Hallock G.G.,Sacred Heart Hospital |
Hallock G.G.,Lehigh Valley Hospital |
Hallock G.G.,St Lukes Hospital
Plastic and Reconstructive Surgery | Year: 2011
Background: Combined flaps serve a unique niche when significant or multidimensional defects need to be corrected. Perforator flaps have become a new alternative for achieving this same objective. As this latter genre evolves, it is reasonable to also expect the development of combined perforator flaps. Methods: Combined flaps based on perforators, as with any other combined flaps, can be classified into two major subtypes. These in turn may be further subdivided into various subcategories according to their inherent pattern of circulation and whether this is indigenous or naturally occurring, or must be intentionally fabricated using microsurgical techniques. Results: The two major subdivisions of combined perforator flaps are conjoined or chimeric perforator flaps. Conjoined perforator flaps incorporate "multiple perforasomes, each dependent due to a common physical junction, with each perforasome supplied by an independent perforator." Chimeric perforator flaps consist of multiple cutaneous territories, involving "multiple perforasomes, each supplied by an independent perforator, and independent of any physical connection with other perforasomes except where the perforators are linked to a common vascular source." Conclusions: As the anatomical knowledge of the vascular basis and technical refinements improves the overall utilization of perforator flaps, their selection as combined flaps will also assume a more definitive role. A standardization and clarification of a schema for the nomenclature for such combined perforator flaps therefore needs to be continually updated to enhance communication and surgical capabilities, reflecting the evolution of the concept of perforator flaps itself. Copyright © 2011 by the American Society of Plastic Surgeons.
Hallock G.G.,St Lukes Hospital |
Hallock G.G.,Sacred Heart Hospital |
Hallock G.G.,Lehigh Valley Hospital
Plastic and Reconstructive Surgery | Year: 2013
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the steps for evaluation of a patient with a lower extremity wound before initiating medical or surgical intervention. 2. Acknowledge that limb amputation and salvage can both be appropriate definitive treatment options. 3. Select proper nonsurgical or surgical techniques for wound management. 4. Appreciate the difference in the expected outcome according to the perspective of the physician versus the patient. SUMMARY: Lower extremity acute trauma is a common occurrence. Ultimate functional outcomes are similar whether amputation or salvage by limb reconstruction is the treatment pathway chosen. The reconstructive surgeon must be knowledgeable enough to assist in making the correct decision for either option. Débridement is the cornerstone of management before embarking on definitive wound closure. Nonsurgical devices have provided a transition to optimize the wound, sometimes even replacing or lessening the need for vascularized tissues to permit this coverage. Nevertheless, flaps will always have a role varying according to the involved region of the lower extremity. Traditional muscle flaps can often today be supplemented by the use of perforator flaps. The latter have great versatility as pedicled flaps for all zones of the lower limb, in addition to being a dependable free flap alternative. Horrendous injuries can now be expected to be salvaged, with a reasonable aesthetic result possible and with minimal donor-site morbidity. Preferences by both physicians and patients tend to favor the course to limb salvage, but it must be appreciated by the caregiver that it is always the patient who has to live with the residua of an altered limb and lifestyle. Copyright © 2013 by the American Society of Plastic Surgeons.
