Surgeons
31 years of experience

Accepting new patients
30 Medical Center Blvd
Ste 102
Chester, PA 19013
610-619-7400
Locations and availability (5)

Education ?

Medical School
Medical College of Ohio (1979)

Awards & Distinctions ?

Awards  
"Top Doctors" in General Surgery, Main Line Today (2011)
Patients' Choice Award (2010 - 2013)
Compassionate Doctor Recognition (2010, 2012 - 2013)
Associations
American Board of Surgery
American Burn Association

Affiliations ?

Dr. Patton is affiliated with 13 hospitals.

Hospital Affilations

Score

Rankings

  • Main Line Hospital - Bryn Mawr
    130 S Bryn Mawr Ave, Bryn Mawr, PA 19010
    • Currently 4 of 4 crosses
    Top 25%
  • Bryn Mawr Rehabilitation Hospital
    414 Paoli Pike, Malvern, PA 19355
    • Currently 4 of 4 crosses
    Top 25%
  • Riddle Memorial Hospital
    1068 W Baltimore Pike, Media, PA 19063
    • Currently 3 of 4 crosses
    Top 50%
  • Taylor Hospital - Crozer Chester
    175 E Chester Pike, Ridley Park, PA 19078
    • Currently 2 of 4 crosses
  • Delaware County Memorial Hospital
    501 N Lansdowne Ave, Drexel Hill, PA 19026
    • Currently 2 of 4 crosses
  • Crozer-Chester Medical Center
    1 Medical Center Blvd, Chester, PA 19013
    • Currently 2 of 4 crosses
  • Springfield Hospital - Crozer Chester
    201 Reeceville Rd, Coatesville, PA 19320
    • Currently 1 of 4 crosses
  • Ccmc - Taylor Hospital
  • Riddle Hospital
  • Riddle Memorial Hospital, Media, Pa
  • Taylor Hospital,
  • Springfield Hospital
  • Riddle Hospital - On staff since
  • Publications & Research

    Dr. Patton has contributed to 42 publications.
    Title Long-term Suppression of Fertility in Female Giraffe Using the Gnrh Agonist Deslorelin As a Long-acting Implant.
    Date July 2007
    Journal Theriogenology
    Excerpt

    Zoological institutions provide an environment conducive to studying proximate mechanisms influencing reproduction that can provide guidance to both field and captive settings seeking to manage their stock. Both national parks and zoos have space limitations that sometimes require the use of reversible contraception in order to reduce reproductive rate or limit specific individuals from reproducing. We designed a study to test the efficacy of a long-lasting contraceptive in female giraffe by monitoring reproductive endocrinology and behavior. We implanted two animals with the GnRH agonist deslorelin and monitored their endocrine status using fecal steroid analysis. We have previously validated an assay for fecal pregnanes and here we report our validation for fecal estrogens. Both sex steroid concentrations were suppressed in two females, although one female exhibited an immediate post-implantation positive feedback response. Sexual activity nearly disappeared in one animal, whereas the other showed regular sexual behavior. The contraceptive effect lasted for at least 472 d, and successfully suppressed estrous cyclicity in one female for >2 y. We conclude that deslorelin implants provide a minimally invasive means for long-term suppression of reproduction in female giraffe.

    Title Quality Assurance Assessment of the Use of Linezolid in the Treatment of Thermal Injury Patients at a Community Teaching Hospital.
    Date March 2007
    Journal Journal of Burn Care & Research : Official Publication of the American Burn Association
    Excerpt

    We sought to evaluate the adverse effect profile of linezolid among thermal injury patients requiring treatment for Enterococcus species or other Gram-positive infection warranting treatment with linezolid. Seventy-six inhalation injury and/or thermal injury patients experiencing 94 exposures to linezolid for 48 hours or longer (range, 2-83 days) were included. We evaluated leukocyte count and platelet count for the time period preceding, during, and after therapy with linezolid based on specified time periods of exposure for evaluation of specific adverse effects. Sixty-three of 76 (83%) patient admissions were complicated by inhalation injury. The average TBSA involvement was 34.4% (range, 0-98%). The onset of thrombocytopenia before linezolid therapy was noted in 21 of 57 patients (36.8%), which was attributable to fluid resuscitation and acute platelet consumption. After they were exposure to linezolid, 12 patients developed thrombocytopenia. Platelet counts recovered in 7 of these 12 patients with continued exposure to linezolid; however, thrombocytopenia persisted for more than 9 days after therapy in 9 patients, of whom 6 patients succumbed to sepsis. On average, thrombocytes increased by 102,000/mm3 during linezolid treatment. Leucopenia was rare in thermal injury patients, and persisting thrombocytopenia in this population was associated with sepsis and mortality. Continuing linezolid therapy after the onset of thrombocytopenia among survivors almost always resulted in recovery from thrombocytopenia.

