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Postoperative adhesion formation in a rabbit model: monopolar electrosurgery versus ultrasonic scalpel

Vetere, Patrick F; Lazarou, George; Apostol, Radu; Khullar, Poonam; Okonkwo, Linda; Nezhat, Farr
BACKGROUND AND OBJECTIVES/OBJECTIVE:To determine if surgery using ultrasonic energy for dissection results in less adhesion formation than monopolar electrosurgical energy in the late (8 weeks) postoperative period. METHODS:Injuries were induced in rabbits by using ultrasonic energy on one uterine horn and the adjacent pelvic sidewall and using monopolar energy on the opposite side. Eight weeks postoperatively, the rabbits underwent autopsy and clinical and pathologic scoring of adhesions was performed by blinded investigators. RESULTS:There was no significant difference in clinical adhesion scores between the two modalities. The mean clinical score for monopolar cautery was 1.00 versus 0.88 for the Harmonic device (Ethicon Endo-Surgery, Cincinnati, Ohio) (P = .71). Furthermore, there was no significant difference found in the pathologic adhesion scores between the ultrasonic scalpel and monopolar energy. The mean pathologic score for monopolar electrosurgery was 4.35 versus 3.65 for the Harmonic scalpel (P = .30). CONCLUSION/CONCLUSIONS:Neither monopolar electrosurgery nor ultrasonic dissection is superior in the prevention of adhesion formation in the late postoperative period.
PMID: 26005316
ISSN: 1938-3797
CID: 3432232

Clinical dilemma of positive histologic chorioamnionitis in term newborn

Cuna, Alain; Hakima, Laleh; Tseng, Yun-An; Fornier, Bianca; Islam, Shahidul; Quintos-Alagheband, Maria Lyn; Khullar, Poonam; Weinberger, Barry; Hanna, Nazeeh
BACKGROUND:Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known. OBJECTIVES/OBJECTIVE:To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns. METHODS:The incidence of HCA and EOCS in term infants born during 2008-2009 was evaluated in a single center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated. RESULTS:Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% confidence interval 1.6-4.2, P < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS. CONCLUSION/CONCLUSIONS:Although HCA in term infants is associated with EOCS, it did not improve the ability of CRP and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.
PMCID:3983512
PMID: 24772410
ISSN: 2296-2360
CID: 3569112

The Prognostic Significance of Lower Uterine Segment Involvement in Endometrioid Endometrial Adenocarcinoma [Meeting Abstract]

Ogden, Lorna; Hakima, Laleh; Feuerman, Martin; Bondoc, Christopher; Villella, Jeannine; Khullar, Poonam
ISI:000209848700085
ISSN: 0002-9173
CID: 3533802

Neonatal Selective Head Cooling: Associated Placental Pathology. [Meeting Abstract]

Yeh, Corinne; Khullar, Poonam; Demishev, Michael; Saleh, Iman; Kinzler, Wendy; Chavez, Martin; Vintzileos, Anthony
ISI:000329543603052
ISSN: 1933-7191
CID: 3319582

Strategies to minimize adhesion formation after surgery

Vetere, Patrick F; Lazarou, George; Mondesir, Carlene; Wei, Kai; Khullar, Poonan; Ogden, Lorna
OBJECTIVES/OBJECTIVE:To compare the potential for postoperative laparoscopic adhesion formation utilizing either monopolar cautery or ultrasonic energy and to determine whether there is added benefit with the addition of a suspension of hyaluronate/carboxymethylcellulose in saline versus saline alone. METHODS:Injuries were induced in rabbits by using monopolar cautery on 1 uterine horn and adjacent sidewall and ultrasonic energy on the opposite. Hyaluronate/carboxymethylcellulose or saline was added to every other animal. Autopsies were performed after 3 weeks. Clinical and pathologic scoring of adhesions was performed by blinded investigators. RESULTS:A very significant difference occurred in pathologic adhesion scores favoring the ultrasonic scalpel when the animals were treated with saline. However, a borderline significant difference was found in pathologic scores favoring the ultrasonic scalpel compared to the monopolar cautery. There was no significant difference in clinical adhesion scores between the 2 modalities. No significant difference in either score was found with the addition of hyaluronate/carboxymethylcellulose or saline with either instrument. CONCLUSION/CONCLUSIONS:No benefit was found for adhesion prevention with hyaluronate/carboxymethylcellulose. Although no reduction was achieved in clinical adhesions, the ultrasonic scalpel resulted in fewer histologic signs of tissue inflammation in the early postoperative period, suggesting that further clinical adhesions might develop over time with cautery.
PMID: 21985723
ISSN: 1086-8089
CID: 3432152

Radiology-Pathology Conference: Mature teratoma arising from an intra-abdominal undescended testis in a 7-month-old infant [Case Report]

Yam, Benjamin; Georgiou, Nicholas A; Khullar, Poonam; Coren, Charles V; Katz, Douglas S
We report a rare case of an intra-abdominal testicular mature teratoma in a 7-month-old male infant presenting with a palpable abdominal mass and unilateral undescended testis. We describe the pathology, clinical presentation, and imaging findings of this entity. Clinical features accompanied by characteristic radiologic findings guide a provisional diagnosis that is confirmed by histologic analysis following surgical removal of the tumor. The pathogenesis and radiologic findings of testicular mature teratomas in the prepubertal population share many similarities to that of mature ovarian teratomas commonly seen in females of reproductive age. Awareness of this entity will permit the radiologist to suggest timely diagnosis and intervention when presented with a similar case.
PMID: 21092878
ISSN: 1873-4499
CID: 3003392

Endoscopic mucosal resection of a mid-esophageal carcinoid with EUS guidance [Case Report]

Babich, J P; Klein, J; Khullar, P; Friedel, D M
PMID: 21113882
ISSN: 1438-8812
CID: 3411452

Fluorescence in situ hybridization (FISH) break-apart probe helps detect lymphoma using fine-needle aspiration cell block material [Meeting Abstract]

Bragdon, Jeremy; Khullar, Poonam; Gupta, Mala; Koduru, Prasad
ISI:000259323400059
ISSN: 0002-9173
CID: 3533832

Radiology-Pathology Conference: choledochal cyst [Case Report]

Wax, Bobbi N; Durie, Nicole M; Khullar, Poonam; Price, Anita P; Coren, Charles V; Katz, Douglas S
We report the radiologic and pathologic findings of a newborn with a choledochal cyst and review the etiology, diagnostic considerations, and management of this entity.
PMID: 17599622
ISSN: 0899-7071
CID: 3002472

Lymphomatoid granulomatosis in a pediatric patient [Case Report]

Mazzie, Joseph P; Price, Anita P; Khullar, Poonam; Montoya, Carlos H; Roberts, Jon E; Lee, Haesoon; Williams, Lewis; Schuss, Allan; Katz, Douglas S
We report the radiology and pathology of a pediatric patient with lymphomatoid granulomatosis (LG) and review the literature, with an emphasis on the radiological findings and on the small subset of pediatric patients with this rare condition.
PMID: 15158227
ISSN: 0899-7071
CID: 3002282