Grand Rounds in the Jefferson Digital Commons

The Jefferson Digital Commons has a collection of grand rounds presentations archived from various departments, including: Surgery Otolaryngology Kimmel Cancer Center Family and Community Medicine Integrative Medicin

Inhibition of Tendon Cell Proliferation and Matrix Glycosaminoglycan Synthesis by Non-Steroidal Anti-Inflammatory Drugs in vitro

The purpose of this study was to investigate the effects of some commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on human tendon. Explants of human digital flexor and patella tendons were cultured in medium containing pharmacological concentrations of NSAIDs. Cell proliferation was measured by incorporation of 3H-thymidine and glycosaminoglycan synthesis was measured by incorporation of 35S-Sulphate. Diclofenac and aceclofenac had no significant effect either on tendon cell proliferation or glycosaminoglycan synthesis. Indomethacin and naproxen inhibited cell proliferation in patella tendons and inhibited glycosaminoglycan synthesis in both digital flexor and patella tendons. If applicable to the in vivo situation, these NSAIDs should be used with caution in the treatment of pain after tendon injury and surgery

Real-time adaptive filtering of dental drill noise using a digital signal processor

The application of noise reduction methods requires the integration of acoustics engineering and digital signal processing, which is well served by a mechatronic approach as described in this paper. The Normalised Least Mean Square (NLMS) algorithm is implemented on the Texas Instruments TMS320C6713 DSK Digital Signal Processor (DSP) as an adaptive digital filter for dental drill noise. Blocks within the Matlab/Simulink Signal Processing Blockset and the Embedded Target for TI C6000 DSP family are used. A working model of the algorithm is then transferred to the Code Composer Studio (CCS), where the desired code can be linked and transferred to the target DSP. The experimental rig comprises a noise reference microphone, a microphone for the desired signal, the DSK and loudspeakers. Different load situations of the dental drill are considered as the noise characteristics change when the drill load changes. The result is that annoying drill noise peaks, which occur in a frequency range from 1.5 kHz to 10 kHz, are filtered out adaptively by the DSP. Additionally a schematic design for its implementation in a dentist’s surgery will also be presented

Clinical applications of computerized thermography

Computerized or digital, thermography is a rapidly growing diagnostic imaging modality. It has superseded contact thermography and analog imaging thermography which do not allow effective quantization. Medical applications of digital thermography can be classified in two groups: static and dynamic imaging. They can also be classified into macro thermography (resolution greater than 1 mm) and micro thermography (resolution less than 100 microns). Both modalities allow a thermal resolution of 0.1 C. The diagnostic power of images produced by any of these modalities can be augmented by the use of digital image enhancement and image recognition procedures. Computerized thermography has been applied in neurology, cardiovascular and plastic surgery, rehabilitation and sports medicine, psychiatry, dermatology and ophthalmology. Examples of these applications are shown and their scope and limitations are discussed

Changes In angulation and phalangeal length of fingers and thumbs following surgical treatment for congenital clinodactyly

INTRODUCTION: Congenital clinodactyly is a condition characterized by the deviation of a digit or digits in the coronal plane. Angulation is often due to the presence of a delta phalanx. There is a scarcity of long-term data regarding the results of surgical treatment for clinodactyly, particularly with respect to postoperative phalangeal growth and risk factors for recurrent deformity. METHODS: Our retrospective study involved the analysis of data from medical records of patients who had corrective surgery for congenital clinodactyly. We also measured radiographs to quantify the angle of deviation and the longitudinal lengths of the surgically corrected phalanx and corresponding metacarpal. Clinodactyly was defined as radiographic angulation of 10° or greater in the coronal plane. Recurrence was defined as a final angulation of 10° or greater as well as an increase of at least 10° compared with the immediate postoperative measurement. The primary ratio was defined as the ratio of the length of the primary ossification center of the surgically corrected phalanx to the length of the primary ossification center of the corresponding metacarpal. The secondary ratio was the ratio of the length of the primary and secondary ossification centers together of the corrected phalanx to those of the metacarpal. Comparisons were made between preoperative, postoperative, and most-recent follow-up values. Postoperative data was restricted to radiographs taken within three months after surgery. Final follow-up data was initially permitted if radiographs were taken at least one year after surgery. Additional analysis was performed of patients with a minimum of two years clinical and radiographic follow-up. RESULTS: There was a significant decrease in angulation with surgery and a significant increase in angulation postoperatively (p<0.001; p<0.01). Overall, the mean preoperative and final digital angulation was 40.4° and 17.4°, respectively, when a two-year minimum between the time of surgery and final follow-up measurements was implemented. This resulted in a significant average correction of 23.3° (p<0.001). The postoperative change in angulation was found to be significantly different depending on the surgical technique used. Digits corrected with reverse wedge osteotomies showed little to no change in angulation during the postoperative period. However, digits corrected with closing wedge osteotomies showed a significant increase in angulation between the immediate postoperative and final follow-up measurements (p=0.007). The rate of recurrence was 43.2% (95% CI: 28.7-58.9% with a one year minimum for follow-up; 95% CI: 27.5-60.4% with a two year minimum for follow-up). Postoperative changes in angulation or recurrence were not significantly associated with gender, patient age at the time of surgery, the type of digit corrected, coexisting congenital syndromes, or the presence of additional hand abnormalities. The primary ratio decreased significantly with surgery, from 0.35 preoperatively to 0.27 postoperatively (p=0.03). The primary ratio then increased significantly over time to 0.40 when there was a two-year minimum between the time of surgery and final follow-up. There was an insignificant change in primary ratio from immediately after surgery to final follow-up when data as early as one year postoperatively was included. The secondary ratio did not change significantly with surgery or during the postoperative period regardless of whether one or two-year time restrictions were in place. The mean secondary ratio was 0.29 before surgery, 0.25 immediately after surgery, and 0.33 at the time of final follow-up at least two years after surgery. CONCLUSIONS: Surgery to correct clinodactyly effectively decreases angulation of the digit, despite the risk of recurrent deformity over time. Our study did not identify any factors associated with recurrence. However, there was a significant difference in the change in angulation between the immediate postoperative and final follow-up measurements depending on the surgical technique used. Surgery to correct clinodactyly does not hinder postoperative growth of the corrected phalanx