News Article | November 8, 2016
Florida Hospital Physician Group (FHPG) is proud to announce the addition of Haane Massarotti, MD, to the Advanced Center for Colorectal Surgery within the Digestive Health Institute at Florida Hospital Tampa. Dr. Massarotti is a highly trained, board certified surgeon with expertise in Colon and Rectal Surgery. Dr. Massarotti completed her residency in General Surgery at Lehigh Valley Hospital in Allentown, Pennsylvania. She then completed a fellowship in Colon and Rectal Surgery at Cleveland Clinic Florida, followed by a second fellowship in Colon and Rectal Minimally Invasive Surgery, also at Cleveland Clinic Florida. She is an active member of the American Society of Colon and Rectal Surgery. Dr. Massarotti specializes in minimally invasive colorectal surgical procedures. Her areas of interest include colon and rectal cancer, laparoscopic colorectal surgery, pelvic floor disorders, fecal incontinence, inflammatory bowel disease, and anorectal disease. Dr. Massarotti will work closely with the Medical Director for the Advanced Center for Colorectal Surgery, Dr. Allen P. Chudzinski. Dr. Massarotti also will be working alongside the specialty physicians of the Digestive Health Institute at Florida Hospital Tampa, which includes the Foregut and HPB practice, The Southeastern Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery with Dr. Alexander Rosemurgy, Dr. Sharona B. Ross and Dr. Iswanto Sucandy; as well as the Digestive Care Center with Dr. Michael Harris, Dr. Arthi Sanjeevi and Dr. Yasser Saloum. “We are thrilled to welcome Dr. Massarotti to the Florida Hospital Physician Group and the Advanced Center for Colorectal Surgery. Her experience and surgical expertise truly round out the continuum of specialty digestive care available to patients only at Florida Hospital Tampa,” shared Chris Jenkins, President of Florida Hospital Physician Group. Dr. Massarotti is located at 3000 Medical Park Drive, 510 Tampa, Florida 33613, and is currently accepting new patients. For more information, or to schedule an appointment, call (813) 615-7366 or visit http://www.FHPhysicianGroup.com. About Florida Hospital Physician Group Florida Hospital Physician Group (FHPG) is a multi-specialty physician group, dedicated to improving the health and wellness of communities throughout the greater Tampa Bay region with more than 160 providers operating in over 45 locations representing over 25 medical specialties. FHPG offers patients the highest level of compassionate and multidisciplinary care through a broad range of medical and surgical services, as well as direct access to five local Florida Hospitals, a Long Term Acute Care facility, imaging centers, specialty and urgent care centers, rehabilitation facilities and home care agencies located throughout Hillsborough, Pasco and Pinellas counties. Part of the Adventist Health System, Florida Hospital is a leading health network comprised of 26 hospitals throughout the state. For more information, visit http://www.FHPhysicianGroup.com. About Florida Hospital Tampa Florida Hospital Tampa is a not-for-profit 517-bed tertiary hospital specializing in cardiovascular medicine, neuroscience, orthopedics, women’s services, pediatrics, oncology, endocrinology, bariatrics, wound healing, sleep medicine and general surgery including minimally invasive and robotic-assisted procedures. Also located at Florida Hospital Tampa is the renowned Florida Hospital Pepin Heart Institute, a recognized leader in cardiovascular disease prevention, diagnosis, treatment and leading-edge research. The recent addition of the Doc1st ER shows that Florida Hospital Tampa is committed to providing compassionate and quality healthcare. Part of the Adventist Health System, Florida Hospital is a leading health network comprised of 26 hospitals throughout the state. For more information, visit http://www.FHTampa.org.
