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Program INTERNATIONAL COLLEGE OF SURGEONS United States Section 68th Annual Surgical Update Preparing For Tomorrow’s Surgery Today June 21-24, 2006 Nashville, Tennessee Nashville... ...a city to discover Table of Contents Letters of Welcome President of the United States of America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Governor of Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Mayor of Nashville . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 ICS World President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 United States Section President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Leadership International Executive Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 United States Section Executive Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Scientific Program Organizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Continuing Medical Education Conflict of Interest and Off-Label Disclosure Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 The Importance of Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Conference Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Credit Designation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 2006 Resident Research Scholarship Competition Winners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Scientific Program Cultural Diversity and Competent Surgical Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Deposition Skills: How to Prepare, How to Protect, and How to Perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Tsunami: Global Disaster, International Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Surgical Cure Of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Orthopaedic Trauma and The Future of Biological Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Colorectal Surgery Case Reports and Free Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Laparoscopic Colectomy: A Hands-On Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Cosmetic Gynecologic Surgery And Urological Trauma In Gynecologic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Endovascular Therapy For Aneurysmal Disease And Quality and Cost Measurements In Thoracic Surgery . . . . . . .17 Presbyopia and the Aging Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Surgery for Obesity and It's Co-Morbidities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Laparoscopic Colectomy: Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 General Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Convocation and Presidential Recognition Ceremony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Welcome Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Social Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Tours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Alliance Fundraising Raffle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 General Meeting Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18,19 ICS-US Headquarters and Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 ICS-US Alliance Executive Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 John C. Scott Surgical Endowment Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 70th North American Federation Congress Announcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Scientific Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Presenter Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Downtown Nashville Hilton Meeting Level Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 3 4 5 A Message from the ICS World President As World President, I welcome you to the 68th Annual Surgical Update, Preparing for Tomorrow’s Surgery Today, hosted by the United States Section of the International College of Surgeons. I welcome you to one of the most entertaining venues in Middle America, Nashville, Tennessee. The United States Section is our largest section in the International College of Surgeons and certainly one of our very best sections. It is our pleasure to experience the sincere hospitality of our United States Section fellows. One of the goals of the International College of Surgeons is “One World—One Organization.” While we emphasize the independence of our sections, we also emphasize our worldwide fellowship. Our goal is to enhance the welfare of mankind by providing quality health care to all without regard to nationality, color, or creed. And it is my goal to do all possible to accentuate this spirit around the world, and, on this particular occasion, at this 68th United States Section meeting. I look forward to meeting you and learning of your experiences. Nadey S. Hakim I congratulate Dr. Enrico Nicolo, President, United States Section, and all others who have worked so hard to make this conference interesting and successful. I am certain that this meeting will continue the succession of fine meetings from this excellent section. A Message from the US Section President Dear Colleagues and Guests, It is my distinct pleasure to welcome you to the 68th Annual Surgical Update of the International College of Surgeons-United States Section. As we gather together in this beautiful city of Nashville, this week’s events will begin the exploration into the triumphs and trials of our profession, and the scientific activities planned will provide us with the knowledge and the tools to begin “Preparing for Tomorrow’s Surgery Today.” While this conference will emphasize the independence of our own national section, one of the goals of the International College of Surgeons is to strengthen our worldwide Fellowship and enhance the global welfare of our patients. This goal will be accentuated this week through the participation of many well-known international physicians as well as prominent faculty members from the Vanderbilt University School of Medicine. Their contributions are a welcomed addition for the overall educational outcomes of this conference. The “key” to our continuing professional development is the accessibility to information and presentation— through lectures, videos, slide presentations and handson workshops. Our Council of Specialty Group Chairs have worked diligently to provide you with a fascinating tour of the emerging trends in the surgical arena. As we prepare for the future of surgery, we must remember that the history of our profession is a heroic story inasmuch as it began as a gallant fight against death. Today, we continue that gallant fight as we have for millennia, for no matter how tremendous the achievements of recent surgical science, disease continues to humble us as physicians and surgeons and keeps us struggling on our pathway to find new and better ways to re-establish health and well being. Today, together, we will advance down that pathway as we communicate through the common language of scientific investigation and share our experiences and reinforce the benefits of cooperation between surgical specialists. Again, my dear Fellows, I welcome you to this, our 68th Annual Surgical Update, and I thank you for your commitment to the College. I welcome your families and friends who, silently in the background, undoubtedly share and support you in your noble cause, and I welcome all our guest faculty, whose presence here is an indication of their own dedication and service to the surgical profession as well as our educational mission. Finally, on behalf of your patients, I welcome you in your preparation for the surgery you will do tomorrow. Everyone, welcome to Nashville! Welcome to the International College of Surgeons! Enrico Nicolo 6 2005 - 2006 2006 United States Section Executive Committee International Executive Council President Enrico Nicolo, MD, FICS McKeesport, Pennsylvania World President Professor Nadey Hakim United Kingdom President-Elect Dr. Fidel Ruiz-Healy Mexico Immediate Past President Dr. Raymond A. Dieter, Jr. United States First Vice President Professor Jose Miguel Alvear Ecuador Corporate Secretary Professor Christopher Chen Singapore Treasurer Dr. Said Daee United States African Federation Secretary Professor Adel Ramzy Egypt Asian Federation Secretary Professor Narendra Pandya India European Federation Secretary Professor Rocco Maruotti Italy Latin American Federation Secretary Dr. Paulo Kassab Brazil North American Federation Secretary Dr. Paul Belliveau Canada Pacific Federation Secretary Dr. Nopadol Wora-Urai Thailand Additional Members Dr. H.S. Bhanushali India Dr. Phyllis Bleck United States Dr. Carmencita Gotauco Philippines Dr. Chen-Hsen Lee Taiwan ROC Professor Dirk Loose Germany President-Elect Sibu Pada Saha, MD Lexington, Kentucky Immediate Past President J. C. Serrato, Jr., MD, FICS Columbus, Georgia Secretary Vijay Mittal, MD, FICS Southfield, Michigan Treasurer Joseph A. Bachicha, MD South San Francisco, California Chair, Board of Regents Larry S. Sasaki, MD Bossier City, Louisiana Chair, Council of Specialty Groups Wickii T. Vigneswaran, MD Chicago, IL Scientific Program Organizers Enrico Nicolo, MD ICS-US President Assistant Clinical Prof. of Surgery University of Pittsburgh Medical Center Pittsburgh, PA Joseph A. Bachicha, MD Department of Obstetrics & Gynecology Chief, Patient Education and Health Promotion Kaiser Medical Center Hayward, CA Mark I. Golden, MD Medical Director Doctors for Visual Freedom Schaumburg, IL Marco A. Pelosi III, MD Associate Director Pelosi Women’s Medical Center Bayonne, NJ Alfonso E. Pino, MD Secretary American Fracture Association De Leon, TX Roque J. Ramirez, MD President SurgeonOne, Inc. Corpus Christi Medical Center Corpus Christi, TX Dinesh Ranjan, MD Chief, Transplant Section, Director of Liver and Pancreas Transplantation University of Kentucky Lexington, KY Dr. Mitsuru Sasako Japan Professor Ken Takasaki Japan 7 Sibu P. Saha, MD Professor of Surgery University of Kentucky Lexington, KY Larry S. Sasaki, MD Assistant Clinical Professor of Surgery Louisiana State University Medical Center Shreveport, LA Ajay Singla, MD Associate Professor Department of Urology & Gynecology Adjunct Associate Professor BioMedical Engineering Wayne State University Detroit, MI Jacob Varon, MD Houston, TX Wickii T. Vigneswaran, MD, Chair, ICS-US Council of Surgical Specialty Groups Professor of Surgery Associate Chief of Cardiothoracic Surgery Director of Lung and Heart-Lung Transplantation University of Chicago Chicago, IL ICS-US Conflict of Interest and Off-Label Disclosure Policies Conflict of Interest A potential conflict of interest exists when there is involvement between the speaker/presenter and any for-profit commercial firm or organization (FPC). This includes, but is not limited to, one or more of the following: 1) consultant, scientific advisory committee member, or lecturer for a FPC from which income is earned; 2) officer, board member, trustee, owner, or employee of a FPC; 3) stock or bond holdings in a FPC (investments entirely managed by a third party such as mutual funds and pension plans are excluded); 4) stock options held in a FPC. Off-Label Disclosure (Including Generic Trade Names and Reporting Scientific Research) Presentations must give a balanced view of options. Faculty use of generic names will contribute to this impartiality. Presentations supported by a commercial entity reporting the results of scientific research must conform to the generally accepted standards of experimental design, data collection, and analysis. When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, it is required that the speaker disclose that the product is not labeled for the use under discussion or that the product is still investigational. The Importance of Identification In order for the audience to evaluate information, analysis and opinions at presentations sponsored by the International College of Surgeons-United States Section, it is crucial that the audience be informed of any aspect of a speaker’s personal or professional affiliations that might affect the speaker’s attitude or judgment regarding that speaker’s presentation. For any presentation, the speakers will identify any aspect of personal or professional affiliations that may reasonably affect their views prior to their presentation(s) (for instance, affiliation with the manufacturer of a drug or device related to the topic). Additionally, faculty members are required to report if their presentations include discussion(s) of investigational products or products not labeled for use. All faculty members are required to comply with these policies and procedures and identify any potential conflicts and/or discussion of investigational products prior to presentation. Signed policy forms for all faculty members will be retained on file in the ICS-US CME Office. An indication of a speaker’s disclosure and potential conflict and or a speaker’s failure to complete and sign off on these policies will be noted and identified in writing on the cover of each program’s evaluation form. Only those faculty members who identify a potential conflict, and/or description of investigational products or experimental research with an explanation of the same will appear on the cover page of the program evaluation along with those faculty members whose presentations we were unable to asses based on their failure to comply to these policies. These individuals and those with a potential conflict must identify the same prior to the start of their presentation. Disclaimer Registrants for this course understand that medical and scientific knowledge is constantly evolving and that the views and techniques of the faculty are their own and may reflect innovations and opinions not universally shared. The views and techniques of the faculty are not necessarily those of the ICS but are presented in this forum to advance scientific and medical education. Overall Conference Objectives As surgeons we share experiences, discoveries and research for the sake of science and mankind. The common language of scientific investigation enriches the surgeon when there is a sharing of experience in a forum that encourages discussion and participation. This program has been designed to keep you abreast of current and emerging trends in surgery and the concepts of a culturally competent surgical practice. The sessions being developed will present a variety of viewpoints on new technologies that will address the need for, as well as reinforce the benefit of, cooperation and communications between surgical specialists. The goals of this conference are to enhance overall technique, to advance surgical knowledge, foster continued training, and improve patient care. Everyone involved in the development of this conference encourages you to attend, to participate, and to share in the continued refinement of surgical knowledge and skills. Accreditation The International College of Surgeons-United States Section is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. Credit Designation The International College of Surgeons-United States Section designates this educational activity for 24 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spends in the activity. 8 8 2006 Resident Research Scholarship Recipients GRAND PRIZE Siddhartha Rath, MD Departments of Surgery and Physiology, Louisiana State University, Shreveport, LA Estrogen Attenuates Hepatic Ischemia-Reperfusion Injury Presentation Date: Friday, June 23 Program: Surgical Cure of Diabetes FIRST PRIZE Kongkrit Chaiyasate, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI The Uncut Roux-En-Y with Jejunal Pouch: A New Reconstruction Technique for Total Gastrectomy Presentation Date: Saturday, June 24 Program: Surgery for Obesity & Its Co-Morbidities HONORS Hanadi Bu-Ali, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI Synchronous Versus Metachronous Breast Cancer: Characteristics of the Second Tumor Presentation Date: Saturday, June 24 Program: General Session HONORS Kevin W. Hatton, MD Departments of Anesthesiology and Surgery, University of Kentucky Chandler Medical Center, Lexington, KY Comparative Hemodynamics of the Piggyback Technique with Veno-Venous Bypass versus the Piggyback Technique Alone during Orthotopic Liver Transplantation Presentation Date: Friday, June 23 Program: Surgical Cure of Diabetes HONORS David A. Machado-Aranda, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI Electroporation-Mediated Gene Transfer in Lipopolysaccharide (LPS) Injured Murine Lungs Presentation Date: Friday, June 23 Program: Endovascular Therapy for Aneurysmal Disease and Quality Cost Measurements in Thoracic Surgery HONORS Reza F. Saidi, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI Effect of Methyprednisolone on Liver Warm Ischemia-Reperfusion Injury Presentation Date: Friday, June 23 Program: Surgical Cure of Diabetes 9 Business Meetings Wednesday, June 21 8:00 am-6:00 pm A schedule of these meetings was mailed to Officers and Committee Members in advance of the meeting. Please refer to the back cover of this book for the full schedule. Thursday, June 22 Scientific Program 7:30 am-8:30 am 9:05 am-9:50 am Breakfast Buffet ARMSTRONG I Thanks to the generous support of Pfizer, we are able to start our meeting today with a full breakfast. All attendees are encouraged to take part. Service will end promptly at 8:15 am to ensure that the morning session begins on time. ADDRESSING HEALTH DISPARITIES WITH HEALTH TECHNOLOGY Raul Perea-Henze, MD, MPH, Senior Medical Advisor and Senior Director for Global Medical Affairs, Pfizer, Inc., New York, NY 9:50 am-10:05 am Coffee Break Prefunction Cultural Diversity and Competent Surgical Practice 10:05 am-10:50 am Thursday, June 22 8:30 am-Noon THE BUSINESS CASE FOR DIVERSITY IN CLINICAL PRACTICE BOONE Course Producer Joseph A. Bachicha, MD, FICS, FACOG, FRANZCOG Treasurer, ICS-US Section, ICS World Governor, Department of Obstetrics and Gynecology, Chief, Patient Education and Health Promotion, Kaiser Permanente Medical Center, Hayward/Union City, CA Cultural Diversity issues are increasingly seen as important aspects of medical and surgical care that influence all areas of practice. At the 2005 Annual Congress, a broad foundation of the importance of attention to diversity issues was built, based on talks that revealed the need for attention to diversity and cultural competence as well as the biological foundation for some of the differences noted among people. General approaches for physicians to engage in culturally competent care were presented. David Newhouse, MD, Assistant Physician in Chief for Marketing and Diversity, Kaiser Permanente Medical Center, Hayward/Fremont, CA 10:50 am-11:35 am LINKING ACROSS CULTURES Mala Seshagiri, MS, RD, Interim Director of Health Education, Kaiser Permanente Medical Center, Hayward/Fremont, CA 11:35 am-Noon PANEL DISCUSSION – ATTENDEE INTERACTIVE Mala Seshagiri, MS, RD Noon-1:15 pm—Lunch Break ARMSTRONG I A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for During this follow-up seminar, a review of the areas of cul- order during the meeting. tural competence and prevailing imbalances in access to AFTERNOON LECTURES care by different population groups in the United States will 1:30 pm-2:30 pm be conducted. The business case for attention to culturally BOONE competent care will be given, with examples of work DEPOSITION SKILLS: HOW TO PREPARE, HOW TO PROTECT, AND HOW TO PERFORM being done in this area. The emerging evidence for a bio- Gary C. Freeman, MD, Houston, TX logical basis for some of the observed differences in health An expert in the field, Dr. Freeman continues to perform outcomes between different cultural groups in the United medical evaluation/peer reviews and case audits for States will also be discussed. Following this, interactive both defense and plaintiff firms. This lecture will provide work will teach surgeons how to incorporate