Pauline Go - Academia.edu (original) (raw)

Papers by Pauline Go

Research paper thumbnail of Outcomes after sublobar resection versus lobectomy in non–small cell carcinoma in situ

The Journal of Thoracic and Cardiovascular Surgery

Research paper thumbnail of Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

BACKGROUND: The incidence of atrial fibrillation (AF) among patients undergoing left ventricular ... more BACKGROUND: The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival. METHODS: Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression. RESULTS: There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF...

Research paper thumbnail of Are Routine Chest Radiographs After Chest Tube Removal in Thoracic Surgery Patients Necessary?

Journal of Surgical Research, 2022

Research paper thumbnail of Pulmonary Artery Aneurysm in a Child

The Annals of Thoracic Surgery, 2020

Research paper thumbnail of Repair of iatrogenic tracheal injury in acute respiratory failure with veno-venous extracorporeal membrane oxygenation

Perfusion, 2020

Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intub... more Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intubation that frequently require lung isolation to repair. This is not tolerated in patients with severe respiratory failure. We describe a case in a patient with acute respiratory distress syndrome, repaired using veno-venous extracorporeal membrane oxygenation.

Research paper thumbnail of Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon

International Journal of Surgery Case Reports, 2019

INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significa... more INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare. PRESENTATION OF CASE: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy. DISCUSSION: In the English literature, there has been 20 reported cases of double cystic duct with a single gallbladder. Most of these cases were diagnosed intraoperatively despite the completion of a preoperative endoscopic retrograde cholangiopancreatography in a few of these patients. CONCLUSION: The limited success of preoperative biliary tract imaging in demonstrating anatomic aberrancies prior to cholecystectomy clearly highlights the importance of maintaining constant vigilance for even the slightest anatomic abnormality at operation. Any uncertainty or concern for ductal injury mandates immediate operative cholangiogram with cannulation of all structures in question.

Research paper thumbnail of An unusual manifestation of diabetic ketoacidosis and acute colonic pseudo-obstruction

JRSM Open, 2017

Patients presenting with diabetic ketoacidosis and acute colonic pseudo-obstruction should underg... more Patients presenting with diabetic ketoacidosis and acute colonic pseudo-obstruction should undergo a focused evaluation to identify underlying precipitants.

Research paper thumbnail of Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

American Journal of Case Reports, 2017

Adverse events of drug therapy Background: Mycophenolate mofetil (MMF) induced lung disease has b... more Adverse events of drug therapy Background: Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associated with MMF after kidney transplantation. Case Report: A 50-year-old Hispanic male with a history of end-stage renal disease secondary to hypertension underwent deceased donor kidney transplantation. His preoperative evaluations were normal except for a chest x-ray which showed bilateral interstitial opacities. Tacrolimus and MMF were started on the day of surgery. His postoperative course was uneventful and he was discharged on postoperative day 5. One month later, he presented with shortness of breath and a cough with blood-tinged sputum. His respiratory condition deteriorated rapidly, requiring intubation. Chest computer tomography (CT) demonstrated patchy ground-glass opacities with interlobular septal thickening. Comprehensive pulmonary, cardiac, infectious, and immunological evaluations were all negative. Open lung biopsy revealed extensive pulmonary fibrosis with no evidence of infection. He temporarily improved after discontinuation of tacrolimus and MMF, however, on resuming MMF his respiratory status deteriorated again and he subsequently died from hypoxic respiratory failure. Conclusions: An awareness of pulmonary lung disease due to MMF is important to prevent adverse outcomes after organ transplantation. MMF must be used with utmost care in recipients with underlying lung disease as their pulmonary condition might make them more susceptible to any harmful effects of MMF.

Research paper thumbnail of Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

The Annals of thoracic surgery, Jan 25, 2016

The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist devic... more The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival. Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression. There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%...