    Title Faecal Glucocorticoid Metabolites and Alarm Calling in Free-living Yellow-bellied Marmots.
    Date January 2007
    Journal Biology Letters
    Excerpt

    When individuals of a variety of species encounter a potential predator, some, but not all, emit alarm calls. To explain the proximate basis of this variation, we compared faecal glucocorticoid metabolite concentrations in live-trapped yellow-bellied marmots (Marmota flaviventris) between occasions when they did and did not emit alarm calls. We found that marmots had significantly higher glucocorticoid levels when they called than when they did not call, suggesting that stress or arousal may play an important role in potentiating alarm calls. Marmots are sensitive to variation in the reliability of callers. The present finding provides one possible mechanism underlying caller variation: physiological arousal influences the propensity to emit alarm calls.

    Title Lamotrigine-induced Toxic Epidermal Necrolysis in Three Patients Treated for Bipolar Disorder.
    Date September 2006
    Journal Pharmacotherapy
    Excerpt

    Exfoliative dermatitis, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a mild-to-life-threatening process that has been described after exposure to many antiepileptic drugs. The increased use of antiepileptic drugs for treatment of bipolar disorder and neurologic disorders has extended the risk of exfoliative disorder to this population of patients, and these patients and their health care providers may not be familiar with the risks involved with these drugs. We describe the cases of a 28-year-old woman with bipolar 1 disorder initially treated with lamotrigine, and two adolescent girls with bipolar 2 disorder treated with lamotrigine after poor responses to other drug regimens. In all three patients, rashes progressed to toxic epidermal necrolysis in spite of treatment with corticosteroids at their local hospitals; thus, they were transferred to our burn treatment center. Response to early corticosteroid treatment in suppressing progression of exfoliation was variable in these patients. Ultimately, two of the three required ventilatory support; their conditions improved within 8-32 days of treatment, and they were discharged from the hospital. Case reports of lamotrigine-induced exfoliative disorder in patients with bipolar disorder have been published. However, these three patients were admitted to our burn treatment center within a 12-month period. Our institution admits approximately 10-12 patients with TEN/year, and the increased use of lamotrigine for treatment of bipolar disorder is likely to result in more patients with TEN. Therefore, health care professionals need to be aware of the early signs and symptoms of exfoliative dermatotoxicity when treating patients with lamotrigine.

    Title The Effect of Long Non-reproductive Periods on the Genital Health in Captive Female White Rhinoceroses (ceratotherium Simum Simum, C.s. Cottoni).
    Date July 2006
    Journal Theriogenology
    Excerpt

    White rhinoceroses suffer from a low reproductive rate in captivity. Intensive efforts to propagate specifically the northern white rhinoceros have been very limited. The dismal outlook for this subspecies in the wild makes successful ex situ breeding programs paramount. In this context, this study examined 48 southern and 6 northern white rhinoceroses using ultrasound and faecal hormone analysis to elucidate causes for female reproductive failure and to determine whether long non-reproductive periods have a detrimental impact on genital health. Results showed that 76% of the nulliparous females had intact hymenal membrane indicating these females had never been bred, at an age when their wild counterparts have delivered multiple offspring. Fifty-six percent of the studied population had various reproductive pathology. Cystic endometrial hyperplasia; leiomyomas of the cervix, uterus and ovary, adenoma; para-ovarian cysts and hydromucometra represent the scope of lesions identified. The stages of the lesions in nulliparous females correlated with age (r = 0.4, P < 0.05). Due to the severity of the lesions, 28% of the study population was considered post-reproductive. Therefore, the reproductive life span in some individuals was 10-20 years shorter than expected. However, in parous females the incidence of pathological lesions was significantly lower (P < 0.0001). Seventy-eight percent females studied had erratic or absent luteal activity. The hormone data corresponded with two ultrasonographic levels of ovarian activity, active and inactive, occurring within an age range of 3-19 years and 15-38 years, respectively. This suggests the lack of ovarian activity by reproductive mid-life in non-reproducing females. The accuracy of the ultrasound findings was validated by necropsy in nine animals showing a strong positive correlation (r2 = 0.9, p < 0.001). Our data suggests that the development of reproductive pathology and ovarian inactivity in white rhinoceros is an age-related consequence of long non-reproductive periods. This asymmetric ageing process of the genital organs can be prevented with the achievement of at least one pregnancy.

    Title Glucocorticoids of Bison Bulls in Relation to Social Status.
    Date May 2006
    Journal Hormones and Behavior
    Excerpt

    A primary response to stress is an increase in circulating adrenal glucocorticoids (GC) such as cortisol. Two hypotheses propose differential stress responses to agonistic and aggressive interactions in social groups. If subordinate animals are subjected to social and psychological stressors leading to chronic GC elevation, the 'stress of subordination' hypothesis predicts that GCs will be higher in subordinates than dominants. Alternatively, if dominant animals are subject to physiological stressors (e.g., fight at higher rates than subordinates) or hierarchies are unstable, the 'stress of domination' hypothesis predicts higher GCs in dominant individuals. Both models predict that GC levels will peak during the breeding season. We tested these predictions in bison bulls (Bison bison) using fecal steroid analysis to characterize GC concentration and behavioral observations to determine dominance rank, copulatory success, and tending status of bulls. Fecal samples were collected during 2003 from adult bison bulls during pre-rut (June), rut (July-August), and post-rut (September). Matched sample data indicated that mean GC levels (ng/g feces) of bulls strongly peaked during the 4-week rut, doubling from pre-rut to rut and then declining again during post-rut. High ranked dominant bulls maintained higher GC levels than lower ranked subordinate bulls. Dominance rank was positively correlated with copulatory success and age, and dominant bulls were more likely to tend (guard) cows as they approached estrus. There was a positive correlation between GC level and copulatory success, with prime-aged bulls (> or =7 years) obtaining the most copulations. GC levels were positively correlated with bull androgen levels determined in a previous study. These results support the 'stress of domination' hypothesis, indicating that dominant bison bulls pay a significant physiological price for high social status and the opportunity to mate.