principles of attendees with tips and pointers for giving depositions. culturally competent care into daily practice. Specific atten2:30 pm-3:00 pm tion will be paid to the needs of surgeons who come from BOONE non-mainstream cultural groups. The importance of tech- TSUNAMI: GLOBAL DISASTER, INTERNATIONAL SOLUTIONS nology as an evolving tool in addressing health disparities Ganepola Ganepola, MD, FACS, Associate Professor of Clinical Surgery, Columbia University, New York, NY due to cultural differences will be discussed. At the conclusion of the seminar, attendees will have a firm grasp on the demographic, racial, and socioeconomic issues involving observed differences in access to health care and in health outcomes in the United States. Attendees will have an improved understanding of the biological basis for some of these observed differences. Finally, surgeons will be taught easily reproducible techniques on how to introduce the principles of culturally competent care into their daily work lives. Attendees will learn how technology can be used to ease observed disparities in health care between cultural groups. Faculty: 8:30 am-9:05 am CURRENT STATUS OF CULTURAL DIVERSITY AND HEALTH DISPARITIES IN AMERICA Joseph A. Bachicha, MD, FICS Thursday, June 22 A tsunami, unlike earthquakes, kills, leaving comparatively few injured who could be saved by emergency interventions. This lecture will examine the vast geographical nature of the tsunami as a global disaster and the urgent need to develop a high quality international network to deliver urgent medical care to tens of thousands of victims. The result of a complete study of the pattern of injuries, its management and the outcomes of the tsunami victims of Sri Lanka will be presented. BOONE 3:00 pm-3:15 pm THE VARICOCOELE IN MALE FACTOR INFERTILITY: THE ROLE OF LAPAROSCOPIC VARICOCOELECTOMY Prof. Christopher Chen, FICS, ICS Corporate Secretary Christopher Chen Centre for Reproductive Medicine, Gleneagles Hospital, Singapore 10 Friday, June 23 Continental Breakfast Scientific Program 7:30 am-8:30 am PREFUNCTION All attendees are encouraged to start their day at the ICS-US breakfast buffet. Service will end promptly at 8:15 am to ensure that the morning session begins on time. Friday, June 23 Surgical Cure Of Diabetes 8:30 am-12:30 pm BOONE Course Producer Dinesh Ranjan, MD, FICS Chief, Transplant Section, Director of Liver and Transplantation, University of Kentucky, Lexington, KY Pancreas There are more than 15 million diabetics in the US; of these, 4 million are insulin dependent. Diabetes is the number one cause of renal failure and is implicated in many other significant disease processes, such as heart disease, peripheral vascular disease, and blindness. Central to the pathology of diabetes is loss of blood sugar control by the patient. While insulin (and other antidiabetic drugs) remain the primary treatment for these patients, having a normal control of blood sugar levels from reaching too high or even too low (due to drug overeffect) without any pharmacological help had been hard to achieve. This forum presents multiple surgical options that have shown success in the cure of diabetes, freeing the patient from the need to resort to insulin or pills for the control of sugar. These proven therapies include pancreas (whole organ) and islet cell transplantation and surgery for morbid obesity. This forum also discusses the advancements in immunosuppression that have contributed to the success of transplantation procedures. Nationally known experts will discuss these surgical modalities. In addition, during the free paper session, papers will be presented to discuss different aspects of organ transplantation. Upon completion of this course, participants will be versed in the current status of surgical options for diabetic patients, including simultaneous kidney-pancreas transplant and pancreas transplant alone, including the current status of islet cell transplants as a therapy for diabetes, and the current advancements in metabolic therapy of diabetes to include bariatric surgery and other surgical adjunctive modalities. 68th Convocation and Presidential Recognition Ceremony Thursday, June 22, ARMSTRONG I&II 4:00 pm All attendees, families, friends and guests are cordially invited to attend this hallmark event of the 68th Annual Surgical Update. Always a conference highlight, this formal ceremony, brimming with splendor and pageantry, will serve as the formal welcome to all conference delegates, and include the formal induction of our New Fellows. Current ICS-US President Dr. Enrico Nicolo will introduce Dr. Sibu P. Saha, section president for the term commencing January 1, 2007, and together with our International World President, Prof. Nadey Hakim, from the United Kingdom, Dr. Nicolo will bestow the title of Honorary Fellow upon Dr. Michael S. Kavic. Welcome Reception Thursday, June 22, 5:00 pm-6:00 pm PREFUNCTION Immediately following the Opening Assembly, this reception will afford you the opportunity to meet your National Section and International Officers, provide you with the opportunity to meet your newest colleagues from coast to coast, and of course, honor our incoming President and Honorary Fellow. All attendees are encouraged to attend and begin friendships that will certainly last a lifetime. Moderator Gazi Zibari, MD, FICS Professor of Surgery Louisiana State University Health Science Center, Shreveport, LA Faculty 8:30 am-8:35 am Introduction Dinesh Ranjan, MD, FICS 8:35 am-9:55 am Presentation—9:55 am-10:00 am Q&A Intragastric Balloons: Weight Loss and Diabetes Control Professor Nadey Hakim, FICS ICS World President, St. Mary’s Hospital, London, England 11 Friday, June 23 Social Events The purchase of tickets for events on-site, at the meeting is very limited as guarantees are given to the hotel before arriving in Nashville. If you do need to purchase a ticket on-site please check with the registration desk as soon as possible. June 22 THURSDAY LUNCH Noon-1:15 pm ARMSTRONG I A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. June 23 FRIDAY LUNCH 12:30-1:30 pm ARMSTRONG II A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. PAST PRESIDENTS LUNCHEON June 24 12:30-1:30 pm ARMSTRONG I This year we take a moment to honor the Past Presidents of the International College of Surgeons-US Section for their continued commitment to the betterment of the College. Please plan to join us in our appreciation. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. CLOSING DINNER June 24 7:00 pm BOONE We will close our meeting with our traditional black tie dinner. Please join us as we bid a fond farewell until our next meeting to Officers, Fellows and Friends of the International College of Surgeons. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. Friday, June 23 10:00 am-10:25 am Presentation—10:25 am-10:30 am Q&A Metabolic Consequences of Obesity Surgery, ESP Type II DM J. Kelly Wright, MD Associate Professor of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN 10:30 am-10:40 am Coffee Break PREFUNCTION 10:40 am-10:50 am Presentation—10:50 am-10-55 am Q&A Comparative Hemodynamics of the Piggyback Technique with Veno-Venous Bypass versus the Piggyback Technique Alone during Orthotopic Liver Transplantation Recipient of “Honorable Mention” for the 2006 ICS-US Resident Research Scholarship Competition Kevin W. Hatton, MD, ICS Junior Fellow Departments of Anesthesiology and Surgery, University of Kentucky Chandler Medical Center, Lexington, KY 10:55 am-11:05 am Presentation—11:05 am-11:10 am Q&A C-KIT Expression in Rejection After Liver Transplantation Cataldo Doria, MD, FICS, Jefferson Medical College, Philadelphia, PA 11:10 am-11:20 am Presentation—11:20 am-11:25 am Q&A Estrogen Attenuates Hepatic Ischemia-Reperfusion Injury Siddhartha Rath, MD, Departments of Surgery and Physiology, Louisiana State University, Shreveport, LA 11:25 am-11:35 am Presentation—11:35 am-11:40 am Q&A Effect of Methyprednisolone on Liver Warm Ischemia-Reperfusion Injury Recipient of “Honorable Mention” for the 2006 ICS-US Resident Research Scholarship Competition Reza F. Saidi, MD, ICS Junior Fellow Department of Surgery, Providence Hospital and Medical Center, Southfield, MI 11;40 am-12:00 pm Presentation—12:00 pm-12:05 pm Q&A Pancreas Transplant and Cure of Diabetes: Current Status David Shaffer, MD Chief, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN 12:05 pm-12:25 pm Presentation —12:25 pm-12:30 pm Q&A Islet Cell Transplant and Cure of Diabetes: Current Status Alvin C. Powers, MD Ruth K. Scoville Professor of Medicine, Molecular Physiology and Biophysics, Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN 12:30 pm-1:30 pm—Lunch Break ARMSTRONG II A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. 12 Orthopaedic Trauma And The Future Of Biological Treatment Friday, June 23 8:30 am-12:30 pm RYMAN III Course Producer Alfonso E. Pino, MD, FICS, FAFA, FAANOS De Leon, TX Tours NASHVILLE UNPUBLISHED WALKING TOUR OF LOWER BROADWAY This course has been designed for orthopaedic surgeons in private or academic practice with a special emphasis on trauma and the biological products that will alter the mode of fracture treatment in the immediate future. The upper extremity will be utilized as a model for this course, although other various types of fractures will be included. Clinical use of implants, indications, contraindications and the most common complications will be explored. Upon completion of this course, participants will become familiarized with the actual biomaterial available for the treatment of fractures on non-union cartilage repair. Participants will further have a better understanding of new and some widely used implants in the United States and abroad. The Poly-trauma patient—a special category in which further surgical trauma in the operating room must be kept at a minimum—will be extensively explored. Faculty 8:30 am-8:45 am X-ray Forum 8:45 am-9:00 am Welcome and Introductions Alfonso E. Pino, MD 9:00 am-9:15 am Pain Outcome in Patients Undergoing Kyphoplasty for Osteoporotic Vertebral Compression Fractures Konstantinos N. Fountas, MD, PhD, FICS Department of Neurosurgery, Mercer University School of Medicine, Georgia Neurological Institute, Macon, GA 9:15 am-9:30 am The Description of Skull Shape and the Correlation with the Suture Configuration as Described by Vesalius Kostas N. Fountas, MD, PhD, FICS Friday, June 23 3:00 pm-4:00 pm GATHER IN THE PREFUNCTION AREA Hear the unpublished stories, "naughty and nice" about these great streets, buildings, songs, events and people that have made Nashville a city whose name is known throughout the world. The lyric of Nashville's history is composed of romance and tragedy, heroes and villains, civil and war, southern belles and brothels. The stories you will hear while on tour read like a John Wayne or Randolph Scott movie, with characters such as Daniel Boone, Davy Crockett, Andrew Jackson, Fannie Battle (arrested by the Union Army for compromising its soldiers and the Army's secrets at the same time). All of these characters will come to life with stories of time spent in Nashville. The fictional stories of "Gone with the Wind" will have nothing on the true stories of Nashville! While on tour you will experience a Behind the Scenes Tour of the Ryman Auditorium. Known as the "Mother Church of Country Music," the walls will tell the stories of Nashville's modern folk heroes of music—Johnny Cash, Elvis Presley, Hank Williams Sr., Patsy Cline, Tootsie Bess and countless others whose songs and lives shaped the image of this city and molded the music home grown in Nashville, "Country Music." TOUR HIGHLIGHTS 9:30 am-9:45 am Use of an Intramedullary Device for Treatment of Peritrochanteric Hip Fractures Gerald Q. Greenfield, Jr., MD, FICS Southwest Texas Methodist Hospital, St. Luke’s Baptist Hospital, San Antonio, TX 9:45 am-10:00 am Proximal Humeral Fractures: Surgical Treatment Eduardo Gonzalez Hernandez, MD Miami Hand Center, Miami, FL 10:00 am-10:15 am Contour Plates for Treatment of Distal Humeral Fractures Eduardo Gonzalez Hernandez, MD 10:15 am-10:30 am Treatment of Colles Fractures with Minimally Invasive Dorsal Nail Plates Alfonso E. Pino, MD, FICS 13 •Behind the Scenes tour; Ryman Auditorium •The ghost and skeleton stories of Nashville •Fantastic Tour Guide—Great Entertainment. On-site tickets may be purchased at the registration desk until Noon on Thursday, June 24. However they are very limited. The cost per person per ticket is $20. You may also purchase tickets for other Grayline Tours from the Hilton Concierge desk. Those of course are not sponsored by the ICS-US. Friday, June 23 10:30 am-10:45 am Coffee Break PREFUNCTION 10:45 am-11:00 am Polarus Nail in Fractures of the Proximal Humerus Alfonso E. Pino, MD, FICS The International College of Surgeons is pleased to recognize Allergan, Inc. EthiconEndoSurgery U.S.A. a division of Johnson & Johnson Co. Pfizer Karl Storz Endoscopy—America, Inc. United States Section Alliance Vanderbilt University and Faculty for their generous support of our Continuing Medical Education Program 11:00 am-11:15 am Pediatric Fracture Management Steven I. Rabin, MD Professor of Orthopaedics, Loyola University Medical Center, Maywood, IL 11:15 am-11:30 am Irrigation and Debridement of Open Fractures: New Techniques Steven I Rabin, MD 11:30 am-11:45 am Intramedullary Nailing of Long Bone Fractures Jose G. Ramon, MD, FICS Chief of Trauma, Kenneth Regional Hospital, Edwardsville, IL 11:45 am-12:00 pm Question and Answer Session 12:00 pm-12:30 pm American Fracture Association Business Meeting 12:30 pm-1:30 pm—Lunch Break ARMSTRONG II A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. Colorectal Surgery Case Reports and Free Papers Friday, June 23 8:30 am-9:30 am ARMSTRONG I Moderator Larry S. Sasaki, MD, FICS Assistant Clinical Professor of Surgery, Louisiana State University Medical Center, Shreveport, LA Faculty 8:30 am-8:45 am Early Diagnosis of Rectal Cancer Fidel Ruiz-Healy, MD, FICS ICS World President-Elect, Chief Service of Colon and Rectal Surgery, Centro Hospitalario Sanatorio Durango, Mexico City, Mexico 8:45 am-9:00 am Colo-Rectal Disease in the Physician Fidel Ruiz-Healy, MD, FICS 9:00 am-9:15 am The Significance of Interferon Receptor Expression in Colorectal Metastases to the Liver This presentation was submitted as part of the ICS-US Resident Research Scholarship Competition Photo Credits: Front Cover: Belle Meade Plantation. and the Parthenon. Back Cover: Nashville skyline by night All photos provided by the Nashville Convention and Visitors Bureau. Friday, June 23 Yeon-Jeen Chang, MD, ICS Junior Fellow Department of Surgery, Division of General Surgery, Providence Hospital and Medical Centers, Southfield, MI 9:15 am-9:30 am New “Sutureless” Technique of Ileostomy and Colostomy Madhav V. Phadke, MD Raleigh, NC 14 Laparoscopic Colectomy: A Hands-On Workshop Friday, June 23 9:30 am-4:45 pm Alliance Raffle ARMSTRONG I Course Producer Larry S. Sasaki, MD, FICS Assistant Clinical Professor of Surgery, Louisiana State University Medical Center, Shreveport, LA Course Overview and Objectives: This course is designed for general and colorectal surgeons who are currently performing advanced laparoscopic procedures and are interested in expanding their skills to hand-assisted and laparoscopic colorectal surgery. Participants should be performing at least 20 open colectomy procedures a year. The focus of the course will be to introduce the current trends in minimally invasive colon surgery, including hand-assisted and laparoscopic techniques. Didactic content will address criteria for patient selection, procedural indications and contraindications, minimally invasive techniques, and management of potential complications. Upon completion of this course, participants should be able to: discuss the evolution of minimally invasive colorectal procedures; define patient selection, preparation and positioning for minimally invasive colon procedures; differentiate minimally invasive colectomy procedures for benign and malignant disease; describe current indications and contraindications for minimally invasive colectomy procedures; discuss the management of complications and the potential to convert to an open procedure; and demonstrate minimally invasive techniques for colorectal surgery in a faculty-guided porcine lab. GATEWAY MX3228 NOTEBOOK CELERON® M PROCESSOR 370 BLACK SAMSONITE-L35 NOTEBOOK CASE WITH INTEL® AND •14" WXGA TFT-LCD widescreen display with Ultrabright technology •60GB hard drive (4200 rpm) •S3 UniChrome Pro Integrated graphics processor with up to 64MB shared video memory •4-in-1 digital media manager supports Secure Digital, MultiMediaCard, Memory Stick and Memory Stick PRO •2 high-speed USB 2.0 ports for fast digital video, audio and data transfer Faculty Bryan N. Butler, MD, FACS, FASCRS Clinical Assistant Professor, Section of Colon Rectal Surgery, State University of New York at Buffalo, Buffalo, NY •Built-in high-speed wireless LAN (802.11g) with SecureEasySetup support; 10/100 Mbps Ethernet LAN with RJ-45 connector; V.92 highspeed data/fax modem Alan J. Herline, MD, FACS Assistant Professor of Surgery and Biomedical Engineering, Vanderbilt University Medical Center, Department of Surgery, Nashville, TN •Weighs 5 lbs. and measures 1.2" thin for easy portability; lithium-ion battery Michael McCue, MD, FACS General and Minimally Invasive Surgery, Sharp Rees-Sealy Medical Group, San Diego, CA Paul E. Wise, MD, FACS Assistant Professor of Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, Department of Surgery, Nashville, TN 9:30 am-9:45 am Welcome and Introduction Larry S. Sasaki, MD •Microsoft Windows XP Home Edition Service Pack 2 (SP2) operating system preinstalled; software package included with CyberLink PowerDVD, RealNetworks RealPlayer, Microsoft Digital Image Starter Edition 2006 and more. $10 each (US) Only 150 tickets will be sold. Drawing will be held on Saturday, June 24, during the closing dinner of the annual meeting. Winner must be present to win or an alternate winner will be selected. 9:45 am-10:15 am Minimally Invasive Colorectal Surgery: Overview Larry S. Sasaki, MD Prize must be accepted immediately. No shipping available. 10:15 am-10:45 am Hand-Assisted Laparoscopic Right Colectomy Michael McCue, MD Purchased 4/15/05 Used only during scientific sessions of this Congress for speaker presentations. 15 Friday, June 23 10:45 am-11:00 am Coffee Break PREFUNCTION 11:00 am-11:30 am Hand-Assisted Laparoscopic Left Colectomy/Low Anterior Resection Bryan N. Butler, MD 12:00 pm-12:30 pm Hand-Assisted Total Proctocolectomy with Ileal Pouch-Anal Anastomosis Larry S. Sasaki, MD 12:30-1:30 pm—Lunch Break ARMSTRONG II A ticketed buffet lunch is open to all attendees. Tickets should have been ordered in advance. On-site tickets are extremely limited, and may not be available for order during the meeting. 