Recipient of the 2010 Alumni Distinguished Leadership Award

Lillian S. Kao, M.D., M.S., is an associate professor in the Department of Surgery and faculty for the Center for Clinical Research and Evidence-Based Medicine at the University of Texas Health Science Center in Houston (UTHSC). She also serves as the Vice-Chief of Surgery at the Lyndon B. Johnson General Hospital in Houston. Dr. Kao’s main research interest is the prevention and treatment of surgical infections. She has several grants for her clinical research, including an NIH career development award. In 2006, Dr. Kao was the recipient of a Robert Wood Johnson Physician Faculty Scholar to study interventions to improve the prevention of surgical site infections, which are a significant problem resulting in worsened patient outcome and increased health care expenditures. In particular, she is interested in maximizing compliance with evidence-based guidelines for the prevention of these infections within a county hospital system with limited resources. Her other interest is in educating surgeons about clinical research. She has co-founded a Center for Surgical Trials and Evidence-based Practice (C-STEP) at UTHSC, co-directed the Fundamentals of Surgical Research Course (a yearly national course which is put on by the Association for Academic Surgery or AAS, a society for academic surgeons of which she is the Secretary on the Executive Council), participated as guest faculty at international research courses (i.e. Developing a Career in Academic Surgery in Australia), and recently was the AAS Visiting Professor to the Taiwan Surgical Association where she lectured on evidence-based surgery. Dr. Kao received her medical degree from the University of Michigan in Ann Arbor, completed surgical residency and a fellowship in gastrointestinal surgery at the University of Washington in Seattle, and completed a surgical critical care fellowship and obtained a Masters Degree in Clinical Research at UTHSC

Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA.</p> <p>Case presentation</p> <p>A 59-year-old Caucasian man with septic shock secondary to community-acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital.</p> <p>Conclusion</p> <p>In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study.</p

Accurate isolation and detection of circulating tumor cells using enrichment-free multiparametric high resolution imaging

IntroductionThe reliable and accurate detection of rare circulating tumor cells (CTCs) from cancer patient blood samples promises advantages in both research and clinical applications. Numerous CTC detection methods have been explored that rely on either the physical properties of CTCs such as density, size, charge, and/or their antigen expression profiles. Multiple factors can influence CTC recovery including blood processing method and time to processing. This study aimed to examine the accuracy and sensitivity of an enrichment-free method of isolating leukocytes (AccuCyte® system) followed by immunofluorescence staining and high-resolution imaging (CyteFinder® instrument) to detect CTCs.MethodHealthy human blood samples, spiked with cancer cells from cancer cell lines, as well as blood samples obtained from 4 subjects diagnosed with cancer (2 pancreatic, 1 thyroid, and 1 small cell lung) were processed using the AccuCyte-CyteFinder system to assess recovery rate, accuracy, and reliability over a range of processing times.ResultsThe AccuCyte-CyteFinder system was highly accurate (95.0%) at identifying cancer cells in spiked-in samples (in 7.5 mL of blood), even at low spiked-in numbers of 5 cells with high sensitivity (90%). The AccuCyte-CyteFinder recovery rate (90.9%) was significantly higher compared to recovery rates obtained by density gradient centrifugation (20.0%) and red blood cell lysis (52.0%). Reliable and comparable recovery was observed in spiked-in samples and in clinical blood samples processed up to 72 hours post-collection. Reviewer analysis of images from spiked-in and clinical samples resulted in high concordance (R-squared value of 0.998 and 0.984 respectively).DiscussionThe AccuCyte-CyteFinder system is as an accurate, sensitive, and clinically practical method to detect and enumerate cancer cells. This system addresses some of the practical logistical challenges in incorporating CTCs as part of routine clinical care. This could facilitate the clinical use of CTCs in guiding precision, personalized medicine

World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

Peer reviewe

Pre Test Surgery

ix.373 hal.;21 c

Success in Academic Surgery : Part 1

XVII, 258p. 19 illus., 4 illus. in color.online r

Randomized Controlled Trials Evaluating Patient-Reported Outcomes after Cholecystectomy: A Systematic Review.

There has been growing interest in patient-reported outcomes (PROs) in benign biliary disease. A PRO is any report of the status of a patient\u27s health condition that comes directly from the patient, without interpretation by a clinician.1 The PRO assessments are increasingly being measured in addition to traditional surgical outcomes.2-8 Furthermore, PROs may be useful for shared decision-making. In order to effectively counsel patients about expected surgical outcomes, physicians need to be able to easily access information on PROs from high quality trials and be able to judge the methodologic quality of PRO assessment