, R, Thacker, JKM, and Guller, U. "Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients." Arch Surg 147.7 (July 2012): 649-655.
PMID
22802061
Source
pubmed
Published In
Archives of Surgery
Volume
147
Issue
7
Publish Date
2012
Start Page
649
End Page
655
DOI
10.1001/archsurg.2012.825

Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Background: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. Methods: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate). Conclusions: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Authors
Nygren, J; Thacker, J; Carli, F; Fearon, KCH; Norderval, S; Lobo, DN; Ljungqvist, O; Soop, M; Ramirez, J
MLA Citation
Nygren, J, Thacker, J, Carli, F, Fearon, KCH, Norderval, S, Lobo, DN, Ljungqvist, O, Soop, M, and Ramirez, J. "Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations." Clinical Nutrition 31.6 (2012): 801-816.
PMID
23062720
Source
scival
Published In
Clinical Nutrition
Volume
31
Issue
6
Publish Date
2012
Start Page
801
End Page
816
DOI
10.1016/j.clnu.2012.08.012

Impact of anemia on surgical outcomes: Innovative interventions in resource-poor settings

Background The aim of this work was to study the impact of anemia on surgical outcomes and the impact of instituting appropriate workup and treatment of anemia on surgical outcomes. Methods We conducted a case-control retrospective chart review of all hernia repair, hydrocele repair, and hysterectomy cases at the SEARCH Hospital in Gadchiroli, India, from January 2008 to April 2010, and included 340 male and 112 female surgical patients. We also performed a prospective assessment of the impact of the institution of appropriate workup and treatment of anemia on the surgical outcomes for all hernia repair, hydrocele repair, and hysterectomy cases at SEARCH from May 2010 to May 2011 and included 138 male and 76 female surgical patients. Results The retrospective arm of the study included 340 males and 112 females with a median age of 39 and 41 years, respectively. The mean hemoglobin values were 12.50 (range = 8.8-15.4) for men and 10.39 (range = 5.2-14.8) for women. Patients with anemia had (1) increased incidence of spinal headache after inguinal hernia repair (p = 0.0266) and (2) increased incidence of fever after total hysterectomy (p = 0.0070). There was no statistically significant correlation between anemia and other outcomes (all p>0.05). The prospective arm of the study included 138 males and 76 females with a median age of 35 and 40, respectively. The mean hemoglobin values were 11.8 (range = 6.4-14.8) for men and 10.6 (range = 6.9-12.8) for women. There was no statistically significant correlation between anemia and any surgical outcomes (p>0.05). The incidence of complications in both the retrospective and the prospective arm was compared according to increasing severity of anemia across genders. Overall, there was no statistically significant increase in complication rates with increasing severity of anemia (p>0.05). Conclusions In the retrospective arm of this study, anemia was associated with increased incidence of spinal headache and fever. In the prospective arm of this study, there was no statistically significant correlation between anemia and any surgical outcome. The incidence of complications did not increase with the severity of anemia in either arm of the study. Further investigation is needed into the optimal management and treatment of anemia prior to surgery in resource-poor settings. © Société Internationale de Chirurgie 2012.

Authors
Lagoo, J; Wilkinson, J; Thacker, J; Deshmukh, M; Khorgade, S; Bang, R
MLA Citation
Lagoo, J, Wilkinson, J, Thacker, J, Deshmukh, M, Khorgade, S, and Bang, R. "Impact of anemia on surgical outcomes: Innovative interventions in resource-poor settings." World Journal of Surgery 36.9 (2012): 2080-2089.
PMID
22543720
Source
scival
Published In
World Journal of Surgery
Volume
36
Issue
9
Publish Date
2012
Start Page
2080
End Page
2089
DOI
10.1007/s00268-012-1615-z

Detection of intestinal dysplasia using angle-resolved low coherence interferometry.

Angle-resolved low coherence interferometry (a/LCI) is an optical biopsy technique that allows for depth-resolved, label-free measurement of the average size and optical density of cell nuclei in epithelial tissue to assess the tissue health. a/LCI has previously been used clinically to identify the presence of dysplasia in Barrett's Esophagus patients undergoing routine surveillance. We present the results of a pilot, ex vivo study of tissues from 27 patients undergoing partial colonic resection surgery, conducted to evaluate the ability of a/LCI to identify dysplasia. Performance was determined by comparing the nuclear morphology measurements with pathological assessment of co-located physical biopsies. A statistically significant correlation between increased average nuclear size, reduced nuclear density, and the presence of dysplasia was noted at the basal layer of the epithelium, at a depth of 200 to 300 μm beneath the tissue surface. Using a decision line determined from a receiver operating characteristic, a/LCI was able to separate dysplastic from healthy tissues with a sensitivity of 92.9% (13/14), a specificity of 83.6% (56/67), and an overall accuracy of 85.2% (69/81). The study illustrates the extension of the a/LCI technique to the detection of intestinal dysplasia, and demonstrates the need for future in vivo studies.