1:30 pm-2:00 pm Faculty/Panel Discussion – Questions & Answers 2:00 pm-2:30 pm Hand-Assisted Laparoscopic Colectomy Case Studies: Video and Discussion 2:30 pm-3:00 pm Managing Potential Complications Michael McCue, MD Coffee Break RYMAN III Course Producers Cosmetic Gynecologic Surgery Marco A. Pelosi III, MD, FICS Associate Director, Pelosi Women’s Medical Center, Bayonne, NJ 11:30 am-12:00 pm Hand-Assisted Laparoscopic Total Colectomy Alan J. Herline, MD 3:00 pm-3:15 pm Cosmetic Gynecologic Surgery And Urological Trauma In Gynecologic Surgery Friday, June 23 1:30 pm-5:45 pm Urological Trauma in Gynecologic Surgery Ajay Singla, MD, FICS Associate Professor Department of Urology & Gynecology, Adjunct Associate Professor Bio-Medical Engineering, Wayne State University, Detroit, MI This program introduces and defines the latest trends in cosmetic plastic surgery and medicine of the female patient as practiced by expert gynecologic surgeons. The faculty will present an introduction to the wide scope of cosmetic, aesthetic and rejuvenation techniques and technologies employed in both the operating room and office settings. The didactic sessions will include video demonstrations that will be of interest to gynecologists, plastic surgeons, and cosmetic surgeons from all specialties. Participants in the course will receive an introduction to cosmeto-gynecology and become acquainted with procedures for tumescent liposuction and fat transfer, endoscopic breast augmentation, sclerotherapy, skin resurfacing with lasers and intense pulsed light and finally, cosmetic gynecologic laser surgery. PREFUNCTION 3:15 pm-3:45 pm Laparoscopic Colectomy for Colon Cancer: COST Study and Future Issues Bryan N. Butler, MD 3:45 pm-4:15 pm Credentialing and Reimbursement Paul E. Wise, MD 4:15 pm-4:45 pm Faculty/Panel Discussion—Questions and Answers Additionally, the program will introduce the participant to the injury risks involved to the bladder or ureter during various gynecological procedures—more commonly with abdominal hysterectomy or re-do cesarean section; however, the bladder is more frequently injured than the ureter. Intra-operative recognition of these injuries is of the utmost importance to avoid unwanted results of fistula formation and/or urinary incontinence. Participants will be versed in the prevention of these and other various urological injuries during gynecologic procedures, including management of the same, preand post-operatively. Faculty 1:30 pm-2:00 pm Introduction to Cosmetogynecology Marco A. Pelosi III, MD, FICS 2:00 pm-2:30 pm Tumescent Liposuction and Fat Transfer Marco A. Pelosi II, MD, FICS Director, Pelosi Women’s Medical Center, Bayonne, NJ Friday, June 23 16 2:30 pm-3:00 pm Endoscopic Breast Augmentation Carlos Avellanet, MD Manati, Puerto Rico Endovascular Therapy For Aneurysmal Disease And Quality and Cost Measurements In Thoracic Surgery Friday, June 23 1:30 pm-6:00 pm BOONE 3:00 pm-3:30 pm Sclerotherapy J. Antonio Garcia, MD Tacoma, WA 3:30 pm-3:45 pm Coffee Break Prefunction 3:45 pm-4:15 pm Skin Resurfacing with Lasers and Intense Pulsed Light J. Antonio Garcia, MD 4:15 pm-4:45 pm Cosmetic Gynecologic Laser Surgery David L. Matlock, MD Los Angeles, CA 4:45 pm-5:00 pm Urological Injuries during Gynecologic Procedure Richard Santucci, MD Wayne State University, Detroit, MI 5:00 pm-5:15 pm Blunt Urological Trauma Richard Santucci, MD 5:15 pm-5:30 pm Results of a Multi-Center Single Practice Cryosurgical Therapy for Prostate and Renal Cancer Arnold J. Willis, MD, FICS Alexandria, VA 5:30 pm-5:45 pm Applying IDEF-0 Modeling Techniques and RCA Performance Audits to Design and Refine Systematic Response During Emergent Cesarean Section “Code Purple” James D. Bauer, MD, FICS Oregon State University, Corvallis, Oregon Course Producers Endovascular Therapy Sibu P. Saha, MD, FICS Professor of Surgery, University of Kentucky, Lexington, KY Thoracic Surgery Wickii T. Vigneswaran, MD, FICS Professor of Surgery, Associate Chief of Cardiothoracic Surgery, Director of Lung and Heart-Lung Transplantation, University of Chicago, Chicago, IL Advances in technology have made it possible to treat difficult vascular problems using endovascular techniques. This session will seek to update physicians on the latest techniques for endovascular therapy for aneurysmal disease of the thoracic and abdominal aorta. Participants in this course will become versed in the “tricks-of-the-trade” for endovascular repair of the abdominal aortic aneurysm; endoluminal grafting for thoracic aortic aneurysm; as well as the pros and cons of carotid artery stenting. The surgical treatment in cardiac and thoracic surgery is rapidly evolving and it is necessary for all physicians to keep abreast of these changes. In addition to the specialty itself, the health care environment is changing. The value of medical care provided to the patient is measured and is becoming very important to advance the field as well as for reimbursement. This value is measured by quality and the cost to deliver it. During the upcoming course, we will cover some of these aspects of practice in cardiothoracic surgery. The topics covered will be thoracoscopic surgery, cardiac surgery in the next decade, performance measurement, and treatment of end-stage cardiac and thoracic disease. Faculty 1:30 pm-1:35 pm Welcome and Introduction Sibu P. Saha & Wickii T. Vigneswaran 1:35 pm-1:55 pm Image-Guided Cardiac Surgery John Byrne, MD Chief of Cardiac Surgery, Vanderbilt University, Nashville, TN 1:55 pm-2:10 pm Predictors of Type II Neurological Complications Following Coronary Artery Bypass Graft Surgery Elias Darido, MD Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, OH 17 Friday, June 23 General Meeting Information 2:10 pm-2:30 pm Minimal-Access Cardiac Valve Surgery Jim Greelish, MD Department of Cardiac Surgery, Vanderbilt University, Nashville, TN The official language of this conference is English, and all sessions and events shall be conducted in English. 2:30 pm-2:45 pm Gender Differences in Diabetic Patients following Coronary Artery Bypass Graft Surgery Andrew J. Ritchison, MD Meeting-related fees must be paid in US funds, drawn on a US bank, made payable to the ICS-US. Company or cashier checks or Visa, Master Card, and American Express credit cards are acceptable forms of payment. 2:45 pm-2:55 pm Safety of the Flex 10 Microwave Catheter with Repeated Ablations in a Canine Model J. Michael Smith, MD Department of Vascular and Thoracic Surgery, Good Samaritan Hospital, Cincinnati, OH All prices and currencies listed in this brochure are in US Dollars unless otherwise noted. Continuing Medical Education (CME) Information CME Program Evaluation Forms will be distributed prior to the commencement of each day’s educational session. To receive CME Credit, you must complete a Program Evaluation Form for each day of educational sessions you attend. Program Evaluation Forms must be completed and returned to the Meeting Registration Desk prior to the conclusion of the conference. You may also mail your forms to: ICS-US Headquarters Department of CME 1516 North Lake Shore Drive Chicago, IL 60610-1694 The deadline for submission of all CME Program Evaluation forms is Friday, July 7, 2006. Convocation Information We request that all new fellows being officially inducted into the College during the convocation ceremony at 4:00 pm on Thursday, June 22, adhere to the following guidelines. •Collect your caps and gowns from the Registration Desk anytime on Thursday. •You must report to the Registration desk by 3:30 pm for line-up. Friday, June 23 2:55 pm-3:15 pm Endoluminal Grafting for Thoracic Aortic Aneurysm Karthikeshwar Kasirajan, MD, FICS Assistant Professor of Surgery, Emory University School of Medicine, Division of Vascular Surgery, Atlanta, GA 3:15 pm-3:30 pm Coffee Break PREFUNCTION 3:30 pm-3:50 pm The Emergent Placement of Stent-Grafts in Arch Vessels David J. Minion, MD Department of Vascular Surgery, University of Kentucky, Lexington, KY 3:50 pm-4:10 pm Carotid Artery Stenting Deb Mukherjee, MD Professor of Interventional Cardiology, Department of Vascular Surgery, University of Kentucky, Lexington, KY 4:10 pm-4:25 pm Decreased Incidence of Gastrointestinal Complications after Endovascular Aortic Aneurysm Repair P.J. Pearson, MD Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, OH 4:25 pm-4:35 pm Groin Lymphoceles Complicating Transfemoral Endovascular Aneurysm Repairs in Patients with Prior Rectal Surgery Andrew J. Ritchison, MD Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, OH 4:35 pm-4:50 pm Video-Assisted Lobectomy Raymond A. Dieter III, MD, FICS University of Tennessee Medical Center, Knoxville, TN 4:50 pm-5:00 pm Current Concepts and Controversies in the Management of Pulmonary Nodules Salik Jahania, MD, ICS Junior Fellow Department of Cardiac Surgery, University of Kentucky, Lexington, KY 5:00 pm-5:10 pm Glomus Tumor: A Rare Neoplasm of the Bronchus Marta Helenowski, MD Loyola University Medical Center, and St. Bernard Hospital, Maywood/Chicago, IL 18 5:10 pm-5:20 pm Solitary Fibrous Tumor of the Pleura Sibu P. Saha, MD, FICS General Meeting Information 5:20 pm-5:30 pm Early Re-Admission following Lung Transplantation Is a Predictor of One-Year Survival F. Lamounier, MD Loyola University Medical Center and University of Chicago, Chicago, IL 5:30 pm-5:40 pm Electroporation-Mediated Gene Transfer in Lipopolysaccharide (LPS) Injured Murine Lungs This presentation received “Honorable Mention” for the ICS-US Resident Research Scholarship Competition David A. Machado-Aranda, MD, ICS Junior Fellow Department of Surgery, Providence Hospital and Medical Center, Southfield, MI Saturday, June 24 Scientific Program Continental Breakfast 7:30 am-8:30 am PREFUNCTION All attendees are encouraged to start their day at the ICS-US breakfast buffet. Service will end promptly at 8:15 am to ensure that the morning session begins on time. Presbyopia And The Aging Eye Saturday, June 24th 8:30 am-5:30 pm RYMAN III Course Producer Mark I. Golden, MD, FICS Medical Director, Doctors for Visual Freedom, Schaumburg, IL Meeting Registration Everyone attending or participating in educational sessions, including faculty, is expected to register for the meeting. Pre-registered attendees may retrieve their conference materials from the ICS-US Meeting Registration Desk in the Prefunction area. The Meeting Desk will be staffed throughout the meeting as follows. Wednesday, June 21 Noon-4:00 pm Thursday, June 22 7:00 am-2:00 pm Friday, June 23 7:00 am-2:00 pm Saturday, June 24 7:00 am-2:00 pm Meeting-related fees must be paid in US funds, drawn on a US bank, and made payable to the ICS-US. Company or cashier checks or Visa, Master Card, and American Express credit cards are acceptable forms of payment. Cancellation Policy The cancellation deadline was June 1, 2006. Refunds will be issued, minus a $50 processing fee, upon receipt of written notification via fax or mail. Cancellations after June 1 will not be honored. Please allow four to six weeks after the meeting for your refund. This program will introduce the latest technologies for the surgical and non-surgical treatment of presbyopia. The course will address the changes in the eye associated with aging. Methods for monitoring and improving the tear film not only for the refractive surgery patient but also for those with primary dry eyes and dry eyes associated with aging will also be presented. Special Needs and Questions If you have any special needs that must be addressed to ensure your comfort, please see the staff at the ICS-US Registration Desk. Upon completion of this course, participants will be versed in the advances in conductive keratoplasty for increased precision; the situations where a phakic intra-ocular lens could be used for ametropia; the advantages of multi-focal vs. accommodating intraocular lens for the correction of near and far vision; testing and pharmacologic enhancement of tear function; and methods for developing a practice to bring presbyopic patients the latest technologies. Attire Business casual attire is recommended in educational sessions. Nashville can be quite warm in June. Please plan to dress for your comfort. Business casual attire is appropriate for most social events. Evening attire is requested for the Closing Dinner Faculty 8:30 am-8:40 am The Presbyopic Patient: We've Come a Long Way Mark Golden, MD, FACS, FICS Weather and Time Zone In June, Nashville’s average temperatures range from 65 to 85 degrees with plenty of sunshine. Nashville is in the Central time zone. 8:40 am-9:05 am The Optics of Presbyopia Margaret McNelis, OD, FAAO; Kerry Navin, OD; Mark Golden, MD, FACS, FICS Doctors For Visual Freedom, Schaumburg, IL 19 Saturday, June 24 United States Section Headquarters International College of Surgeons United States Section 1516 N. Lake Shore Drive Chicago, Illinois 60610-1694 United States of America Telephone: (800) 766 FICS or (312) 787-6274 Facsimile: (312) 787-9289 Website: www.ficsonline.org Executive Director Nick Rebel Extension: 3127 E-mail: [email protected] Director of Continuing Medical Education and Membership Paul Pancer Extension: 3126 E-mail: [email protected] Meeting and Publications Manager Maggie Kearney Extension: 3129 E-mail: [email protected] United States Section Alliance Executive Committee President Judy Nicolo President-Elect Becky Saha Immediate Past President Birgitta Fathie Treasurer Rupy Vigneswaran Secretary Lata Mittal First Vice President of Membership Ratna Ranjan Second Vice President of Hospitality Claudia Ray Third Vice President of Assembly Jennifer Sasaki Directors Bette Dieter Lydia Ramirez Pooja Singla Saturday, June 24 9:05 am-9:35 am Correcting the Presbyope: Personal and Professional Perspectives John Galanis, MD, FACS, Southwest Eye Center, St. Louis, MO 9:35 am-10:20 am Development of the Market to the Presbyopic Patient Bill Voyles Allergan Eye Care, Irvine, CA 10:20 am-10:45 am Multifocal Laser Ablation for the Correction of Near and Far Vision Chris Blanton, MD Temecula, CA 10:45 am-11:00 am Coffee Break PREFUNCTION 11:00 am-11:30 am Presbyopic Correction with the use of IntrOcular Lenses H.L. Rick Milne, MD The Eye Center, Columbia, SC 11:30 am-12:00 pm My Own Experience and My Early Cases Wayne Crewe-Brown, MD Rosen Eye Associates, Salford Quays, Greater Manchester, United Kingdom 12:00 pm-12:30 pm The Restor Lens in Eyes with Pathology Johnny L. Gayton, MD Warner Robbins, GA Past President’s Luncheon 12:30 pm-1:30 pm ARMSTRONG I On this day we honor the Past Presidents of the International College of Surgeons-United States Section for their dedication and continued efforts on behalf of the College. This ticketed lunch is open to all attendees who ordered tickets. On-site tickets are extremely limited, and may not be available for purchase during the meeting. 1:30 pm-2:00 pm Comparing My Results with Restore and Rezoom Craig McCabe, MD Murfreesboro, TN 2:00 pm-2:30pm Counseling Patients on Presbyopic Surgical Options Diana M. Hatsis, RN, BSN, COT Boynton Beach, FL 2:30 pm-2:45 pm Big Pupils and Small IntraOcular Implants: Is this a Problem? John H. Fournier, MD, FACS, FICS Chicago, IL 2:45 pm-3:00 pm The Pupil Controversy Mark Golden, MD, FACS, FICS; Chris Pavone, BA 20 3:00 pm-3:30pm Pharmacologic Treatment of the Tear Film of the Aging Eye Mark Golden, MD, FACS, FICS 3:30 pm-3:45 pm Coffee Break PREFUNCTION 3:45 pm-4:15 pm Light Touch CK for the Correction of the Presbyopic Patient H.L. Rick Milne, MD 4:15 pm-4:45 pm Crystalens Placement for the Treatment of the Aphakic Patient Jim Loden, MD Goodlettsville, TN 4:45 pm-5:15 pm Surgical Enhancement after the Placement of the Restor Lens Johnny L. Gayton, MD 5:15 pm-5:45 pm The Controversial Theories of Accommodation Kari M. Navin, OD; Mark I. Golden, MD, FACS, FICS; Margaret M. McNelis, OD, FAAO Rush University Department of Ophthalmology and Doctors For Visual Freedom, Schaumburg, IL Laparoscopic Colectomy Workshop Saturday, June 24 8:30 am-2:30 pm OFF-SITE, GATHER IN PREFUNCTION Course Producer Larry S. Sasaki, MD, FICS Assistant Clinical Professor of Surgery, Louisiana State University Medical Center, Shreveport, LA For details on this program, see the description found on page 15. Participation in the Lecture Series is a course pre-requisite. Pre-registration in this workshop is required, on-site registration is not possible. Following is the schedule for registered participants: Session 1: 7:00 am-1:00 pm Breakfast (Downtown Hilton Nashville) Depart Hotel for Vanderbilt University (Transportation provided) 8:00 am: Lab Overview 8:15 am–11:30 am: First Session – Porcine Lab Session 2: 11:30 am-5:00 pm 11:30 am: Session 2 participants depart the Hilton for lunch and the afternoon program at Vanderbilt. 12:00 pm: Lunch, both Sessions 1:00 pm: Lab Overview and Session 1 participants will return to the Hilton. 1:15 pm-4:30 pm: Second Session – Porcine Lab 5:00 pm: Session 2 participants return to the Hilton 7:00 am: 7:30 am: Surgery For Obesity and It’s Co-Morbidities Saturday, June 24th 8:30 am-2:30 pm CROCKETT Course Producer Roque J. Ramirez, MD, FICS President, SurgeonOne, Inc. Corpus Christi Medical Center, Corpus Christi, TX Obesity affects nearly 60% of Americans and is the second leading cause of preventable death in the United States. The treatment of obesity and its co-morbidities, including hypertension, diabetes, degenerative joint disease, sleep apnea, depression and gastroesophageal reflux disease (GERD), results in $52 billion of direct medical care expenditures every year. A morbidly obese person’s life expectancy is reduced by 13 to 20 years when compared to a non-obese person. Severely overweight people are four or more times likely to die of heart disease, and two or more times more likely to die of cancer (colon, prostate and breast). And adolescents are no exception, with obesity in this population rising just as fast, if not faster, than adults. The percentage of children and adolescents who are defined as overweight has more than doubled since the early 1970s and presently 20% of all adolescents in the United States are obese. This session will therefore focus on surgical procedures on the obese and its associated co-morbidities. Direct emphasis will be placed on adult and pediatric surgical endoscopy; the surgical evaluation and treatment of gastroesophageal reflux disease; the pros and cons of bariatric surgery, with an extensive overview of current bariatric surgery techniques, the metabolic component of obesity, the early and late management of the bariatric patient and postbariatric plastic surgery; and obstructive sleep apnea. This course is designed to complement other courses in this program that will focus on other surgical procedures in this particular population. At the end of the course, participants should have a better understanding of the obesity epidemic in the United States. With a core understanding of the metabolic components of obesity and how it directly causes or indirectly worsens pre-existing co-morbid conditions, surgeons will be better prepared to treat their own obese patients, regardless of their own particular surgical specialty, and direct these patients to experts who focus on these comorbidities. Participants will also have a better understanding of new and improved surgical innovations currently being used to evaluate and treat obesity and its comorbid conditions in the adult and pediatric patient. Faculty 8:30 am-8:35 am Welcome and Introduction Roque J. Ramirez, MD, FICS 8:35 am-8:55 am Metabolic Component of Obesity John Husted, MD Cumberland Center for Surgery, Nashville, TN 21 Saturday, June 24 8:55 am-9:15 am Current Surgical Therapy for Weight Loss in the United States Albert T. Spaw, MD, FICS General Session Saturday, June 24 2:30 pm-5:30 pm 9:15 am-9:35 am The Uncut Roux-En-Y with Jejunal Pouch: A New Reconstruction Technique for Total Gastrectomy Moderator Enrico Nicolo, MD, FICS, President, United States Section, Assistant Clinical Professor of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA This presentation was submitted as part of the ICS-US Resident Research Scholarship Competition Kongkrit Chaiyasate, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI 9:35 am-9:55 am Robotics in Bariatric Surgery Michael D. Holzman, MD Vanderbilt University Medical Center, Nashville, TN 9:55 am-10:15 am Long-Term Management of the Bariatric Patient Albert T. Spaw, MD, FICS Cumberland Center for Surgery, Nashville, TN 10:15 am-10:35 am Post Bariatric Surgical Patient Donald W. Griffin, MD Nashville, TN 10:35 am-10:50 am Coffee Break PREFUNCTION 10:50 am-11:10 am Are You Screening