CONTROVERSIES IN SURGERY PROGRAM

June 12-13, 2015

WESTIN HOTEL ANNAPOLIS, MARYLAND

TABLE OF CONTENTS 3 ...... 8 ...... 29

...... Inside Back Cover

...... Back Cover ...... Back ...... 16 ...... 18 ...... 17

Scientific Abstracts

Social Events Acknowledgements

Open Forum—Free Paper Presentation...... 14 Paper Open Forum—Free Annual Ethics Forum...... 14 Neurological and Orthopaedic Surgery...... 12 The Latest Update in Hepato-Pancreatic-Billary (HPB) Surgery...... 12 Keynote Lecture Sponsored by AANOS...... 11 Lecture Keynote The Dr. Andre Crotti Award Recipient’s Lecture Andre Crotti Award Recipient’s The Dr...... 11 Trauma and Acute Care Surgery II...... 10 Part Trauma Neurological ad Orthopaedic Surgery...... 10

Keynote and Featured Lectures Credit Designation ...... 7 Scientific Program Accreditation ...... 7 Disclosure Policy ...... 7 Overall Course Objectives ...... 7 Course Sponsor ...... 7 Continuing Medical Education Continuing Medical 2015 Education and Scientific Organizing Committee and Scientific Organizing Committee 2015 Education ...... 7 Board of Directors ...... 7 Leadership Chair, American Academy of Neurological and OrthopaedicNeurological and Academy of American SurgeonsChair, ...... 6 Mayor of AnnapolisMayor of ...... 5 Governor of Maryland...... 4 of Governor Letters of Welcome Letters

Annapolis Westin, Floor Plans Schedule at a Glance Moderator and Presenter Index 4 GOVERNOR’SWELCOME MAYOR’S WELCOME 5 6 CHAIRMAN’S WELCOME Chair, Surgeons AmericanAcademyof NeurologicalandOrthopaedic William E.Mathews,MD, FICS Sincerely, you toAnnapolisandourconference. welcome I Directors of Board the and Committee Organizing Scientific the of members the of behalf On Fund. Scholarship Do evening. the of camaraderie the of memories fond Oy Eastport the by entertainment arranged Specially Banquet onSaturdayeveningfeaturinganelegantdinner, and awards. entertainment Closing ICSUS the with conjunction in Dinner Awards and FundRaiser Annual 6th The host also Wewill where surgeonsofallspecialtieswillbeamazedbyDr. Canavero’slecture. ICS with session joint ever first this attend to sure Be world. the around from media the and colleagues of spinal fusion and its specific application for the first ever head transplant has sparked the imagination of and excited that we welcome our Keynote Speaker, Dr. Sergio Canavero from pleased Italy.extremely am His I research in well. the area as members Academy and speakers guest invited several by topics Surgery Orthopaedic and Neurosurgical cutting-edge controversial on presentations includes program year's This ofSaturday,sion ontheafternoon oursessionconcludes.Iencourageyoutoattend. June13thafter are also several relevant presentations during the Orthopaedic Surgery specialists that will be presen and Neurosurgery for specifically program a designed have we ICSUS, with Workingclosely (ICSUS). tion We have once again combined our meeting with the International College of Surgeons-United States Sec- oneCMEcredits. toacquiremorethan20hoursofACCMEaccreditedcategory of thisopportunity 13th. As you join your peers from around the world in this historic location, I hope you will take advantage and 12th June on Annapolis in WestinHotel the at here held being Surgeons Orthopaedic and rological It is my pleasure to welcome you to the 39th Annual Scientific Meeting of the American Academy of Neu- Dear Colleagues, sessions on Thursday, June 11th, as well as an Ethi ted on Friday and Saturday during this conference. ster Boys will provide some local flare and create and flare local some provide will Boys ster n't miss this event, which will benefit the AANOS the benefit will which event, this miss n't cs ses- There Chairman of the Board William Mathews, MD, FICS Lafayette, CA

Manuel Alzugaray, MD, FICS Jeffrey Epstein, MD, FICS Quirico Torres, MD, FICS Miami, FL Babylon, NY Abilene, TX

Anca Bereanu, MD Kazem Fathie, MD, FICS Paul Wakim, DO Yardley, PA Past Chair of the Board Huntington Beach, CA Las Vegas, NV Gene Bolles, MD, FICS David Weiss, MD Boulder, CO Robert Mathews, MD, FICS Morrisville, PA Millersville, PA W. Craig Clark, MD, FICS David Wren Jr, MD, FICS President Mark Perlmutter, MD, FICS Richmond, CA Greenwood, MS Mechanicsburg, PA B Charles, Xeller, MD, FICS Maxime Coles, MD, FICS Alfonso Pino, MD, FICS Vice President OF OARD Treasurer DeLeon, TX Houston, TX Coffeyville, KS Sudhir Rao, MD Lucia Zamorano, MD, FICS Clara Raquel Epstein, MD, FICS Big Rapids, MI Secretary Boulder, CO Birmingham, MI 2015 Education and Scientific Organizing Committee

CO-CHAIRS

Maxime J.M. Coles, MD, FICS W. Craig Clark, MD, FICS D Orthopaedic Surgeon Neurosurgeon Greenwood, MS Coffeyville, KS IRECTORS

MEMBERS

Jeffrey Epstein, MD, FICS Mark Perlmutter MD, FICS Sudhir Rao, MD Neurosurgeon Orthopaedic Surgeon Orthopaedic Surgeon Babylon, NY Mechanicsburg, PA Big Rapids, MI

John Galea, MD Alfonso Pino, MD, FICS Lucia Zamorano, MD, FICS Neurologist Orthopaedic Surgeon Neurosurgeon Michigan City, IN DeLeon, TX Birmingham, MI

Course Sponsor planning or presenting in a program designated for AMA Physician's Recogni- International College of Surgeons - United States Section tion Award Category 1 Credit™ must disclose all relevant financial relationships An ACCME Accredited Provider with a commercial interest prior to being included in the final program. This information is disclosed to the audience prior to the activity. The ICS-US has OVERALL COURSE OBJECTIVES procedures in place to address a conflict of interest should one arise. Our com- The Annual Scientific Meeting is designed to offer information regarding the latest plete Policy on Commercial Support and Independence is available on FICS surgical advancements and technology to address gaps in knowledge that may Online or by request from Headquarters. Additionally, faculty members are exist for practicing surgeons in all surgical specialties, residents in training, and allied asked to disclose when any discussion of unapproved use of a pharmaceutical health professionals. The desired outcome of this program is increased knowledge, or medical device occurs. better competency in cutting edge treatment modalities, and enhanced treatment decision making. It is the expressed goal of the course to provide enough material Accreditation that upon completion of the activity the participant can make educated decisions The International College of Surgeons-United States Section is accredited by the to incorporate the latest surgical techniques and technologies as well as discern Accreditation Council for Continuing Medical Education (ACCME) to sponsor Con- when these procedures are warranted to provide optimum patient care. tinuing Medical Education for physicians.

Topics presented during the Annual Scientific Meeting have been designed to ad- Credit Designation dress and improve the attendee’s knowledge and skills in the following compe- The International College of Surgeons-United States Section designates this tencies; patient care or patient-centered care, medical knowledge, practice-based live activity for a maximum of 16 AMA PRA Category 1 Credits. Physicians learning & improvement, quality improvement and professionalism. should claim only the credit commensurate with the extent of their partici- pation in the activity. Disclosure Policy It is the policy of both the American Academy of Neurological and Or- thopaedic Surgeons and the ICS-US that any individual who is involved in 7 8 KEYNOTE AND FEATURED LECTURES available inourAnnapolisandBowielocations. Dr.companies. biotechnology several for consultant is Dix serve and teaching and research in involved also is He spine. and brain the of conditions treat non-invasively radiosur stereotactic as well as procedures, vasive in- minimally latest the of use the incorporating disorders, He has extensive experience with complex spine and brain Hospital. Hospital andNorthwest And The Quest For Immortality (Dec2014). And TheQuestFor Immortality several books to his credit, including Head Transplantation recovery.peer-reviewed100 over has He and publications media outlets in international December 2008) and stroke Parkinson disease, stimulati the vegetative state (featured in several brain cortical surgical introduced 2007), monograph Press University Cambridge his of cation publi- painonline.orgfollowing website US the by genius” “Italian and mankind” of “benefactor a as hailed been has he which (for 27 of age Painthe Central at of genesis the o worked he way the Along possible. fi transplant head the making on focused he years, 30 past the Over Con- Why sciousness isNotintheBrain. IMMORTAL. book his in discusses he conscio to which filter a as acts only brain the believes scending human limits. In the tradition of Prof. Penfield, he result of the preclinical swine composite tissue al tissue composite swine preclinical the of result di a as conducted successfully was US in plantation gate immunosuppressants. The Nation’s First Hand Trans- investi- to and reaction immune the of modulation allow to transplantation limb CTAfor animal model large sibility He entered neurosurgery with the goal of tran- brain stimulation. of advancement the to devoted tank think a Group, Neuromodulation Turin Advanced the of Director is Canavero Sergio Dr. St. Josephs Medical Center, General Maryland Center, Spine Samaritan Good Hospital, Sinai Dr. Dix worked in Baltimore, seeing patients at this, to prior years four For 2004. November Spine & Brain Maryland joined Dix Gary Dr. 2000). During this period Dr. Ren created a fea- at the University of Louisville in Kentucky (1996- Clinical and Research Hand Fellowship training his performed He 1984. in University Medical Dr. Xiaoping Ren received his MD from Harbin S X ERGIO IAOPING G lotrans- gery to gery usness n for on s as a as s ARY C rect rst ANAVERO ut in D , R IX boards in neurosurgery (2006). boards inneurosurgery staff neurosurgeon for two years. He passed the certifying ser he where Calgary, in Hospital Foothills at ship fellow- surgery spine a completed then and gary,Canada of University the at program residency neurosurgery surgery.their Dr.about 1993, decisions In the entered Dix viding him a unique perspective in helping patients practiced family medicine in northern British h Colum where Canada to immigrated he Soweto, in Baragwane Hospital at internship his completing After bosch. St of University the from degree medical his ceived re- he where Africa South in raised and born was Dr.Dix the futureofmankind.Andmore… the hold will which transplant head full a achieve the be will he why directly him from hear You will ext life frontier: new a of opening the but orders, one. The consequences?anoth Notwith only the curereconnected of hopelesbe can cord spinal severed a In June 2015, he will push and science proveforward that problem ofspinalcord fusioninnewterms. the recast to past, the from some research, of lines many togeth brings Canavero Dr. prophecy, White’s Robert fulfil and events, of turn unprecedented an in Now, curing intractable medical disorders. monkeys,rejoinspinalcouldinnotthecord.but H White carried out the first cephalosomatic anastomo be at the cutting edge. In 1970, US neurosurgeon impact Dr technology human life medical like never see before, head-body will transplanta that century the In of thedeathpenalty. ulation in the rehabilitation of criminal psychopat Recently, he made the news for pushing cortical bra viewed journals. He also serves as a peer reviewer reviewer peer a several journals. as serves also He journals. pee viewed in publications 40 over had has Ren Dr. lation. published in the of Journal Surgical Research and in Circu- studies These cardioprotection. nociceptor-induced understand molecular and neuronal basis of non-ischemic program research his of focus another CTA, as well Professor.Associate and professor Assistant As appointed then 2001, in member faculty as Medicine of College nati plantation model (CTA). He joined the University of Cincin- , MD EN , MD , MD hs in place to make bia, pro- sis (CSA) . Robert tion will ension. in stim- is goal:is ved as ved first to first key to key ellen- s dis- were Cal- is to is r-re- ling for th er er e KEYNOTE AND FEATURED LECTURES 9 n r- s c n an al e, o- in the cal hu- after Sur- earch iding erves e has Mon- olden nding ceived urolo- rgeons. ult sco-ult ical in- tic dele- tic mas, pi- mas, stenosis, d in multi- in d ent Golden ent , MD , MD lead efforts to update a 10-year brain tumor retrospective tumor brain 10-year effortsa lead update to database at Johns Hopkins, he has mined national data- and Sample Inpatient Nationwide the including bases he and database, Results End and Epidemiology veillance of quality capture to database prospective a developing is glio high-grade and low- with patients on data life multiple at tumors CNS metastatic and tuitaryadenomas, involve also is He country. the across institutions disciplinary work aimed at using pre-operative MRI signal gene cell tumor with conjunction in characteristics tions and histological markers with the aim of prov future patients better pre-operative informa-prognosistic tion while providing providers useful new information for operative planning. gical intern at Johns Hopkins Hospital, where he where intern gical re at Hospital, Hopkins Johns Resid the as well as excellence clinical for awards Award. Teaching Apple Mukherjee'sDr. clinical research has focused on fi ways to improve brain tumor patient outcomes. He ha cervical and lumbar spine, disc herniations,spinal disc cervicalspine, lumbar and compressionad fractures,aswell spinaltumors, as liosis and deformity. Patton graduated Dr. medical school as a member of AOA Honor Medical Society and a strong background i research. As a resident, his orthopaedic trauma res top honors in the New was England awarded region, and Su of College American the by recognized nationally Currently, his interests focus on patient outcomes spine surgery. Dr. Patton is Ame Northa Spine AO memberSurgeons, Orthopaedic of ofAcademy the Americ ica, and the North American Spine Society. tocol. She spends her free time with her husband, g husband, her with time free her spends She tocol. retriever and children. she completed her neurology residency at the Massac the at residency neurology her completed she settsGeneral Hospital/Brigham HospitalWomen'sand Boston. There, she published severaldeath andpapers comaon braibased onmedi duringHospitalMassachusettsGeneral at began translational research she school. She developed a strong interest in headach gist at Salinas Valley Memorial Hospital. Her clin terests include headache, pain management, traumati brain injury (TBI) and acute neurological care.started Sh an inpatient headache program at her andhospitserves ontheir bioethics committee. Shealso s as a neurologist for the Laguna Seca race track in terey where she is implementing a concussion/TBI pr and was chosen for the 2014 InternationalAcademy at the Mayo Clinic. Headache Currently,she resides in CA,Monterey, and is a ne , MD, MS , MD, CRIPKO , r, g p UKHERJEE al S lta ch on ard cell l In-l M epi- ion's ATTON con- n the n P at the at icy fel- icy Honor ed sur- ed h. She h. th both th s of theof s f spine-f Sommer centered University napolis, he napolis, ATRICIA the Univer- the EBRAJ HAD P . Patton com- Patton . C D