Authors
Terry, N; Zhu, Y; Thacker, JKM; Migaly, J; Guy, C; Mantyh, CR; Wax, A
MLA Citation
Terry, N, Zhu, Y, Thacker, JKM, Migaly, J, Guy, C, Mantyh, CR, and Wax, A. "Detection of intestinal dysplasia using angle-resolved low coherence interferometry." Journal of biomedical optics 16.10 (October 2011): 106002-.
PMID
22029349
Source
epmc
Published In
Journal of Biomedical Optics
Volume
16
Issue
10
Publish Date
2011
Start Page
106002
DOI
10.1117/1.3631799

Evaluation of pectus bar position and osseous bone formation

Purpose: Minimally invasive repair has become a popular approach for pectus excavatum (PE). The bar is secured to the thoracic wall and left for approximately 2 years. The authors have noticed an intense bone formation (BF) around some of these bars at removal. A review of children undergoing bar removal was performed to better understand this BF in relation to bar placement. Methods: A retrospective review of children undergoing bar removal after PE repair since January 1998 was performed. Chart review included age at bar insertion and removal, bar insertion position (subcutaneous [SC] v submuscular [SM]), BF on Chest x-ray and at bar removal, operating time, and estimated blood loss (EBL). Results: Thirty-six patients underwent bar removal during the study period (16 SC and 20 SM). Chest x-ray evaluation was possible in 27 patients (16 SM, 11 SC). No difference existed for length of time the bar was in place or age at insertion/removal between groups. EBL was higher in the SM (18.3 v8.8 mL, not significant). BF was seen radiographically in 15 SM and 3 SC patients (P < .001). BF was encountered at removal in 19 SM patients and a single SC patient (P < .001). Operating time was statistically longer (P < .01) for the SM group (30.2 v 15.6 min). Conclusions: Bar position during repair of PE is important. SM positioning virtually always results in BF with increased EBL and statistically longer operating time at removal. Careful placement of the bar in the SC position without violating the fascia should be used to avoid these undesirable effects. © 2003 Elsevier Inc. All rights reserved.

Authors
Ostlie, DJ; Marosky, JK; Spilde, TL; Snyder, CL; Peter, SDS; Gittes, GK; Sharp, RJ; Meier,
MLA Citation
Ostlie, DJ, Marosky, JK, Spilde, TL, Snyder, CL, Peter, SDS, Gittes, GK, Sharp, RJ, and Meier, . "Evaluation of pectus bar position and osseous bone formation." Journal of Pediatric Surgery 38.6 (2003): 953-956.
PMID
12778401
Source
scival
Published In
Journal of Pediatric Surgery
Volume
38
Issue
6
Publish Date
2003
Start Page
953
End Page
956
DOI
10.1016/S0022-3468(03)00132-5

Fibroblast growth factor signaling in the developing tracheoesophageal fistula

Background/Purpose: The Adriamycin-induced rat model of esophageal atresia and tracheoesophageal fistula (EA/TEF) provides a reliable system for the study of EA/TEF pathogenesis. The authors previously hypothesized that faulty branching lung morphogenesis pathways were a critical component of its pathogenesis. The authors have found evidence for faulty fibroblast growth factor (FGF) signaling related to epithelial-mesenchymal interactions in the fistula tract. To better define FGF signaling, the differential expression of FGF ligands and their receptors between lung, fistula tract, and esophagus are described. Methods: Time-dated pregnant, Sprague-Dawley rats were injected with Adriamycin (2 mg/kg intraperitoneally) on days 6 through 9 of gestation. Tissues were processed for histology and reverse transcriptase polymerase chain reaction. FGF-1, -7 and -10 were measured from whole lung, fistula tract, and esophagus of TEF or normal embryos. Expression of FGF2RIIIb and FGF2RIlIc receptors was measured in isolated epithelium and mesenchyme of lung and fistula tract of TEF embryos as well as lung and esophagus from normal controls. Results: FGF-1 mRNA was present in the fistula tract and normal and Adriamycin-exposed lung but absent from whole esophagus. Interestingly, FGF-7 mRNA was present only in normal lung. FGF-10 was present in all tissues examined. FGF2RIIIb mRNA was absent in fistula mesenchyme but present in all other tissues examined. However, the splice variant FGF2RIIIc mRNA was present in all tissues examined. Conclusions: These findings support defective FGF signaling in the rat model of EA/TEF. Absence of FGF-7 mRNA in Adriamycin-exposed tissues suggests the primary effect of Adriamycin may be to inhibit FGF-7 expression. Moreover, absence of FGF2RIIIb in fistula mesenchyme may be caused by loss of positive feedback from FGF-7, its normal obligate ligand. Understanding these specific defects in FGF signaling may provide insight into faulty mechanisms of EA/TEF. Copyright 2003, Elsevier Science (USA). All rights reserved.