    Title Fecal Steroid Analysis of Female Giraffe (giraffa Camelopardalis) Reproductive Condition and the Impact of Endocrine Status on Daily Time Budgets.
    Date August 2005
    Journal General and Comparative Endocrinology
    Excerpt

    Gestation and lactation can impose substantial energetic costs on female mammals. We developed a non-invasive means to determine reproductive condition in female giraffe using fecal steroid analysis. Giraffe may be especially challenged during their reproductive cycle because of two characteristics: they are impregnated while lactating and they do not breed seasonally. We studied the social behavior and endocrinology of seven female giraffe in a large naturalistic outdoor enclosure in order to chart connections between maternal physiology and behavior across the reproductive cycle. We found that giraffe gestation averages 448 days among females producing a calf that survived, with fecal pregnane concentrations reaching a zenith during the last trimester of pregnancy. Resumption of ovarian cyclicity following parturition was accelerated after neonatal calf mortality, but ovarian cycles resumed as early as 39 days postparturition while nursing. Although time spent feeding was unaffected by reproductive state, pregnant females significantly reduced time allocated to social behavior and had a tendency to locomote less than when cycling or acyclic. We suggest that modifications in foraging strategies as a function of reproductive state among wild giraffe derive from antipredator activity rather than from metabolic demands. Female giraffe probably cope with simultaneous lactation and gestation by producing high quality milk for neonatal calves commensurate with slow fetal growth and accelerating fetal growth simultaneous with weaning of nursing calves.

    Title Reproductive Soundness of Captive Southern and Northern White Rhinoceroses (ceratotherium Simum Simum, C.s. Cottoni): Evaluation of Male Genital Tract Morphology and Semen Quality Before and After Cryopreservation.
    Date March 2005
    Journal Theriogenology
    Excerpt

    White rhinoceroses suffer from a low rate of reproduction in captivity. This study examines the role of male reproductive function as a contributing factor. We used ultrasonography to image accessory sex glands, testis and epididymis. Electroejaculation provided 36 ejaculates from 21 rhinoceroses. Based on the percentage of progressively motile spermatozoa, semen was categorized in three groups, high (I: >75%), intermediate (II: 50-70%) or low (III: <50%) quality. Only 52% of the males showed high semen quality. Ejaculates in the high motility category also had the highest proportion of morphologically intact spermatozoa. Both semen parameters, sperm motility and morphology, were found to positively correlate with size of the accessory sex glands. The semen category was associated with group size suggesting that the social status influenced functional reproductive parameters. Change of territorial status (n = 1) improved semen quality. Testicular fibrosis was characterized as a sign of reproductive ageing in all males older than 15 years of age (n = 13); although, this ageing process did not notably affect semen parameters. Furthermore, for the benefit of assisted-reproduction and genetic banking programs protocols for the storage of cooled semen and the cryopreservation of spermatozoa were designed using different cryodiluents. This report provides basic data for the evaluation of reproductive components and of breeding management in male rhinoceros. Our results indicate that low rate of reproduction in captivity can be attributed to reduced male reproductive fitness. Changes in management of white rhinoceroses may positively affect male reproductive function.

    Title Fecal Androgens of Bison Bulls During the Rut.
    Date January 2005
    Journal Hormones and Behavior
    Excerpt

    The influence of sex hormones is a key proximate factor underlying male reproductive behavior in mammals. Effective conservation policies for the remaining purebred plains bison (Bison bison bison) herds require knowledge of the physiology underlying bison reproductive biology. We used fecal steroid analysis to characterize androgen levels in adult bison bulls before, during, and after the rut, and to examine androgen levels of bulls differing in reproductive status, age, and mating success. Fieldwork was carried out at the Fort Niobrara National Wildlife Refuge in north-central Nebraska. All adult bison in the herd were individually known by unique brands. Fecal samples were collected during 2003 from bulls during pre-rut (June), rut (July-August), and post-rut (September), and behavioral observations focused on reproductive status and mating success during the rut. Matched sample data indicated that androgen levels (ng/g feces) of bulls peaked during the rut, doubling from pre-rut to rut and then declining by 75% during post-rut. Dominant bulls that tended (guarded) cows maintained higher androgen levels than bulls that were not tending. There was a positive correlation between bull age (associated with mating success) and androgens, with higher androgen levels in prime-aged bulls compared with younger bulls. Nonetheless, there was no correlation between mating success (measured by number of copulations observed) and androgen level. This suggests that while androgens may provide the proximate motivation to compete for matings, other factors determine the mating success of bison bulls.