THE IMPACT OF PENILE CANCER TREATMENT ON SEXUAL RELATIONSHIPS: A QUALITATIVE ENQUIRY

Background: Penile cancer is a rare but highly treatable condition. Current guidance recommends the use of a surgical procedure to excise the primary tumour (and a margin of normal penile tissue). Whilst treatment can be effective, treatment often has a significant impact on a patient's sexual and urinary function, and physical and mental wellbeing. The objective of this study was to explore the impact of treatment for penile cancer on sexual function and relationships. Methods: Qualitative data was collected via narrative video interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. All interviews were recorded using either a digital video recorder or digital audio recorder, transcribed. A method of constant comparison analysis was used to illicit themes and outliers. Results: Twenty seven men were interviewed; mean age at diagnosis = 63 (range = 41-82); Mean number of years post-surgery = 3 (range = 0-15 years) 15 men were married, a further two were in a committed relationship, the remaining 10 were single/widowed. All men had received surgical treatment ranging from circumcision to total penectomy. Just two men had attended any form of psychological therapy. The impact of treatment varied considerably. The majority of men talked about still being able to experience arousal and sexual pleasure in some way. However, for many, penetrative sex was awkward and less gratifying than before treatment. One man who had received a total penectomy was surprised to experience a form of orgasm after surgery. For a number of men, the impact of treatment on their ability to satisfy their sexual partners was a key concern. Men who were able to openly talk with their partners about sex and the impact of the treatment on sexual practice found this a great comfort. Conclusion: The significance of sex for a man can differ considerably between individuals; relationship status, age and life stage are all likely to have a bearing on the role that sex plays in a man life. A diagnosis of cancer can also affect how a man (and his partner) views sex and the level of importance which he attaches to it. For men who are sexually active prior to treatment, surgery will undoubtedly result in changes to sexual practice, however, treatment does not have to result in sexual abstinence

Christian Albert Theodor Billroth, M.D., founding father of abdominal surgery (1829-1894).

In the 1800s, the field of surgery was in its infancy, somewhat primitive and embryonic. The technical nature of surgery was the basis for the dividing line between the disciplines of surgery and internal medicine. Sterilization was not a common practice. Radical surgical resections and experimentation in medicine were shunned. With his boldness equaled only by his innovation and resourcefulness, Theodor Billroth would become a pioneer not only in the development of modern surgery, but also in the advancement of its cultural and historical significance

John Chalmers DaCosta (1863-1933): restoration of the old operating table.

John Chalmers DaCosta was an influential chairman and the first Samuel D. Gross Professor of Surgery at Jefferson Medical College in Philadelphia. He was well known throughout the field as a skilled surgeon, passionate speaker, and exceptional writer. In addition to countless accomplishments during his career, DaCosta was deeply dedicated to the preservation and commemoration of surgical history. This ideology was exemplified when he set out on a mission to recover the old wooden operating table used by many of his iconic mentors including Samuel D. Gross, Joseph Pancoast, and William W. Keen. This table was originally used for surgical demonstrations and anatomy lessons in a lecture room of the Ely Building and later in the great amphitheater of the Jefferson Sansom Street Hospital. It was found forgotten in the basement of the College Building and was promptly refurbished, donned with dedicatory plaques, and returned to its honored position in the medical college. Dr. DaCosta also contributed a detailed article recalling the history of the table and the notable leaders in surgery who taught and practiced on its surface. The old table currently stands proudly in the entranceway of the Department of Surgery where it will remain as a cherished symbol of the early beginnings of surgical practice and education