Dr. "Raj" Mukherjee obtained his Dr. undergradu- Uni- Commonwealth Virginia from degree ate select the into accepted was he where versity, BS/MD program as a Presidential Scholar and where he graduated in 3 years at the top of his class, summa cum laude with university Dr. Scripko was Dr. born in Baltimore, Maryland. She attended Bucknell University where she studied dance and biology. Scripko then at- ClevelandClinicthe atschool medicaltended Lerner College of Medicine of Case Western completedalso shewhere Reserve University, Originally from Kentucky, Dr. Patton completed Patton Dr. Kentucky, from Originally his studies undergraduate in at Neuroscience subse- He TN. Nashville, in University Vanderbilt in degree Science of a Master obtained quently human using injury cord spinal of treatment the from Degree, as as Medical his well cells, stem

Bloomberg School of Public Health, where he where studied Health, of Public School Bloomberg School, School, where he was named a C. Medicine in Everett Koop Schola Humanism Gold finalist, Scholar Rhodes pol health a as served he where and member, Society low under Surgeon General Richard Carmona. Followin medical school, Raj was recruited to biostatistics, and demiology, clinical Johns design as a Hopkins Scholar, Albert Schweitzer Fellow, and member of De honors as a Biology major. He received his institut He He received his medical degree from Dartmouth Medic Award of Case Western Reserve. After medical school o work his for award research undergraduate highest of calcineurin in status epilepticus. role Halst a also was Mukherjee Dr. Society. Honor Omega work, as well as Bioethicsresearcher for awardsseveral andGrant, a Cleveland Clinic Clinicalpresented her Bioethics Researwork at multiple stem cell ferences,Harvard Business School, Harvard StemCel graduation, she was given the Alice Paige Leadershi a Master'sa Bioethics.in Herinterest Bioethicsin researchfellowshipyear 1 completed aschool,she enhancement, and human life/death. While in medical Sarnoff Cardiovascular Research Grant for her stem around human enhancement, specifically neurological HarvardStemCellInstitute.Howawardedwas Shea Hughes Medical Institute Research Scholarship and a stitute, Cleveland Clinic and Oxford University. Up Dr. Patton specializesPatton Dr. inthe operative treatment o pleted his residency in Orthopaedic Surgery at the the at Surgery Orthopaedic in An residency his in pleted surgery spine performing to Prior Vermont. of at training fellowship Surgery Spine his completed wi worked he where Medicine, of School Utah of sity neurosurgeons. and surgeons spine Orthopaedic relateddisorders,includingdegenerative condition the University of Louisville School of Medicine. Dr Medicine. of School Louisville of University the 10 SCIENTIFIC PROGRAM sentations by renowned surgeons in these major surg major these in surgeons renowned by sentations sub abstract include Presentations Committee. izing assistance and support the with developed been have Orthopa and Neurosurgery of specialties the in ming Ortho and Neurological of Academy American the with like-minded organizations to advance the art and sc continued onnext page Thomas M.Scalea,MD Innovative ManagementforTraumaticBrain Injury: CompartmentsCommunicate GeneBolles,E. MD,FICS Damage ControlSurgery Adrian Park, MD Acute CareSurgeryModelintheWorldofSpecialty Chief, DivisionofAcuteCareSurgery, Baltimore,MD MD Efron, David The MultidisciplinaryManagementofComplexHepaticTrauma Domingo Alvear,MD&MayurNarayan, Moderators: 10:00 AM-N Charles Xeller,MD,FICS Current StateofOpioidGuidelines Gary Dix,MD Minimally InvasiveInstrumentedSurgeryforSacroiliacJointDysfunction Annapolis,MD MedicineCenterAnnapolis,Maryland, thopaedic andSports MS MD, Patton, Chad Surgical ManagementofBackPain the of Section States United the of goal primary A Moderator: W. MD Craig Clark, 9:00-11:00 AM Innovation andLearning (SAIL) CenterofAnneArundelHealthSystem(AAHS)inAnnapolis,Maryland Health Medical Center, Denver, CO , Neurosurgeon, Maryland BrainandSpine,Annapolis,MD , Neurosurgeon,Maryland OON , Chairman of the Department of Surgery and Chair o , Associate Professor of Surgery, Anesthesiology and Critical Care Medicine, Emergency Medicine Emergency Medicine, Care Critical and Surgery,Anesthesiology Professorof Associate , , Spine Surgery Medical Director, Anne Arundel Medi Arundel Anne Director, Medical Surgery Spine , , Professor ofSurgery, SchoolofMedicine,Baltimore,MD University ofMaryland , Orthopaedic Surgeon,League, Orthopaedic City, TX , AssociateProfessor Neurosurgery,of University of N T AM AND RAUMA UOOIA AND EUROLOGICAL F RIDAY Coffee Break - 9:45-10:00 AM Coffee Break-9:45-10:00AM A , J CUTE ience of surgery. For more than 10 years, the Colle International College of Surgeons is to foster rela foster to is Surgeons of College International missions from members of both groups as well as inv as well as groups both of members from missions UNE edic Surgery. The sessions presented on Friday and and Friday on presented sessions The Surgery. edic ical specialties. ical of the Academy, its Board of Directors and Scienti Academy,and of the of Directors Board its O paedic Surgeons (Academy) to develop scientific pro scientific develop to (Academy) Surgeons paedic C RTHOPAEDIC ARE 12, 2015 S URGERY f the newly created Earl Simulation to Advance S P URGERY ColoradoMedical Center andDenver ART cal Center Spine Program, The Or- The Program, Spine Center cal II C S ge has worked tionships with tionships APITOL ENATE fic Organ- fic Saturday ited pre- ited gram- A&B A&B SCIENTIFIC PROGRAM 11 D pital, A&B A&B APITAL C ENATE APITAL ward ward recipient, S al management al C ced. The number The ced. S. Using evidence- Using S. Dr. William Stewart William Dr. idual from our past. past. our from idual d pancreas. d URGERY University School of Medicine, (HPB) S ECTURE L AANOS ILIARY -B lock Distinguished Service Professor, The Johns The Professor, Service Distinguished lock ROTTI C ow 12, 2015 12, , Assistant, Professor ofSurgery,Johns Hopkins Hos NDRE ANCREATO PONSORED BY . A -P S UNE R D gery are staggering. This year’s Dr. Andre Crotti A Crotti Andre gery This year’s Dr. are staggering. , Attending Surgeon Providence Hospital, Southfield, MI , Attending Surgeon Providence D ses involving the liver, gallbladder, bile ducts an ducts bile gallbladder, liver, the involving ses and influential surgeon the United States has produ has States United the surgeon influential and , J gery, will remind us all about this important indiv important this about all us remind will gery, a comprehensive overview of the surgical and medic and surgical the of overview comprehensive a he past 100 years more fascinating than the life of life the than fascinating more years 100 past he erts from Johns Hopkins as well as by members of IC of members by as well as Hopkins Johns from erts EPATO HE T ECTURE H Coffee Break - 3:00-3:15 PM L RIDAY F MatthewWeiss, MD , Associate Professor of Surgery, The Johns Hopkins EYNOTE PDATES IN UNCH AND K U L , Director, Turin Advanced Neuromodulation Group, Turin, Italy Group, Turin, Advanced Neuromodulation Turin , Director, , 2015 Andre Crotti Award Recipient, The Alfred Bla Alfred The Recipient, Award Crotti Andre 2015 , Michael J. Jacobs, MD, FICS ATEST L HE T -1:30 PM

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and magnitude of Dr. Halsted's contributions to sur contributions Halsted's of and Dr. magnitude who is in his own right considered a pioneer in sur in pioneer a considered right own his in is who

based medicine, this session is designed to provide to designed is session this medicine, based disea and neoplasms, malignancies, with patients of continued on next page

Andrew Cameron, MD, PhD Recent Advances in Liver Transplantation: HCC, Hepatitis C, and Sharing Recent Advances in Liver Transplantation: HCC, Hepatitis C, Open Approach: MinimallyInvasive Approach: Debate - Controversies of Pancreatectomy Various HPB related topics will be addressed by exp by addressed be will topics related HPB Various Moderators: Reza Saidi, MD & Michael Jacobs, MD 3:15-5:45 PM

tation with spinal linkage (GEMINI). Sergio Canavero, MD opportunities for the discussion head of anastomosis HEAVEN: venture project for the first human head transplan- N Is Future Transplantation—The Head HEAVEN-GEMINI: tap the power of the central nervous system and make it work. This lecture will include details about and provide tioning what we used to believe was the correct view of motor and sensory we can physiology, now move on to The past has given us to the achieve key spinal cord fusion and conduct the first human head transplant. By ques- When Robert White carried out his first head transplantation on a monkey, he was drowned in criticisms of all kinds. all of criticisms in drowned was he monkey, a on transplantation head first his out carried White Robert When routine. Same goes for the brain. Not to mention transplantation. Surgeryroutine. Same goes for the brain. Not is outsmarting nature. achievable. No more than a few decades ago, surgeryago, is decades it few now a grasp, than our more beyond heartNo be the achievable. to on believed was What is surgery? Pushing the limits. That is why we became surgeons. our Testing limits and the limits of what is Moderators: Uretz Oliphant, MD & William Mathews, MD Baltimore, MD 1:30- 3:00 PM

John Cameron, MD Cameron, John William Stewart Halsted: Our Surgical Heritage William Stewart

There is perhaps no story in medical science over t over science medical in story no perhaps is There Moderator: Moderator: MD Uretz Oliphant,

N Halsted, generally regarded as the most innovative innovative most the as regarded generally Halsted,