    Title Emergence of Resistance of Vancomycin-resistant Enterococcus Faecium in a Thermal Injury Patient Treated with Quinupristin-dalfopristin and Cultured Epithelial Autografts for Wound Closure.
    Date March 2003
    Journal Burns : Journal of the International Society for Burn Injuries
    Excerpt

    Vancomycin-resistant Enterococcus faecium and faecalis (VRE) remains a major complication among critically ill patients. A 26-year-old patient with 65% total body surface area burns (TBSA) was infected with several E. faecium strains during his admission that were resistant to vancomycin. Because chloramphenicol was the standard treatment at this time, this drug was initiated until, the organism was identified as E. faecium and reported as susceptible to quinupristin-dalfopristin. Given these data, it was then decided to discontinue the chloramphenicol therapy. Quinupristin-dalfopristin therapy resulted in initial reduction of fever and white blood cell counts that continued over the next 5 days. However, on day 7 of quinupristin-dalfopristin therapy, a return of fever and elevation of the white blood cell count was noted and a repeated E. faecium blood culture demonstrated sudden resistance to quinupristin-dalfopristin (Bauer-Kirby zone size <14 mm). Chloramphenicol was restarted and the patient improved slowly over a period of 16 days. Our indigenous VRE had limited exposure to quinupristin-dalfopristin in the recent past; however, resistance emerged with the first commercial use of this agent in our burn treatment center. High-dose chloramphenicol treatment did not appear to impair engraftment of cultured epithelial autografts (CEA) in this patient.

    Title Levofloxacin-induced Toxic Epidermal Necrolysis in an Elderly Patient.
    Date December 2002
    Journal Pharmacotherapy
    Excerpt

    Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) are mild-to-life-threatening adverse reactions that have been described after exposure to fluoroquinolones. No published reports, however, exist of exfoliative disease after treatment with levofloxacin. A 78-year-old woman with many medical problems, including chronic obstructive pulmonary disease, was treated with parenteral levofloxacin for community-acquired pneumonia. She was discharged with oral levofloxacin to complete an additional 3 days of treatment as an outpatient. Two days after completing this regimen, the patient developed a rash with blistering. The rash progressed to TEN in 7 days, and she was transferred to a burn treatment center. She was treated with fluid resuscitation, wound dressing, and antibiotics. Her condition improved, and she was discharged after 22 days. To our knowledge, this case is the first published report of levofloxacin-induced TEN.

    Title Identification of a Series of C(21)o(2) Pregnanes from Fecal Extracts of a Pregnant Black Rhinoceros (diceros Bicornis Minor).
    Date January 2002
    Journal Steroids
    Excerpt

    Fecal extracts from a pregnant black rhinoceros, Diceros bicornis, were analyzed by radioimmunoassay, HPLC, and by GC-mass spectrometry. From 40 g of dried feces a total of 33 pregnanes in the C(21)O(2) series, including a number of novel 17 alpha epimers were identified. No progesterone was recovered. The principal progesterone metabolite by mass was 5 alpha-pregnan-3 beta,20 alpha-diol (44.5%), which did not cross react with the antibody used in our RIA. The antibody recognized progesterone and pregnanes with 20-one configuration, which when combined made up less than 15% of the total C(21)O(2) steroid mass. Of the 33 pregnanes in the C(21)O(2) series identified, 81%, by mass, were in the 5 alpha-configuration. These results are compared with studies in other rhinoceros species (Asian and Sumatran) in which pregnanes in the 5 beta-configuration are the major fecal metabolites, and the white rhinoceros in which pregnanes in the 5 alpha-configuration are the dominant form.

    Title Ultrasonographic Characterization of Ovarian Events and Fetal Gestational Parameters in Two Southern Black Rhinoceros (diceros Bicornis Minor) and Correlation to Fecal Progesterone.
    Date June 2001
    Journal Theriogenology
    Excerpt

    A tremendous potential exists for the application of transrectal ultrasonography as a tool to enhance the captive management of endangered species. Reproductive study of two southern black rhinoceros (Diceros bicornis minor) females was performed daily to every other day for a approximately 60 day period to document ovarian changes, and three times weekly in early pregnancy to once monthly in late pregnancy in order to characterize changes in fetal parameters throughout gestation. All ovarian and fetal anatomical structures were measured in millimeters. The mean (+/- SD) length of the estrous cycle or interovulatory period was 26 +/- 1.4 days (n=2 cycles). Follicular growth rate of a dominant follicle was approximately 3 mm/day once the follicle reached 35 mm in diameter. Ovulation was observed to occur at a mean (+/- SD) follicular diameter of 49.5 +/- 2.6 mm (n=4) and within 48 to 72 h after observed estrus (n=2). Large ovarian structures [mean (+/- SD) diameter of 71.7 +/- 2.9 mm; n=3], considered analogous to equine anovulatory hemorrhagic follicles, were observed to form in the winter months and suggest seasonal periods of reduced fertility. Fecal progesterone assays confirmed ultrasonographic events. Although preliminary, the results of fetal sexing are presented and compared to the horse. Our data indicate that fetal eye or fetal foot diameter measurements can be used to accurately predict gestational age from about 2 months to term, providing useful information to managers of both captive and wild rhino populations. The ability to identify and quickly release animals in late term pregnancy in the wild and thereby reduce-abortions and neonatal mortalities in holding bomas is one potential practical conservation benefit of the fetal age predictive models.