Research paper thumbnail of Should Patients With Hepatic Fibrosis Undergo LVAD Implantation: A Comparative Analysis

ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 22, 2016

The purpose of our study was to evaluate outcomes in patients with hepatic fibrosis at the time o... more The purpose of our study was to evaluate outcomes in patients with hepatic fibrosis at the time of LVAD implantation. There were 5 (2.1%) patients with preoperative hepatic fibrosis with a mean age of 51.2 + 16.8 years. Survival at 180 days was significantly reduced in patients with hepatic fibrosis - 40.0% vs. 88.0%; p=0.001. Hepatic fibrosis was a significant independent predictor of mortality in multivariate analysis (HR 2.27, p=0.036).

Research paper thumbnail of Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience

The Annals of thoracic surgery, Jan 10, 2016

Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for pati... more Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience. From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT). Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients (p < 0.001). There was a higher incidence of preoperative diabetes, renal insufficiency, peripheral vascular disease, and previous cardiac operation in DT patients (p < 0.05). Survival was higher for BTT patients, with 1-, 6-, 12-, and 24-month survivals of 91.0%, 90.0%, 88.5%, and 72.1%, respectively, versus 85.3%, 81.1%, 75.6%, and 59.0%, respectively, for DT patients (p = ...

Research paper thumbnail of Effect of Body Mass Index on Outcomes in Left Ventricular Assist Device Recipients

Journal of cardiac surgery, Jan 9, 2016

Obesity is associated with higher mortality following heart transplantation, but there remains no... more Obesity is associated with higher mortality following heart transplantation, but there remains no consensus regarding outcomes in left ventricular assist device (LVAD) recipients. We sought to determine the impact of body mass index (BMI) on outcomes in patients undergoing LVAD implantation. This was a single-institution retrospective review, including all patients who received a HeartMate II LVAD or HeartWare HVAD between March 2006 and June 2014. Patients were stratified into three groups based on normal (<25 kg/m(2) ), overweight (25-30 kg/m(2) ), and obese (>30 kg/m(2) ) BMI. Two hundred patients were included in the analysis. Mean BMI was 28.3 kg/m(2) , (27% normal, 36% overweight, and 36.5% obese). Obese patients were younger (51.9 years, p = 0.03) and had higher incidence of diabetes (58.9% vs. 24.1%; p < 0.001) and peripheral vascular disease (16.4% vs. 1.9%; p = 0.03). Normal BMI patients were more likely to undergo LVAD implantation as destination therapy compared...

Research paper thumbnail of Eventration of the diaphragm presenting as spontaneous pneumothorax

Cleveland Clinic journal of medicine, 2016

Research paper thumbnail of Robotic resection of a mediastinal parathyroid cyst

General Thoracic and Cardiovascular Surgery, 2015

Mediastinal parathyroid cysts (PC) are rare, benign lesions, reported in fewer than 150 cases wor... more Mediastinal parathyroid cysts (PC) are rare, benign lesions, reported in fewer than 150 cases worldwide. Although most are asymptomatic and discovered incidentally on imaging, symptoms of dyspnea, dysphagia, hoarseness, palpitations, hypercalcemia, and innominate or jugular venous thrombosis have been reported. Sternotomy or thoracotomy has traditionally been the approach used to resect mediastinal PCs. We describe the first reported case of a robot-assisted resection of a mediastinal PC.

Research paper thumbnail of Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation

ASAIO Journal, 2015

Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim ... more Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim was to establish the impact of serum albumin on outcomes after left ventricular assist device (LVAD) implantation. This was a single-institution retrospective review, including all patients who underwent LVAD implantation between March 2006 and June 2014. Two hundred patients were included in the analysis. Mean serum albumin was 3.27 ± 0.47 g/dl, with 7% in the low albumin group (<2.5 mg/dl), 67.5% in the mid-range (2.5-3.5 mg/dl), and 25.5% in the normal albumin groups (> 3.5 mg/dl). Lower albumin was associated with a significant increase in postoperative renal failure (42.9 vs. 16.5 vs. 17.3%; p = 0.05) and prolonged hospitalization (median 28.5 vs. 16 vs. 15.5 days; p = 0.008). Six month, 1 year, and 5 year survival was 79%, 79%, and 49% with low, 84%, 78%, and 51% with mid-range, and 94%, 88%, and 60% with normal albumin, respectively (p = 0.22). Preoperative hypoalbuminemia is associated with postoperative acute renal failure (ARF) and prolonged hospitalization after LVAD implantation, with no effect on overall survival. Hypoalbuminemia is most likely a marker of advanced disease and should not, in itself, be considered a contraindication to LVAD candidacy.

Research paper thumbnail of Long-Term Survival After Local Resection of Cervical Esophageal Cancer

The Annals of Thoracic Surgery, 2015

Squamous cell carcinoma of the esophagus may be seen in patients with history of head and neck ma... more Squamous cell carcinoma of the esophagus may be seen in patients with history of head and neck malignancies. Anatomic factors may limit management options. We present a case of second primary early cervical esophageal squamous cell cancer managed by local resection with reconstruction using a radial forearm flap.

Research paper thumbnail of Trauma to a Horseshoe Kidney: Case Report and Review of the Literature

UroToday International Journal, 2011

A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. It occurs in approxi... more A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. It occurs in approximately 1 in 400 persons, with a 2:1 male:female incidence. Traumatic synchronous, multiorgan injury in the setting of anomalous anatomy adds to the complexity of surgical exposure and creates a formidable hemostatic challenge. We present a 30-year-old male with multiorgan injury secondary to blunt abdominal trauma sustained during a motor vehicle accident. We describe the preoperative evaluation that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical procedure. Surgical management of blunt abdominal trauma to an HSK is difficult due to multiple variations in vascular anatomy and the location of this renal anomaly. Such anatomical variations can make reconstruction and preservation of the damaged kidney very challenging.

Research paper thumbnail of Residency selection: do the perceptions of US programme directors and applicants match?

Medical Education, 2012

OBJECTIVES This study sought to evaluate the practices and perceptions of US residency programme ... more OBJECTIVES This study sought to evaluate the practices and perceptions of US residency programme directors (PDs) and residency applicants with reference to the use of social media and Internet resources in the resident doctor selection process. METHODS A survey was distributed via e-mail (SurveyMonkey â) to 2592 PDs of programmes in 22 specialties accredited by the Accreditation Council for Graduate Medical Education. A separate survey was distributed to all residency candidates applying for postgraduate year 1 (PGY1) positions at the Saint Barnabas Medical Center, Livingston, New Jersey. RESULTS A total of 1200 (46.3%) PDs completed the survey. Overall, 16.3% (n = 196) of respondents reported visiting Internet resources to gain more information about applicants, 38.1% (74 of 194) of whom had ranked an applicant lower as a result. American medical graduates (AMGs), US international medical graduates (USIMGs) and non-USIMGs all felt that performance on Step 1 of the US Medical Licensing Examination (USMLE) was a critical aspect of a residency application. More AMGs than USIMGs and non-USIMGs believed that PDs made use of social media resources when evaluating applicants and that their online profiles might influence their rankings. CONCLUSIONS Residency candidates universally understand the importance of USMLE Step 1 scores in maintaining a competitive application. However, significant differences exist among AMGs, USIMGs and non-USIMGs in their perceptions of the value of other applicant criteria, which may place some applicants at a disadvantage. A small but growing number of PDs currently use Internet resources to learn more about applicants and base their recruitment decisions in part on the information they encounter. At present, applicants are generally unaware of the implications their online activity may have on their selection for residency. Content guideline programmes that raise awareness of the possible impact of social media on the residency recruitment process are needed and should be delivered early in medical education. making choices

Research paper thumbnail of An ERAS-Based Survey Evaluating Demographics, United States Medical Licensing Examination Performance, and Research Experience Between American Medical Graduates and United States Citizen International Medical Graduates: Is the Bar Higher on the Continent?