Hopkins University School of Medicine, Baltimore, M Baltimore, Medicine, of School University Hopkins Baltimore, MD 12 SCIENTIFIC PROGRAM HSC Shreveport FICS Bharat Guthikonda, MD, Outcomes Better To Transition A Surgery: Transphenoidal Endoscopic Patricia Scripko,MD, Commodifying HumanTraits:TheNeuroethical Aspect Sudhir B.Rao,MD Surgical TreatmentofHumerusFractures Paul Park, MD, PhD Cambodia Brain Traumatic in Craniectomy Decompressive Early UK London, London, College University Musculos and of Orthopaedics Institute Engineering, MSc MRCS, (hons), ChB MB Thangarajah, Tanujan Shoulder ArthroplastyinEpilepticPatients UK London, London, College University Musculos and of Orthopaedics Institute Engineering, MSc MRCS, (hons), ChB MB Thangarajah, Tanujan Instability Shoulder Recurrent Arthropl Shoulder Reverse Fixed-Fulcrum Constrained See Page 10fordescription William Mathews,MD SudhirB.Rao,MD& Moderators: 8:00-10:00 AM University of Massachusetts Medical School, Provide RezaF.Saidi, MD,FICS Liver TransplantationforMalignantNeoplasms Alagappan Annamalai,MD,FICS Incidence and Risk Factors of Deep Vein Thrombosis Timothy Pawlik,MD,MPH,PhD Controversies andUpdatesinManagementofPatientswithIntrahepaticCholangiocarcinoma Martin Makary,MD,MPH Laparoscopic PancreasSurgery Christopher Wolfgang,MD,PhD 3:15-5:45 PM Cystic NeoplasmsofthePancreas Penh, KingdomofCambodia,Reno,NV T HE L ATEST , Big Rapids Orthopaedic PCPremier, BigRapids Orthopaedic HandCenterBigRapids, Michigan,BigRapids, MI , Global Outreach Fellow, Korean American Medical A U Neurologist, SalinasValley MemorialHospital,Salinas,CA , FACS,, Assistant Professor ofSurgery Division of DTSIN PDATES , Professor of Surgery JohnsHopkinsHospital,Baltimore, MD , Professor ofSurgery N UOOIA AND EUROLOGICAL , Associate Professor Director of Skull Base Research Department of LSU Neurosurgery , Professor of Surgery andOncology,, Professor ofSurgery JohnsHopkinsHospital,Baltimore,MD , AssociateProfessor ofSurgery, Pathology andOncology, Baltimore,MD , Cedars-SinaiMedicalCenter, Los Angeles,CA H F S EPATO RIDAY ATURDAY Coffee Break - 9:45-10:00 AM Coffee Break-9:45-10:00 AM -P , J nce, RI ANCREATO , J keletal Science, Division of Surgery and Interventi and of Surgery Division Science, keletal Interventi and of Surgery Division Science, keletal UNE UNE O , Research Fellow, The John Scales Centre for Biome for Centre Scales John The Fellow, Research , Biome for Centre Scales John The Fellow, Research , RTHOPAEDIC After Liver Transplant 12, 2015 13, 2015 Injuries: A Case Series from the Kingdom of Kingdom the from Series Case A Injuries: Neurosurgery-Ent Collaboration Producing Collaboration Neurosurgery-Ent -B asty for the Treatment of Epilepsy-Related of Treatment the for asty ILIARY OrganTransplantation Department ofSurgery ssociation, Preah Kossamak Hospital, Phnom S (HPB) S URGERY URGERY ( CONTINUED S S ENATE ENATE onal Science, onal Science, onal ) A&B A&B dical dical SCIENTIFIC PROGRAM 13 D A&B A&B APITOL C ENATE ENATE S S ) ) of Neurosurgery Cedars-Sinai Neurosurgery of nt Oakland University School of CONTINUED ( CONTINUED ( e, PA cine at the University of Pennsylvania, The Second Affiliated Hospital, Harbin Colorado Medical Center and Denver Health Denver and Center Medical Colorado URGERY S URGERY S ationsin Cerebrospinal Fluid Dynamics in osurgery for Benign Tumors in the Adult ce and Impact on Functional Outcome, a 13, 2015 13, Advancements in Painful Osteoarthritis of the Hip the of Osteoarthritis Painful in Advancements es UNE UNCH L RTHOPAEDIC , J RTHOPAEDIC O O ATURDAY , Clinical Assistant Professor, Orthopaedic Surgery University of Texas Health Texas of SurgeryOrthopaedicUniversity Professor, Assistant Clinical , S , Maxine Dunitz Neurosurgical Institute Department Department Institute Neurosurgical Dunitz Maxine , , Director of First InstituteTeam LLC, Millersvill , Orthopaedic Coffeyville Orthopedics Surgeon, , Coffeyville, KS , Greenwood Leflore Neurosurgery, Greenwood, MS Greenwood, Neurosurgery, Leflore Greenwood , MS Greenwood, Neurosurgery, Leflore Greenwood , , Professor of Neurological Surgery, William Beaumo EUROLOGICAL AND Associate Professor of Neurosurgery, University of of University Neurosurgery, of Professor Associate , , EUROLOGICAL AND N Professor of Surgery Hand and Microsurgical Center, N , Carpal Pain Solutions, Inc., Palm City, FL City, Solutions, Inc., Palm , Carpal Pain Third Year Medical Student, Perelman School of Medi OON -1:30 PM

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Medical Center Los Angeles, CA, Los Angeles, CA Angeles, Los CA, Angeles, Los Center Medical Medical University, Harbin, China Hao-Hua Wu, BA, Clinical Depression and ACL Reconstruction: Inciden The Latest Clinical Surgical Total Hip Replacement Replacement Hip Total Surgical Clinical Latest The Robert S. Mathews, MD, PhD

Debraj Mukherjee, MD, MPH, MPH MPH, MD, Mukherjee, Debraj DynamicCervicomedullary Cord Compression and Alter Children with Achondroplasia Prospective Cohort Study Moderator: Bereneau, MD Anca 1:30-2:15 PM N

Xiaoping Ren, MD, Preclinical Studies of Allogeneic Head and Body Reconstruction Preclinical Studies of Allogeneic

Surgical Management of Epilepsy Surgical Management of Epilepsy Lucia Zamorano, MD, FICS Pitfalls in the Treatment of Distal Humerus Fractur Humerus Distal of Treatment the in Pitfalls Maxime J.M. Coles, MD, FICS Gene E. Bolles, MD, FICS MD, Bolles, E. Gene Management and Treatment of Sports Concussions Sports of Treatment and Management Posterior Fossa FICS PhD, MD, Clark, Craig W. Medicine, Birmingham, MI Controversies in Neurosurgery: Radiosurgery vs Micr W. Craig Clark, MD, PhD, FICS PhD, MD, Clark, Craig W. Controversies in Neurosurgery: Vertebroplasty vs Kyphoplasty Neurosurgery: Vertebroplasty Controversies in

Claudication- Neurogenic or Vascular Claudication- Neurogenic FICS MS. MD, Jr., Greenfield, Q. Gerald Long-Term Effectiveness of a Non-surgical Treatment for Carpal Tunnel Syndrome for Carpal Tunnel Treatment of a Non-surgical Effectiveness Long-Term Michael Politis, PhD Antonio, San Antonio, TX San Sciences Center-

Moderators: Moderators: MD & Maxime Coles, MD Bharat Guthikonda, 10:00 AM-N

Philadelphia, PA Medical Center, Denver, CO Denver, Center, Medical 14 SCIENTIFIC PROGRAM Jonathan Cook,MD Non-Surgical Management ofPilonidalDisease-isitFeasible? Milad Mohammadi,MD Sel Patient Fractures: Rib Traumatic of Plating Rib Jesse Flores,MD Massive Gastrointestinal Bleeding From Jejunal Dive Joshua M.V. Mammen, MD, PhD, MBA, FICS Successful IncorporationofMidlevelProviders inanAcademicSurgicalDivision Phillips KirkLabor,MD,FICS Update onLightAdjustableLenses Marco A.PelosiIII,MD,FICS Vaginal SurgeryUnderLocalAnesthesia:AnEmergingParadigm Raymond A.Dieter,MD,FICS Profound HemorrhagicAnemiawithNoTransfusions Sivamainthan Vithiananthan, MD, FICS Teaching Hospital Pati Surgical Improve Can Intervention Based Team A setting. comprehension ofthetopicsandcasesdiscussedallowingforoptimalpatientcareinamulti-disciplinary special surgical varied the address will that dents This session will include submitted abstract presen Marco Pelosi,III,MD&JoshuaMammen, Moderators: 3:30-5:30 PM Timothy Pawlik,MD,MPH,PhD How MedicalCareIsBeingCorrupted with ampletimeforinteractionbetweentheaudienceandpanelists. are threatening patient care and the relationship b influences outside how debate will session This patients. their of detriment the to forces these by influenced be may Many outside forces seem to corrupt and threaten th Frank Bongiorno,MD Moderator: 2:15-3:30 PM University Chief, Minimally Invasive and Bariatric University of Kansas, Kansas City, KS , Resident,Texas Tech UniversityHealthSciencesCenter, Lubbock, TX , General Surgery Resident,PinnacleHealth Hospitals, Harrisburg,PA, GeneralSurgery , Resident,Texas Tech UniversityHealthSciencesCenter, Lubbock, TX O , Director, Pelosi MedicalCenter, Bayonne,NJ , Founder, EyeConsultantsofTexas, Grapevine,TX PEN , CardiothoracicSurgeon,GlenEllyn,IL , Professor of Surgery andOncology,, Professor ofSurgery JohnsHopkinsHospital,Baltimore,MD F ORUM S , FACS, Associate Professor of Surgery (Clinical) A ATURDAY A NNUAL Surgery The Miriam and Rhode Island Hospitals, Prov , Associate Professor of Surgery and Molecular & In — F etween a doctor and their patient. Various scenario tations from ICS Fellows, Non-members, Residents an ties represented within the College. Participants w Participants College. the within represented ties e relationship between doctors and patients. A doct , J REE E UNE THICS rticulosis: Angiographic Localization and Resection P ection, Operative Planning and Technique and Planning Operative ection, APER 13, 2015 ent Satisfaction and Readmission Rates in a in Rates Readmission and Satisfaction ent F ORUM P RESENTATIONS lpert Medical School of Brown tegrative Physiology, s will be presented idence, RI C C ill increase their increase ill d medical stu- APITAL APITAL or’s or’s decisions A&B A&B ACKNOWLEDGEMENTS 15 : Abilene, TX Neurosurgery Richmond, CA Philadelphia, PA Corey Ruth, MD Quirico Torres, MD Quirico Torres, David Wren Jr., MD Jr., David Wren Ryadh, Saudi Arabia Khalid Mehmood, MRCS Khalid Mehmood, SI-BONE, Inc. the American Academy of elcome the following new following the elcome Southern Spine, LLC EETING M XHIBITORS E Astoria, NY CIENTIFIC Lebanon, TN Lebanon, Lafayette, CA S Neurosurgery Big Rapids, MI Big Rapids, Las Vegas, NV Las Vegas, Sudhir Rao, MD Sudhir Rao, Williamsville, NY Kazem Fathie, MD Kazem Fathie, Mechanicsburg, PA Stephen Neely, MD Stephen Neely, Welcome Tobias Mattei, MD HIS Mark Perlmutter, MD Mark Perlmutter, Orthopaedic Surgery William Mathews, MD T Mohamed Ahmed, MD Mohamed With Our Thanks Our With to bring Dr. Canavero to Annapolis to Canavero bringto Dr. Globus Medical WOULD NOT BE POSSIBLE WITHOUT THE GENEROUS SUPPORT FROM THE FOLLOWING DePuy Synthes Spine the Keynote Speaker Fund that enabled the Academy Yardley, PA Yardley, Del City, OK Del City, Boulder, CO Boulder, Babylon, NY Neurosurgery Allentown, PA Columbus, OH San Antonio, TX Gene Bolles, MD Tariq Lamki, MD Stephen Earle, MD Jay Talsonia, MD Jay Talsonia, Anca Bereanu, MD Jeffrey Epstein, MD Orthopaedic Surgery

Christopher Barry, MD Christopher Barry,

The following individuals made financial contributions individuals establish to The following