Your Patients for Obstructive Sleep Apnea? Roque J. Ramirez, MD, FICS 11:10 am-11:30 am Surgical Endoscopy: Diagnostic Evaluation and Surgical Treatment of GERD Thom E. Lobe, MD Blank Children’s Hospital, Des Moines, IA 11:30 am-11:50 am Endoscopic Treatment of GERD Alfonso Torquati, MD Assistant Professor of Surgery, Vanderbilt University Medical Center, Nashville, TN 11:50 am-12:10 pm Barrett’s Esophagus: Role of Laparoscopic Fundoplication Alfonso E. Torquati, MD 12:10 pm-12:30 pm Question & Answer Past Presidents Luncheon CROCKETT Faculty 2:30 pm-2:35 pm Welcome and Introduction Enrico Nicolo, MD, FICS 2:35-2:45 pm Remote Surgi-Center Hospital Admissions Raymond A. Dieter, Jr., MD, FICS, Immediate Past World President, Glen Ellyn, IL 2:47 pm-2:57 pm Off-Pump Myocardial Revascularization Adib H. Sabbagh, MD, FICS Cardiac Surgery Consultant and Clinical Advisor, Department of Cardiothoracic Surgery of Tucson Medical Center, Tucson, AZ 3:00 pm-3:10 pm Atrial Fibrillation Adib H. Sabbagh, MD, FICS 3:24 pm-3:34 pm An Animal Model of Uterine Auto and Allo-Transplantation with Successful Pregnancy Edwin Ramirez, MD Texas A&M University, Prairie View, TX 3:36 pm-3:46 pm Combined Abdominoplasty and GYN Surgery Anthony N. Dardano, Jr., DO, FICS Boca Raton Community Hospital, Boca Raton, FL 3:48 pm-3:58 pm A Novel and Inexpensive Technique for Inguinal Hernia Repair Stephen Yoo, MD, ICS Junior Fellow, Department of Surgery, Providence Hospital and Medical Center, Southfield, MI 4:00 pm-4:10 pm Micro-Analysis TN Medium Nematic Liquid Crystal for Ferromagnet by Twisted Nematic Polarizer Angle Chia-Fu Chang, MD; Ti-Tug Chen, MD; Wou-ni Chang, MD Yung-Kang City, Taiwan, ROC 12:30 pm-1:30 pm ARMSTRONG I On this day we honor the Past Presidents of the International College of Surgeons-United States Section for their dedication and continued efforts on behalf of the College. This ticketed lunch is open to all attendees who ordered tickets. On-site tickets are extremely limited, and may not be available for purchase during the meeting. Saturday, June 24 22 4:12 pm-4:22 pm FDG-PET Is Superior to CT Scanning in Detecting Local Hepatic Recurrence in Liver Resection Patients Kerry Byrnes, MD Louisiana State University Health Sciences Center, Shreveport, LA 4:24 pm-4:34 pm Insulin Prevents Oxidant-Induced Endothelial Cell (EC) Barrier Dysfunction and Actin Cytoskeletal Reorganization through a cGMP and Protein Kinase G Signaling Pathway This presentation received “Grand Prize Honors” for the ICS-US Resident Research Scholarship Competition Siddhartha Rath, MD Departments of Surgery and Physiology, Louisiana State University, Shreveport, LA 4:36 pm-4:46 pm Combined Use of Minimal Invasive Surgery and Algon Plasma Coagulator in Treating Early Gastro-Intestinal Cancer Jerome Canady, MD, FICS Hampton, VA 4:48 pm-4:58 pm Suicide Gene Therapy Exploiting Over-Expression of Eukaryotic Initiation Factor 4E in a Rat Minimal Residual Disease Model of Cancer Kerry Byrnes, MD 5:00 pm-5:10 pm Synchronous Versus Metachronous Breast Cancer: Characteristics of the Second Tumor This presentation received “Honorable Mention” for the ICS-US Resident Research Scholarship Competition Hanadi Bu-Ali, MD Department of Surgery, Providence Hospital and Medical Center, Southfield, MI 5:12 pm-5:22 pm FNA Biopsy: State-of-the-Art in Diagnosis and Management of Benign and Malignant Lesions of the Breast Arno A. Roscher, MD, FICS (Hon), CAP, ASCP, Clinical Professor of Pathology, University of Southern California, Keck School of Medicine, Los Angeles, CA 23 Saturday, June 24 THE JOHN C. SCOTT, MD, SURGICAL ENDOWMENT FUND OF THE UNITED STATES Mark Your Calendar... 70th North American Federation Congress The Surgical Endowment is organized to provide permanent financial resources for the future of surgery by supporting charitable programs involving medicine, including those of the International College of Surgeons-United States Section (ICS-US). The Surgical Endowment is a separate entity and has its own tax exemption under Internal Revenue Service Section 501(c)(3). A direct link exists to ICS-US through the Surgical Endowment’s Board of Trustees, which has substantial representation from within the ICS-US membership. Principal contributions to the Surgical Endowment can become a permanent asset of the Endowment if so designated. Revenue generated from investments will be allocated by the Board of Trustees of the Surgical Endowment to the programs of the International College of Surgeons-United States Section or other worthy causes. It is the goal of this fund to one day have an adequate financial base to satisfy all the needs of the programs it was organized to support. Recently the Surgical Endowment Fund of the United States has supported scholarships and the continuing medical education program of the ICS-US. and joint Annual Meeting of the United States, Canadian, and Mexican Sections June 9–16, 2007 This 7-day Cruise on the 5-Star Holland American Line Will Depart from Boston Harbor and End in Montreal Canada. Clear Your Calendars Now to rediscover these historic cities from a new perspective. representatives from University at Sea will be on hand in Nashville to Answer your questions. See them at their table near the ICS-US Registration Desk. All contributors will receive a personal letter of thanks from the President of the John C. Scott, MD, Surgical Endowment Fund of the United States, and their names will be published in the ICS-US newsletter International US Surgeon. In addition, depending on the size of your contribution, various other forms of recognition will be provided. See the ICS-US staff at the registration desk for more details. Amount of Donation: $__________ Name ______________________________________________ Address ____________________________________________ _____________________________________________________ Cabin Rates City _____________________ State _______ Zip __________ Phone ______________________________________________ Fax _________________________________________________ E-Mail ______________________________________________ Payment Information P Check P Visa P Master Card P American Express Standard Staterooms Ocean View Staterooms Ocean View Staterooms w/ Balconies Large Suites with Balconies $988 $1,253 $1,875 $2,875 Plus port charges, taxes and fees of $297.77 per person for entire week. Taxes subject to change. Credit Card # ___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/ ...For New England! Exp. Date ___/_____ Cardholder Name _______________________________________________ Signature ________________________________________________ 24 SCIENTIFIC ABSTRACTS Abstracts are presented on the following pages in alphabetical order by presenting author and have been reprinted with minimal editorial changes. 25 Applying IDEF-0 Modeling Techniques and RCA Performance Audits to Design and Refine Systematic Response during Emergent Cesarean Section “Code Purple” James D. Bauer, MD, FACOG, FICS; Roberto J. Nicolalde, MS; David Telasha, MD, FACOG; Kenneth H. Funk II, PhD; Toni L. Doolen, PhD., PeaceHealth, Florence Oregon, Oregon State University, Corvallis, OR BACKGROUND Successful response to an obstetrical crisis requiring an emergent cesarean section demands timely execution, and high human reliability in a situation that leaves slim margins for error. Similar situations exist in the aviation and nuclear power domains; however these industries have implemented a number of well designed and rehearsed response plans that include countermeasures to system vulnerabilities and human fallibilities anticipated to commonly occur. The tight coupling of rapidly evolving events and human response becomes critical in smaller rural hospitals because of lack of extra medical staff present in the facility, limited equipment redundancy, and geographic distances creating significant reaction delays. An effective plan is needed to avert obstetrical catastrophe when cesarean section is required to rescue the fetus from asphysixia and the mother from harm. PURPOSE OF STUDY This case study describes an IDEFO defined process developed for the rapid response to obstetrical emergencies and how both the process & performance can be refined by using Root Cause Analysis audits. METHODOLOGY A rural hospital on the coast of Oregon formed an Obstetrics Redesign Team led by an Obstetrician/Gynecologist, expert in safety and systems engineering, that included Midwives, Obstetrical Nursing, Hospital Medical Director, and Risk Manager. Analysis of national loss databases and regional mishap experience identified that failure to rapidly summon a surgeon, assemble a surgical and a pediatric team, and to configure the OR in a timely manner were major causes of failure and vulnerabilities for loss. At the appropriate discussion sessions, Directors of Anesthesia and the Operating Room participated in crafting their areas of the plan. The Redesign Team operated in a nonhierarchical fashion and emphasized creating a team solution. From the discussion, the redesign team leader created an IDEF0 model of a process that captured the essential task and performance specifications of an adequate response from which a comprehensive “Code Purple” response plan was developed. The plan included policy modifications, equipment acquisitions, training requirements, and checklists to support the actors in accomplishing their defined tasks and responsibilities. After initial “Code Purple” training of the obstetrical providers, nursing, and hospital staff, an unexpected Grade 3 placental abruption occurred that required an Emergent Cesarean and triggered a “Code Purple.” After the incident, a performance audit was conducted by an independent Obstetrician/Gynecologist and a Systems Engineer which included records review, and interviews of the patient and all actors. The audit utilized RCA analysis techniques that referenced the underlying IDEF0 model of the “Code Purple” process as vehicle to define potential team, facility and procedural improvements. The end product was step-specific spreadsheet of training, facility needs and managerial attention items. RESULTS: Formal IDEF0 modeling served as useful tool in crafting and implementing our emergency response plan. IDEF0 provided the necessary framework from which to conduct insightful RCA-based performance evaluations from which constructive modifications to process, hospital policies and facility equipment were suggested. CONCLUSIONS/IMPLICATIONS: Many hospitals are at considerable risk for potentially avoidable poor performance in the execution of emergent cesarean sections. Adoption of modern system engineering techniques offers a solution. Scientific Abstracts 26 Synchronous Versus Metachronous Breast Cancer: Characteristics of the Second Tumor Hanadi Bu-Ali, MD, Melhem Solh, MD, Vijay Mittal, MD, FACS Introduction: Synchronous breast cancer, which carries an incidence ranging from 0.3% to 12%, is defined as a tumor diagnosed simultaneously with, or within a period of three months from the diagnosis of the first tumor. There is, currently, no consensus whether the synchronous tumor has the same disease entity as the primary tumor, or if it is a totally independent second primary. Our study describes the clinical, histopathologic and prognostic factors of synchronous breast cancer and compares them with metachronous breast cancer. Methods: A retrospective analysis of all patients with synchronous and or metachronous breast cancer treated at a single institution between January, 1991 and March, 2004 was done through chart review. Further data regarding chemo-radiotherapy, hormonal treatment, local control and metastasis was obtained by accessing the database at the patients’ oncologist’s office. Results: Demographics - The total number of patients was 114, 97% females and 3% males. 63% had metachronous breast cancer (72) compared with 37% in the synchronous group (42). Both groups were similar regarding: a) average age of patients upon diagnosis of first tumor b) ethnicity and c) menopausal status. 77.8% of the metachronous breast cancer group who had a family history documented a first degree relative whereas only 22.2% in the synchronous group did so (p<0.05). Tumor characteristics: 84% of metachronous tumors and 87% of the synchronous group involved the contralateral breast. Infiltrating ductal carcinoma was the most common histological type of the first tumor in both groups. Synchronous breast cancer was found to have a higher incidence of LCIS (16% vs. 4%; p<0.01). This was observed in the second tumor as well. However, even though there was a higher percentage of infiltrating lobular cancer in the synchronous group here too, it was not statistically significant (p>0.05). Both the first and second tumors of the synchronous group were histologically more aggressive than in the metachronous group (p<0.05). Both groups were similar regarding the expression of estrogen and progesterone receptors in both the first and second diagnosed tumors. Both groups were also similar regarding the distribution of tumor stage with 64% of first diagnosed tumors as stage I-II. Treatment and Survival: Most women received conservative surgery (62%). 21% of patients presented with distant metastasis with lung and bone being the most common sites in both groups. Synchronous cancer metastasis involved more than one organ (p<0.05). The average lifetime survival from the day of diagnosis for the synchronous group was 4.7 years compared with 12.5 in the metachronous group (p<0.005). Conclusions: A key point of investigation is whether the disease is monoclonal. Our series shows that synchronous breast cancer tends to be more aggressive than metachronous breast cancer and has a poorer outcome. Moreover, the concordance between different tumors within the same patient, in particular for histology, grade, stage and receptor status support the hypothesis of monoclonal origin of synchronous breast cancer. Suicide Gene Therapy Exploiting Overexpression Of Eukaryotic Initiation Factor 4e In A Rat Minimal Residual Disease Model Of Cancer. Kerry Byrnes, MD; Derek McClusky, MD; Quyen D. Chu, MD; Jie Li, MD, PhD; Yoshi Okadata, PhD; Carol Meschonat, MT; Arrigo De Benedetti, PhD; Michael Mathis, PhD; Richard Turnage, MD; Benjamin D.L. Li, MD, Louisiana State University Health Sciences Center, Shreveport, LA Purpose: Eukaryotic Initiation Factor 4E (eIF4E) overexpression is associated with malignant cells but not normal tissue. Its elevation results in worse outcome in human breast cancer. To exploit the characteristic overexpression of eIF4E in malignant cells, a complex 5’UTR was spliced upstream of the herpes simplex virus thymidine kinase gene in an adenovirus vector (Ad-HSV-UTK). Cytoreductive surgery (CS) plus Adriamycin (ADR), in combination with Ad-HSV-UTK and ganciclovir (GCV) was administered in a syngeneic rat adenocarcinoma model. We hypothesize that malignant cells infected with Ad-HSV-UTK after CS when treated with GCV results in improved diseasefree (DFS) and overall survival (OS). Methods: 106 MatBIII cells were injected into flanks of Fischer 344 rats to grow to 1 cm3. The rats were divided into three groups (N=5 rats/group) after CS: CS, CS plus ADR (CS/ADR), and CS/ADR + Ad-HSV-UTK/GCV. ADR was administered at a single dose (1mg/kg) perioperatively. GCV was administered (80 mg/kg) every other day for 14 days. Western blot analysis was performed to quantify eIF4E and UTK levels in normal and tumor tissues. % infectivity was quantified by fluorescent microscopy. Endpoints measured were time to tumor recurrence and death. Statistical analysis was performed using the Kaplan-Meier methods, Log rank test, and ANOVA. Results: Overexpression of eIF4E in Mat BIII cells was 6.5-fold over normal. UTK expression was only demonstrated in Mat BIII cells. At multiplicity of infection of 104, infectivity was >99%. The DFS and OS were highest in the CS/ADR + Ad-HSV-UTK/GCV group (p<0.001) [Graph 1 & 2]. 27 Scientific Abstracts Graph 2 18 16 14 12 10 8 6 4 2 0 1 Cum. Survival Mean days of recurrence Graph 1 .8 Survival (CS/ADR) .6 .4 Survival (CS/ADR +UTK) .2 CS CS/ADR CS/ADR+UTK P<0.001 0 P<0.001 10 15 20 25 Time (days) 30 35 Conclusions: The complex 5’UTR placed upstream of HSV results in UTK elevation in malignant cells, exploiting eIF4E overexpression in malignant cells but not in normal rat tissue. This resulted in significant improved DFS and OS in this minimal residual breast cancer rat model. Fdg-Pet Is Superior To Ct Scanning In Detecting Local Hepatic Recurrence In Liver Resection Patients. Kerry Byrnes, MD; Mary K. Whitlock, MD; Quyen Chu, MD; Warren Maley, MD; *David Lilien, MD; Lester Johnson, MD; John C. McDonald, MD; Gazi B. Zibari, MD. Departments of Surgery, Louisiana State University Health Sciences Center, *Biomedical Research Foundation of Northeast Louisiana, PET Imaging Center, Shreveport, LA Purpose: Patients who have undergone a hepatic resection for metastatic disease represent a challenging population to detect recurrence. Promising results have been reported in the past using PET imaging to diagnose both primary and metastatic liver cancer. The aim of this study was to compare the accuracy of FDG-PET to CT scanning in the detection of local recurrence in patients with a history of hepatic resection for malignant disease. Methods: All patients who underwent hepatic resection for malignancy from 1999 to 2004 were retrospectively reviewed. The results of FDG-PET and CT scan performed in patients who had suspected recurrent disease after partial hepatic resection were analyzed. Exclusion criteria included time interval between studies of more than two months and positive histologic margin from initial surgery. Recurrence was confirmed by either histopathology or clinical progression of disease. The sensitivity and specificity of each imaging modality was determined. Results: A total of 85 patients were found to have undergone hepatic resection, of which 36 patients were identified who underwent concomitant PET and CT imaging to detect recurrence. The median age of this population of patients was 63, and included 16 females and 20 males. Initial resections included 17 wedge resections and 19 partial or complete lobe resections. Of these, 27 had a previous hepatic resection for metastatic colon cancer, while 9 underwent hepatic resection for primary hepatic malignancy, either hepatocellular carcinoma (HCC) or cholangiocarcinoma. Of these 36 patients, 31 recurrences occurred. The sensitivity of PET imaging in the detection of recurrence was 100 (colon cancer primary) and 86% (primary hepatic malignancy) respectively. The sensitivity of CT scanning in the detection of recurrence was 41 (colon cancer primary) and 43% (primary hepatic malignancy) respectively. The specificity of both modalities was 100%, as there were no false positive results. Conclusion: In this retrospective review, FDG-PET appears superior to CT scanning in the surveillance of patients who have previously undergone a curative hepatic resection. The Uncut Roux-en-y With Jejunal Pouch: A New Reconstruction Technique For Total Gastrectomy Kongkrit Chaiyasate, MD, Steven E. Brooks, MD, Gelen del Rosario, MD, PhD, Lee Andrus, LVT, William Kestenberg, MD, FACS, Michael Jacobs, MD, FACS Hypothesis: Reconstruction with an uncut roux limb and jejunal pouch following total gastrectomy would preserve unidirectional intestinal myoelectrical activity, improve postoperative weight gain, nutritional parameters and diminish roux stasis syndrome in total gastrectomy dogs. Design: Randomized-controlled, experimental animal study. Setting: Tertiary university-affiliated community hospital. Participants: Ten dogs. Interventions: Total gastrectomy was performed and two methods were used for reconstruc-tion: roux-en-Y esophagojejunostomy (RY) was performed on five dogs (control) and the uncut roux-en-Y with a jejunal pouch (URYJP) was performed on five dogs (experimental). Main Outcome Measures: Subjects were monitored for ten weeks postoperatively. Serial weight and nutritional parameters were measured. Emptying profiles and motility studies were performed in the fasting and postprandial states. Scientific Abstracts 28 Results: Ten weeks after surgery, the URYJP group had significantly improved nutritional parameters including weight, total protein, albumin, hemoglobin, serum TIBC, IgA, IgG, IgM. Emptying time for the URYJP group was faster than for the RY group, but did not reach statistical significance. The RY group showed significantly slower frequency of pacesetter potential (PP) propagation during fasting (p=0.04) and postprandially (p=0.04). Aboral propagation occurred more frequently in the URYJP group during fasting and postprandially (98% ±0.35 versus 39% ±16; p = 0.02, and 99 % ±0.45 versus 43 % ±18; p = 0.03). Luminal occlusions were intact in the URYJP group at ten weeks. Conclusions: The combination of jejunal pouch and uncut roux limb improved overall nutritional parameters when compared to the traditional roux-en-Y, while preserving normal propagation of small bowel motility. The Significance Of Interferon Receptor Expression In Colorectal Metastases To The Liver Yeon-Jeen Chang, MD, Raja Gidwani, MD, Monali Laxpati, MD, Steven Brooks, MS, Frances Williams, MBA, MT, Reza Saidi, MD, Boris Silberberg, MD Sponsor: Michael J. Jacobs, MD, FACS, Providence Hospital and Medical Centers Introduction: Colorectal cancer (CRCA) is the third most common malignancy and also the third leading cause of death in both sexes. Metastases are the major cause of cancer-associated death and the liver is the most common site harboring distant metastases. Several clinical trials have used IFN therapy for CRCA, but only partial remissions have been demonstrated. Few studies have described the IFN receptor status in patients with CRCA metastases and even less is known about the role of IFNs in vivo. The objective was to assess IFN receptor expression in CRCA metastatic lesions to the liver and to determine their subsequent impact on clinical outcome. Methods: The slides from 30 patients operated on for CRCA liver metastases between 1992-2003 were reviewed. Tissue sections from tumor and normal tissues were incubated with antibodies for IFN alpha-beta and gamma receptors and then histologically examined. The intensity of staining was scored (0-3). The relationship between IFN receptor expression and patient age, gender, and type of treatment were examined by frequencies and crosstabulation. Survival was assessed using the Kaplan-Meier method. Results: IFN alpha/beta receptor expression was present in 83.3% of tumors and in 92.9% of normal tissue, while IFN gamma expression was present in all cases. IFN alpha/beta receptor expression was more intense in the normal liver tissue, whereas gamma expression had equal intensity in tumor and normal tissue. IFN alpha-beta receptors showed a predilection for centrilobular distribution, whereas the distribution of IFN gamma was homogeneous throughout the specimen. In tumor tissue, alpha-beta and gamma IFN expression was more prevalent for patients aged >60 years. The expression levels of both IFNs were equivalent for gender. There was a trend toward prolonged survival in patients with expression of IFN alpha/beta receptor (32 months vs. 28 months). Conclusions: Expression of IFN alpha/beta receptor seems to be a prognostic factor in patients with colorectal metastases of the liver. The Varicocoele In Male Factor Infertility: The Role of Laparoscopic Varicocoelectomy Professor Christopher Chen, Faculty of Health, University of Newcastle, NSW, Australia; Ricardo Palma University, Lima, Peru, South America; Sri Ramachandra Medical College & Research Institute, Deemed, University (Harvard Medical International), Christopher Chen Centre for Reproductive Medicine, Singapore Purpose There is a worldwide decline in fertility and the male contributes about 40% of the causes, with the varicocoele accounting for about 40% among these causes. Whilst varicocoeles are most commonly treated by varicocoelectomy through the inguinal route, a high peritoneal approach using videolaparoscopy may provide a new modality of treatment. A study was therefore embarked to develop the technique of videolaparoscopic varicocoelectomy, and to treat and evaluate this method of therapy for male factor infertility. Methods Videolaparoscopic varicocoelectomy was employed to treat 700 spouses of infertile couples in the study. All had varicocoeles and the operation comprised high bilateral ligation, using a 3-chip video camera, a 5mm laparoscope and 2 side punctures for the application of titanium clips to the testicular veins. A testicular biopsy was also done to evaluate the extent of damage by the varicocoeles. Results The duration of the surgery varied between 1 to 2 hours and the patients were discharged as ambulatory cases the same day. Testicular seminiferous tubular damage by the varicocoeles varied between 1 to 30% or greater. The semen profiles of the men improved among 80% with an overall pregnancy rate of 43% among their wives. 29 Scientific Abstracts Conclusions The surgery was very well accepted because of rapid recovery, improved sexual performance and cost savings. It may be considered an innovative method of therapy for varicocoeles, with good results. Combined Abdominoplasty and GYN Surgery Anthony N. Dardano, DO, FACS, FICS, Fernando Recio, MD, FACOG, FACS, Boca Raton Community Hospital, Boca Raton, Florida PURPOSE: To report our technique of a safe, and predictable procedure to combine any GYN procedure and an abdominoplasty. METHODS: A retrospective review of 50 consecutive cases of combined abdominoplasty and GYN surgery in a busy community hospital. Patients scheduled to undergo GYN surgery were referred for combined abdominoplasty. Patients with known malignancies were excluded. Patients were between the ages of 26 and 72 years old. GYN procedures included TAH (16), TAH BSO,( 24), oophorectomy (4), tubal ligation (4), urogenital corrective surgery (2). All procedures ere performed by the same Plastic surgeon and GYN oncologist. A low transverse incision is made on the abdomen and a fasciocutaneous flap is elevated to the umbilicus by the plastic surgeon. The intraabdominal surgery is completed. The wound is pulse-irrigated with 3 liters of saline. The abdominal wall fascia is plicated, the umbilicus transposed, and excess skin is excised. JP drains are placed and the incision is closed. Patient wears an abdominal binder for 4 weeks post-op. Operative time varied from 1 hr 45 minutes minimum to 3 hours 15 maximum skin to skin. RESULTS: We report only three complications with no deaths in 50 consecutive women undergoing GYN surgery with a 1 year follow up. 1 DVT, 1 myocardial infarction, 1 wound infection, No returns to the operating room for revisional surgeries Predictors of Type II Neurological Complications Following Coronary Artery Bypass Graft Surgery Elias Darido1, J. Michael Smith MD FACS FACC FACP1,2, Amy M. Engel MA3 1. Department of Surgery, Good Samaritan Hospital 2. Cardiac, Vascular, and Thoracic Surgery, Inc. 3. E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio Purpose: The objective of this study was to determine the risk factors and adverse outcomes of postoperative type II neurologic complications. Methods: A study from an eleven year hospitalization cohort with prospective data collection was conducted. There were 595 CABG patients with neurologic complication, which was defined as having mild mental status, severe mental status, or confusion, following CABG (7.1% of the patients included in the study). There were 7,793 CABG patients without any neurologic complications following CABG. The study examined 26 potential risk factors and 13 outcome variables. Results: Univariate analysis on potential risk factors revealed 17 significant factors. Correlation coefficients were calculated for the 17 significant confounding risk factors and the three remaining factors were age, previous intervention in past ten days, and creatinine level. Using logistic regression analysis, we found that patients were more likely to experience a neurological complication following CABG surgery if they were older than 70 (OR 3.8, 95% CI 3.1-4.5, p<0.001), had a previous intervention within ten days prior to surgery (OR 3.4, 95% CI 1.4-8.3, p=0.008), and a higher creatinine level (OR 0.9, 95% CI 10.9-0.9, p=0.013). CABG patients with a neurological complication tended to also experience additional complications. There was a significant difference between CABG patients with and without neurological complications on 12 outcomes. Conclusion: Type II neurologic complications after coronary bypass surgery are common. They are associated with a substantial increased risk of postoperative morbidity and mortality. New diagnostic and therapeutic strategies must be developed to lessen such injury. Pain Outcome In Patients Undergoing Kyphoplasty For Osteoporotic Vertebral Compression Fractures Kostas N. Fountas, MD, PhD, Leonidas G. Nikolakakos, MD, VG Dimopoulos, MD, Theofilos G. Machinis, MD, Joe Sam Robinson III, MS, Carlos H. Feltes, MD, Kim W. Johnston, MD, FACS, Joe S. Robinson, MD, FACS, Department of Neurosurgery, Medical Center of Central Georgia, Mercer University School of Medicine, Georgia Neurosurgical Institute, Macon , GA Scientific Abstracts 30 Purpose: Osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability for the elderly. In the last few years, kyphoplasty, a minimally invasive technique, has been developed in order to provide immediate pain relief and return patients to premorbid level of activity. Methods: We retrospectively reviewed 24 patients (16 female, 8 male) treated with balloon kyphoplasty for osteoporotic VCFs. The average age of the patients was 72.6 years (range 48-87 years). A total of 37 vertebral levels (25 thoracic and 12 lumbar) were intervened upon. Kyphoplasty was performed in all cases within 9 weeks from the onset of pain. VAS scores were documented in the immediate pre- and post-operative period, as well as 4, 12, and 72 weeks after the procedure. Vertebral body height restoration was assessed on post-operative x-rays. Results: Mean pre-operative VAS score was 9.3 and improved to 5.4 in the immediate post-operative period. At 4, 12 and 72 week post-operative, mean VAS scores were 5.1, 5.9, and 6.1 respectively. All patients were discharged from the hospital within 24 hours and were able to return to their daily activities. However, no significant restoration of vertebral body height was observed. No severe complications were associated with the procedure. Conclusion: Kyphoplasty is a safe and effective treatment modality for osteoporotic VCFs when undertaken early after the onset of pain, even when no significant restoration of vertebral body height is achieved. Key Words: kyphoplasty, vertebral compression fracture, pain, height restoration The Description Of Skull Shape And The Correlation With The Suture Configuration As Described By Vesalius KN Fountas, MD, PhD, VG Dimopoulos, MD, TG Machinis, MD, JS Robinson, Jr., MD, FACS Department of Neurosurgery, Medical Center of Central Georgia, School of Medicine, Mercer University, Georgia Neurosurgical Institute, Macon, GA, USA Introduction: Vesalius is considered to be one of the greatest physicians in the history of medicine. The purpose of our current communication is to present his thoughts regarding the different morphology of the human skull and its clinical implications. Methods: We reviewed the relevant text of the first book of his monumental work: “De Humani Corporis Fabrica” and present the famous plate with the figures of normal and abnormal skull shapes. We also reviewed the relevant Hippocratic works, which inspired Vesalius for his classification. Results/Discussion: Vesalius defined the normal head shape as an oblong sphere slightly depressed on either side and protruding anteriorly and posteriorly. He described four different abnormal head shapes and correlated them with the configuration of the sutures. He also described the difference of the skull shape in different populations and reported the significance of the head position in the formation of the head shape in infants. Conclusion: Vesalius provided a detailed description of the head shape and suture configuration, as inspired by Hippocrates. Some of the modern principles in the description of craniosynostosis can be identified in the text written in 1543, which is considered one of the milestones in medical history. Modular Rigid Angle Fixation Of Three And Four Part Fractures Of The Proximal Humerus In The Elderly Eduardo Gonzalez-Hernandez MD* Luis Osorio MD, Igor Indriago MD. Miami Hand Center. Miami, Florida INTRODUCTION Treatment of proximal humerus fractures remains controversial. In the elderly, osteoporosis and limited rehabilitation potential pose formidable challenges. Our treatment of choice for three and four part fractures has become rigid internal fixation and early rehabilitation. METHODS From August 2002 to May of 2003 twenty seven consecutive patients older than 65 years with three and four part fractures were managed with ORIF using a modular fixed angle plate and trans-osseous wires. Rehabilitation was begun within a week of the surgery. Radiologic evaluation included the quality of the reduction, the presence of avascular necrosis and collapse. Range of motion and return to function and activities of daily living is recorded. Pain is rated from an analog visual scale. The minimum follow up was 12 months. 31 Scientific Abstracts RESULTS All fractures healed. One prominent screw required removal. Pain control was god and excellent except in two patients. Return to pre-morbid level of function was possible in most patients and motion was excellent in 21 patients. Minimal abduction was 90 degrees and patient satisfaction was high. DISCUSSION Hemiarthroplasty replacement has been the preferred method for management of four part fractures because of the risk of AVN. Modular fixed angle plate systems are now available and are well suited for the management fractures in the elderly with osteopenic bone. CONCLUSION Despite the osteoporosis present in advanced age, ORIF of three and four part fractures of the proximal humerus appears to be an excellent option obviating the need for hemiarthroplasty replacement with superior outcomes at least in the short term up to 12 months. Contoured Plates On The Management Of The Distal Humerus Fractures Eduardo Gonzalez-Hernandez M.D. Miami Hand Center Introduction Recent advances in orthopedic technology include modular fixed angular fixation and anatomical designs. For complicated supracondylar and intercondylar fractures of the distal humerus these new developments have many practical advantages which are reviewed. The first immediate advantage is the practicality of these devices as the surgeon no longer has to bend or contour standard compression plates to fit the patient’s anatomy. In addition, these devices are particularly useful in osteopenic bone in the elderly. Earlier rehabilitation and range of motion can be undertaken. In addition, some fractures which used to be irreconstructable such as the capitellar fractures can be reconstructed with excision of capitalium and soft tissue arthroplasty based on a stable lateral condyle afforded by a well contoured plate. Other pearls are reviewed including the use of double plating along the radial or the ulnar column in the reconstruction of the severe osteopenic bone. The complications are also reviewed including soft tissue failure, and the formation of heterotrophic bone. The surgeon’s experience with contoured plates is reviewed. The cases that are addressed include severely communited fractures of the distal humerus the specific techniques of osteosynthesis are reviewed including olecranon osteotomies and extensile approaches to gain access not only to the distal humerus but also to frequently associated radial head fractures and coronoid or proximal ulna fractures. The fractures in the elderly are also reviewed. A significant development is circumventing the olecranon osteotomy in the elderly and the use of double plating along the radial or the ulna column together with the additional plate on the opposite column. Earlier rehablitation can be instituted almost immediately. Management of soft tissue breakdown can be addressed with pedicle flaps or rotational flaps. Pedicle flaps such as the distal radial forearm flap is an excellent choice. A proximally based dorsal interosseous flap can also present an excellent choice for coverage. Soft tissue free transfers are also a possibility although not as practical. Soft tissue releases and excision of heterotrophic bone following a severe supracondylar intercondylar fractures more frequently require external hinge fixator for stability. There is a significant trend to move away from these devices in favor of more physiologic releases, avoiding removal of the collateral ligaments. In conclusion, well contoured distal humerus plates are fixed angle fixation pose great advantages for the management of these difficult injuries. This paper intends to review some of those advantages and some of the pitfalls and the management of these complicated injuries. In addition, we also intend to review future concepts in the development of the hardware for the management of these injuries. Use Of An Intramedullary Device For Treatment Of Peritrochanteric Hip Fractures Gerald Q. Greenfield, Jr. MD, Emeka O. Ofobike, Jr. MD, Southwest Texas Methodist Hospital, St. Luke’s Baptist Hospital, North Central Baptist Hospital, Santa Rosa Northwest Hospital, Northeast Methodist Hospital, San Antonio, TX Peritrochanteric fractures account for 55% of the 250,000 hip fractures occurring in the United States annually, with 90% of these injuries affecting people over age 50. The incidence of hip fractures is expected to double by the year 2050. Though, the sliding compression screw with side plate has been the traditional surgical treatment, our purpose is to review a series of patients treated with intramedullary devices to assess perioperative morbidity, complication rates, and the speed at, and quality to, which they regained function. Methods: We reviewed one surgeon’s hospital and office charts of 38 consecutive patients treated with an intramedullay device for noncervical hip fractures. Data were collected on variables such as operative time and intraoperative Scientific Abstracts 32 blood loss, postoperative transfusion rates, length of hospital stay, complications and return to activities of daily living. Results: Review showed an average 74 ml blood loss and 38 minute operative time. No deaths and one episode of screw cut-out (screw protrusion) occurred in the early (6 week) postoperative period. Three episodes of screw cut-out occurred at 3-4 months post-operatively and were treated by conversion to hemiarthroplasty. At final follow-up, most patients were independent ambulators with or without walking aids. Conclusion: Treatment of peritrochanteric fractures with intramedullary devices yields a predictable good result with relatively few postoperative complications. With appropriate device placement and recent design improvements, the higher complication rates cited by previous studies may approach those of the traditional sliding compression screw with the added benefit of decreased operative time and blood loss. Comparative Hemodynamics of the Piggyback Technique with Veno-Venous Bypass versus the Piggyback Technique Alone during Orthotopic Liver Transplantation Kevin W. Hatton, MD; Angela Drake, MD; Lori Craig, MS; Dinesh Ranjan, MD; Zaki-Udin Hassan, MBBS Departments of Anesthesiology and Surgery, University of Kentucky Chandler Medical Center, Lexington, KY Introduction: Veno-venous bypass (VVBP) is commonly used during orthotopic liver transplantation (OLT) to provide relatively stable intraoperative hemodynamics and prevent intraoperative profound hypotension, cardiac depression and shock due to surgical manipulation of the inferior vena cava and portal vein.1 OLT utilizing the modified piggyback technique (PBT) does not involve caval cross-clamping and may be associated with less severe hemodynamic changes which may not be improved with VVBP.2-3 Methods: This was a retrospective case control study of 38 patients undergoing PBT with and without VVBP in a single transplant center. Preoperative baseline characteristic data and intraoperative hemodynamic data (HR, MAP, CI, SVO2, SVRI and DO2I) were collected from the three phases of the operative procedure. Results: There were no significant differences in baseline characteristics between groups. There were also no significant differences in hemodynamic measures between these groups of patients during any phase of the transplant procedure. Overall, the mean HR, MAP, and SVO2 did not appreciably change during the three phases of the procedure. Mean CI and DO2I decreased 13% and 9% during the anhepatic phase in the PBT+VVBP and PBT-VVBP groups respectively, while SVRI concomitantly increased 10% and 29%. Discussion: We conclude that VVBP does not improve intraoperative hemodynamics (including, HR, MAP, CI, SVO2, SVRI and DO2I) during the piggyback technique for orthotopic liver transplantation. However, because of the limitations of this small retrospective study, a larger prospective study of routine use of the piggyback technique with VVBP may be warranted. References: Baker J, Yost CS, Niemann CU. Organ Transplantation. In: Miller RD, ed. Miller’s Anesthesia. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2005: 2231-83 Tzakis A, Todo S, Starzl TE. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg. 1989; 210: 649-52. Jones R, Hardy KJ, Fletcher DR, et al. Preservation of the inferior vena cava in orthotopic liver transplantation with selective use of veno-venous bypass: the piggy back operation. Transplant Proc. 1992; 24: 189-91. Glomus Tumor: A Rare Neoplasm of the Bronchus Marta Helenowski, Adel Zayaad*, Praba Rajan, Umesh Kapur, Wickii T.Vigneswaran, Loyola University Medical Center, Maywood and *St Bernard Hospital, Chicago, IL Purpose Airway glomus tumor is a rare neoplasm, only a few cases are reported worldwide. Majority of the reports are in the trachea and it is rarely reported in the distal airway. We present a case of a glomus tumor in the right intermediate bronchus, initially diagnosed as a carcinoid tumor. Method A 34 years old morbidly obese, hypertensive, diabetic and asthmatic black male presented with a persistent pain in the right chest and flank, made worse by coughing. He was investigated with a chest x-ray (CXR), CT scan of the chest (CT), bronchoscopy, pulmonary function testing and an exploratory thoracotomy. Result The CXR showed right lower lobe collapse and CT revealed a soft density within the intermediate bronchus with postobstructive atelectasis of lower and middle lobes. Bronchoscopy revealed a complete obstruction of intermediate bronchus by a tumor. The initial bronchoscopic diagnostic biopsy of this tumor was reported as a typical carcinoid 33 Scientific Abstracts tumor. During exploratory thoracotomy a sleeve resection of the right intermediate bronchus was performed conserving lung parenchyma. Detailed pathological examination of the specimen confirmed the diagnosis of a bronchial glomus tumor. Patient underwent an uneventful post-operative recovery and remains asymptomatic at follow-up. Conclusion Glomus tumor is an uncommon primary tumor of the bronchus and should be considered in the differential diagnosis of distal airway lesions. Local resection is curative in this condition. Endoluminal Grafting for Thoracic Aortic Aneurysm Karthikeshwar Kasirajan, MD, FICS, Emory University School of Medicine, Atlanta, GA PURPOSE: The objective of this study was to assess endovascular treatment of thoracic aortic aneurysms and noaneurysmal diseases of the thoracic aorta. METHODS: 142 patients underwent endovascular repair of thoracic aortic disease between September 2003 and Jan 2006. Patients represented 7 major disease groups: degenerative aneurysm (n = 63), aortic dissection (n = 31), penetrating ulcers (n = 17), traumatic aortic injury (n = 11), pseudo-aneurysms and fistula (n = 9), coarctation (n = 6), and “shaggy aorta” (n = 5). RESULTS: Mean age in the entire study group was 61 years. Primary technical success was obtained in 92% of patients. Endoleaks on completion were noticed in 11 patients. Paraplegia was a postoperative complication in 4.0% of patients. Thirty-day mortality in the entire study group was 7.7%. Moratilty rates were noted more frequently in dissection and pseudo-aneurysm group (6/40; 15%). During follow-up open conversion was required in 4 patients, only in one with a degenerative aneurysm. Secondary intervention were required for seal and other graft related complications in 5.6% of patients. One-year follow-up was complete in 54 patients. Sac was stable or decreased in size in 92% of patients. CONCLUSION: This single center experience demonstrates acceptable rates for operative mortality and paraplegia after endovascular repair of thoracic aortic disease. Early Re-Admission Following Lung Transplantation Is A Predictor Of One Year Survival Lamounier F, Helenowski M, Bhorade S, Pelletier K, Garrity E, Vigneswaran, WT., Loyola University Medical Center and University of Chicago, Chicago, IL Purpose: Early morbidity following lung transplantation consume significant amount of resources and may be a marker for early mortality. Prompt recognition and treatment of the causes may avert the serious consequences. The etiology however, for early readmissions after lung transplantation is poorly reported. We reviewed the causes and impact on early survival of readmissions within 90 days following isolated lung transplantation. Patients and Method: The charts of 206 consecutive patients undergoing isolated lung transplantation in a single institution between January 1998 and December 2004 were reviewed. The prospectively collected data on readmission and survival were compiled and analyzed. Results: The median hospital stay following the transplantation was 8 days for this cohort and 15 patients (7.4%) died in the post operative period or within 30 days of the operation. 90 of the survivors (48%) were readmitted within 90 days of transplantation. 28 patients (13.6%) required multiple readmissions with a total number of 125 readmission within 90 days of transplantation. Causes for readmissions included, respiratory (59%), gastrointestinal (18%), cardiac (5%), metabolic (2.5%), neurological (2.5%), hematological (2%), and miscellaneous (11%). The respiratory readmissions were infections (19%), non infectious pulmonary or pleural (26%) bronchial anastomotic (12%), and rejection (5.6%). 14 of the patients who were readmitted died during the first year, either during the first readmission or a subsequent readmission, where as 5 patients died in the first year who did not require readmission in the first 90 days ( p< 0.05). Conclusions: We conclude that early readmissions following lung transplantation are mainly due to pulmonary or pleural complications. Readmission within 90 days is a significant predictor of first year mortality. Scientific Abstracts 34 Electroporation-Mediated Gene Transfer In Lipopolysaccaride (Lps) Injured Mouse Lungs David A. Machado-Aranda1, Gökhan M Mutlu2, David A. Dean2 and Vijay Mittal1, Sponsor: Vijay Mittal, MD, FACS 1Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, and 2Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL Introduction: Several gene therapy strategies have been proposed to treat ALI/ARDS. The lung’s defense mechanisms, somewhat impaired during disease, still constitute a formidable barrier for current viral and non-viral vectors. Electroporation has been shown to be a highly efficient method for gene transfer in the intact lung and with this study we wanted to test it in the context of a damaged lung. Methods: Lipopolysaccaride (LPS) (4 mg/kg) was given endotracheally to female Balb/c mice to induce lung injury. Damage as assayed by pathology, BAL cellularity, gravimetric measurements, and pulmonary function tests, developed by 24 hr and peaked by 72 hr after the challenge. One to three days after LPS challenge, plasmid DNA suspended in saline was delivered to the lungs via the trachea and eight, 10 msec square wave pulses at a field strength of 200 V/cm were applied using cutaneous electrophysiology electrodes placed on the chest. Animals recovered without incident. Gene expression was measured three days later. Results: Luciferase reporter gene expression was similar in both LPS challenged and their saline challenged control animals. Immunohistochemistry for the reporter gene product showed expression in, or very close to, the injured alveoli. There were no changes in the lung pathology score, or BAL cellularity among electroporated animals. Using a plasmid construct expressing the beta1 subunit of the Na+/K+ ATPase, we saw an improvement in lung injury scores, gravimetric measurements and lung mechanics, suggesting an increased alveolar fluid clearance. Conclusions: Electroporation is an effective means for introducing naked DNA into the injured lung. By overexpressing the beta1 subunit of the Na+/K+ ATPase, lung epithelial barrier functions were improved. This could be a potential treatment for ALI/ARDS. Decreased Incidence of Gastrointestinal Complications after Endovascular Aortic Aneurysm Repair PJ Persson MD1, Joann Lohr MD1, Amy Engel MA2, Patrick Muck MD1, Sasidhar Kilaru MD1 1. Good Samaritan Hospital, 2. E. Kenneth Hatton, MD, Institute for Research and Education Cincinnati, Ohio Purpose: Endovascular aortic aneurysm repairs have a lower mortality and a shorter hospital stay than open repairs. There are significant gastrointestinal complications following open repairs, however, there is little data related to these complications following endovascular repair. This study examined endovascular aortic aneurysm repairs that occurred in the past four years at one institution. Methods: A retrospective chart review was conducted of 61 patients that underwent endovascular aortic repair at one mid-west institution from 2002-2005. Charts were reviewed for demographics, potential risk factors, disease specific and procedure related, and postoperative outcomes. Results: Of the 61 cases reviewed, 49 (80.3%) were male. Fifty six 56 (91.8%) of the 61 cases were Caucasian. The average age was 72 years. All procedures except one were elective. The one mortality that occurred (1.6%) was related to ischemic colitis. Three patients (4.9%) developed a post operative ileus requiring NGT decompression. No patients developed cholecystitis, bowel obstruction, hernia, chylous ascites, abdominal compartment syndrome, or pancreatitis. Length of stay ranged from one to 47 days with 3 days as the median. Intensive care unit length of stay ranged from none to 552 hours with a median of 24 hours. Ten patients did not have any time in the ICU. Conclusion: Postoperative gastrointestinal complications after endovascular aortic repair are less common than after open repairs, but still can lead to prolonged length of hospital stay and mortality. New “Sutureless” Technique of Ileostomy and Colostomy Madhav V. Phadke, MD FACS, Raleigh, NC PURPOSE To prevent infection and complications of Ileostomy and Colostomy operations. The technique is founded on established basic scientific facts and the principles of delayed-primary wound closure. METHODS Discovered by serendipity in 1986 during an Ileostomy, the procedure was used for Ileostomy and Colostomy. Bowel serosa was sutured to the opening in rectus fascia proximal to stoma starting at the mesenteric corner. A 35 Scientific Abstracts 2-3 cm cone of bowel was formed by lifting the anti-mesenteric corner as the apex of the stoma, and serosa was anchored to rectus fascia circumferentially. This neutralized the pulling effect of peristalsis at the mesenteric corner. Stoma was covered using an appliance with transparent pouch. Obstructed stoma prevented wound contamination by feces. Postoperatively, the serosal surface was covered by angiogenesis, making the stomal wound refractory to infection. When peristalsis returned, the bulging stoma was opened using electro-cautery as a bedside procedure. Mucosal cuff protrudes, everts on angiogenesis over a single layer of serosa, and fuses with dermis, completing natural maturation of stoma. Absence of sutures (required for conventional maturation) reduced tissue trauma and eliminated foreign body reaction resulting in better wound healing. This new procedure was named “DELAYED-PRIMARY SELF-MATURATION (DPSM)” of stoma. RESULTS 17 Colostomies and 3 Ileostomies were performed using DPSM. Infection in the stomal, main wounds and associated complications were prevented. CONCLUSIONS DPSM prevents infection and complications associated with Ileostomy and Colostomy operations. It is technically easier and more scientific than a conventional stoma and is recommended for all types of intestinal stomas. Treatment of Colles Fractures with Minimally Invasive Dorsal Nail Plate Alfonso E. Pino MD, FICS, FAANOS; Jose G, Ramon MD, FICS, FAANOS More than 300,000 Colles fractures present to the Emergency departments in U.S.A. every year. Making this type of injury one of the more frequently seen especially in the elderly population. There is a great difference between a Colles fracture in young individuals and the elderly with Osteoporotic Bones. In the last group the fracture can be considered a Pathological injury due to the type of trabecular bone present with associated weakness to break during minimal falls. The demands and expectations are quite different. The modes of treatments must be tailor to the different age groups. There is not a single solution to all problems. For the elderly with very low demands the Dorsal Intramedullary Nail Plate is an Excellent solution due to the minimally invasive incision, brief operation and recuperation, early Range of Motion and a complication rate close to zero. Hand Grip and Pinch are recuperated sooner. Patient is capable to return to Daily Living Activities within 2 weeks. The design of this implant permits the patient to use the extremity with less risk of loosening the anchor in the osteoporotic distal fragment. We recommend the use of this IM nail-Dorsal Plate innovative device for the displaced Colles Fractures in the elderly. Polarus Nail in Fractures of the Proximal Humerus Alfonso E. Pino MD, FICS, FAANOS; Jose G. Ramon MD, FICS, FAANOS Fractures of the proximal humerus are very common in the old osteoporotic patient. They are difficult to treat due to a myriad of factors including: type of fracture, grade of osteoprosis, age, habits specially smokers are alcoholics, comorbiditis like Rheumatoid Arthritis, corticosteroid dependence, mental status, confine to Nursing Homes, etc. To obtain a reduction is simple, what is very difficult is to maintain it until there is Bone Consolidation. To keep the osteoporotic segment of the head aligned to the proximal metaphysis is the real challenge. That is were this intramedullary locking device work very nicely. The Polarus Nail is a Short rigid device which is inserted antegrade via a short deltoid splitting incision over the Greater Tuberosity of the Humerus under Fluoroscopy control. There is an excellent targeting device for the insertion of the 4 proximal elective cancellous screws and 2 distal locking cortical smaller screws. The limited experience in our cases is very rewarding with few complication. This devices is also very useful for the treatment of non unions of the Proximal Humeral Fractures. An Animal Model Of Uterine Auto And Allo –Transplantation With Successful Pregnancy Edwin Ramirez, MD, Hugo Ramirez MD, Doris Ramirez MD, Department of Obstetrics and Gynecology, Texas A&M University, Prairie View, TX Purpose: The purpose of this project is three-fold: (1) to investigate an animal model of uterine transplantation after ovarian vessel ligation and uterine vessel reanastomosis (2) to determine the rates of “successful” uterine transplant, with endpoint of delivery of a viable pregnancy and (3) to evaluate the role of omentopexy as a source of neovascularization for the transplanted uterus (dogs). Scientific Abstracts 36 Methods: Our research project explores feasibility of uterine transplantation by comparing avascular and vascular uterine transplantations and by exploring the impact of immunosuppressive therapy on fertility. Our endpoint is delivery of a viable live born from the transplanted organ. As we develop surgical methods and techniques, pathological assessment of vascularity, and tissue rejection will be quantified. Results: Based on other published results, we projected a survival rate of 70- 80%, death rate of 0-20%, and a pregnancy rate of 20-30%. Our preliminary results were comparable to the above with the exception of higher mortality in pigs. Animals that died underwent complete necropsy with sampling of tissue to document presence and extent of neovascularization and/or tissue rejection. After four to six months of documented infertility, exploratory laparotomies procured tissue samples for histopathologic studies. Conclusion: By exploring the different alternatives for fertility such as in vitro fertilization, gamete intrafallopian tube transfer, intracytoplasmic sperm injection and surrogacy, the uterine transplant may be considered another alternative for infertility. Key words: Animal model; Transplantation; Non-vascular; Vascular; Cryopreservation; Cyclosporine; Embryo transfer; Pregnancy Are You Screening Your Surgical Patients For Obstructive Sleep Apnea? Roque J. Ramirez, MD, FICS, SurgeonOne Inc., Corpus Christi Medical Center, Corpus Christi, Texas. PURPOSE: To determine the significance of Obstructive Sleep Apnea in the surgical patient. METHODS: Prompted by the prevalence of this condition in my obese, diabetic, and hypertensive surgical patient population, a literature review was performed to investigate the interrelationship between OSA and Surgery. RESULTS: OSA is present in 20 million American adults and largely undiagnosed (85%). The acute physiological changes associated with OSA include systemic and pulmonary hypertension, dysrrhythmia, reduced cerebral blood flow, increased left ventricular afterload, decreased cardiac output and increased gastric acid secretion. These changes may be the result of hypoxemia and hypercarbia, repeated arousals, increased catecholamine levels, increased sympathetic tone, and/or intrathoracic pressure swings. OSA has been linked to GERD, hypertension, obesity, diabetes and increased surgical complications. The prevalence rate of OSA in patients with cardiovascular disease ranges from 30 – 80%. Obesity results in 36% higher annual medical expenditures and is a risk factor for development of both OSA and type 2 diabetes. The prevalence of OSA is doubled in diabetic patients compared to non-diabetics. OSA is identified in 77-98% of all bariatric patients and contributes to a 3 fold increase in post bariatric surgical complications. It remains unclear whether GERD contributes to OSA or OSA is a risk factor for GERD, but the association between these conditions is sufficiently robust to suggest that clinicians should be alert for the presence of both even if a patient presents with symptoms of only one. CONCLUSIONS: Although the exact mechanisms have not been studied in sufficient detail, it is clear that obstructive sleep apnea is an often overlooked, identifiable risk factor for potential surgical complications. Estrogen Attenuates Hepatic Ischemia-Reperfusion Injury Siddhartha Rath MD, Richard H Turnage MD, Carson C Cunningham MD, David M Lefer PhD, Gazi B Zibari MD, Departments of Surgery and Physiology—Louisiana State University State University Health Sciences Center in Shreveport, Shreveport, LA PURPOSE: We hypothesized that exogenous administration of estrogen to male mice would attenuate hepatic ischemia-reperfusion injury. Tissue ischemia-reperfusion injury impacts many areas of surgical care with research directed at limiting or preventing reperfusion injury. Previous studies have shown that in mice, female gender resulted in increased survival versus male counterparts, possibly due to the effect of estrogen. METHODS: Male C5BL/6 mice were divided into two groups. The control group received no estrogen and the experimental group received estrogen twenty-four hours prior to surgery. In both groups ischemia was accomplished by midline laparotomy with ligation of the vascular pedicle of the left lateral lobe of the liver for 45 minutes and followed by a reperfusion period of five hours. At that time 0.5 ml of blood was taken for measurement of AST and ALT as an indicator of hepatic dysfunction. At the end of reperfusion, we also directly visualized leukocyte dynamics in both control and experimental animals using intra-vital microscopy. 