Journal of Surgical Education, 2012

To provide an assessment and comparison of the demographics, medical school academic performance,... more To provide an assessment and comparison of the demographics, medical school academic performance, United States Medical Licensing Examination (USMLE) performance, and research experience between American Medical Graduate (AMG) and United States International Medical Graduate (USIMG) candidates who applied for and successfully matched into categorical general surgery residency programs. DESIGN: Data were obtained through the Electronic Residency Application Service (ERAS) and a post-match survey distributed to all applicants. SETTING:. The study was conducted at a community-based, university-affiliated hospital. PARTICIPANTS: All United States citizen graduates of allopathic American medical schools or international medical schools, who were applying for a general surgery residency position at our institution. RESULTS: A total of 854 candidates applied, including 143 AMGs and 223 USIMGs. Seventy-two AMGs (50.3%) and 41 USIMGs (18.4%) were invited to interview (p Ͻ 0.0001). Mean USMLE step 1 scores were higher among USIMG applicants overall (USIMG: 212.1 Ϯ 14.9 vs AMG: 206.9 Ϯ 15.5; p Ͻ 0.0005) and among those invited to interview (USIMG: 227.8 Ϯ 16.2 vs AMG: 215.5 Ϯ 16.2; p Ͻ 0.0001). Seventy percent of AMGs matched into a categorical surgery residency compared with 31.6% of USIMGs (p Ͻ 0.001). Compared with AMGs, USIMGs applied to more programs (USIMG: 90.3 Ϯ 42.8 vs AMG: 52.1 Ϯ 26.4; p Ͻ 0.002), were offered fewer interviews (USIMG: 9.0 Ϯ 6.9 vs AMG: 20.9 Ϯ 13.7; p Ͻ 0.0001), and subsequently ranked fewer programs (USIMG: 7.5 Ϯ 4.5 vs AMG: 12.5 Ϯ 6.1; p Ͻ 0.0008). CONCLUSIONS: USIMGs require higher USMLE scores than their AMG counterparts to be considered for categorical general surgery residency positions. However, excellence on the USMLE neither ensures an invitation to interview nor categorical match success. A well-rounded application in conjunction with a practical application strategy is critical for USIMGs to achieve success in attaining a general surgery residency position.

Research paper thumbnail of Attitudes and Practices of Surgery Residency Program Directors Toward the Use of Social Networking Profiles to Select Residency Candidates: A Nationwide Survey Analysis

Journal of Surgical Education, 2012

To determine whether residency program directors (PDs) of general surgery and surgical subspecial... more To determine whether residency program directors (PDs) of general surgery and surgical subspecialties review social networking (SN) websites during resident selection. DESIGN: A 16-question survey was distributed via e-mail (Survey Monkey, Palo Alto, California) to 641 PDs of general surgery and surgical subspecialty residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). SETTING: Institutions with ACGME-accredited general surgery and surgical subspecialty residency programs. PARTICIPANTS: PDs of ACGME-accredited general surgery and surgical subspecialty residency programs. RESULTS: Two hundred fifty (39%) PDs completed the survey. Seventeen percent (n ϭ 43) of respondents reported visiting SN websites to gain more information about an applicant during the selection process, leading 14 PDs (33.3%) to rank an applicant lower after a review of their SN profile. PDs who use SN websites currently are likely to continue (69%), whereas those who do not use SN currently might do so in the future (yes 5.4%, undecided 44.6%). CONCLUSIONS: Online profiles displayed on SN websites provide surgery PDs with an additional avenue with which to evaluate highly competitive residency applicants. Applicants should be aware of the expansion of social media into the professional arena and the increasing use of these tools by PDs. SN profiles should reflect the professional standards to which physicians are held while highlighting an applicant's strengths and academic achievements.