Neurologic and Orthopaedic Surgeons would like to w to like would Surgeons Orthopaedic and Neurologic months. in the last 12 joined the Academy who have members The Chairman of the Board, Officers and Members of 16 SOCIAL EVENTS rdy Jn 284 MNo GatheratRegistration 8:45AM-Noon Friday June12 Everyone Everyone Warhero. Revolutionary PaulJones, John of Crypt the and open) (when Chapel Main Monument, Herndon Court, Price: $12perperson. least onemileofwalkingovervariedsurfacesandsteps. Academy.at Naval be the will from There and to transportation including half & a hour an roughly last will tour The cannot beaccepted.IfyouarenotaUScitizen,pleasebringyourpassport. Update; reconnect with old friends welcome New Fell Our first day’s scientific session in Annapolis end success ofourmeetingandSection.ThewinnerstheScholarshipcompetitionwillalsobeannounced here. Please join us as we induct our Section’s new Fellows into the College and honor those who have contributed to the shouldn’t bemissed. rent & future social activities for the Alliance. I Please join us to discuss Alliance plans for the Annual Meeting and beyond. Topics will include future leaders, and cur- Free toallattendeesbutcheck with Registration for On-Site Availability. andhighlightsofourhostcity.be yourguidetothehistoricalimportance it is today and an understanding of the highlights not-to-be-missed of the city during your visit. A local historian will city,the of history the of what be to came Annapolis how overview an with attendees provide will Meeting Annual the during Annapolis visiting are who members family and spouses, members, Alliance towards geared event; This Price: $100per person. wineat yourtable,acashbar,meal willfeature complimentary award presentationsandliveentertainment. style buffet The ICS-US. the AANOS and of dinner closing combined the attend to you invite MD Mathews, William befo event last one for together come we as us Join highlights include life at the U.S. Naval Academy p Academy.Naval States United Yourfamed the of tour tour historical a for depart to choose Fridaymay you morning hrdy ue1 :070 MSenateB CapitalD 6:00-7:00PM SenateA&B Noon-1:30 PM Thursday, June11 11:20-Noon Thursday, June11 Thursday, June11 audy ue1 :01:0P CapitalD 7:00-10:00 PM Saturday, June13 hrdy ue1 02-12 MSenateA&B 10:20-11:20AM Thursday, June11 18 and older must have a government-issued photo ID photo government-issued a have must older and 18 A LLIANCE T Check with Registration for On-Site Availability. HE Check with Registration for On-Site Availability. T B HE A ADOF OARD MERICAN I NTERNATIONAL A AEYOF CADEMY D N W E f you have ever wondered what the Alliance is or do IRECTORS H C AVAL s with a cocktail reception. Join us as we kick off XPLORE LEEOF OLLEGE ELCOME C ONORS LOSING ast and present. Tour includes Lejeune Hall, Bancro N UOOIA AND EUROLOGICAL A ows and meet members you may not have encountered b OTDBY HOSTED re we bid farewell until next year. Uretz J. Olipha J. year.Uretz next until farewell bid we re CADEMY AND A S & G L URGEONS R NNAPOLIS UNCHEON D ECEPTION INNER ENERAL T - U OUR . Photo copies of ID (passports, ID Cards, etc.) Cards, ID (passports, ID of copies Photo . O NITED RTHOPAEDIC M S EMBERSHIP TATES S S ECTION URGEONS M the 77th Annual Surgical EETING es, then this meeting ft ft Hall, Tecumseh nt, MD and MD nt, efore. The following Abstracts are listed in alphabetical order by A BSTRACTS presenting author.

They have been reproduced as submitted with limited editing.

17 Incidence And Risk Factors Of Deep Vein Thrombosis After Liver Transplant Anand Annamalai, MD, FICS Cedars-Sinai Medical Center, Los Angeles, CA

Purpose: Deep venous thrombosis (DVT) occurs in 0.1% of persons per year affecting 15-40% of general surgical procedures without prophylaxis. Thromboembolic prophylaxis is not commonly used after orthotopic liver transplan- tation (OLT) due to the risks of bleeding and coagulopathy. Cirrhosis and the association with the coagulation cas- cade, pre and post-transplant, are not well understood. The purpose of our study was to determine the incidence of DVT and its’ risk factors after OLT.

Methods: We retrospectively reviewed OLT performed at our center from 2005 to 2012. We identified patients with Doppler examinations showing DVT post-OLT, platelet count and international normalized ratio (INR) at time of DVT, associated symptoms, DVT prophylaxis, and perioperative risk factors. We determined the incidence of DVT, the odds ratio of each preoperative risk factor, the difference in platelet count and INR between those with and without a DVT, and the weighted risk of each factor in the development of a DVT using logistic regression modeling.

Results: Of 314 patients, the incidence of DVT was 8.6% (27/314). Between those with and without DVT there was no significant difference in age, gender, platelet count, INR, infection, hepatocellular cancer, use of venous bypass, and prior surgery. There was a significant difference in mobility, 67% vs 20% (p < 0.0001) and the use of factor VII, 11% vs 2% (p < 0.05). The estimated risk for of developing DVT for patients with neither of these factors was 4%; with factor VII the risk rose to 17%; with mobility difficulty the risk rose to 23%; and with both the risk was 62%. In our entire population, there were no cases of pulmonary embolism.

Conclusions: The risk of developing a DVT after OLT is at least 9% even with mechanical DVT prophylaxis. Consid- eration should be given to using both mechanical and chemical prophylaxis after OLT.

Controversies in Neurosurgery: Vertebroplasty vs Kyphoplasty W Craig Clark, MD,PhD, FICS Greenwood Leflore Neurosurgery, Greenwood MS

Purpose: Vertebral Compression Fractures (VCFs) are quite common in the elderly due to a combination of more fragile or brittle osteopenic or osteoporotic bone and an increased number of falls. Due to the overall increase in the aging population, we can expect an ever increasing incidence of VCFs. Maybe of even more significance are com- plications associated with these events due to the associated pain and secondary lack of mobility. Within the last decade minimally invasive procedures that involve the internal fixation of these fractures with bone cement have BSTRACTS been developed. Initially this was the vertebroplasty, and later kyphoplasty. The relative advantages and disadvantages

A of each procedure or technique is explored, with an emphasis on complication avoidance and maximizing patient safety.

Methods: This study involves the retrospective review of the author’s 15 year experience with cementoplasty admin- istered for the treatment of VCF. Parameters examined include patient demographics, LOS, OR time, rates of extrava- sation or embolization of the bone cement, intra- and perioperative complications, and patient satisfaction

Results: There were in excess of 300 cases available for review and followup. The treatment groups were stratified based on vertebroplasty versus kyphoplasty. Parameters of each group will be presented with nonparametric statistical tests of significance.

Conclusions: Based upon the statistical analysis noted above, subgroup analysis and stratification will attempt to rec- ommend the most efficacious, least costly and safest cementoplasty treatment of VCFs.

Controversies in Neurosurgery: Radiosurgery versus Microsurgery for Benign Tumors in the Adult Poste- rior Fossa W Craig Clark, MD,PhD, FICS Greenwood Leflore Neurosurgery, Greenwood MS

Purpose: The most common benign posterior fossa tumors in adulthood are generally recognized to be meningiomas and nerve sheath tumors. As experience developed the goal of treatment shifted from complete resection to preser- vation of hearing and facial function. Several large clinical series have now been published and provide the case data for this report. When should the neurosurgeon recommend open microsurgery and when should stereotactic radio- surgery be employed? How effective is radiosurgery in providing growth control of these usually slowly progressive masses? How important is “Gross Total Resection” in the management scheme? 18 continued on next page ABSTRACTS 19 into healing into ion was first onic infection onic scomfort, and scomfort, e of any hearing any of e the prevention of prevention the ssion free intervals free ssion intergluteal region intergluteal in mild and moderate and mild in erapy in the prevention of prevention the in erapy in conjunction with surgery to prevent hair growth growth hair prevent to surgery with conjunction in ion affecting the sacrococcygeal region. The condit al disease that minimizes time to wound healing, di healing, wound to time minimizes that disease al e commonly manifests as recurrent abscesses and chr and abscesses recurrent as manifests commonly e redictive variables were tumor size and the presenc the and size tumor were variables redictive ical management of pilonidal disease, especially in especially disease, pilonidal of management ical tive hearing status and facial function, and progre and function, facial and status hearing tive al approaches and closures, excision of skin in the in skin of excision closures, and approaches al ase, laser therapy alone achieves excellent results excellent achieves alone therapy laser ase, laser hair removal as an alternative to surgical th surgical to alternative an as removal hair laser Jonathan Cook, MD Jonathan Cook, Raymond A. Dieter, Jr., MD, FICS Cardiothoracic Surgeon, Glen Ellyn, IL Profound Hemorrhagic Anemia with No Transfusions

General Surgery PA Hospitals, Harrisburg, PinnacleHealth Resident,

Non-Surgical Management of Pilonidal Disease – is it Feasible? of Pilonidal Disease Non-Surgical Management

* Outcomes are improved when laser therapy is used used is therapy laser when improved are Outcomes * * Laser treatment is less morbid than conventional surgery with less post operative pain. disease.

* Although not proven to be curative in severe dise severe in curative be to proven not Although * Conclusions: * Laser hair removal provides a safe and effective adjunct to surgical management of pilonidal disease. pilonidal of management surgical to adjunct effective and safe a provides removal hair Laser * Conclusions: * Data collection is ongoing occurred in twenty-one of twenty-three patients (91%). occurred in twenty-one of twenty-three * Clinical response (significant reduction in symptoms) was achieved in 100% of those treated. Complete resolution Complete treated. those of 100% in achieved was symptoms) in reduction (significant response Clinical * Results: * Nine of twenty-three patients (40%) required surgery throughout the course of the study. (40%) required surgery patients Results: * Nine of twenty-three throughout the course of the study. patrick skin type. performed. * Laser therapy consisted of alexandrite (1064nm), (755nm) depending or on NdYag hair type and Fitz- gorithm. Incision and drainage was undertaken when necessary, but surgical excision of intergluteal skin was not Methods: * Twenty-three patients, ages 11 – 23 were treated over a five year period, according to our treatment al-treatment our to according period, year five a over treated were 23 – 11 ages patients, Twenty-three * Methods: recurrences.

* Further study is needed to determine the role of of role the determine to needed is study Further * wounds. recurrences. * Develop an algorithm for the treatment of pilonid of treatment the for algorithm an * Develop described by Herbert Mayo in 1833. Pilonidal diseas Pilonidal 1833. in Mayo Herbert by described recurrence. Purpose: Purpose: Pilonidal disease is a dermatologic condit

considerable morbidity. Despite a variety of surgic of variety a Despite morbidity. considerable of hair follicles in the gluteal cleft. It is a debilitating condition and conventional surgical management can result in