37 Scientific Abstracts RESULTS: Among the parameters of leukocyte dynamics, there was a significant difference in all measured parameters (rolling, saltating, and adhesion) between the two groups. AST, but not ALT, was significantly higher in the control group than the group receiving estrogen. CONCLUSION: These data suggest that estrogen attenuates hepatic ischemia-reperfusion injury in mice possibly by contributing to inhibition of leukocyte activation and/or adhesion in the microcapillaries. Insulin Attenuates Intestinal I/R Mediated Pulmonary Injury Via A No Dependent Mechanism Siddhartha Rath MD, Nicholas Mai, BS, Theodore Kalogeris, Ph.D, J. Steven Alexander, Ph.D, Gazi B Zibari MD, Richard H Turnage MD, Departments of Surgery and Physiology—Louisiana State University State University Health Sciences Center in Shreveport, Shreveport, LA PURPOSE: Intestinal ischemia-reperfusion (I/R) causes pulmonary microvascular dysfunction. Our laboratory has shown that insulin attenuates peroxide-induced barrier dysfunction via a nitric oxide (NO)-dependent mechanism. This study examines the hypothesis that insulin prevents I/R-induced pulmonary microvascular barrier dysfunction in vivo by a NO dependent mechanism. METHODS: Male C57/BL6 mice underwent occlusion of the superior mesenteric artery (SMA) for 60 minutes followed by 120 minutes of reperfusion (I/R) or dissection of the SMA without occlusion (SHAM). The animals received vehicle, insulin (0.1 units/kg, 30 min. prior to ischemia) or insulin + L-NAME (100mM, a NO synthase inhibitor, 60 min. prior to ischemia) intravenously. We determined pulmonary microvascular dysfunction by measuring the concentration of Evans Blue Dye (EBD) within the lung following the intravenous administration of 20 mg/kg. Statistical significance was determined using a one-way ANOVA with a Bonferroni post-hoc test. RESULTS: The concentration of EBD within the lungs of mice undergoing I/R was nearly twice that of SHAM operated animals (p < 0.01, SHAM vs. I/R), an effect prevented by the administration of insulin (p < 0.05, I/R + insulin vs. I/R). Inhibition of NOS with L-NAME abolished insulin’s beneficial effect (p < 0.05, I/R + insulin vs. I/R + insulin + L-NAME). In the absence of I/R, insulin or L-NAME alone had no effect on pulmonary EBD concentration (data not shown). 15 min. Control 100 + 1.2 H2O2 101 + 0.3 insulin + H2O2 97 + 1.9 DT-2 + insulin + H2O2 98 + 0.8 60 94 73 94 min. + 1.1 + 1.3** + 2.7 90 92 66 90 min. + 0.2 + 1** + 3.1 120 min. 92 + 0.6 60 + 3.7*** 87 + 2.6 83 + 3.4* 69 + 5.2** 60 + 4.6*** dibutyrl cGMP + H2O2 99 + 0.6 90 + .03 88 + 0.2 85 + 0.5 CONCLUSIONS: Intestinal I/R causes pulmonary microvascular barrier dysfunction, which is prevented by insulin pretreatment. As in our in vitro studies on oxidant-stressed endothelial cells, this protective effect was dependent upon the activity of nitric oxide synthase. These data suggest that insulin’s protective effect on endothelial barrier function during pro-inflammatory states is related to insulin’s known stimulatory effect on endothelial nitric oxide release. Insulin Prevents Oxidant-Induced Endothelial Cell (Ec) Barrier Dysfunction And Actin Cytoskeletal Reorganization Through A Cgmp And Protein Kinase G Signaling Pathway Siddhartha Rath MD, Nicholas Mai, BS, Theodore Kalogeris, Ph.D, J. Steven Alexander, Ph.D, Gazi B Zibari MD, Richard H Turnage MD, Departments of Surgery and Physiology—Louisiana State University State University Health Sciences Center in Shreveport, Shreveport, LA PURPOSE: Insulin induces endothelial nitric oxide (NO) release through a PI3Kinase/eNOS signaling cascade. cGMP and PKG are downstream effectors of many of the physiologic effects of NO. Since PKG inhibits rho mediated actin cytoskeletal reorganization, we postulated that insulin’s effect on H2O2-induced endothelial cell (EC) barrier dysfunction is dependent upon PKG activity. METHODS: Confluent murine pulmonary EC monolayers were exposed to media (control), H2O2 (100µM), insulin (100nM) + H2O2, or insulin+ H2O2 + DT-2 (1-4 µM). Monolayer permeability was determined by measuring the trans-endothelial electrical resistance (TEER) every 15 min for 120 minutes. Other ECs were exposed to media, H2O2 or H2O2 + dibutyrl-cGMP (1mM, cGMP analog) after which TEER was measured. Fluorescent microscopy of AlexaFluor-488-phalloidin stained cells was performed to relate changes in barrier function to H2O2-induced actin skeletal reorganization. Scientific Abstracts 38 RESULTS: Insulin prevented H2O2-induced barrier dysfunction, whereas inhibition of PKG abolished insulin’s protective effect. Dibutyrl cGMP mimicked insulin’s protective effect. Microscopy demonstrated actin stress fibers and intercellular gaps in cells exposed to H2O2 but not in cells treated with H2O2 + insulin or dibutyrl cGMP. In contrast, actin stress fibers and intercellular gaps were readily apparent in cells exposed to H2O2 alone or H2O2 + insulin + DT-2, Experimental Groups (n=10) SHAM I/R I/R + insulin mg 0.9 1.7 0.9 EBD / g lung tissue + 0.2 + 0.2* + 0.3# I/R + insulin + L-NAME 1.6 + 0.2* ** * p < 0.01 vs. SHAM # p < 0.05 vs. I/R ** p < 0.05 vs. I/R + insulin * P< 0.05 vs. baseline, **P<0.01 vs. baseline, ***P<0.001 vs. baseline; Mean + SEM; statistical analysis with repeated measures ANOVA; p<0.05 considered significant. CONCLUSION: Together with our previous work, these data suggest that insulin modulates H2O2 –induced barrier dysfunction by activating a signal transduction pathway involving IRS-1/2/PI3K/Akt/eNOS/guanylylcyclase/PKG. FDG-Pet In The Staging And Surveillance For Patients With Cholangiocarcinoma Siddhartha Rath, MD, Kerry Byrnes, MD, Markus John, MD, David Lilian, Ph.D, Lester W. Johnson, MD, Richard H. Turnage, MD, Gazi B Zibari, MD, Departments of Surgery and Physiology—Louisiana State University State University Health Sciences Center in Shreveport, Shreveport, LA PURPOSE: FDG-PET is a valuable tool in both staging and surveillance of multiple malignancies. Cholangiocarcinoma is rare and frequently presents late. Computed tomography has become the gold standard in staging cholangiocarcinoma, however has weaknesses. The purpose of this study is to assess the value of conventional FDG-PET in both the staging and surveillance of patients with cholangiocarcinoma. METHODS: All patients with a diagnosis of cholangiocarcinoma from 1999-2004 were identified and reviewed retrospectively. Patients who underwent PET scanning as part of their staging preoperative workup and surveillance were selected. Concomitant computed tomography scans were reviewed when available. Pathology reports and operative findings were reviewed in detail. The sensitivity of both PET imaging and computed tomography was determined. RESULTS: Thirteen patients with cholangiocarcinoma who underwent FDG-PET scanning were identified. A total of 19 PET scans were obtained of which eight were performed as pre-operative staging; the remaining eleven underwent PET for surveillance. All patients who had pre-operative PET scans underwent surgery, (7 laparotomies, 1 laparoscopy), and in all cholangiocarcinoma was confirmed by histology. The sensitivity of PET in detecting primary disease was 100%. In two patients distant disease existed and PET scan accurately identified one of these. Eleven surveillance (post-operative) PET and CT scans were performed in seven patients. The sensitivity of PET in detecting recurrence was 100%. In comparison, computed tomography detected recurrence with a sensitivity of 33%. CONCLUSIONS: PET scan is a valuable tool for pre-operative staging of cholangiocarcinoma and compares favorably to conventional computed tomography as a surveillance tool. Gender Differences in Diabetic Patients following Coronary Artery Bypass Graft Surgery Andrew Ritchison MD1, J. Michael Smith MD FACS FACC FACP1,2, Amy M. Engel MA3 1. Department of Surgery, Good Samaritan Hospital, 2. Cardiac, Vascular, and Thoracic Surgery, Inc., 3. E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, OH Purpose: The objective of this study was to examine the influence of gender in diabetic patients following coronary artery bypass graft surgery (CABG). Methods: A study from an eleven year hospitalization cohort with prospective data collection was conducted. Included in the study were diabetic patients undergoing CABG surgery between October 1993 and May 2004 (N=2,781). Patients who underwent any surgery other CABG or had a previous cardiac surgery were excluded. The study examined 25 risk factors and 14 outcome variables. 39 Scientific Abstracts Results: Twelve risk factors were found to be significantly different between male and female diabetic undergoing CABG. Correlation coefficients were computed and resulted in three risk factors: age 70 or greater, abnormal LVH, and number of grafts. For outcomes variables, females experienced more renal complications, intra-operative complications, longer hospital stay, and mortality. Logistic regression analysis showed that after controlling for age, LVH, and number of grafts, female diabetic patients undergoing CABG were more likely to experience intra-operative complications (OR 1.8, 95% CI 1.1-3.0, p=0.025) and longer hospital stay (OR 0.99, 95% CI 0.97-0.99, p=0.039). However, there was no significant difference between male and female diabetics after CABG surgery with renal complications (OR 1.39, 95% CI 0.95-2.1, p=0.132) or mortality (OR 1.6, 95% CI 0.85-2.8, p=0.153). Conclusion: Diabetic females, when compared to diabetic males undergoing CABG have significantly more intraoperative complications and longer hospital stays following the procedure. Groin Lymphoceles Complicating Transfemoral Endovascular Aneurysm Repairs in Patients with Prior Rectal Surgery Andrew J. Ritchison, MD, Patrick E. Muck, MD, Mark McAndrew, MD, Section of Vascular Surgery, Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio BACKGROUND: Surgical exploration and ligation of leaking lymphatics is currently reported as the effective treatment for retroperitoneal lymphocele formation. However, additional procedures are sometimes necessary to gain better access to the vessels which can lead to transection of lymphatic channels. METHODS: Aortic endograft placement is quickly becoming a preferential alternative to open repair of abdominal aortic aneurysms with reduction in blood loss, decreased duration of aortic cross-clamping, cardiac stress, and reduced length and cost of hospitalization. With the advent of this new procedure, some otherwise non-preferential candidates are now being considered for repair. RESULTS: At our institution, two patients, age 69 and 72 with remote history of abdominoperineal resection and radiation therapy to the pelvic region for rectal cancer presented to the vascular surgeon for incidental finding of abdominal aortic aneurysm on follow-up CT scan for their rectal carcinoma. Both were found to be amenable to aortic endograft placement for treatment of their aneurysm and underwent their procedures without complication. CONCLUSION: Despite precautions, if pelvic lymphatic anatomy is “rerouted”, lymphoceles will most certainly appear if conventional dissection of the groin continues to be the accepted means for access to femoral vessels. Accessing femoral vessels percutaneously could alleviate some morbidity risk and would effectively bypass all dissection and severing of lymphatic channels following abdominoperineal resection. Fine Needle Aspiration Biopsy (FNA) In Diagnosis Of Benign And Malignant Breast Diseases A.A. Roscher, MD, CAP, ASCP, ICS (Hon), International College of Surgeons Honorary Fellow, Clinical Professor University of Southern California, Keck School of Medicine. In 1931Martin and Ellis utilized fine needle aspiration in the diagnosis of head and neck tumors successfully. Subsequently in 1932, Stewart published 2300 cases of fine needle aspiration in the breast in the diagnosis of mammary neoplasms. After that, there was a significant long dormant period of fine needle aspiration. It did not catch on in the United States until the European experience initiated by Sixteen Francen, from the Karolinske Institute in Stockholm Sweden. Dr. Francen was a clinical oncologist utilizing this method diagnosing various neoplasms at different body sites. In the mid-70s and early 80s, this method was introduced in the United States and then became rapidly recognized as an important diagnostic tool in the diagnosis of neoplastic diseases. This method is utilized in university and non-university centers throughout the country and is readily available in fine needle aspiration clinics. Fine needle aspiration of the breast has become a very common and routine modality in preoperative diagnosis of surgical breast lesions. The reliability, accuracy, and sensitivity are in the neighborhood of 92-96%. Of paramount importance is the need to produce an adequate sample, the expert preparation of the specimen, and ultimately the interpretation by qualified cytotechnologists and/or pathologists specifically trained in the techniques of fine needle aspiration. The process of securing the sample, preparation of the sample, and interpretation of the sample has to be 100% in order to achieve a high diagnostic accuracy level. Fine needle aspiration of the breast is ordinarily done in the office of the physician, at the hospital bedside of the patient, and diagnostic interpretation is rendered within a few minutes. This gives an accurate assessment of the patient’s condition, which allows for further management of the patient, such as observation, excisional biopsy, and/or subsequent more radical procedures if the process has determined a malignant lesion. Lesions rapidly diagnosed with this technique include fibroadenomas of the breast, lipomas, and phylloides tumors. Fine needle aspiration allows the diagnosis of malignant lesions of the breast, immediately making decision making for the surgeon very timely and accurate. Scientific Abstracts 40 Fine needle aspiration has been amplified in recent years with the technique of core biopsies, which yield, in addition to the diagnosis of malignancy, also the pattern of the lesion, in particular whether the lesion is in situ and/or infiltrative. Fine needle aspirations of the breast are ordinarily not allowing a differentiation between in situ and/or infiltrative lesion. However, using cytology in association with core biopsy renders this methodology of high value. Material produced by fine needle aspiration from a malignant lesion can be submitted for further studies utilizing immunohistochemistry to assess estrogen (ERA) and progesterone (PRA) positivity and other diagnostic parameters. Some of the benefits of fine needle aspiration for the patient include cost containment, no hospitalization, absence of general anesthesia, and rapidity of the procedure for full diagnosis. Fine needle aspiration on breast lesions, for instance, allows optimizing scheduling of the patient for surgery and reducing a two-stage procedure to a onestage procedure, where only one general anesthetic is required when needle aspiration is successfully utilized. As contrasted to the dual procedure, where excision of the lesion is done under general anesthesia with frozen section and subsequently, several weeks later, a second procedure is carried out for mastectomy if the diagnosis of malignancy was rendered beforehand. Complications of fine needle aspiration are rare and are usually associated only with hematoma and possible skin irritation. The ever-present worry of potential spread of malignancy from the aspiration procedure has not been justified based on almost no reports in the literature. One paramount reason for the scarcity or absence of demonstrated seeding of malignant cells in the biopsy site is probably due to the fact that subsequent surgical procedures and/or chemotherapy associated with radiation eliminates tumor spread in the area of investigation and also the few tumor cells spread during the procedure may be destroyed by the natural immune mechanism of the patient. The benefits and accuracy of fine needle aspiration is well documented and will remain a significant diagnostic tool in the armamentarium and diagnosis of neoplastic diseases. Solitary Fibrous Tumor Of The Pleura Sibu P. Saha, MD, MBA, Professor of Surgery, University of Kentucky, Lexington, KY Purpose: Solitary fibrous tumor of the pleura is a rare clinical entity. Approximately 600 such cases have been reported in the literature. The purpose of this study was to review the surgical outcome of this disease. Methods: This is a retrospective review of 4 cases of Solitary Fibrous tumor of the pleura. There were 3 women and 1 man. Their ages ranged from 24 to 65 years. Symptoms included cough, shortness of breath and chest pain. Diagnostic studies included chest x-ray, CT scan, bronchoscopy and CT guided needle biopsy. All the tumors were pedunculated. The sizes ranged from 5.0 cm to 11.0 cm. All of them were resected via thoracotomy. The largest of these tumors weighed 68 grams. Results: All patients remain disease free. Follow up ranged from 2 to 20 years. Conclusion: This is a rare disease. Complete resection offers the best chance for long-term care. Safety of the Flex 10 Microwave Catheter with Repeated Ablations in a Canine Model J. Michael Smith MD1,2, Mohammed Hassan MD1, Jenny Hawes MD1, Elias Darido MD1, Amy M. Engel MA3 1. Department of Surgery, Good Samaritan Hospital, 2. Cardiac, Vascular, and Thoracic Surgeons, Inc., 3. The E. Kenneth Hatton, MD, Institute for Research and Education Purpose: Surgical treatment of atrial fibrillation using a unipolar energy source has resulted in case reports of mediastinal injury, including esophageal perforation. The objective of our study was to test the safety of a unipolar microwave catheter, when used repeatedly, to ablate cardiac tissue and assess for evidence of mediastinal tissue damage. Methods: Ten canine subjects underwent a right chest, daVinci robotic beating heart left atrial isolation procedure using Guidant’s Flex 10 catheter. Six subjects completed the procedure with the aim of ablating the tissue ten times each. The subjects were recovered and followed for three months. Results: Five of the six subjects achieved ten ablations and one achieved three and a half ablations secondary to catheter dysfunction. All six subjects made an uneventful recovery and underwent autopsy at three months. At autopsy there was no evidence of “collateral” damage to any mediastinal tissue. Conclusion: Even with maximal ablations, no subject suffered an adverse outcome such as esophageal or mediastinal injury. 