Authors
Spilde, TL; Bhatia, AM; Marosky, JK; Preuett, B; Kobayashi, H; Hembree, MJ; Prasadan, K; Daume, E; Snyder, CL; Gittes, GK; Schwartz, M; Cass, D
MLA Citation
Spilde, TL, Bhatia, AM, Marosky, JK, Preuett, B, Kobayashi, H, Hembree, MJ, Prasadan, K, Daume, E, Snyder, CL, Gittes, GK, Schwartz, M, and Cass, D. "Fibroblast growth factor signaling in the developing tracheoesophageal fistula." Journal of Pediatric Surgery 38.3 (2003): 474-477.
PMID
12632370
Source
scival
Published In
Journal of Pediatric Surgery
Volume
38
Issue
3
Publish Date
2003
Start Page
474
End Page
477
DOI
10.1053/jpsu.2003.50082

A role for sonic hedgehog signaling in the pathogenesis of human tracheoesophageal fistula

Background/Purpose: Many theories of the pathogenesis of esophageal atresia with tracheoesophageal fistula (EA/TEF) have been proposed, but no specific mechanism has been demonstrated. The authors previously reported data suggesting a respiratory origin of the fistula tract in the rat model and in humans. Sonic hedgehog (Shh) "knockout" mice have the VACTERL association, and thus it was hypothesized that defects in Shh signaling may exist in the human neonatal EA/TEF fistula tract. Methods: With IRB approval, human proximal esophageal pouch and distal fistula samples were removed at the time of standard repair of EA/TEF in accordance with what the surgeons deemed appropriate in preparation for anastomosis. Tissues were processed for HE, reverse-transcriptase polymerase chain reaction (RT-PCR), and immunohistochemistry. Normal embryonic lung cDNA was used as a positive control for the RT-PCR reactions. Results: As expected, Shh was present by immunohistochemistry in the proximal esophageal pouch, but was specifically absent in the distal fistula tract. Gli-1, -2, and -3 (all intracellular mediators of Shh signaling) were present in the proximal pouch and distal esophagus by RT-PCR. Conclusions: The absence of Shh signaling in the developing fistula tract of the human neonate was surprising given that Shh normally is present in esophagus and other gut components. These results support the conclusion that the fistula tract is not an esophaguslike structure, despite both its histologic appearance and its use as an esophageal replacement. Also, like in Shh-null mutant mice, aberrant Shh signaling may play a critical role in the pathogenesis of EA/TEF in humans. Copyright 2003, Elsevier Science (USA). All rights reserved.

Authors
Spilde, T; Bhatia, A; Ostlie, D; Marosky, J; III, GH; Snyder, C; Gittes, GK
MLA Citation
Spilde, T, Bhatia, A, Ostlie, D, Marosky, J, III, GH, Snyder, C, and Gittes, GK. "A role for sonic hedgehog signaling in the pathogenesis of human tracheoesophageal fistula." Journal of Pediatric Surgery 38.3 (2003): 465-468.
PMID
12632368
Source
scival
Published In
Journal of Pediatric Surgery
Volume
38
Issue
3
Publish Date
2003
Start Page
465
End Page
468
DOI
10.1053/jpsu.2003.50080

Organogenesis particularly relevant to fetal surgery

In utero surgical intervention is an exciting frontier in medicine. Fetal surgeons strive to treat congenital anomalies definitively while organogenesis is still occurring. Many of these anomalies pose such a threat to the viability of the affected fetus that waiting until after the child is born to treat them is frequently not satisfying and too often unsuccessful. We review the embryology of selected systems that have associated aberrancies of development for which fetal surgery is particularly applicable. The surgeon can more effectively launch an assault against congenital anomalies when armed with a solid appreciation of normal development. Recognizing the critical period for the development of a system allows him or her to formulate the optimal time and mode of intervention.