risks for tumor necrosis, swelling and mass effect in the posterior fossa. swelling and mass effect in the risks for tumor necrosis, use radiosurgery or microsurgery. There are finite limits on ideal tumor size to be treated with radiosurgery due to the to radiosurgerydue with treated be to size tumor ideal on limits finite are There microsurgery. radiosurgeryor use Conclusions: The ability to preserve hearing is most often related to tumor size, regardless if the surgeon elects to Results: The preliminary results suggest the most p most the suggest results preliminary The Results: of presentation during follow-up. loss or facial weakness. The data are yet to tested for statistical significance, with that information reported at time tumor size, any prior surgery in the area, preopera area, the in surgery prior any size, tumor have have been combined to provide the case mix for the included current were report. patient demographics, Variables Methods: Methods: Several large clinical series of the tumors in question have been reported in the literature. These studies continued on next page cently, the wisdom of when to transfuse has been questioned due to potential risks. the wisdom of when to transfuse has been questioned due to potential cently, transfusion has been utilized frequently for treatment of shock, hemorrhage, anemia, and other diseases. More re- and success. No crossmatch was done - only withdraw from the donor and inject the recipient. Since then, blood The first blood transfusion in DuPage County was in the early 1930’s by Dr. C. A. Gutzmer for meningitis with shock with meningitis for Gutzmer A. C. Dr. by 1930’s early the in was County DuPage in transfusion blood first The * Evaluate laser hair removal as an adjunct to surg to adjunct an as removal hair laser Evaluate * * Determine the efficacy of laser therapy as an alternative to surgery* Determine the efficacy of laser therapy in the treatment of pilonidal disease. removing hair both in primary Our study goals: and recurrent pilonidal disease. moval. When utilized as part of a strategy to treat pilonidal disease, laser therapy has been shown to be effective in development of recurrent disease after Laser surgery. epilation is a safe and effective outpatient method of hair re- recognized that hair in the natal cleft plays a central role in the etiology of primary pilonidal disease as well as in the is associated with high recurrence rates and difficulties in achieving optimal wound healing. Numerous studies have studies Numerous healing. wound optimal achieving in difficulties and rates recurrence high with associated is 20 ABSTRACTS Both patients hemoglobin rose rapidly while followe with blood. Both patients received IV fluids and wa The second patient, struck by a train, bled down to flipped off a bus onto a Chicago curb into the snow Methods:Retrospective case review: Jejunal Divert nosed andlocalizedwithangiography, andsubsequentlyresected. diag- to Jejunal Diverticulosis Purpose: The case herein describes massive lower gastrointestinal bleeding secondary proach tomanagingthisproblem,withlowcomplicationratesandgoodlongtermpatientoutcomes. ap- novel a represents dysfunction and pain SIJ symptomatic persistently of fusion instrumented invasive Minimally operation onthecontralateralside.Post operativecomplicationrateshavebeenlow. short and long term patient satisfaction rates, wit joint, following thorough clinical and radiographic work up. Six month and 2 year follow up results confirm excellent plas triangular, multiple of placement cally-guided fluoroscopi- invasive, minimally undergone have that patients 70 than more of series single-surgeon a present We outcomes andqualityoflifeindices. A novel minimally invasive technique for fusing the tation. Results for this type of operation have con consists of with open or in-situ without treatment, arthrodeses instrumen- traditional surgical intervention servative con-to respond to failed have that dysfunction and pain SIJ intractable with patients those In (SIJ). joints sacroiliac Purpose: Studies indicate that for up to 25% of patients diagnosed with low back pain, their symptoms arise in their Twopatient examples demonstrate that such an arbit gramhemoglobin in the postoperative period before gram hemoglobin were felt to be an acceptable indic Ingeneral, hemorrhagic shock hasbeen routinely tr Results: The patient is a 62 year-old male who pres anastomosis. intestinal resectionwithprimary rhaging and potentially unstablehemor- the patient.in location Treatmentand etiology diagnose rapidly to physician the challenge Diverticula Jejunal Bleeding scan. mography (CT) angiography, small bowel contrast study, mesenteric angiogram and technetium-99m red blood cell to- computerized by made be can Diagnosis artery. perforating a through erosion diverticular from results orrhage massive and acute, requiring emergent surgical Likeintervention. that of colonic diverticula, Jejunal diverticular hem- Hemorrhage from JD usually occurs as lower GIB, although hematemesis has been described. Hemorrhage may be struction, and perforation. 0.3%-4.5% at autopsy. These false diverticula are m more commonly in older males. Major complications travasation of contrast in the proximal jejunum. Mi an EGD and colonoscopy that showed diverticulosis, continued onnext page Seven days later, he began having bright red blood colectomy. hemi- left for emergently OR the to taken was He observed. diverticuli colon sigmoid bleeding with repeated, was After an episode of acute bleeding, mesenteric angi clusive due to blood in the colon. was negative. He subsequently had several episodes Minimally InvasiveInstrumentedFusionforSacroiliacJointDysfunction Massive Gastrointestinal Bleeding From Jejunal Dive Jejunal From Bleeding Gastrointestinal Massive Resident, Texas Tech University HealthSciencesCenter, Lubbock TX Neurosurgeon, Maryland BrainandSpine,Annapolis,MD Neurosurgeon, Maryland Angiographic Localization and Resection and Localization Angiographic crocatheter remained in the Jejunal arcade for intr ented with abdominal pain, diarrhea, and hematochez h more than 20% of patients subsequently electing t sistently been associated with low success rates an Jesse Flores,MD a hemoglobin of 2.0 grams at age 20. Neither patie from the end colostomy. Repeat mesenteric angiograp lked out of the hospital with no ill consequences e ucosal evaginations on the mesenteric border of the . She bled down to 1.8 gram hemoglobin, due to a la sacroiliac joint appears to significantly improve iculosis(JD) is a rare clinical condition, with a of lower GIB secondary to jejunal diverticulosis i Gary Dix,MD ogram was performed and no source was identified. C eatedwith fluids andblood infusion. Initially, gu but no evidence of bleeding. A tagged RBC scan was d as outpatients. of bright red blood per rectum and repeat colonosco ma-coated, titanium dowels across the symptomatic s symptomatic the across dowels titanium ma-coated, ation for transfusion. Later this level was dropped include diverticulitis, gastrointestinal bleeding ( redcell transfusion. Most non-surgeons transfusing rarylevel does not necessarily bode ill. A 90 year rticulosis: rticulosis: aoperative localization. reportedincidence of patients' functional ncludes segmental GIB), intestinal ob- xcept feeling tired. idelinesto10of9 nt was transfused d high morbidity. ia. He underwent o have a second Jejunum, found -oldfemale was to as low as 7.0 hy revealed ex- py was incon- rge laceration. also done and before then. olonoscopy acroiliac ABSTRACTS 21 een the ined neu- ined microscopic nsphenoidal c procedure. c collaborative c claudiation r claudication. r gical versus a gical versus Shreveport LA Shreveport uld be included be uld bleeding. JD may JD bleeding. Neurosurgery-ENT Collaboration . We have noted a lower rate of conversion to open open to conversion of rate lower a noted have We . d loss was lower in the cases performed by the comb the by performed cases the in lower was loss d nt was the rate of conversion to an open microscopi open an to conversion of rate the was nt iddle skull base pathologies. Many centers employ a employ centers Many pathologies. base skull iddle nosis and complications. Jejunal diverticulosis sho diverticulosis Jejunal complications. and nosis abase was performed. We included all endoscopic tra endoscopic all included We performed. was abase anding of the basis for both neurogenic and vascula and neurogenic both for basis the of anding Complications were also assessed and compared betw difference between claudication based on a based neurolo claudication between difference two clinical situations and treatment for neurogeni h, Department of Neurosurgery, LSU HSC Shreveport, Shreveport, HSC LSU Neurosurgery, of Department h, tion that may present with massive gastrointestinal massive with present may that tion Bharat Guthikonda, MD, FICS Producing Better Outcomes Gerald Greenfield, Jr, MD, MS, FICS Gerald Greenfield, Claudication- Neurogenic or Vascular Claudication- Neurogenic Clinical Assistant Professor of Orthopaedic SurgeryClinical Assistant Professor

University of Texas Health Sciences Center- San Antonio, San Antonio TX Health Sciences Center- University of Texas Endoscopic Transphenoidal Surgery: A Transition to

Associate Professor, Director of Skull Base Researc Base Skull of Director Professor, Associate

in the differential diagnosis of an older patient with massive GIB. of an older patient diagnosis in the differential demonstrate high mortality rate due to delayed diag delayed to due rate mortality high demonstrate

Conclusions: Jejunal diverticulosis is a rare condi rare a is diverticulosis Jejunal Conclusions: anastomosis was performed. Postoperatively, he progressively recovered and was discharged home. was discharged and recovered progressively he Postoperatively, performed. was anastomosis erative injection of methylene blue localized the bleeding to this area. Segmental small bowel resection with primary with resection bowel small Segmental area. this to bleeding the localized blue methylene of injection erative Intraoperatively, several large Jejunal diverticula containing blood clots were identified in the mesenteric fat. Intraop- fat. mesenteric the in identified were clots blood diverticula containing Jejunal large several Intraoperatively, Purpose: The purpose of the report is to define the is to define of report the purpose The Purpose: Methods: A review of a prospectively maintained dat maintained prospectively a of review A Methods: especially as they relate to the rate of conversion to open (microscopic) approach and extent of resection of tumors. of resection of extent and approach (microscopic) open to conversion of rate the to relate they as especially laborative team approach for skull base endoscopy. We have appreciated significant improvements in our outcomes, our in improvements significant appreciated have We endoscopy. base skull for approach team laborative performing a single service management of these lesions for the past few years, we have recently converted to a col- a to converted recently have we years, few past the for lesions these of management service single a performing endpoi primary Our team. ENT / neurosurgery orative iopharyngiomas, CSF leaks, and other anterior and m and anterior other and leaks, CSF iopharyngiomas, in Other advanced centers endoscopy. may utilize a single service strategy for management of these lesions. After collab- a by performed those evaluated separately and servicealone neurosurgical the by performed were that dures Purpose: Endoscopic Purpose: transphenoidal surgery has become a mainstay in the treatment of pituitary adenomas, cran- management team consisting of a skull base neurosurgeon working together with an ENT surgeon with expertise proce- transphenoidal endoscopic all evaluated We time. present the until 2007 August from performed procedures

for CSF rhinorrhea), and intraoperative blood loss. Secondary endpoints were extent of resection of the neoplastic lesions, CSF leak recurrences (in the cases performed cases the (in recurrences leak CSF lesions, neoplastic the of resection of extent were Secondaryendpoints less blood loss, and improved extent of tumor resection. surgery, pituitary macroadenomas was better and overall bloo overall and better was macroadenomas pituitary There was one failed CSF leak repair requiring a subsequent transcranial repair in both subsets. Extent of resection of resection of Extent subsets. both in repair transcranial subsequent a requiring repair leak CSF failed one was There approach rate of 18% in the cases done by neurosurgeryneurosurgeryby combined done the cases in the 0% cases. in and ENT 18% alone / of rate approach and 25 were performed by the combined neurosurgery / ENT team. There was a conversion to open microscopic team ENT / neurosurgery combined a using by surgery Results: A total of 75 endoscopic transphenoidal cases were evaluated. 50 were performed by neurosurgery alone transphenoidal endoscopic in outcomes better achieving of concept the supported has experience Our Conclusions: two subsets of cases. rosurgery / ENT team.

Results: Results will define the difference in the for the diagnoses.Testing option for differentiation between the two disorders. option for differentiation for the diagnoses.Testing Methods: Historical perspective for claudication and its definition will be reviewed along with the anatomical bases vascular factors. vascular Several noninvasive methods to differentiate the two. Several noninvasive methods to differentiate