41 Scientific Abstracts Current Surgical Therapy for Weight Loss in the United States Albert T. Spaw, MD, FACS, FICS, Nashville, TN Of the 295 million people in the United States, 40 million are overweight and of those, nearly 30% are morbidly obese. The term “morbid obesity” is defined specifically as a body mass index (BMI) greater or equal to 40 or generally as a weight greater than 200% of ideal body weight. Medical conditions associated morbid obesity are type II diabetes, hypertension, obstructive sleep apnea, hyperlipidemias, osteoarthritis and malignancy. In the United States, 100 billion dollars or 5% of the total health care dollar are spent annually on obesity-related illnesses. Surgical therapy offers the only reliable option for sustainable, long-term weight loss in the morbidly obese population. Three surgical procedures have evolved to become the main armamentarium for weight loss surgeons, laparoscopic adjustable gastric banding (Lap Band), Roux-en-Y gastric bypass (RYGBP), and biliopancreatic diversion with duodenal switch (BPD-DS). Two primary strategies are employed in the surgical management of morbid obesity, restriction and malabsorption. Restriction results from surgically creating a small-capacity gastric pouch thereby limiting meal volume and decreasing caloric intake. Malabsorption, on the other hand results from bypassing significant lengths of small intestine, limiting the ability to absorb ingested nutrients. The Lap Band procedure offers restriction as the primary and only strategy for limiting intake of nutrition. RYGBP and BPD-DS combine both reductive and malabsorptive strategies and, therefore result in more durable weight loss. The surgical technique, expected weight loss, risks, long-term complications and mortality associated with each of these procedures will be discussed. Long-Term Management of the Bariatric Patient Albert T. Spaw, MD, FACS, FICS, Nashville, TN The primary benefit of weight loss surgery is the permanent resolution of obesity-related diseases as hypertension, type 2 diabetes, hyperlipidemias and obstructive sleep apnea. These benefits have been repeatedly documented in numerous published analyses of the effects of weight loss surgery. The Roux-en-Y gastric bypass (RYGBP) is the most common procedure performed for weight loss in the United States. Evaluation of abdominal pain or nausea and vomiting in the RYGBP patient requires an understanding of the alterations in GI anatomy. CT scanning with oral and IV contrast provides the most sensitive assessment of the causes of gastrointestinal symptoms after RYGBP. Small bowel obstruction may result from internal herniae or adhesive disease. When reviewing abdominal CT scans in the RYGBP patient, it is important to remember that only the gastric pouch and the Roux limb will fill with oral contrast; the bypassed stomach, duodenum and proximal biliopancreatic limb should appear decompressed and without luminal contrast. Strictures at the gastojejunal anastomosis occur in 7- 10% of RYGBP patients. Upper endoscopy is useful in the assessment and therapy of marginal ulcers and anastomotic strictures. The efficacy of the RYGBP is based on the restrictive nature of the procedure; however, the detrimental long-term metabolic consequences result from the malabsorptive effect of bypassing the stomach and duodenum. Because the duodenum is the primary site for calcium and iron absorption, RYGBP patients face a life-long requirement for the daily ingestion of high doses calcium, iron, intrinsic factor, B12 and vitamin D to avoid deficiencies. Compliance with daily vitamin and nutrient ingestion may become problematic in RYGBP patients. Long-term calcium and iron deficiencies eventually result in osteoporosis and anemia. Hypovitaminoses are also well-known consequences in those non-compliant RYGBP patients. Scientific Abstracts 42 Results Of a Multi-Center Single Practice Cryosurgical Therapy For Prostate And Renal Cancer Arnold. J. Willis MD, FICS Purpose: To show the successful results of a minimally invasive approach to GU cancers treated by percutaneous or laproscopically approached cryosurgy. Methods: Mid -Atlantic Cryotherapy ,LtC supplies training, equipment and proctoring for all participating centers. We collated and present the results of 92 prostate cancer patients and 67 renal cancer patients treated by our group and the outcomes. All participating Urologists were fully trained in the same fashion to insure consistency and were proctored for control purposes. The results are presented herein. Results: 92 prostate cancer patients were successfully treated with cure or control of their cancer with minimal complications. The complications include : ~.2 % tissue sloughing 3.2 % stress urinary incontinence 1.1 % pelvic pain 1,1 % transient obstruction 67 renal cancer patients were successfully treated with cure or control with the following complications: 2 2 1 1 2 blood transfusIons nausea with vomiting patient with postop confusion 1 atrial fibrillation 1 plewal effusion acute nephrectomy delayed nephrectomy Conclusion: We feel that our results show the safety and efficacy of cryosurgical ablation of Adenocarcinomas of the Prostate and Kidney. The patient’s hospital stays were shortened and in fact mostly required only outpatient stays. The cure rates and control rates were equivalent to open treatment with less risk and cost to the patient. In conclusion, we feel cryosurgery with modern techniques offer the patient effective cure and improved outcomes. A Novel and Inexpensive Technique for Inguinal Hernia Repair Stephen Yoo, MD, Michael J Jacobs, MD, FACS, and Sumet Silapaswan, MD, FACS, Department of Surgery, Division of General Surgery, Providence Hospital and Medical Centers, Southfield, Michigan In 2003, more than 800,000 herniorrhaphies were performed in the United States and the majority were for inguinal hernias.i The outcome of a hernia repair is affected by several features, including: Durability; pain; operative time; cost; and time away from routine function. Despite the numerous operative approaches that have been undertaken for such a common problem, the technique and results of herniorraphy have remained a topic of discordance among surgeons.ii Though the recent debate addresses the suitability of laparoscopic techniques for the management of inguinal hernias, the merit and utility of open repairs have been well proven.iii Most surgeons, however, would agree that excess tension applied to the repair is a risk factor for recurrence. Successful open methods that help to improve tissue reinforcement and limit tension include the Lichtenstein tension-free repair and various mesh-plug repairs. Unfortunately, none of these methods directly address the outward force specifically involved in direct inguinal hernias.4,5 Herein, we describe a method that directly stabilizes and counters the outward force vectors by incorporating the hernia floor with a rolled polypropylene mesh into a triple-buttress repair (Figure 1). Technique: 1. 2. 3. A standard oblique supra-inguinal incision is made to include Scarpa’s fascia and the external oblique aponeurosis. The spermatic cord is isolated to expose the inguinal floor and transversalis muscle. If present, an indirect hernia sac is mobilized and reduced through the internal ring. The nerves are dissected and preserved. The preperitoneal space is dissected medial to the internal ring for 2-3 cm and superiorly with relation to the spermatic cord to create a space for lateral mesh placement. Infero-medially, a 1 cm cranio-caudal incision is placed in the transversalis fascia (inguinal floor) approximately 1-2 cm from the suprapubic tubercle to expose the preperitoneal space (Figure 2). 43 Scientific Abstracts 4. 5. 6. 7. 8. Blunt dissection posterio-medial to the pubis is performed to accommodate medial mesh placement. A rolled polypropylene mesh is cut to length and may be sutured to itself on both ends. The ends of the mesh are inserted into the internal ring laterally and the transversalis orifice medially, enabling the mesh-coil to function as a truss rod that is triply-buttressed when sutured in place (Figure 3). The mesh is secured by a few interrupted sutures superiorly to the conjoined tendon and inferiorly to the shelving edge of the inguinal ligament (Figure 4). An overlay mesh can be fashioned and sutured to the shelving edge of the inguinal ligament inferiorly, internal oblique superiorly, and medially along the lateral border of the investing fibers of the rectus fascia. This step is not mandatory. The ilioinguinal nerve and spermatic cord are returned to their anatomic positions. External oblique and remainder of the incision are sutured in layers to complete the operation. Discussion: The immediate effect of the rolled mesh is to provide strength and reinforcement to the inguinal floor, which is based on the ability to transfer, buttress, and distribute the tension equally and circumferentially. Apropos to direct hernias, force and tension are taken up by the mesh and transferred medially and laterally rather than to the re-approximated suture lines. This technique takes advantage of the Lichtenstein tension-free mesh repair through the reduction of forces applied to the tissue edges that enables a synergistic effect of the two methods.4 The application of the rolled-mesh method has been shown in our clinical experience to produce superior patient outcomes. The procedure can be performed with little difficulty and does not require additional expensive mesh material or composite hernia systems. In our practice, these outcomes have manifested lower recurrence rates and less post-operative pain, compared with non-mesh or plug-repair techniques. References: 1. 2. 3. 4. 5. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 2003;83:1045-51. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2003;90:1479-92. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819-27. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989;157:188-93. Hay JM, Boudet MJ, Fingerhut A, et al. Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients. Ann Surg 1995;222:719-727. Scientific Abstracts 44 Presenter Index A M Carlos Avellanet . . . . . . . . . . . . . . . . . . . . . . . . 17 David A. Machado-Aranda . . . . . . . . . . . . . . . . 19 David L. Matlock . . . . . . . . . . . . . . . . . . . . . . . 17 Michael McCue . . . . . . . . . . . . . . . . . . . . . . 15,16 Margaret McNelis. . . . . . . . . . . . . . . . . . . . . 19,21 H. L. Rick Milne . . . . . . . . . . . . . . . . . . . . . . . . 20 David J. Minion . . . . . . . . . . . . . . . . . . . . . . . . 18 Debabrata Mukherjee . . . . . . . . . . . . . . . . . . . . 18 B Joseph A. Bachicha . . . . . . . . . . . . . . . . . . . . . 10 James D. Bauer . . . . . . . . . . . . . . . . . . . . . . . . 17 Chris Blanton . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Hanadi Bu-Ali . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Bryan Butler . . . . . . . . . . . . . . . . . . . . . . . . 15-16 John G. Byrne . . . . . . . . . . . . . . . . . . . . . . . . . 17 Kerry Byrnes . . . . . . . . . . . . . . . . . . . . . . . . . . 23 C Jerome Canady . . . . . Kongkrit Chaiyasate . . Yeon-Jeen Chang . . . . Chia-Fu Chang . . . . . . Christopher Chen . . . . Wayne Crewe-Brown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 22 14 22 10 20 Anthony N. Dardano, Jr. . . . Elias Darido . . . . . . . . . . . . Raymond Andrew Dieter III Raymond A. Dieter, Jr. . . . . Cataldo Doria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 17 18 22 12 D . . . . . . . . . . . . . . . . . . N Kari M. Navin . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Dave Newhouse . . . . . . . . . . . . . . . . . . . . . . . 10 Enrico Nicolo . . . . . . . . . . . . . . . . . . . . . . . . . . 22 P Chris Pavone . . . . . . . . . . . . . . . . . . . . . . . . . . 20 P.J. Pearson . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Marco A. Pelosi II . . . . . . . . . . . . . . . . . . . . . . . 16 Marco A. Pelosi III . . . . . . . . . . . . . . . . . . . . . . 16 Raul Perea-Henze . . . . . . . . . . . . . . . . . . . . . . 10 Madhav V. Phadke . . . . . . . . . . . . . . . . . . . . . . 14 Alfonso E. Pino . . . . . . . . . . . . . . . . . . . . . . 13,14 Alvin C. Powers . . . . . . . . . . . . . . . . . . . . . . . . 23 R Steven I. Rabin . . . . . . . . . . . . . . . . . . . . . . . . 14 Roque J. Ramirez . . . . . . . . . . . . . . . . . . . . 21,22 Edwin Ramirez . . . . . . . . . . . . . . . . . . . . . . . . 22 Jose G. Ramon . . . . . . . . . . . . . . . . . . . . . . . . 14 Dinesh Ranjan . . . . . . . . . . . . . . . . . . . . . . . . . 11 Siddhartha Rath . . . . . . . . . . . . . . . . . . . . . 12,23 Andrew J. Ritchison . . . . . . . . . . . . . . . . . . . . . 18 Fidel Ruiz Healy . . . . . . . . . . . . . . . . . . . . . . . . 14 F Konstantinos N. Fountas . . . . . . . . . . . . . . . . . 13 John H. Fournier . . . . . . . . . . . . . . . . . . . . . . . 20 Gary C. Freeman . . . . . . . . . . . . . . . . . . . . . . . 10 G S John Galanis . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Ganepola Ganepola . . . . . . . . . . . . . . . . . . . . . 10 J. Antonio Garcia . . . . . . . . . . . . . . . . . . . . . . . 17 Johnny L. Gayton . . . . . . . . . . . . . . . . . . . . 20,21 Mark I. Golden . . . . . . . . . . . . . . . . . . . . 19,20,21 Eduardo Gonzalez-Hernandez . . . . . . . . . . . . . 13 James P. Greelish. . . . . . . . . . . . . . . . . . . . . . . 17 Gerald Q. Greenfield, Jr. . . . . . . . . . . . . . . . . . . 13 Donald W. Griffin . . . . . . . . . . . . . . . . . . . . . . . 22 Adib H. Sabbagh . . . . . . . . . . . . . . . . . . . . . . . 22 Sibu Pada Saha . . . . . . . . . . . . . . . . . . . . . 17,18 Reza F. Saidi . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Richard Santucci . . . . . . . . . . . . . . . . . . . . . . . 17 Larry S. Sasaki . . . . . . . . . . . . . . . . . 14,15,16,21 Mala Seshagiri . . . . . . . . . . . . . . . . . . . . . . . . . 10 David Shaffer . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Ajay Singla. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 J. Michael Smith . . . . . . . . . . . . . . . . . . . . . . . . 18 Albert T. Spaw . . . . . . . . . . . . . . . . . . . . . . . . . 22 H Nadey Hakim . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Diana M. Hatsis . . . . . . . . . . . . . . . . . . . . . . . . 20 Kevin W. Hatton . . . . . . . . . . . . . . . . . . . . . . . . 12 Marta Helenowski . . . . . . . . . . . . . . . . . . . . . . 18 Alan J. Herline . . . . . . . . . . . . . . . . . . . . . . . 15,16 Michael D. Holzman . . . . . . . . . . . . . . . . . . . . . 22 John Husted . . . . . . . . . . . . . . . . . . . . . . . . . . 21 T J W Alfonso Torquati . . . . . . . . . . . . . . . . . . . . . . . 22 V Wickii T. Vigneswaran . . . . . . . . . . . . . . . . . 17,19 Bill Voyles . . . . . . . . . . . . . . . . . . . . . . . . . . 19,20 M. Salik A. Jahania. . . . . . . . . . . . . . . . . . . . . . 18 Arnold J. Willis . . . . . . . . . . . . . . . . . . . . . . . . . 17 Paul E. Wise . . . . . . . . . . . . . . . . . . . . . . . . 15,16 J. Kelly Wright. . . . . . . . . . . . . . . . . . . . . . . . . . 12 K Karthikeshwar Kasirajan . . . . . . . . . . . . . . . . . . 18 Y L Stephen Yoo . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Fernando Lamounier . . . . . . . . . . . . . . . . . . . . 19 Thom E. Lobe . . . . . . . . . . . . . . . . . . . . . . . . . 22 Jim Loden . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 z Gazi Zibari . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 45 46 All events scheduled as part of the 68th Annual Surgical Update of the International College of Surgeons will be located on the Mezzanine Level of the Downtown Nashville Hilton, unless otherswise noted. Schedule at a Glance Wednesday Thursday 21-Jun-06 Continental Breakfast 7:00 AM - 9:00 AM Prefunction 22-Jun-06 Meeting Registration 7:00 AM - 2:00 PM Prefunction Executive Committee Meeting 7:00 AM - 8:00 AM Ryman 1 Complimentary Breakfast Buffet 7:30 AM - 8:30 AM Armstrong 1 COMBINED STANDING COMMITTEE MEETING AMA Advisory Committee Constitution and Bylaws Board of Trustees Cultural Diversity and a Competent Surgical Practice 8:30 AM - Noon Boone Endowment Board of Directors Ethics & Greivance Committee Fund Raising Committee Honors Committee Past Presidents Committee Scholarship Committee 8:00 AM - 10:00 PM Ryman 1 Morning Coffee Break 9:50 AM - 10:05 AM Prefunction Alliance Meet & Greet 10:30 AM - 11:30 AM Armstrong 2 Alliance Board of Directors and General Membership Meeting 9:00 AM - 10:00 AM Ryman 2 Thursday Lunch 12:00 PM - 1:15 PM Armstrong 1 CME Committee and Council of Specialty Group Chairs 10:00 AM - 12:00 PM Ryman 2 Deposition Skills: How to Prepare, How to Protect, and How to Perform 1:30 PM - 2:30 PM Boone Meeting Registration Noon - 4:00 PM Prefunction Officer & Alliance Luncheon 12:00 PM - 1:00 PM Park View Café Board of Regents 1:00 PM - 2:30 PM Ryman 3 Executive Council and House of Delegates Joint Meeting 2:30 PM - 5:00 PM Ryman 3 Executive Committee Meeting 5:00 PM - 6:00 PM Ryman 2 Tsunami: Global Disaster, International Solutions 2:30 PM - 3:00 PM Boone Convocation and Presidential Recognition Ceremony 4:00 PM - 5:00 PM Armstrong I & II New Fellow Reception 5:00 PM - 6:00 PM Prefunction Friday 23-Jun-06 Meeting Registration 7:00 AM - 2:00 PM Prefunction Continental Breakfast 7:30 AM - 8:30 AM Prefunction Orthopaedic Trauma and The Future of Biological Treatment 8:30 AM - Noon McKissack 1 Surgical Cure Of Diabetes 8:30 AM - 12:30 PM Boone Colorectal Surgery Case Reports and Free Papers 8:30 AM - 9:30 AM Armstrong 1 Laparoscopic Colectomy: A Hands-On Workshop 9:30 AM - 4:45 PM Armstrong 1 Morning Coffee Break 10:30 AM - 11:00 AM Prefunction American Fracture Association General Membership Meeting Noon - 12:30 PM McKissack 1 Friday Lunch 12:30 PM - 1:30 PM Armstrong 2 Cosmetic Gynecologic Surgery And Urological Trauma In Gynecologic Surgery 1:30 PM - 5:45 PM McKissack 1 Endovascular Therapy For Aneurysmal Disease And Quality and Cost Measurements In Thoracic Surgery 1:30 PM - 6:00 PM Boone Saturday 24-Jun-06 Meeting Registration 7:00 AM - 2:00 PM Prefunction Continental Breakfast 7:30 AM - 8:30 AM Prefunction Laparoscopic Colectomy: Workshop 8:00 AM - 5:00 PM Prefunction AANOS 8:30 AM - 4:30 PM Armstrong 2 Presbyopia and the Aging Eye 8:30 AM - 5:30 PM Ryman 3 Surgery for Obesity and It’s Co-Morbidities 8:30 AM - 2:30 PM Crockett Morning Coffee Break 10:35 AM - 10:50 AM Prefunction Past President’s Luncheon 12:30 PM - 1:30 PM Armstrong 1 General Session 2:30 PM - 5:30 PM Crockett Afternoon Coffee Break 3:30 PM - 3:45 PM Prefunction Closing Dinner 7:00 PM - 10:00 PM Boone Afternoon Coffee Break 3:00 PM - 3:45 PM Prefunction Alliance Walking Tour 3:00 PM - 4:30 PM Prefunction American Academy of Neurological and Orthopaedic Surgery Business Meeting 3:00 PM - 5:00 PM McKissack 2 California, Illinois and Texas Division Business Meetings 6:00 PM - 7:00 PM McKissack 1 All events scheduled as part of the 68th Annual Surgical Update of the International College of Surgeons will be located on the Mezzanine Level of the Downtown Nashville Hilton, unless otherswise noted.