Computed tomography-based anatomic assessment overestimates local tumor recurrence in patients with mass-like consolidation after stereotactic body radiotherapy for early-stage non-small cell lung cancer
Dunlap N.E.,University of Louisville |
Yang W.,Cedars Sinai Medical Center |
McIntosh A.,Lehigh Valley Hospital |
Sheng K.,University of California at Los Angeles |
And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012
Purpose: To investigate pulmonary radiologic changes after lung stereotactic body radiotherapy (SBRT), to distinguish between mass-like fibrosis and tumor recurrence. Methods and Materials: Eighty consecutive patients treated with 3- to 5-fraction SBRT for early-stage peripheral non-small cell lung cancer with a minimum follow-up of 12 months were reviewed. The mean biologic equivalent dose received was 150 Gy (range, 78-180 Gy). Patients were followed with serial CT imaging every 3 months. The CT appearance of consolidation was defined as diffuse or mass-like. Progressive disease on CT was defined according to Response Evaluation Criteria in Solid Tumors 1.1. Positron emission tomography (PET) CT was used as an adjunct test. Tumor recurrence was defined as a standardized uptake value equal to or greater than the pretreatment value. Biopsy was used to further assess consolidation in select patients. Results: Median follow-up was 24 months (range, 12.0-36.0 months). Abnormal mass-like consolidation was identified in 44 patients (55%), whereas diffuse consolidation was identified in 12 patients (15%), at a median time from end of treatment of 10.3 months and 11.5 months, respectively. Tumor recurrence was found in 35 of 44 patients with mass-like consolidation using CT alone. Combined with PET, 10 of the 44 patients had tumor recurrence. Tumor size (hazard ratio 1.12, P=.05) and time to consolidation (hazard ratio 0.622, P=.03) were predictors for tumor recurrence. Three consecutive increases in volume and increasing volume at 12 months after treatment in mass-like consolidation were highly specific for tumor recurrence (100% and 80%, respectively). Patients with diffuse consolidation were more likely to develop grade ≥2 pneumonitis (odds ratio 26.5, P=.02) than those with mass-like consolidation (odds ratio 0.42, P=.07). Conclusion: Incorporating the kinetics of mass-like consolidation and PET to the current criteria for evaluating posttreatment response will increase the likelihood of correctly identifying patients with progressive disease after lung SBRT. © 2012 Elsevier Inc. All rights reserved.
Bhatt S.P.,University of Iowa |
Nanda S.,Lehigh Valley Hospital |
Kintzer J.S.,Temple University
Respiratory Medicine | Year: 2012
Purpose: Acute exacerbations of chronic obstructive pulmonary disease (COPD) sometimes appear to occur without a precipitating cause. Heterogeneous repolarization and arrhythmias occur in COPD patients. Given the close inter-relation between heart and lung, we hypothesized that unrecognized arrhythmias might be precipitants of acute exacerbations. Methods: Electrocardiograms (ECG) of thirty patients during acute exacerbations were compared with ECG during stable phase. P wave dispersion was used to assess atrial depolarization heterogeneity, and dispersion of QT interval to assess ventricular repolarization. p < 0.05 was considered significant. Frequent exacerbations were defined as two or more exacerbations in a year. Results: Mean age of patients was 70.3 ± 11.8 SD years. P wave dispersion was greater during acute exacerbation than during stable phase (56.7 ± 19.2 vs 47.7 ± 15.9 ms, p = 0.009). There was a trend toward greater QTc dispersion (108.3 ± 61.7 vs 90.3 ± 47.0 ms, p = 0.13) in acute exacerbation compared to stable phase. Sixteen (53%) had frequent exacerbations. There was a significant difference in PR interval during stable phase between those with frequent exacerbations and those without (163.9 + 17.4 vs. 145.1 + 22.8; p = 0.02). The P wave dispersion during stable phase was greater in those with frequent exacerbations, but did not reach statistical significance (52.6 + 18.8 vs. 42.2 + 9.8 ms; p = 0.06). Conclusions: P wave dispersion is more in the acute phase than in stable phase, and is greater in patients with more frequent exacerbations. This does not prove, but suggests an intriguing possibility that P wave dispersion predates acute exacerbations. This might be a new target for prediction, prevention and therapy of acute exacerbations of COPD. © 2012 Elsevier Ltd. All rights reserved.