Conclusions: Attendees will have a concrete underst concrete a have will Attendees Conclusions: (ESI),distraction,decompression. 22 ABSTRACTS through accommodative or multifocal modalities. Thi correct surgically-induced simultaneously aphakiato way and a presbyopia.as surgeons cataract to available made been have lenses Intraocular years 20 almost For endpoint maybeachievedthroughtheuseofuniquelydesignedmonofocallens. of midlevel providers can serve asamodelforotheracademicornon-academicdivisions. of midlevelproviderscanserve via email to ensure that they were aware of the thought process involved in decisions. The successful incorporation Additionally, they would be present in the operatin patients. post-surgical and pre-surgical of treatment and evaluation the of elements critical the learn the to order in Both midlevel providerselements. spentseveral had extensiveexperience) timecare evalua primary extensive but experience surgical no had midlevel whom the of of (both providers training The team. the on role their appreciate and provider midlevel the of role the value service the on Residents room. operating the in assists also providers midlevel the of one setting outpatient the in sibilities emergently,and elective respon- to addition In diagnoses. cancer complex with patients of evaluations initiate and phone complex (returning patients with liaisons as addition, two midlevel providers are members of thi In residents. surgical three and physicians attending five of composed is Kansas of University the at division cology is to describe the effective incorporation of midlevel providers within an academic surgical division. The surgical on- portunities to work most efficiently and with great departments. Surgeons, particularly those who practice in academic settings, have had challenges in op- identifying emergency and settings care primary many in healthcare of delivery the in roles important Providersserve Midlevel Methods: We have identified afferent peripheral fib process the painfulinflammatory generative process brought cellular lysosomal enzym de- this with cope to cells scavenger the of inability The histiocytes. and cells mast attack and process flammatory on ambulation. The femoral head debris lost via repetitive microfracture on motion tended to self-perpetuate the in- motion joint of rigors the to react to appeared synovium the joint, hip osteoarthritic painful severely the Purpose:In and the scarified tissue near articular cartilage a cartilage articular near tissue scarified the and Conclusions: Inall,weachieved 95percenthippainreliefinthesepatients stress risers,Cementtechnique, Titanium porous, Length control,Ceramics andAntibioticsincement Furthermore, other progress by all of us included: hip painreliefinthesepatients. fore and after surgery. Each patient seen post-ope Results: The anatomic data in our total hip replacement patients was correlated with the clinically evaluated pain be- (PlateI). wall ofthefemoralcortex myelinated fibers of bone were found near un- and themyelinated The vascu trabeculae. the along follow and epiphysis the toward travel and artery nutrient the with bone. The intramedullary, endosteal unmyelinated a supply the capsule, These the nerves periosteum and tissue the of soft the appear hip throughout joint. the Nerves human joints. Associate Professor of Surgery andMolecular&IntegrativePhysiology,Associate Professor ofSurgery UniversityofKansas,KansasCity, KS Successful IncorporationofMidlevelProvidersinanAcademicSurgicalDivision The Latest Clinical Surgical Total Hip Replacement Replacement Hip Total Surgical Clinical Latest The Director ofFirst Team InstituteLLC,Millersville,PA Joshua Mammen,MDPhDMBA,FICS Update onLightAdjustableLenses Painful Osteoarthritis of the Hip the of Osteoarthritis Painful Robert Mathews,MD,PhD,FICS Phillips Labor,MD,FICS Polyethylene improved, Collarless femoral prostheti s well as nerves in the bone cortex and cancellous cancellous and cortex bone the in nerves as well s est efficacy with midlevel providers. The purpose g room often. Finally, they were included in the a ratively had significant relief of pain. In all, w ers in the hip joint, tendons, synovium, capsule, p s division for the previous one year. The midlevel These lenses have been constructed so that they fun ting patients in the clinics of their collaborating Grapevine, TX lar elements. On occasion, a few fibers extended t nd myelinated fibers enter the bone through the nut s presentation will show how this same corrective a ic release and cell death in bone which served to s calls, communicating results), examine post-operati examine results), communicating calls, Advancements in in Advancements e achieved 95 percent attending physician of this presentation providers function ll patient decisions cs which decrease eriosteum bone, o the endosteal red marrow of marrow red elf-perpetuate ction primarily rient foramen nd functional ve patients ve ABSTRACTS 23 id e scale ly with min- with ly tal in Phnom in tal ma associated ma al stabilization, al I Trauma Center Trauma I lail chest, fractures chest, lail uma, cardiothoracic uma, ilation due to altered to due ilation Injuries: matoma (n=3), brain contusion (n=5), and subarachno without any significant disability [Glasgow outcom ection of patient information at a government hospi government a at information patient of ection versial treatment option for malignant cerebral ede cerebral malignant for option treatment versial roved outcomes in rib fracture patients with surgic with patients fracture rib in outcomes roved of Cambodia, can be performed safely and effective and safely performed be can Cambodia, of erative management conducted at a University Level Level University a at conducted management erative Operative candidates had radiographic or clinical f or clinical radiographic had candidates Operative ain, and inability to liberate from mechanical vent mechanical from liberate to inability and ain, y trauma centers and practiced by a minority of tra of minority a by practiced and centers trauma y Paul Park, MD, PhD Milad Mohammadi, MD Mohammadi, Milad Kingdom of Cambodia, Reno, NV A Case Series from the Kingdom of Cambodia Resident, Texas Tech University Health Sciences Center, Lubbock, TX Lubbock, Center, Sciences Health University Tech Texas Resident, Early Decompressive Craniectomy in Traumatic Brain

Global Outreach Fellow, Korean American Medical Association, Preah Kossamak Hospital, Phnom Penh Kossamak American Medical Association, Preah Korean Global Outreach Fellow,

Rib Plating Of Traumatic Rib Fractures: Patient Selection, Operative Planning and Technique and Planning Operative Selection, Patient Fractures: Rib Of Traumatic Plating Rib

Rib fixation is predominantly described in specialt in described predominantly is fixation Rib intubated patients with deteriorating pulmonaryintubated patients the setting of flail chest. function in imp detailing studies numerous Despite Conclusions: motion with respiration), persistent instability of the chest wall with inability to liberate from the ventilator, and non- and ventilator, the from liberate to inability with wall chest the of instability persistent respiration), with motion 4 days of surgery. The patients were discharged within from the ventilator within 24hrs postoperatively. Open reduction internal fixation of ribs is most beneficial in patients who have clinical flail chest (paradoxical chest liberated both and ribs, 2nd their of plating successful had They respectively. levels fixation 7 and 6 had patients Two Studies have shown improved clinical outcomes following operative stabilization of flail segments. operative stabilization of flail segments. improved clinical outcomes following Studies have shown using titanium plating and screws is also detailed. rib. Our preferred technique of stabilization bidity associated with traumatic rib fractures includes respiratory failure, pneumonia and prolonged hospitalization. second the of plating including chest, secondaryflail mechanics clinical wall to chest disrupted of stabilization screw Results: In 2009, over 300,000 patients with rib fractures were seen in U.S. emergency departments. Significant mor- Significant departments. emergency U.S. in seen were fractures rib with patients 300,000 over 2009, In Results: and plate titanium successful demonstrate herein cases The fixation. rib 2nd describe which literature Western the in also to describe the benefits and reduction in morbidities. will benefit from the procedure, and with displaced ribs, chest wall deformity, severe p severe deformity, wall chest ribs, displaced with respiration. of mechanics or orthopedic describing operative techniques are rare, and there are no known publications surgeons. Publications patients which define to needed sorely are trials Prospective care. of standard the become yet not has operation this for patients who suffered traumatic rib fractures. fractures. rib traumatic suffered who patients for Methods: This retrospective case review includes op includes review case retrospective This Methods: report in the Western literature that describes plating of the 2nd rib. plating of the that describes literature report in the Western to clinical flail chest. also We describe operative technique with a titanium plate and screw system. This is the first Purpose: Herein we present cases of rib fixation for trauma patients with disrupted respiratory disrupted with patients trauma for secondary fixation mechanics rib of cases present we Herein Purpose: included acute subdural hematoma (n=9), epidural he Results: All DC patients were male with an average age of 26 years (SD=7; range 19-43 years). Indications for DC 8% (n=1). Five patients (42%) made a good recovery period. The indications, midline shift, outcomes, and complications were analyzed for a series of 12 patients. mm (SD=2.8; range=8.0-16.5 mm), and MLS of 16.5 mm resulted in death even with DC. The mortality rate was Penh, Cambodia. A retrospective analysis was performed on patients who underwent DC for TBI during a 5-month a during TBI for DC underwent who patients on performed was analysis retrospective A Cambodia. Penh, 9.4 shift was midline (MLS) average The range=5-15). (SD=3, 9 was DC to prior GCS Average (n=1). hemorrhage

Methods: A customized database was created for coll for created was database customized A Methods: monitoring technology may be nonexistent, early DC may be preferable to maximize chances for survival.monitoring technology may be nonexistent, early DC may be preferable tension. In developing countries, however, where intensive care unit (ICU) support may be minimal and intracranial and minimal be supportmay (ICU) unit care intensive where however, countries, developing In tension. improve mortality rates when compared to medical therapy in patients with TBI related refractoryhyper- related intracranial TBI with patients in therapy medical to compared when mortalityrates improve with traumatic brain injury (TBI). A recent multi-center study in the U.S. showed that early DC did not significantly

Purpose: Decompressive craniectomy (DC) is a contro a is (DC) craniectomy Decompressive Purpose: imal risk and favorable outcomes.

in developing medical settings, such as the Kingdom the as such settings, medical developing in bilities may be minimal or nonexistent. Early DC may not increase survival in TBI patients with MLS > 16 mm. DC Conclusions: Early DC may be preferable over medical therapy when ICU support and intracranial monitoring capa- monitoring intracranial supportand ICU when therapy medical over preferable be may DC Early Conclusions: operative and included bone flap infection at site of abdominal storage (n=2) and hygroma (n=2). operative and included bone flap infection at site of abdominal storage (GOS) score of 5]. Average hospital stay was 15 days (SD=7; range 10-32 days). Complications were primarily post- primarily were Complications days). 10-32 range (SD=7; days 15 was stay hospital Average 5]. of score (GOS) 24 ABSTRACTS need forsupplementalsedationwithproperpatientandprocedureselectionadequateprotocols. infrequent an with anesthesia local strict under effectively performed be can procedures Gynecologic Conclusions: infections (0.076%). tract urinary 21 to limited were complications Postoperative complications. intraoperative no were There sedation. continued on nextpage require surgery. andgrowth involve theepiphysis ormetaphysisand often Onemust beawareofvascularinjury Fracturesusually fractures group age pediatric the In group. age any in treat to challenging be can Humerus the of management of carpal tunnel syndrome. effective alternative to carpal tunnel release surg symptomat of level high The syndrome. tunnel carpal Conclusions:currentpuresearchpriorsupportsThe and product satisfaction. There was a slight inverse correlation between symptoms severity and patient satisfaction. resolution symptoms to respect with coincided results PSQ and MHQ both general, In surveyed. categories overall relief. Meanproductsatisfactionwas92.2%in reported needing to use the product on a periodic b (MHQ) for symptoms relief and a standardized Produc question survey was used to assess patient satisfac Carpaltheused patientswho 66 oftotal Methods: A lasting, nonsurgicaltreatmentofcarpaltunnelsyndrome. for means effective an is device this if determine help to results satisfaction patient long-term obtained study This long-term datahavenotbeenpublished. automated device called Carpal Rx, which has been in use for several years. Patients report highly effective results but therapies are sparse and difficult to One ascertain. alternative therapy is tissue soft manipulation as performed by an non-surgically.syndrome tunnel nonsurgical carpal alternative However,their on managed data efficacy long-term Purpose: Abundant data indicate that most patients were successfully completed. There were no anesthet Results: A total of 2,761 gynecologic procedures initiated under strict local anesthesia were identified. All procedures scores andtreatmentoutcomeswereevaluated. procedure selection criteria, anesthetic protocols, Center was performed Medical spanningPelosi the the interval fromat Jan anesthesia local strict under done procedures gynecologic of review fifteen-year A Methods: dures understrictlocalanesthesiaisdemonstrated. Purpose: The feasibility of effectively and efficiently performing a variety of commonly performed gynecologic proce- MHQ results indicated at least a 91.4% and 85.9% sy overall patients, of 12% and 88% In months. 27.4 was Rx Carpal the of use initial from time mean The participants. non-from gathered was information other No product. the to related reasons for declined 3 product; the to lated Results: Of the patients contacted, 52 completed the telephonic 11 survey; declined participation for reasons not re- Rank-sum nonparametric analyses were used to analyz subjectivebaseda on opinion scale0-10(represof sato. te ifrain band nldd ypos eeiy c-obdte, g, edr Cra R use Rx Carpal gender, age, co-morbidities, severity, symptoms history/schedule, included and whether obtained surgery information was/is consid Other isfaction. Long-Term EffectivenessofaNon-surgicalTreatmentforCarpalTunnelSyndrome Vaginal SurgeryunderLocalAnesthesia:AnEmergingParadigm Big Rapids Orthopaedic PC,PremierBig Rapids Orthopaedic HandCenter, BigRapids, Michigan Surgical TreatmentofHumerus Fractures Director, Pelosi MedicalCenter, Bayonne,NJ Carpal Pain Solutions,Inc.,Palm City, FL Marco PelosiIII,MD,FICS ery. These data support the use of the Carpal Rx fo Michael Politis,PhD surgical protocols, perioperative protocols, patie tion based primarily on the Michigan Hand Outcomes Sudhir Rao,MD ered/scheduled/performed. Both questionnaires requi entingleastmostsymptomsto resolution productor asis within the past 12 months to maintain or resto blished short-term data on the use of the Carpal RxCarpalthe of use the onblishedshort-term data who undergo carpal tunnel release surgery could hav mptoms resolution, respectively; and 62% and 88%, r t Satisfaction Questionnaire (PSQ) for overall prod uary uary 1, 1998, through January 1, 2013. Patient sele ic complications. Sixty six patients (2.4%) require Rx more than 24 months were contacted by telephonecontactedweremonthsby 24 than more Rx e results. ic relief and patient satisfaction suggest that thi that suggestsatisfaction patient and relief ic r effective long-term nt report visual pain d supplemental re symptomatic uct/patient sat- red a response Questionnaire s device is an is device s satisfaction). ction criteria, for relievingfor e effectively espectively, . A 17 A . ABSTRACTS 25 le curve le to limit n, n, 18 mice hours, the hours, donor and donor inical trans- inical transplanted ons of people. people. of ons ical activity. The activity. ical group patients. group iological animal iological rs moving, etc.). moving, rs struction (AHBR) struction ion to avoid brain avoid to ion The heart rate was rate heart The hing spontaneously, hing versity, Harbin, China Harbin, versity, nts to reach AHBR long-term survival. Successful cl Successful survival. long-term AHBR reach to nts an medical history and potentially could save milli save could potentially and history medical an cordings were made directly from the cortex of the the of cortex the from directly made were cordings n adequate level during surgery by anastomosing the anastomosing by surgery during level adequate n te of respiration was 140±15/minute. During these 3 these During 140±15/minute. was respiration of te Hg. Although ECG and EEG monitoring shows an unstab an shows monitoring EEG and ECG Although Hg. postoperative decerebrate rigidity. rigidity. decerebrate postoperative inical experiments did not establish an effective b effective an establish not did experiments inical underwent the AHBR procedure. After transplantatio After procedure. the AHBR underwent hemoembolization, or cryotherapy might be indicated and characteristic responsiveness (blinking, whiske (blinking, responsiveness characteristic and ical procedures, which allow for the cross-circulat the for allow which procedures, ical , CTA next frontier, allogeneic head and body recon body and head allogeneic frontier, next CTA , emerged as proven treatment modality for selected selected for modality treatment proven as emerged The Second Affiliated Hospital, Harbin Medical Uni Medical Harbin Hospital, Affiliated Second The ycardia nor bradycardia, and no lethal arrhythmia. arrhythmia. lethal no and bradycardia, nor ycardia Xiaoping Ren, MD Xiaoping nnected. As anticipated, they were capable of breat of capable were they anticipated, As nnected. nd post-operative EEG and ECG show electrophysiolog show ECG and EEG post-operative nd Reza F. Saidi, MD, FICS Liver Transplantation for Malignant Neoplasms Liver Transplantation for Malignant Alpert Medical School of Brown University, Providence, RI Providence, Alpert Medical School of Brown University, Preclinical Studies of Allogeneic Head and Body Reconstruction Head Studies of Allogeneic Preclinical