    Title Successful Contraception in a Herd of Chinese Goral (nemorhaedus Goral Arnouxianus) with Melengestrol Acetate.
    Date February 2001
    Journal Journal of Zoo and Wildlife Medicine : Official Publication of the American Association of Zoo Veterinarians
    Excerpt

    Thirteen Chinese goral (Nemorhaedus goral arnouxianus) (five males and eight females) were each given 0.8 mg of melengestrol acetate orally in pelleted food for 224 days. The previous breeding season, six of the eight females calved (two were immature). No calf was born during the treatment season. The season after treatment, six females calved (one was immature prior to treatment). Two females were moved to other institutions, and the status of these is unknown. On the basis of this information, melengestrol acetate in feed was successful in preventing conception and was reversible. This treatment did not prevent the siring of offspring the following year and did not prevent a female that was subadult prior to the treatment from calving.

    Title Trichosporon Beigelii Infection: Experience in a Regional Burn Center.
    Date July 2000
    Journal Burns : Journal of the International Society for Burn Injuries
    Excerpt

    Trichosporon beigelii is a fungus once thought to cause only superficial infections, but recently has been increasingly identified as an opportunistic systemic pathogen in immunocompromised patients. There have been very limited reports of this organism in the burn patient population. We describe the first report of pharmacological management of invasive T. beigelii with a combination of amphotericin B and high dose fluconazole in a burn patient. Antifungal susceptibility testing of T. beigelii determined a change in minimum inhibitory concentrations (MICs) of amphotericin B and a consistent resistance pattern with the use of flucytosine. This paper will review our experience with T. beigelii fungus in a regional burn treatment center and review the literature on other experiences in the burn population.

    Title Intravenous Immunoglobulin As Adjunctive Treatment for Streptococcal Toxic Shock Syndrome Associated with Necrotizing Fasciitis: Case Report and Review.
    Date February 2000
    Journal Pharmacotherapy
    Excerpt

    Streptococcal toxic shock syndrome (STSS) is caused by infection with a toxicogenic strain of Streptococcus pyogenes. Clinical manifestations may be those of a mild illness, characterized by malaise, fever, and muscle pain, to severe sepsis and multisystem organ failure. The syndrome may be associated with several invasive infections including necrotizing fasciitis. Treatment is primarily surgical debridement of infected tissue with supportive care, antibiotics, and hemodynamic monitoring. Intravenous immunoglobulin (IVIG) is reported to have beneficial effects in the management of STSS associated with necrotizing fasciitis. The agent was successful in conjunction with surgical excision and antibiotics in a patient with necrotizing fasciitis, toxic shock, and multisystem organ failure. On the basis of this experience and a thorough literature review, we concur that IVIG may be a useful adjunct in the treatment of STSS associated with necrotizing fasciitis.

    Title Update of Hernia Repair-1998.
    Date June 1999
    Journal Jsls : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
    Title Obturator Hernia: Laparoscopic Diagnosis and Repair.
    Date January 1999
    Journal Jsls : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
    Excerpt

    OBJECTIVE: Review of international literature reveals eight reported cases of laparoscopic obturator hernia repair. Non-specific signs and symptoms make the diagnosis of an obturator hernia difficult. Laparoscopic intervention provides a minimally invasive method to simultaneously diagnose and repair these hernias. METHODS AND PROCEDURES: A 35 year old woman presented with lower abdominal pain, vaginal bleeding, and dyspareunia. During gynecological diagnostic laparoscopy, a pelvic floor hernia was suspected, and a general surgical evaluation was sought. At a subsequent laparoscopy, the diagnosis of a left direct inguinal and a right obturator hernia was made. Both were repaired laparoscopically with polypropylene mesh. RESULTS: At follow-up at one and six weeks postoperatively, the patient's complaints of pain had completely resolved. CONCLUSION: The diagnosis of obturator hernia is problematic. The usual presenting signs and symptoms are non-specific. Without conclusive historical or physical findings, laparoscopy is an excellent method for diagnosing obturator hernia. This entity, once diagnosed laparoscopically, can be repaired simultaneously via laparoscopic mesh technique.

    Title Successful Utilization of Ecmo to Treat an Adult Burn Patient with Ards.
    Date December 1998
    Journal Burns : Journal of the International Society for Burn Injuries
    Excerpt

    We present an interesting case of the first adult reported in the United States to suffer from thermal burns, adult respiratory distress syndrome (ARDS) and to be treated with extracorporeal membrane oxygenation (ECMO) who survived. Our patient is a 26 year old male who sustained thermal burns (12% TBSA) to his face and anterior trunk and broncoscopically demonstrable inhalation injury. He was transported to our regional burn center for burn wound care and ventilatory support. The patient was treated with silver sulfadiazine 1% to his wounds which healed per primam. Because of low oxygen saturation he required increasing FIO2. The following parameters: FIO2= 1, PEEP = 17, minute ventilation of 15.1 1, peak airway pressure of 45 and mean of 27, along with chest X-rays corroborated the severity of ARDS. The patient failed volume control ventilation. A trial of pressure ventilation was attempted but the patient only reached O2 saturation in the low 80s. At this point, the decision was made to transfer the patient to a hospital capable of ECMO treatment. The patient was subsequently treated with veno venous ECMO. Six weeks later the patient was discharged from the hospital off all ventilatory support.

