Search

Background Accurate preoperative risk stratification remains elusive. Existing tools are often missing important patient-reported and functional factors. We sought to implement a novel tool, with dynamic functional data and comorbidity variables, to define factors which predict postoperative outcomes.Materials and Methods We expanded a previously validated functional questionnaire to create the Tennessee Preoperative Assessment Tool (TPAT). Unique elements included change in functional status, usual and best activity tolerance, and development of new conditions. The survey was administered to all new patients seen in several surgery clinics from July 2021 to June 2022.Results A total of 1950 patients completed the survey. Of the completed surveys, 197 patients underwent an elective, inpatient, abdominal surgery and were included in the study. Several patient-reported factors were associated with poor postoperative outcomes. For example, decrease in functional activity in the previous 60 days (n = 50; 25.4%) was a strong predictor of poor postoperative outcomes including readmission (30-day: 8.8% vs .0%; P= .034), wound dehiscence (12.0% vs 3.4%; P= .022), blood transfusion (6.0% vs .0%; P = .003), sepsis (4.0% vs .0%; P= .015), and wound infection (18.0% vs 6.8%; P= .076).Discussion In this preliminary implementation study, patients undergoing elective, inpatient, abdominal surgery, utilization of a novel, patient-reported survey tool proactively identifies patients at risk of clinically relevant postoperative outcomes. Patient-reported decreased activity in the 60 days prior to surgeon evaluation was associated with several adverse postoperative outcomes. Additionally, this study demonstrates that the TPAT can be seamlessly integrated into the usual clinical workflow and is hypothesis generating for future interventional studies.

Variability exists regarding the surgical technique in breast conservation therapy. The purpose of this project was to determine differences between single (SH) or flanking (FH) hooked needle localization wires used for nonpalpable breast lesions. We retrospectively reviewed 201 female patients at a single institution from 2004 to 2008. All patients had biopsy-proven ductal carcinoma in situ or invasive disease. Comparisons were made in regard to margin status, reoperation, completion mastectomy, size of lesion, and breast specimen volume. SH was placed in 122 patients (61%) and FH in 79 patients (39%). In SH, 23 patients (18%) had positive margins and 31 patients (25%) had reoperations as compared with 31 patients (25%) with positive margin and 36 patients (44%) in the FH cohort (P= 0.039 and 0.0037). Average lesion size and volume resected was 1.5 cm and 137 cm3in SH and 2.85 cm and 188 cm3in FH, respectively (P= 0.0001 and 0.006). Positive margins were associated with lesion size and not volume of tissue excised. The FH technique was associated with more positive margins, reoperation, and completion mastectomy.

The focus of this work was to improve the DQE performance of a full-field digital mammography (FFDM) system by means of selecting an optimal X-ray tube anode-filter combination in conjunction with an optimal scintillator configuration. The flat panel detector in this work is a Varian PaxScan 3024M. The detector technology is comprised of a 2816 row × 3584 column amorphous silicon (a-Si) photodiode array with a pixel pitch of 83m. The scintillator is cesium iodide and is deposited directly onto the photodiode array and available with configurable optical and x-ray properties. Two X-ray beam spectra were generated with the anode/filter combinations, Molybdenum/Molybdenum (Mo/Mo) and Tungsten/Aluminum (W/Al), to evaluate the imaging performance of two types of scintillators, high resolution (HR) type and high light output (HL) type. The results for the HR scintillator with W/Al anode-filter (HRW/ Al) yielded a DQE(0) of 67%, while HR-Mo/Mo was lower with a DQE(0) of 50%. In addition, the DQE(0) of the HR-W/Al configuration was comparable to the DQE(0) of the HL-Mo/Mo configuration. The significance of this result is the HR type scintillator yields about twice the light output with the W/Al spectrum, at about half the dose, as compared to the Mo/Mo spectrum. The light output or sensitivity was measured in analog-to-digital convertor units (ADU) per dose. The sensitivities (ADU/uGy) were 8.6, 16.8 and 25.4 for HR-Mo/Mo, HR-W/Al, HL-Mo/Mo, respectively. The Nyquist frequency for the 83 m pixel is 6 lp/mm. The MTF at 5 lp/mm for HR-Mo/Mo and HR-W/Al were equivalent at 37%, while the HL-Mo/Mo MTF was 24%. According to the DQE metric, the more favorable anodefilter combination was W/Al with the HR scintillator. Future testing will evaluate the HL-W/Al configuration, as well as other x-ray filters materials and other scintillator optimizations. While higher DQE values were achieved, the more general conclusion is that the imaging performance can be tuned as required by the application by modifying optical and x-ray properties of the scintillator to match the spectral output of the chosen anode-filter combination.

