Consecutive Case Series of Melanoma Sentinel Node Biopsy for Lymphoseek Compared to Sulfur Colloids

Introduction: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy (LS) with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids (SC) in patients with melanoma undergoing SLNB. Methods: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012-2016 with at least one year of follow up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy, and SLNB. Student’s t-test and Chi-Square were used to analyze the data with a p-value of \u3c0.05 being considered significant. Results: Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to SC, Lymphoseek required lower radiation dosages (p\u3c0.001), shorter mapping times (p=0.008), and decreased number of sentinel nodes removed (p=0.03). There was no difference in the number of patients with positive nodes (p=0.5). Additionally, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false negative SLNB. Conclusion: Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false negative rates despite fewer nodes removed

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

Engineering the Hardware/Software Interface for Robotic Platforms - A Comparison of Applied Model Checking with Prolog and Alloy

Robotic platforms serve different use cases ranging from experiments for prototyping assistive applications up to embedded systems for realizing cyber-physical systems in various domains. We are using 1:10 scale miniature vehicles as a robotic platform to conduct research in the domain of self-driving cars and collaborative vehicle fleets. Thus, experiments with different sensors like e.g.~ultra-sonic, infrared, and rotary encoders need to be prepared and realized using our vehicle platform. For each setup, we need to configure the hardware/software interface board to handle all sensors and actors. Therefore, we need to find a specific configuration setting for each pin of the interface board that can handle our current hardware setup but which is also flexible enough to support further sensors or actors for future use cases. In this paper, we show how to model the domain of the configuration space for a hardware/software interface board to enable model checking for solving the tasks of finding any, all, and the best possible pin configuration. We present results from a formal experiment applying the declarative languages Alloy and Prolog to guide the process of engineering the hardware/software interface for robotic platforms on the example of a configuration complexity up to ten pins resulting in a configuration space greater than 14.5 million possibilities. Our results show that our domain model in Alloy performs better compared to Prolog to find feasible solutions for larger configurations with an average time of 0.58s. To find the best solution, our model for Prolog performs better taking only 1.38s for the largest desired configuration; however, this important use case is currently not covered by the existing tools for the hardware used as an example in this article.Comment: Presented at DSLRob 2013 (arXiv:cs/1312.5952

Is Excision of Radial Scars Identified on CNB Necessary?

Introduction: Quantifying the risk of upgrade to malignancy with radial scars has been an ongoing challenge, as the published upgrade rate varies widely from 0-40%, making management strategy controversial. The lack of consensus on optimal management highlights the need for further analysis. We sought to identify our institutional upgrade rate of radial scar identified on core needle biopsy (CNB). Methods: A retrospective review of pathology and radiology databases was performed to identify radial scars found on CNB. We excluded patients with malignancy associated with radial scar and those who did not undergo surgical excision. The upgrade rates to malignancy or other atypia on surgical excision were then evaluated. Results: We identified 127 patients with radial scar on CNB, of which 75 patients were excluded, leaving 52 patients for analysis. Of these, 4 of 52 (7.7%) patients had an upgrade to malignancy upon excision. Eight patients had additional atypia with radial scar on CNB, two of which upgraded to malignancy on excision. The rate of malignancy upgrade for isolated radial scar was 2 of 44 (4.5%). Of the 44 patients with isolated radial scar, 15 (34%) were found to have additional atypia on excision. Discussion: Although the upgrade rate to malignancy was only 4.5%, there was a substantial upgrade rate of isolated radial scar to additional atypia which can alter subsequent management. Additionally, 25% of radial scars with atypia upgraded to malignancy. Thus, careful consideration should be given to surgical excision of CNB showing radial scar with and without atypia

Iliac Compression Syndrome Treated with Stent Placement.

Iliac compression syndrome is usually diagnosed during the third and fourth decades of life when the patient has iliofemoral deep vein thrombosis. Catheter-directed thrombolytic therapy is an accepted method of treatment for iliofemoral deep vein thrombosis, which has been reported to afford greater success with clot dissolution than with system therapy. Although this method is not new, this is the first case, to our knowledge, reporting successful treatment of computerized tomographically demonstrated iliac compression syndrome with stent placement after lysis and insufficient response to balloon angioplasty

Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center

Background: Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.https://jdc.jefferson.edu/surgeryposters/1002/thumbnail.jp

The Role of the Uncinate Margin in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Survival Analysis

Introduction: Positive margins during pancreaticoduodenectomy for pancreatic cancer portend worse survival, but additional resection of the uncinate margin is typically unfeasible without major vascular reconstruction. The survival benefit of resecting additional neck or bile duct margins in the face of a positive uncinate is also unknown. We examined the impact of re-resection of these margins on survival. Methods: Patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy from 2006-2015. Pancreatic neck, bile duct, uncinate, and duodenal frozen section margins were assessed before and after resection of positive margins. Kaplan-Meier survival curves were compared with log-rank tests. Multivariable Cox regression was used to assess the effect of margin status on overall survival. Results: Among 508 patients identified, 388 (76.4%) underwent a pylorus-preserving procedure, 435 (85.6%) had T3 tumors, and 379 (74.6%) had nodal involvement. There were 21 instances where an uncinate margin was concurrently positive with a neck or bile duct margin; this additional neck or bile duct margin was resected in 13 cases (61.9%). Resection of additional margins when the uncinate was concurrently positive was not associated with improved survival (p=0.36). Median survival with and without positive uncinate margins was 13.8 vs. 19.7 months (p=0.04). A positive uncinate margin was associated with decreased survival independent of other margins and cancer stage (HR 1.28 [95% CI 1.00-1.65]). Conclusion: In patients with pancreatic adenocarcinoma, positive uncinate margins are associated with decreased overall survival; resection of additional margins at the neck and bile duct in those with a positive uncinate margin is not warranted