Research paper thumbnail of Outcomes after sublobar resection versus lobectomy in non–small cell carcinoma in situ

The Journal of Thoracic and Cardiovascular Surgery

Research paper thumbnail of Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

BACKGROUND: The incidence of atrial fibrillation (AF) among patients undergoing left ventricular ... more BACKGROUND: The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival. METHODS: Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression. RESULTS: There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF...

Research paper thumbnail of Are Routine Chest Radiographs After Chest Tube Removal in Thoracic Surgery Patients Necessary?

Journal of Surgical Research, 2022

Research paper thumbnail of Pulmonary Artery Aneurysm in a Child

The Annals of Thoracic Surgery, 2020

Research paper thumbnail of Repair of iatrogenic tracheal injury in acute respiratory failure with veno-venous extracorporeal membrane oxygenation

Perfusion, 2020

Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intub... more Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intubation that frequently require lung isolation to repair. This is not tolerated in patients with severe respiratory failure. We describe a case in a patient with acute respiratory distress syndrome, repaired using veno-venous extracorporeal membrane oxygenation.

Research paper thumbnail of Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon

International Journal of Surgery Case Reports, 2019

INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significa... more INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare. PRESENTATION OF CASE: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy. DISCUSSION: In the English literature, there has been 20 reported cases of double cystic duct with a single gallbladder. Most of these cases were diagnosed intraoperatively despite the completion of a preoperative endoscopic retrograde cholangiopancreatography in a few of these patients. CONCLUSION: The limited success of preoperative biliary tract imaging in demonstrating anatomic aberrancies prior to cholecystectomy clearly highlights the importance of maintaining constant vigilance for even the slightest anatomic abnormality at operation. Any uncertainty or concern for ductal injury mandates immediate operative cholangiogram with cannulation of all structures in question.

Research paper thumbnail of An unusual manifestation of diabetic ketoacidosis and acute colonic pseudo-obstruction

JRSM Open, 2017

Patients presenting with diabetic ketoacidosis and acute colonic pseudo-obstruction should underg... more Patients presenting with diabetic ketoacidosis and acute colonic pseudo-obstruction should undergo a focused evaluation to identify underlying precipitants.

Research paper thumbnail of Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

American Journal of Case Reports, 2017

Adverse events of drug therapy Background: Mycophenolate mofetil (MMF) induced lung disease has b... more Adverse events of drug therapy Background: Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associated with MMF after kidney transplantation. Case Report: A 50-year-old Hispanic male with a history of end-stage renal disease secondary to hypertension underwent deceased donor kidney transplantation. His preoperative evaluations were normal except for a chest x-ray which showed bilateral interstitial opacities. Tacrolimus and MMF were started on the day of surgery. His postoperative course was uneventful and he was discharged on postoperative day 5. One month later, he presented with shortness of breath and a cough with blood-tinged sputum. His respiratory condition deteriorated rapidly, requiring intubation. Chest computer tomography (CT) demonstrated patchy ground-glass opacities with interlobular septal thickening. Comprehensive pulmonary, cardiac, infectious, and immunological evaluations were all negative. Open lung biopsy revealed extensive pulmonary fibrosis with no evidence of infection. He temporarily improved after discontinuation of tacrolimus and MMF, however, on resuming MMF his respiratory status deteriorated again and he subsequently died from hypoxic respiratory failure. Conclusions: An awareness of pulmonary lung disease due to MMF is important to prevent adverse outcomes after organ transplantation. MMF must be used with utmost care in recipients with underlying lung disease as their pulmonary condition might make them more susceptible to any harmful effects of MMF.

Research paper thumbnail of Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

The Annals of thoracic surgery, Jan 25, 2016

The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist devic... more The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival. Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression. There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%...