Odontogenic Ameloblast Associated Protein (ODAM) is a protein isolated in ameloblasts during odontogenesis. ODAM expression was identified in breast cancer, but its significance remains unknown. The purpose of this study is to determine if ODAM expression can serve as a prognostic marker and provide information regarding treatment in human breast cancer. Breast cancer patients were identified from our tumor registry from 1993 to 2003. Archived breast cancer tissue from 243 patients (stage 0 = 53, stage I = 51, stage II = 53, stage III = 47, stage IV = 39) was stained using monoclonal antibody for ODAM. Presence or absence of immunostaining was correlated with stage, histologic grade, response to chemotherapy, and survival using ?2and logistic regression analyses. Tumor nuclear staining for ODAM increased with increasing group stage (P< 0.001). Staining for ODAM did not correlate with histologic grade or chemotherapy (P= 0.558, P= 0.093). Improved outcomes within each stage were noted with ODAM staining, statistically significant for stages 0, I, and II (P< 0.001, P= 0.003, P= 0.003) and underpowered for stages III and IV (P= 0.724, P= 0.059). Survival benefit associated with tumor nuclear staining increased with advancing stage (P< 0.001). These results show that ODAM predicts survival in breast cancer. Research is ongoing to determine ODAM's clinical utility and role in carcinogenesis.

Presented at the Annual Scientific Meeting and Postgraduate Course Program, Southeastern Surgical Congress, Lake Buena Vista, FL, February 18–21, 2006.

We hypothesized that hepatic injury is associated with severe acute pancreatitis (SAP) and may result in lung injury through nuclear factor kappa B (NF-B)-dependent inflammatory mediators. The study characterizes the timing and determines the involvement of selected cytokines and chemokines in the pathogenesis of hepatocellular injury associated with SAP.

Background: Ischemia-reperfusion (I/R) of remote organs is a common cause of lung injury. We observed that lung injury after partial hepatic I/R in mice coincides with the appearance of 3-nitrotyrosine (NT) in the lung tissue, a marker of peroxynitrite involvement and oxidant stress. Peroxynitrite can cause mitochondrial dysfunction by inactivation of manganese superoxide dismutase (MnSOD), the major antioxidant enzyme in mitochondria. Our aims were to examine whether pulmonary MnSOD is a target of nitration following hepatic I/R and whether nitrated MnSOD (N-MnSOD) correlates with acute lung injury.Methods: Five 20–25-g male C57BL/6 mice underwent laparotomy, and atraumatic occlusion of the portal and arterial blood supply to the upper three lobes of the liver for 90 min. This warm ischemic period was followed by 4 h of reperfusion, and the animals were then euthanized. Lung injury was assessed by LDH and protein levels in bronchoalveolar lavage (BAL) fluid. Pulmonary MnSOD activity in pulmonary homogenates was measured by the cytochrome c reduction method. The presence of N-MnSOD was determined by immunoprecipitation (IP) and Western Blot analysis. Controls (N = 5) underwent sham operation.Results: Elevated plasma transaminases confirmed hepatic injury. Lung injury was demonstrated by elevation in BAL protein and LDH levels (495.7 (48.4) versus 644.9 (37.3) [p < 0.05] and 56.5 (11.8) versus 345.2 (80) [p < 0.01], respectively). Immunoprecipitation and Western blot demonstrated N-MnSOD in the lung tissue of I/R animals but not controls. MnSOD activity decreased following I/R (8.1 (0.7) versus 10.8 (0.3) [p < 0.05]).Conclusions: Pulmonary MnSOD is both nitrated and inactivated following hepatic I/R and is associated with acute lung injury. These findings suggest that MnSOD incapacitance may contribute to I/R-induced lung injury and provide a therapeutic target in attenuating multisystem injury following hepatic I/R.