    Title Trilaminar Skin Coverage Combined with Cultured Epithelial Autografts--a New Technique for Treating the Elderly Patient with Burn Injuries.
    Date April 1998
    Journal The Journal of Burn Care & Rehabilitation
    Excerpt

    Additional morbidity may be associated with standard split-thickness skin graft donor sites in elderly (65 years or older) patients with burn injuries. In an attempt to minimize the area of the donor sites and maximize autografts, we describe a new technique that uses trilaminar harvesting of skin grafts with dermolipectomy closure, and permanent coverage of the autograft layers achieved with cultured epithelial autografts in an elderly burn victim. An 80-year-old man was admitted with a 15% total body surface area burn to the bilateral lower extremities and buttocks. All meshed split-thickness skin grafts (12) applied showed excellent take, and it was reported that the cultured epithelial autograft take was approximately 90%. All dermolipectomy sites healed without infection. Our procedure proved to be a useful technique in the permanent closure of full- and partial-thickness burns in an elderly patient admitted to the burn unit.

    Title Underutilization of Breast-conservation Surgery with Radiation Therapy for Women with Stage Tis, I or Ii Breast Cancer.
    Date July 1997
    Journal International Surgery
    Excerpt

    Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

    Title Concomitant Laparoscopic Cholecystectomy and Splenectomy for Surgical Management of Hereditary Spherocytosis.
    Date June 1997
    Journal The American Surgeon
    Excerpt

    Laparoscopic splenectomy is rapidly becoming a common treatment modality in the surgical management of hematological processes involving the spleen. Hereditary spherocytosis is the most common red blood cell membrane disorder, and its diagnosis is often associated with hemolytic crisis and premature cholelithiasis. This condition has not been successfully treated laparoscopically until recently, and to our knowledge, the technique of concomitant laparoscopic splenectomy and cholecystectomy described here is the first reported in U.S. literature. Our patients, a 16-year-old 5-foot 3-inch-tall 90 pound emaciated albino, presented with cholelithiasis, splenomegaly, and anemia. Because of persistent anemia and gastrointestinal symptoms, the patient underwent laparoscopic cholecystectomy and splenectomy. The cholecystectomy was performed in a standard laparoscopic fashion. An additional 12-mm trocar was utilized for takedown of the spleen. The umbilical incision was extended to 4.5 cm, and the spleen was extracted manually. Total operative time was 12 hours. Examination demonstrated a 15 x 10 x 5-cm spleen, which weighed 350 grams. The gallbladder microscopically showed cholecystitis and had several stones. In conclusion, we present a combined laparoscopic cholecystectomy and splenectomy for hereditary spherocytosis associated with splenomegaly, cholelithiasis, and cholecystitis.

    Title Intravenous Ketorolac for Pain Management in a Ventilator-dependent Patient with Thermal Injury.
    Date September 1996
    Journal Pharmacotherapy
    Excerpt

    A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.

    Title Toxic Epidermal Necrolysis After Initiation of Felbamate Therapy.
    Date August 1995
    Journal Pharmacotherapy
    Excerpt

    A 33-year-old woman with a 13-year history of partial complex seizures experienced toxic epidermal necrolysis requiring management in a regional burn treatment center after 16 days of single-agent treatment for epilepsy with felbamate 3600 mg/day. Within 24 hours the target lesions involved 45% of her total body surface area. They coalesced and progressed to exfoliation involving the mucosa and the conjunctiva. The patient was hospitalized for 25 days. Reports in the literature describe life-threatening rashes after treatment with felbamate in combination with other anticonvulsant agents. We believe this to be the first reported case of felbamate-induced toxic epidermal necrolysis induced by single-agent therapy. Although felbamate provides many advantages as an anticonvulsant, its structure can be arranged to a conformation in space similar to that of hydantoins and barbiturates, and thus warrants careful patient monitoring for life-threatening rashes.

    Title Barium and Fecal Impaction: an Unusual Case of Bilateral Hydronephrosis.
    Date August 1995
    Journal The American Surgeon
    Excerpt

    We present an interesting case report of the second adult female reported to suffer from bilateral ureteral hydronephrosis, secondary to a fecal impaction, and the first caused by complications from residual barium. This elderly patient suffers from many associated neurologic, bowel, and urinary tract problems; this case report demonstrates their close proximal relationship. Through ureteral stent placement and manual disimpaction of the barium fecaloma, the patient was able to recover her normal renal and bowel functions. Aided by the use of excellent figures, it is our intent to inform physicians that they should consider fecal impaction as a cause for bilateral ureteral hydronephrosis in predisposed patients, and also the necessity of purging the GI tract of residual barium following radiologic studies.