Assistant Professor of Surgery, Division of Organ Transplantation, Department of Surgery Division of Organ Transplantation, of Surgery, Assistant Professor

Professor of Surgery Hand and Microsurgical Center, Microsurgical and Hand Surgery of Professor Conclusions: Liver transplantation is an valuable option in selected patients with liver tumors. Conclusions: Liver transplantation is an valuable option in selected patients lected patients can approach that for other patients with end-stage liver disease. lected patients can approach that for other patients with end-stage liver junctive procedures like radiofrequency ablation, c cluding chemotherapy and radiotherapy followed by liver transplantation, are carried through. Survival in these se- termined whether patients with more extensive tumors can be reliably selected to benefit from the procedure. Ad- and even cure in a number of patients. Cholangiocarcinoma might qualify if aggressive neoadjuvant therapies, in- adult population yields good results for patients whose tumor do not exceed the Milan criteria. It remains to be de- survivallong-term in result can transplantation liver which for tumor, neuroendocrine a primaryis the which in cases is an excellent indication in pediatric patients with unresectable tumors. Similarly, liver transplantation for HCC in the in HCC for transplantation liver Similarly, tumors. unresectable with patients pediatric in indication excellent an is for liver transplantation. Metastatic liver disease is not an indication for liver transplantation, with the exception of Currently, around 30% of all liver Currently, transplants performed in US are for hepatocellular cancer (HCC). Hepatoblastoma tumor progression for patients on waiting lists. Epitheloid hemangioendothelioma is also an appropriate indication Results: Liver transplantation for malignancies has malignancies for transplantation Liver Results: Methods: Literature Search/Review Purpose: To review the correct data on liver transplantation for hepatic tumors. To Purpose: ternal fixation to arthroplasty fixation ternal options and treatment situations clinical various will discuss This paper . fracture and other parameters. There is a wide spectrum of surgical options ranging from percutaneous pinning, in- pinning, percutaneous from ranging options surgical of spectrum wide a is There parameters. other and fracture impairment. impairment. In the adult the fracture pattern and treatment methods vary based on the age of the patient, type of

Results: Forty Kunming mice and forty C57 wild type C57 wild and forty mice Kunming Forty Results: relevant to translation, including long-term survivalrelevant to translation, including long-term and mental function. we plan to further develop AHBR model in mice and establish the model in monkeys in order to evaluate outcomes evaluate to order in monkeys in model the establish and mice in model furtherAHBR to develop plan we preliminary data in mice. This is the first successful use of this model to build date. the To AHBR research platform, the remainder of the brain. This allows for retention of breathing and circulatory functions, and this is supported by Methods: Our approach, pioneered in mice, involves retaining the donor brainstem and transplanting the head with head the transplanting and brainstem donor the retaining involves mice, in pioneered approach, Our Methods: has been subject unable to complete necessary precl necessary complete to unable subject been has AHBR. the clinical translational of the model and thus hinder in the body. The only surgical treatment strategies treatment surgical only The body. the in there is still no effective way in which to saving the lives of patients with a healthy mind dying of other organ failure organ other of dying mind healthy a with patients of lives the saving to which in way effective no still is there these studies have been clinically validated for more than 10 years, and now are internationally adopted. However, munosuppressive regimen and immune rejection taxonomy and other important scientific indicators adopted from and according to the hand and face conversion, achieved a successful clinical representative of the Joint CTA. im- allotransplantation (CTA), allotransplantation in (CTA), preclinical swine models, and initiation of the US first clinical hand allograft procedure Purpose: Previously, our work Purpose: has Previously, led to the design and completion of the world’s first successful composite tissue

survived for 3 hours after the ventilator was disco was ventilator the after hours 3 for survived ra The intact. remained brainstem donor the because lation of AHBR will become another milestone of hum of milestone another become will AHBR of lation veloping optimization of immune-suppressive treatme immune-suppressive of optimization veloping cephalons. Because blood supply was maintained at a at maintained was supply blood Because cephalons. a intra- the vessels, jugular and carotid recipient mm/ 50 above maintained was pressure blood systolic tach significant neither was there postoperatively, show not did mice the Interestingly, 300±20/minute. surg critical developed has study This Conclusions: de- recoveryand function CNS promoting to study PEG for preliminarydata brainstem, donor of retention ischemia, mice awakened and displayed cranial nerve function function nerve cranial displayed and awakened mice re (EEG) electroencephalogram awoke, mice the After 26 ABSTRACTS continued on nextpage instability and establishitsroleinthemanagement ofthischallenging condition. the The functional aim outcome of following this FF-RSAstudy was to report for epilepsy-related recurrent shoulder agement strategyinthecurrent publishedliterature. man- this of reports no are There component. glenoid the of fixation primary secure for stock bone glenoid ficient features make it a potential treatment option for patients with epilepsy-related recurrent shoulder instability and suf- the lever arm of the deltoid, but to a lessershoulder, increases degrenormal which the of axis the to distally and medially placed is rotation of center The problems. (FF-RSA) prosthesis that was specifically conceived for the treatment of patients with difficult shoulder reconstruction anatomy reverse fixed-fulcrum constrained Bayley-Walkera The is UK) WorldwideLtd, Implants (Stanmore shoulder symptoms. patients stillexperiencepersistentinstabilityandincreasing arthritis pertension. This represents the first therapy for for therapy first the represents This pertension. hy- intracranial reducing in effective be can head the from remote compartments in Decompression Conclusions: Thisdownwardspiralcanbereversedbydecompressingeithertheabdomenorchest. compartment. original the in pressure increase to back feed then and another affect compartment one in pressures where drome, Syn- Compartment Multiple termed have we that abnormalities physiologic of constellation a develop can patients Moreover, pressure. intracranial decrease to way effective an is decompression wall abdominal that demonstrated We have deleterious. very be can injury brain with patients in pressure intracranial in rises but likelyunimportant, is injury,brain without this patients In veins. large the likelyvia cranium the to transmitted be can abdomen or chest another.one to adjacent immediately sit abdomen and mediastinum thorax, cranium, The Results: Pressures the in perfusion pressure,resultinginischemia. limiting venous compartment, return. Pressure continues to rise until the pressure within exceeds the compartment syndrome are well understood. Pressureevated intraabdominal pressures. The principles of compartment rises in a dominal wall decompression to treat This intracranial therapy hypertension. was successful, even with modestly el- ab- of use the described have we manuscripts, length full two then and reports case of series a Through Methods: the brain.Recently, wehavedescribedanovelalternativetreatmentstrategy. affecting directly by ICP reduce hyperventilation, mild even and therapy hyperosmolar bed, the of head the evating Purpose:Traditional el- as such Therapies brain. the treating at directed all is hypertension intracranial for treatment technologies issuggested. advancing these of era an in practicing physicians of responsibilities and role the for guidelines of set general a and posed, are brain the concerning technologies theoretical and current dangers potential The cognitive). and logical, physio- (cosmetic, enhancement human and death, brain research, cell stem abortion, concerning realms in made arguments on based stages different at life human define we how between comparisons using drawn are clusions Con- brain. the in lies life human is what defines which that argument: the explores It enhancement. or restoration This presentation addresses those controversies spe We are in an age of rapidly advancing neuroscience and technology. With these advances, come ethical questions. arthritis, which can be a long-term complication. D complication. long-term a be can which arthritis, addressing also while joint glenohumeral bony the of augmentation and/or restoration on focus strategies surgical is approximately 0.6% but this is probably an underestimation since go undetected. The majority of non-arthroplasty Purpose: Epileptic seizures can cause shoulder disl strategies may be very helpful in limiting intracranial hypertension andguidingtheneedfordecompression. helpfulinlimitingintracranialhypertension strategies maybevery ence, Division of Surgery and Interventional Scienc Research Fellow, The John Scales Centre for Biomedi Constrained Fixed-Fulcrum Reverse Shoulder Arthropl Shoulder Reverse Fixed-Fulcrum Constrained Innovative ManagementforTraumaticBrainInjury:CompartmentsCommunicate Professor ofSurgery, SchoolofMedicine,BaltimoreMD UniversityofMaryland Commodifying HumanTraits:theNeuroethicalAspect Neurologist, SalinasValley MemorialHospital,SalinasCA Tanujan Thangarajah,MBChB(hons),MRCS,MSc Related Recurrent Shoulder Instability Shoulder Recurrent Related tal, Stanmore, London UK Patricia Scripko,MD Thomas Scalea,MD e than most existing non-linked reversed anatomy pr e, University College London, The Royal National Or brain injury not directed at the brain itself. Tar itself. brain the at directed not injury brain ocation and instability. The incidence of dislocati cific to manipulating or altering the brain for the cal Engineering, Institute of Orthopaedics and Musc espite technically satisfactory reconstruction proc reconstruction satisfactory technically espite asty For The Treatment Of Epilepsy- Of Treatment The For asty purpose of medical geted resuscitation geted on during a seizure thopaedic Hospi- ostheses. These uloskeletal Sci- edures some edures ABSTRACTS 27 these, ed. ed. Mean o revisions o oved from atively. The atively. ge, ge, 80-900). OSS improved OSS ernal rotation, ernal ce, Division of Division ce, noted in mean in noted ished literature. literature. ished multidirectional ormed or antic- or ormed , Stanmore, Lon- Stanmore, , instability or per- or instability further episodes further mean SSV, which SSV, mean tients with epilepsy underwent shoulder surgery. Of surgery. shoulder underwent epilepsy with tients r, an isolated glenoid replacement was performed. N performed. was replacement glenoid isolated an r, tively (range, 45-1300) to (ran tively 45-1300) (range, 850 postoperatively operatively (range, 0-800) to operatively 400 postoper (20-700) sures included active forward elevation, active ext active elevation, forward active included sures eratively (range, 70-1700). A similar gain was also was gain similar A 70-1700). (range, eratively postoperatively. postoperatively. Mean active forward elevation impr 15) to 27 postoperatively (range, 16-37). The mean mean The 16-37). (range, postoperatively 27 to 15) of of either the or humeral were component not glenoid .4 - 6.4 years). There were no further episodes of of episodes further no were There years). 6.4 - .4 but there have been no reports of this in the publ the in this of reports no been have there but Four patients had anterior instability and one had had one and instability anterior had patients Four Institute of Orthopaedics and Musculoskeletal Scien Musculoskeletal and Orthopaedics of Institute (range, 30-70) postoperatively. 30-70) (range, tively (range, 15-34). An increase was noted in the in noted was increase An 15-34). (range, tively don Middlesex, UK Middlesex, don ion procedures and no revision procedures were perf were procedures revision no and procedures ion ued to have grand mal seizures but did not have any have not did but seizures mal grand have to ued ege London, The Royal National Orthopaedic Hospital Orthopaedic National Royal The London, ege