Research paper thumbnail of Should Patients With Hepatic Fibrosis Undergo LVAD Implantation: A Comparative Analysis

ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 22, 2016

The purpose of our study was to evaluate outcomes in patients with hepatic fibrosis at the time o... more The purpose of our study was to evaluate outcomes in patients with hepatic fibrosis at the time of LVAD implantation. There were 5 (2.1%) patients with preoperative hepatic fibrosis with a mean age of 51.2 + 16.8 years. Survival at 180 days was significantly reduced in patients with hepatic fibrosis - 40.0% vs. 88.0%; p=0.001. Hepatic fibrosis was a significant independent predictor of mortality in multivariate analysis (HR 2.27, p=0.036).

Research paper thumbnail of Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience

The Annals of thoracic surgery, Jan 10, 2016

Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for pati... more Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience. From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT). Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients (p < 0.001). There was a higher incidence of preoperative diabetes, renal insufficiency, peripheral vascular disease, and previous cardiac operation in DT patients (p < 0.05). Survival was higher for BTT patients, with 1-, 6-, 12-, and 24-month survivals of 91.0%, 90.0%, 88.5%, and 72.1%, respectively, versus 85.3%, 81.1%, 75.6%, and 59.0%, respectively, for DT patients (p = ...

Research paper thumbnail of Effect of Body Mass Index on Outcomes in Left Ventricular Assist Device Recipients

Journal of cardiac surgery, Jan 9, 2016

Obesity is associated with higher mortality following heart transplantation, but there remains no... more Obesity is associated with higher mortality following heart transplantation, but there remains no consensus regarding outcomes in left ventricular assist device (LVAD) recipients. We sought to determine the impact of body mass index (BMI) on outcomes in patients undergoing LVAD implantation. This was a single-institution retrospective review, including all patients who received a HeartMate II LVAD or HeartWare HVAD between March 2006 and June 2014. Patients were stratified into three groups based on normal (<25 kg/m(2) ), overweight (25-30 kg/m(2) ), and obese (>30 kg/m(2) ) BMI. Two hundred patients were included in the analysis. Mean BMI was 28.3 kg/m(2) , (27% normal, 36% overweight, and 36.5% obese). Obese patients were younger (51.9 years, p = 0.03) and had higher incidence of diabetes (58.9% vs. 24.1%; p < 0.001) and peripheral vascular disease (16.4% vs. 1.9%; p = 0.03). Normal BMI patients were more likely to undergo LVAD implantation as destination therapy compared...

Research paper thumbnail of Eventration of the diaphragm presenting as spontaneous pneumothorax

Cleveland Clinic journal of medicine, 2016

Research paper thumbnail of Robotic resection of a mediastinal parathyroid cyst

General Thoracic and Cardiovascular Surgery, 2015

Mediastinal parathyroid cysts (PC) are rare, benign lesions, reported in fewer than 150 cases wor... more Mediastinal parathyroid cysts (PC) are rare, benign lesions, reported in fewer than 150 cases worldwide. Although most are asymptomatic and discovered incidentally on imaging, symptoms of dyspnea, dysphagia, hoarseness, palpitations, hypercalcemia, and innominate or jugular venous thrombosis have been reported. Sternotomy or thoracotomy has traditionally been the approach used to resect mediastinal PCs. We describe the first reported case of a robot-assisted resection of a mediastinal PC.

Research paper thumbnail of Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation

ASAIO Journal, 2015

Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim ... more Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim was to establish the impact of serum albumin on outcomes after left ventricular assist device (LVAD) implantation. This was a single-institution retrospective review, including all patients who underwent LVAD implantation between March 2006 and June 2014. Two hundred patients were included in the analysis. Mean serum albumin was 3.27 ± 0.47 g/dl, with 7% in the low albumin group (<2.5 mg/dl), 67.5% in the mid-range (2.5-3.5 mg/dl), and 25.5% in the normal albumin groups (> 3.5 mg/dl). Lower albumin was associated with a significant increase in postoperative renal failure (42.9 vs. 16.5 vs. 17.3%; p = 0.05) and prolonged hospitalization (median 28.5 vs. 16 vs. 15.5 days; p = 0.008). Six month, 1 year, and 5 year survival was 79%, 79%, and 49% with low, 84%, 78%, and 51% with mid-range, and 94%, 88%, and 60% with normal albumin, respectively (p = 0.22). Preoperative hypoalbuminemia is associated with postoperative acute renal failure (ARF) and prolonged hospitalization after LVAD implantation, with no effect on overall survival. Hypoalbuminemia is most likely a marker of advanced disease and should not, in itself, be considered a contraindication to LVAD candidacy.

Research paper thumbnail of Long-Term Survival After Local Resection of Cervical Esophageal Cancer

The Annals of Thoracic Surgery, 2015

Squamous cell carcinoma of the esophagus may be seen in patients with history of head and neck ma... more Squamous cell carcinoma of the esophagus may be seen in patients with history of head and neck malignancies. Anatomic factors may limit management options. We present a case of second primary early cervical esophageal squamous cell cancer managed by local resection with reconstruction using a radial forearm flap.

Research paper thumbnail of Trauma to a Horseshoe Kidney: Case Report and Review of the Literature

UroToday International Journal, 2011

A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. It occurs in approxi... more A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. It occurs in approximately 1 in 400 persons, with a 2:1 male:female incidence. Traumatic synchronous, multiorgan injury in the setting of anomalous anatomy adds to the complexity of surgical exposure and creates a formidable hemostatic challenge. We present a 30-year-old male with multiorgan injury secondary to blunt abdominal trauma sustained during a motor vehicle accident. We describe the preoperative evaluation that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical procedure. Surgical management of blunt abdominal trauma to an HSK is difficult due to multiple variations in vascular anatomy and the location of this renal anomaly. Such anatomical variations can make reconstruction and preservation of the damaged kidney very challenging.

Research paper thumbnail of Residency selection: do the perceptions of US programme directors and applicants match?

Medical Education, 2012

OBJECTIVES This study sought to evaluate the practices and perceptions of US residency programme ... more OBJECTIVES This study sought to evaluate the practices and perceptions of US residency programme directors (PDs) and residency applicants with reference to the use of social media and Internet resources in the resident doctor selection process. METHODS A survey was distributed via e-mail (SurveyMonkey â) to 2592 PDs of programmes in 22 specialties accredited by the Accreditation Council for Graduate Medical Education. A separate survey was distributed to all residency candidates applying for postgraduate year 1 (PGY1) positions at the Saint Barnabas Medical Center, Livingston, New Jersey. RESULTS A total of 1200 (46.3%) PDs completed the survey. Overall, 16.3% (n = 196) of respondents reported visiting Internet resources to gain more information about applicants, 38.1% (74 of 194) of whom had ranked an applicant lower as a result. American medical graduates (AMGs), US international medical graduates (USIMGs) and non-USIMGs all felt that performance on Step 1 of the US Medical Licensing Examination (USMLE) was a critical aspect of a residency application. More AMGs than USIMGs and non-USIMGs believed that PDs made use of social media resources when evaluating applicants and that their online profiles might influence their rankings. CONCLUSIONS Residency candidates universally understand the importance of USMLE Step 1 scores in maintaining a competitive application. However, significant differences exist among AMGs, USIMGs and non-USIMGs in their perceptions of the value of other applicant criteria, which may place some applicants at a disadvantage. A small but growing number of PDs currently use Internet resources to learn more about applicants and base their recruitment decisions in part on the information they encounter. At present, applicants are generally unaware of the implications their online activity may have on their selection for residency. Content guideline programmes that raise awareness of the possible impact of social media on the residency recruitment process are needed and should be delivered early in medical education. making choices

Research paper thumbnail of An ERAS-Based Survey Evaluating Demographics, United States Medical Licensing Examination Performance, and Research Experience Between American Medical Graduates and United States Citizen International Medical Graduates: Is the Bar Higher on the Continent?