    Title Use of Percutaneous Endoscopic Gastrostomy Tubes in Burn Patients.
    Date January 1995
    Journal Surgical Endoscopy
    Excerpt

    Alimentation and decompression are imperative to the successful management of the severely burned patient. Utilization of percutaneous endoscopic gastrostomy (PEG) tubes for these purposes has become a proven effective procedure in non-burned patients with few major complications. We retrospectively reviewed placement of PEG tubes in 31 burn patients, some of whom had been admitted with additional diagnoses such as inhalation injury and/or dysphagia. In 90% of our burn patients, the use of PEG tubes was without complication. The placement of PEG tubes through burn wound areas or donor sites added no increase in wound complications. In summary, there was no mortality referable to the use of PEG tubes, there were no major operative or wound complications, and feedings were tolerated well. This study reports on the use of PEG tubes in a regional Burn Treatment Center. It shows that PEG tubes offer safe and effective alimentation and decompression in the management of burned patients.

    Title An Improved Technique for Needle Localized Biopsy of Occult Lesions of the Breast.
    Date February 1993
    Journal Surgery, Gynecology & Obstetrics
    Excerpt

    The current retrospective study reports the results of the 98 outpatient procedures using a modified version of needle localized excisional biopsies of occult lesions of the breast at a community hospital. Intraoperative fluoroscopy is used to direct a second needle placement along the dissection tract to localize more accurately the intraglandular lesion. The medical records of 88 patients who underwent this procedure between 1989 and 1991 were reviewed. A detailed description of the procedure used as well as clinical data from roentgenographic, histologic and operative reports are given. Benign histologic findings were reported in 80.6 percent of the instances, with fibrocystic disease accounting for most (66 of 79) of the benign diagnoses. Primary malignancy was found in 18 biopsies, with noninfiltrating ductal carcinoma being the most prevalent (n = 8). Infiltrating ductal carcinoma was found six times, infiltrating lobular carcinoma was found three times and a combination of noninfiltrating ductal and noninfiltrating lobular carcinoma was found once. Metastasis to axillary lymph nodes was found twice. One lesion of the breast was large cell lymphoma. Mass lesions accounted for 46 of the 98 lesions and calcifications accounted for the remaining 52. Thirteen of the 18 primary lesions that proved to be malignant presented as calcifications, whereas five presented as a mass. Infiltrating carcinoma, however, was more likely to be associated with mass lesions than with calcifications--all five malignant mass lesions were infiltrating, whereas of the 13 lesions with calcifications, four were infiltrating. Failure to confirm the removal of the lesion roentgenographically occurred once, but there were no other complications to this technique. Additionally, a circumareolar incision was used in 64.7 percent of the procedures and 76.5 percent of the procedures were done using local anesthesia and intravenous sedation. We conclude that the technique introduced herein is a simple, highly reliable means to localize accurately nonpalpable lesions of the breast using a combination of fluoroscopy and needle localization that allows a better cosmetic result.

    Title Diminishing Blood Loss During Operation for Burns.
    Date February 1993
    Journal Surgery, Gynecology & Obstetrics
    Excerpt

    The current placebo-controlled, randomized clinical trial was done to determine the effect of preoperative 1-desamino-8-D-arginine vasopressin (DDAVP) infusion on blood loss in patients undergoing burn débridement and grafting, a patient population in which extreme blood loss is a frequent occurrence. Eleven patients undergoing 22 surgical procedures completed the study protocol--mean age was 33 years (range of 12 to 70 years), mean burn size was 53 percent body surface area (BSA) (range of 17 to 92 percent) and mean area débrided and grafted was 3,935 centimeters squared (range of 848 to 8,134) or 21.1 percent (range of 4.0 to 43.5 percent) BSA. The treatment group received 0.3 microliter per kilogram DDAVP infused during 15 to 30 minutes within one hour of anesthetic induction. The control group received placebo in a similar manner. Standard hemostatic maneuvers were used in all patients. Blood loss was calculated based on Warden's formula. No significant hemodynamic consequences or changes in routine coagulation profiles were noted in either group. No significant difference was found between the control and treatment groups in the volume of blood lost per percent BSA débrided and grafted (145.9 +/- 109.7 versus 130.2 +/- 61.7, respectively) or the volume lost per unit area débrided and grafted (0.75 +/- 0.54 versus 0.74 +/- 0.41, respectively). Based on these data, we cannot conclude that preoperative DDAVP infusion reduces blood loss in patients undergoing débridement and grafting of burn wounds.