Shoulder Arthroplasty In Epileptic Patients Shoulder Arthroplasty In Epileptic Tanujan Thangarajah, MB ChB (hons), MRCS, MSc Tanujan Thangarajah, MB ChB (hons),

The John Scales Centre for Biomedical Engineering, Engineering, Biomedical for Centre Scales John The Surgery and Interventional Science, University Coll University Science, Interventional and Surgery

1110 preoperatively (range, 70-1500) to 1160 postop 1160 to 70-1500) (range, preoperatively 1110 shoulder replacement was undertaken and in the othe the in and undertaken was replacement shoulder Two patients with hemiarthroplasty required further surgery due to painful glenoid erosion. In one, revision to a total a to revision one, In erosion. glenoid painful to surgeryfurtherdue required hemiarthroplasty with patients Two have developed degenerative changes at the time of surgery. have developed degenerative changes at the time of surgery. of instability/dislocation. No further stabilisation procedures were performed in the cohort. Six patients were found to found were patients Six cohort. the in performed were procedures stabilisation further No instability/dislocation. of

- 5.8 years). Following surgery six patients contin patients six surgery Following years). 5.8 - Results: Mean age of the cohort was 33 years (range, 17-44) and follow-up was for a mean of 3.2 years (range, 1.5 and 0, unbearable pain. In addition, all patients were assessed using the subjective shoulder value (SSV). and 0, unbearable pain. In addition, all patients were assessed using the abduction and pain. Pain abduction was and graded pain. as Pain 4 which indicated no pain; 3, mild pain; 2, moderate pain; 1, severe pain; glenoid erosion. Clinical outcome measurements included active forward elevation, active external rotation, active the position of the components. Radiographs for patients who underwent hemiarthroplasty were also examined for examined also underwenthemiarthroplastywere who patients for Radiographs components. the of position the All radiographs were reviewed for the presence of glenohumeral subluxation, periprosthetic lucency and alteration in alteration and lucency periprosthetic subluxation, glenohumeral of presence the for reviewed were radiographs All terior instability. Arthroplasty performed after was 0-3). an average of two previous stabilisation procedures (range, terior instability. seizures. The cohort consisted of seven males and one female. Six patients had anterior instability and two had pos- had two and instability anterior had patients Six female. one and males seven of cohort consisted The seizures. replacements (TSR) and five humeral resurfacing hemiarthroplasty procedures. All patients suffered from grand mal eight shoulders in eight patients underwent arthroplasty for recurrent instability. These included three total shoulder total three included These underwentpatients eight in shoulders eight arthroplasty instability. recurrent for Methods: Between November 1996 and July 2013 179 pa 179 2013 July and 1996 November Between Methods: stability to assess the results and rate of revision. stability to assess the results and rate We report our We 17-year experience with shoulder arthroplasty in patients recurrent with shoulder epilepsy-related in-

(range, 10-80) preoperatively to 52 (range, 15-90) 1.9 (range, 0-3) This postoperatively. was accompanied by an increase in the which mean improved SSV, from 33 There was a mean increase in pain score of 1.1 points, from a mean of 0.8 (range, 0-1) preoperatively to a mean of continued on next page were undertaken in the TSR group. 10-600) to 390 (20-700) postoperatively. active external rotation, which improved from 310 preoperatively (range, may therefore represent a suitable treatment option treatment suitable a represent therefore may being pathognomic of the condition. Owing to a poor bone stock further reconstruction is challenging. Arthroplasty challenging. is reconstruction further stock bone poor a to Owing condition. the of pathognomic being from the glenoid and humeral head is thought to be responsible for the high recurrence rate and is recognized as Purpose: Purpose: Epileptic seizures can cause dislocation of the shoulder joint and Significant recurrent bone instability. loss considered in this highly selected patient population as an alternative to arthrodesisconsidered in this highly selected patient or non-surgical treatment. provement in pain and range of movement (external rotation) was also noted. The procedure should therefore be from 7 preoperatively (range, 4-13) to 26 postopera 26 to 4-13) (range, preoperatively 7 from 54 to preoperatively 0-50) (range, 17 from improved Conclusions: In our eliminated series, recurrent FF-RSA instability and improved overall functional outcome. An im- The cohort consisted of four males and one female. female. one and males four of consisted cohort The lated lated recurrent The shoulder index instability. dislocation occurred a mean of 13 years (range, 2-38) before surgery. Methods: Between November 1996 and June 2013 five shoulders in five patients underwent FF-RSA for epilepsy-re- for FF-RSA underwent patients five in shoulders five 2013 June and 1996 November Between Methods:

Mean active external rotation improved Mean from improved active rotation external 150 pre 1- (range, preoperatively 7 from improved OSIS mean Preoperative and postoperative clinical outcome mea outcome clinical postoperative and Preoperative the size of the defect on the anteroposterior radiograph using the four-part grading system devised by Sirveaux et al. Sirveauxet by devised system grading four-part the using radiograph anteroposterior the on defect the of size the Preoperative and postoperative radiographic imaging was performed in all cases. Scapular notching was classified by classified was notching Scapular cases. all in performed was imaging radiographic postoperative and Preoperative 2 (range, years 3.6 was follow-up mean The Results: instability. FF-RSA was performed after was performed 0-5). (range, stabilisation procedures of two previous an average FF-RSA instability. score (OSIS). Shoulder Instability (OSS) and the Oxford Shoulder Score the Oxford stabilisat further no and apprehension, of sistence No ipated. cases of or notching scapular loosening from active forward improved 710 elevation preopera 28 ABSTRACTS comitant ligamentous injuries or revision surgery w surgery revisionorligamentous injuriescomitant Committee(IKDC)SubjectiveFormLysholm andscores weeks, 12 weeks, 24 weeks, and one year postoperati threshold for diagnosis of MDD. MDD and non-MDD gro DepressiveofSymInventoryQuick a given wereACLR Methods: In this IRB approved, multi-center prospec going ACLreconstruction(ACLR). under- patients in function knee patient-rated with symptoms depression correlate and (MDD) disorder depressive major of incidence the quantify to was investigation this of purpose The controversial. still is (ACLR) reconstruction following orthopaedic procedures, the recognized im Purpose: Although recent literature has suggested t selected patientpopulation. SSV.mean the in increase an by accompanied was This ment. this in considered be therefore should procedure The However,low-up. did eliminate recurrent shoulder instability,arthroplasty reduce pain and improve range of move- fol- short-term a with even revision of rate high a with associated was hemiarthroplasty series, our In Conclusions: tation in daily activity, lengthen time needed to r limi- greater in manifest may patients MDD atively.for postoperatively function knee of perception poor Continued high as 44% preoperatively, and that these patients have significantly worse clinical self-reported one year postoper- as be may ACLR undergoing patients among MDD self-reported of incidence the suggests study This Conclusions: 0.51) andbetweenQIDSIKDC(r=-.053)werealsofoundateachtimepoint. Lysholmand QIDS between correlation inverse moderate A group. non-MDD the to comparison in 0.001) = - = (r on their IKDC at baseline (43.7 vs. 57.0; p < 0.001) and 17.5 points lower on their IKDC at one year (71.8 vs. 89.3; p lower points 13.3 as well as 0.04), = p 88.4; vs. (75.2 year one Lysholmat their on lower points 13.2 and 0.001) < p 64.9; Lysholmvs. their (50.8 on baseline lower at points 14.1 scored patients MDD addition, In 0.05). < (p points preoperative intervention andpostoperativemanagementtoimproveACLRoutcomes. preoperative intervention multidisciplinary from benefit can patients MDD of subset this whether determine to warranted are studies further significant was group MDD the of score QIDS average The complications. postoperative and pathology knee history,concomitant smoking BMI, demographics, to spect re- with groups two the between found differences significant no were There group. MDD the in categorized were and preoperatively QIDS the on greater or 6 study,scored the (44%) in 37 enrolled patients 82 the Among Results: Third Year MedicalStudent,Perelman SchoolofMedicineattheUniversityPennsylvania, Philadelphia,PA Incidence and Impact on Functional Outcome, a Prosp a Outcome, Functional on Impact and Incidence Clinical Depression and ACL Reconstruction: Reconstruction: ACL and Depression Clinical eturn to competition and adversely impact sport per Hao-Hua Wu,BA hat depression is a potential risk factor for poor tive cohort study, 82 consecutive adult patients un ere excluded. A QIDS score of 6 or greater served a served greater or 6 of score QIDS Aexcluded. ere vely to assess MDD symptoms. International Knee Doc pact of depression on the outcome of anterior cruci ptomatologySelf-Report(QIDS-SR16) preoperatively were also obtained at similar time points.similarPatientobtainedtimealsoatwere ly higher than that of the non-MDD group at all fiv all at group non-MDD the of that than higher ly ups were assigned based on preoperative QIDS scores ective Cohort Study Cohort ective functional outcome dergoing primary formance. Thus, s a validateda s ate ligament s with con-with s umentation and at 6 at and e time e . MODERATOR AND PRESENTER INDEX 29

Z Zamorano, Lucia...... 13 S Saidi, Reza F...... 11,12,25 Scalea, Thomas M...... 10,26 PatriciaScripko, ...... 9,12,26 T Thangarajah, Tanujan...... 12,26,27 V Vithiananthan, Sivamainthan ...... 14 W Matthew...... 11Weiss, Christopher...... 12 Wolfgang, Hao-Hua...... 13,28Wu, X Charles...... 10 Xeller, N Mayur...... 10Narayan, O Uretz...... 11Oliphant, P Adrian...... 10 Park, Paul...... 12,23 Park, Chad...... 9,10 Patton, Timothy...... 12,14 Pawlik, III, Marco A...... 14,24Pelosi MichaelPolitis, ...... 13,24 R Sudhir B.Rao, ...... 12,24 Ren, Xiaoping ...... 8,13,25

Mukherjee, Debraj ...... 9,13 Mohammadi, Milad...... 14,22 Mathews, William ...... 11,12 Mathews, Robert S...... 13,22 Mammen, Joshua M.V...... 14,15,22 Makary, Martin...... 12 Makary, M

Labor, Phillips Kirk...... 14,15,22Labor, L

Jacobs, Michael J...... 11 J

Guthikonda, Bharat...... 12,13,21Guthikonda, G Gerald Q.Greenfield, Jr., ...... 13,21 Flores, Jesse...... 14,20 F E Efron, David...... 10

Dix, Gary...... 8,10,20 Dieter, Jr., Raymond A...... 14,19 Raymond Jr., Dieter, D Cook, Jonathan...... 14,19 Coles, Maxime J.M...... 12,13 Clark, W. CraigClark, W...... 10,13,18 Canavero, Sergio...... 8,11 Cameron, Andrew...... 11 Cameron, John...... 11 C Bongiorno, Frank...... 14 Bolles, Gene E...... 10,13 Bereneau, AncaBereneau, ...... 13 B Annamalai, Alagappan...... 12,18Annamalai, Alvear, Domingo T. Domingo Alvear, ...... 10 A

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