Journal of Surgical Education, 2012

To provide an assessment and comparison of the demographics, medical school academic performance,... more To provide an assessment and comparison of the demographics, medical school academic performance, United States Medical Licensing Examination (USMLE) performance, and research experience between American Medical Graduate (AMG) and United States International Medical Graduate (USIMG) candidates who applied for and successfully matched into categorical general surgery residency programs. DESIGN: Data were obtained through the Electronic Residency Application Service (ERAS) and a post-match survey distributed to all applicants. SETTING:. The study was conducted at a community-based, university-affiliated hospital. PARTICIPANTS: All United States citizen graduates of allopathic American medical schools or international medical schools, who were applying for a general surgery residency position at our institution. RESULTS: A total of 854 candidates applied, including 143 AMGs and 223 USIMGs. Seventy-two AMGs (50.3%) and 41 USIMGs (18.4%) were invited to interview (p Ͻ 0.0001). Mean USMLE step 1 scores were higher among USIMG applicants overall (USIMG: 212.1 Ϯ 14.9 vs AMG: 206.9 Ϯ 15.5; p Ͻ 0.0005) and among those invited to interview (USIMG: 227.8 Ϯ 16.2 vs AMG: 215.5 Ϯ 16.2; p Ͻ 0.0001). Seventy percent of AMGs matched into a categorical surgery residency compared with 31.6% of USIMGs (p Ͻ 0.001). Compared with AMGs, USIMGs applied to more programs (USIMG: 90.3 Ϯ 42.8 vs AMG: 52.1 Ϯ 26.4; p Ͻ 0.002), were offered fewer interviews (USIMG: 9.0 Ϯ 6.9 vs AMG: 20.9 Ϯ 13.7; p Ͻ 0.0001), and subsequently ranked fewer programs (USIMG: 7.5 Ϯ 4.5 vs AMG: 12.5 Ϯ 6.1; p Ͻ 0.0008). CONCLUSIONS: USIMGs require higher USMLE scores than their AMG counterparts to be considered for categorical general surgery residency positions. However, excellence on the USMLE neither ensures an invitation to interview nor categorical match success. A well-rounded application in conjunction with a practical application strategy is critical for USIMGs to achieve success in attaining a general surgery residency position.

Research paper thumbnail of Attitudes and Practices of Surgery Residency Program Directors Toward the Use of Social Networking Profiles to Select Residency Candidates: A Nationwide Survey Analysis

Journal of Surgical Education, 2012

To determine whether residency program directors (PDs) of general surgery and surgical subspecial... more To determine whether residency program directors (PDs) of general surgery and surgical subspecialties review social networking (SN) websites during resident selection. DESIGN: A 16-question survey was distributed via e-mail (Survey Monkey, Palo Alto, California) to 641 PDs of general surgery and surgical subspecialty residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). SETTING: Institutions with ACGME-accredited general surgery and surgical subspecialty residency programs. PARTICIPANTS: PDs of ACGME-accredited general surgery and surgical subspecialty residency programs. RESULTS: Two hundred fifty (39%) PDs completed the survey. Seventeen percent (n ϭ 43) of respondents reported visiting SN websites to gain more information about an applicant during the selection process, leading 14 PDs (33.3%) to rank an applicant lower after a review of their SN profile. PDs who use SN websites currently are likely to continue (69%), whereas those who do not use SN currently might do so in the future (yes 5.4%, undecided 44.6%). CONCLUSIONS: Online profiles displayed on SN websites provide surgery PDs with an additional avenue with which to evaluate highly competitive residency applicants. Applicants should be aware of the expansion of social media into the professional arena and the increasing use of these tools by PDs. SN profiles should reflect the professional standards to which physicians are held while highlighting an applicant's strengths and academic achievements.