Authors
Crisera, CA; Marosky, JK; Longaker, MT; Gittes, GK
MLA Citation
Crisera, CA, Marosky, JK, Longaker, MT, and Gittes, GK. "Organogenesis particularly relevant to fetal surgery." World Journal of Surgery 27.1 (2003): 38-44.
PMID
12557036
Source
scival
Published In
World Journal of Surgery
Volume
27
Issue
1
Publish Date
2003
Start Page
38
End Page
44
DOI
10.1007/s00268-002-6735-4

Complete discontinuity of the distal fistula tract from the developing gut: Direct histologic evidence for the mechanism of tracheoesophageal fistula formation

The embryogenesis of tracheoesophageal anomalies remains controversial. The purpose of this study was to better define the embryogenesis of developing esophageal atresia with tracheoesophageal fistula (EA/TEF), with specific attention to the controversial issue of whether a discontinuity exists in the foregut during its development of EA/TEF. Pregnant outbred rats were injected with adriamycin (2 mg/kg i.p.) on days 6-9 of gestation (E6-E9). At E12.5 and 13.5, microdissection of the entire foregut was performed. Foreguts were examined by phase microscopy, and serial, precisely transverse sections were created for hematoxylin and eosin (H&E) staining. Gross microdissection of the developing foregut at E 12.5 (n = 9) revealed a blind-ending, bulbous fistula tract arising from the middle branch of the tracheal trifurcation (as seen by direct and phase microscopy). No connection with the gut could be appreciated at E12.5, but by E13.5 (n = 10) there was an obvious connection between the fistula and the stomach. Serial H&E transverse sections also demonstrated a blind-ending fistula tract arising from the trachea at E12.5. This fistula tract was clearly discontinuous from the developing stomach, which appeared much further caudal to the end of the fistula tract. These results strongly support a model of experimental TEF wherein the fistula tract arises from a trifurcation of the trachea, and (only during a specific gestational window between days 12.5 and 13.5) there is discontinuity between the fistula tract and the stomach. By day 13.5, the fistula joins with the stomach anlage. These observations in the developing EA/TEF should help to resolve the controversy about the mechanism of EA/TEF formation. © 2002 Wiley-Liss, Inc.

Authors
Spilde, TL; Bhatia, AM; Marosky, JK; Hembree, MJ; Kobayashi, H; Daume, EL; Prasadan, K; Manna, P; Preuett, BL; Gittes, GK
MLA Citation
Spilde, TL, Bhatia, AM, Marosky, JK, Hembree, MJ, Kobayashi, H, Daume, EL, Prasadan, K, Manna, P, Preuett, BL, and Gittes, GK. "Complete discontinuity of the distal fistula tract from the developing gut: Direct histologic evidence for the mechanism of tracheoesophageal fistula formation." Anatomical Record 267.3 (2002): 220-224.
PMID
12115271
Source
scival
Published In
Anatomical Record
Volume
267
Issue
3
Publish Date
2002
Start Page
220
End Page
224
DOI
10.1002/ar.10106

Lectin as a marker for staining and purification of embryonic pancreatic epithelium

The embryonic pancreatic epithelium, and later the ductal epithelium, is known to give rise to the endocrine and exocrine cells of the developing pancreas, but no specific surface marker for these cells has been identified. Here, we utilized Dolichos Biflorus Agglutinin (DBA) as a specific marker of these epithelial cells in developing mouse pancreas. From the results of an immunofluorescence study using fluorescein-DBA and pancreatic specific cell markers, we found that DBA detects specifically epithelial, but neither differentiating endocrine cells nor acinar cells. We further applied this marker in an immunomagnetic separation system (Dynabead system) to purify these putative multi-potential cells from a mixed developing pancreatic cell population. This procedure could be applied to study differentiation and cell lineage selections in the developing pancreas, and also may be applicable to selecting pancreatic precursor cells for potential cellular engineering. © 2002 Elsevier Science (USA). All rights reserved.

Authors
Kobayashi, H; Spilde, TL; Li, Z; Marosky, JK; Bhatia, AM; Hembree, MJ; Prasadan, K; Preuett, BL; Gittes, GK
MLA Citation
Kobayashi, H, Spilde, TL, Li, Z, Marosky, JK, Bhatia, AM, Hembree, MJ, Prasadan, K, Preuett, BL, and Gittes, GK. "Lectin as a marker for staining and purification of embryonic pancreatic epithelium." Biochemical and Biophysical Research Communications 293.2 (2002): 691-697.
PMID
12054524
Source
scival
Published In
Biochemical and Biophysical Research Communications
Volume
293
Issue
2
Publish Date
2002
Start Page
691
End Page
697
DOI
10.1016/S0006-291X(02)00278-4
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