Bechtel P.,Lehigh Valley Hospital |
Boorse R.,Lehigh Valley Hospital |
Rovito P.,Lehigh Valley Hospital |
Harrison T.D.,Lehigh Valley Hospital |
Hong J.,Lehigh Valley Hospital
Obesity Surgery | Year: 2013
Background: Lehigh Valley Health Network (LVHN), a nonprofit tertiary care facility in Allentown, Pennsylvania, is an accredited American College of Surgeons Bariatric Surgery Center Network (ACSBSCN) Level 1 site performing 400+ bariatric procedures annually. Bariatric data submission began in April 2008. Complication review revealed that approximately 17 % of patients on chronic anticoagulation (warfarin) therapy preoperatively were readmitted with supratherapeutic international normalized ratios (INRs), postsurgical bleeding, anastomotic ulcer, or other intraluminal hemorrhage. Opinion level recommendations have been published regarding the adjustment of warfarin dosages post-bariatric procedures with no widespread consensus. Case series have been published detailing perioperative hemorrhage risk for bariatric patients on preoperative anticoagulation. Little data of post-discharge hemorrhage rates have been published. With increasing numbers of bariatric surgical procedures performed annually, there is a potential for developing serious coagulopathic complications in those patients who resume their anticoagulation therapy postoperatively. Methods: Retrospective review of LVHN data from the ACSBSCN database was analyzed for 30-day readmissions due to documented extra- or intraluminal hemorrhage with INR and coagulopathy. Follow-up INR and warfarin doses were collected up to 6 months postoperatively. Results: Over a 3-year period, 38 patients undergoing bariatric procedures were identified as being on preoperative warfarin therapy. Six of 38 developed hemorrhage within 30 days. Two patients presented beyond 30 days with bleeding. Supratherapeutic INR was present in five of six readmitted patients. Mean INR was 5.8. Warfarin sensitivity was present in a statistically significant higher number of patients within 30 days of surgery. After 30 days, a resistance to warfarin was demonstrated. Conclusions: Bariatric surgery patients taking warfarin are prone to coagulopathy in the early post-op period requiring vigilant monitoring to prevent supratherapeutic INR and corresponding risk of hemorrhage. © 2013 Springer Science+Business Media New York.
Sexton S.E.,Lehigh Valley Hospital
Clinics in Podiatric Medicine and Surgery | Year: 2014
Open fractures of the lower extremity cover a wide gamut of injuries ranging from the mangled, pulseless leg necessitating amputation to the more innocuous pinhole open wounds associated with simple fracture patterns. Prompt diagnosis and appropriate care can make a dramatic difference in decreasing complication rates and improving ultimate outcomes. Principles of management of open fractures have been created with the main goal of decreasing infection rates, while providing for stabilization of the bone and soft tissue injury. © 2014 Elsevier Inc.
Reimer N.,Lehigh Valley Hospital
Clinical Journal of Oncology Nursing | Year: 2013
Understanding compassion fatigue and devising and implementing interventions to address the subject are important for nurses and patients. However, few literature reports exist that address interventions for nurses who experience compassion fatigue. This article discusses how nurses on a medical-surgical oncology unit in an academic, community Magnet™ hospital adopted these themes as a conceptual framework on which to focus actions to avoid and mitigate compassion fatigue. © Oncology Nursing Society.
Dailey E.,Lehigh Valley Hospital
Clinical Journal of Oncology Nursing | Year: 2016
Palliative care services provided alongside traditional oncology care have been shown to be beneficial to patients and families. This article provides a brief history of palliative care, a pathway to implementing these services into currently established oncology programs, and a brief discussion of common barriers. At a Glance• Palliative care increases quality of life and patient satisfaction and decreases caregiver burden and healthcare costs. • Palliative care program development requires education, review of population needs and available services, effective screening tools, and participation in quality improvement processes. • Integration of palliative care into oncology care is expected to increase with the transition to a patient-centered model with value-based reimbursement. © 2016 by the Oncology Nursing Society.
Bykov Y.,Lehigh Valley Hospital
Clinics in Podiatric Medicine and Surgery | Year: 2014
The talus is the most proximal bone of the hindfoot that couples the foot to the leg. It is the second most common fracture of the tarsal bones, second in frequency to the calcaneous. However, overall injuries to the talus are relatively rare, and most surgeons have little experience in managing them. This article discusses fractures of the talus, including injuries to the talar neck, body, head, and processes. Although subtalar dislocations and osteochondral injuries are important topics, they are not addressed in this article. © 2014 Elsevier Inc.