    Title Cultured Epidermal Autograft and the Treatment of the Massive Burn Injury.
    Date May 1992
    Journal The Journal of Burn Care & Rehabilitation
    Excerpt

    As a rule, adult and pediatric patients with thermal injuries that involve more than 90% total body surface area (TBSA) burn have poor prognoses. Even for patients who are 5 to 34 years old with a 70% TBSA burn, the mortality rate is 80%. Lack of autologous donor skin, which is essential for permanent wound closure, is the major problem. Recent advances in growth of cultured epidermal autograft (CEA) have allowed closure of full- and partial-thickness burns; in approximately 3 weeks, a 2 cm2 biopsy specimen will produce enough CEA to cover a pediatric patient. Since 1989, we have used this product on nine patients; the average age was 39, and the average TBSA burn was 70% (range, 44% to 93%). We report our approach to use of CEA in six of these patients, including topical applications of 1% silver sulfadiazine and excision of full- and deep partial-thickness wounds within 2 weeks of injury. Temporary closure was achieved with cadaver allograft. "Take" of the allograft forecasted take of CEA. The total operative time of CEA placement was decreased by a two-step technique that obviates repeating debridement: the technique consists of debriding and grafting with allograft, then removing it at the time of CEA placement. CEA take is best on early granulation tissue or freshly excised wounds. Early excision of burn eschar, temporary wound closure with cadaveric allograft and Biobrane (Winthrop Pharmaceuticals, Wound Care Div., Fountain Valley, Calif.), and permanent closure with CEA may improve survival rates among patients with massive burn wounds. CEA is a tremendous asset to the management of massive burn injuries.

    Title The Response of Statocyst Receptors of the Lobster, Homarus Americanus, to Movements of Statolith Hairs.
    Date May 1992
    Journal Comparative Biochemistry and Physiology. Comparative Physiology
    Excerpt

    1. While recording from the statocyst nerve of Homarus americanus, we deflected the statolith hairs from the "rest" position they assumed after the lith was removed. 2. Each of the smaller statocyst hairs apparently drove three sensory receptors; all receptors were sensitive to hair position, hair movement velocity, and hair movement direction. 3. Two of the receptors, types A and C, only responded when the hair was lifted up and away from rest; the third, type B, only responded vigorously when a hair was moved back toward rest from such a deflexion. 4. Type A and B receptors were phasic-tonic; type C receptors were phasic.

    Title Statolith Hair Movements and the Regulation of Tonic Gravity Reflexes in the Lobster, Homarus Americanus.
    Date May 1992
    Journal Comparative Biochemistry and Physiology. Comparative Physiology
    Excerpt

    1. The irregularity of the statolith of the lobster, Homarus americanus, probably causes a large and haphazard variation in the response of the individual statocyst receptors to body rotation. 2. Lobster gravity reflexes are regulated by the summed responses of the statocyst receptors; this probably compensates for the haphazard variation in the sensory input.

    Title Impairment of Follicular Development by Intra-ovarian Infusion of Gonadotrophin-releasing Hormone Antiserum in Prepubertal Pigs.
    Date March 1992
    Journal Journal of Reproduction and Fertility
    Excerpt

    Antiserum against gonadotrophin-releasing hormone (GnRH) was infused into one ovary in 4 prepubertal gilts and control porcine serum was infused into one ovary in 4 other gilts. Ovaries were infused for 156 h, after which infused and non-infused ovaries were removed surgically and processed for histology. Infusion of GnRH antibodies did not alter (P greater than 0.10) concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH) or oestradiol-17 beta, and GnRH titres in peripheral circulation were low, averaging 1:15. Weights of ovaries not infused were similar (P greater than 0.10) between treatment groups. There were fewer (P less than 0.05) follicles greater than 0.5 mm in diameter in the ovaries infused with GnRH antiserum than in the others, but there were no differences (P greater than 0.10) between treatment groups in the number of follicles less than 0.5 mm in diameter. Infusion of GnRH antibodies increased (P less than 0.05) the incidence of atresia in follicles with greater than 4 layers of granulosa cells compared with the other treatment groups. These results provide evidence that a peptide binding to the GnRH antibodies is involved directly in ovarian follicular development.

    Title Can General Surgeons Perform Colonoscopy Safely?
    Date March 1992
    Journal American Journal of Surgery
    Excerpt

    The purpose of the current study was to review the safety of colonoscopy performed by nonfellowship-trained general surgeons. To address this issue, we reviewed more than 1,000 consecutive diagnostic and therapeutic colonoscopies and recorded the complications. This was a multi-institutional study involving seven general surgeons, none of whom had had formal fellowship endoscopic training. Perforation was confirmed by laparotomy, bleeding was defined as that requiring hospitalization and/or transfusion, and cardiopulmonary arrest was self-explanatory. There was one perforation in the diagnostic group and none in the therapeutic group, for a rate of 0.10% overall and 0.12% in diagnostic colonoscopy. There were no instances of bleeding or cardiac arrest. This complication rate of 1 per 1,025 colonoscopic procedures by general surgeons compares favorably with that previously reported by other specialties (p less than 0.001). We conclude that postgraduate endoscopy fellowship is not necessary for general surgeons to become safe colonoscopists.

    Title Hydrofluoric Acid-induced Hypocalcemia.
    Date December 1988
    Journal The Journal of Trauma
    Excerpt

    Among patients exposed to hydrofluoric acid the potentially lethal effect of calcium depletion induced by binding with fluoride ion has not been well reported. Three patients exposed to hydrofluoric acid had acute fluoride poisoning with serum calcium levels equal to or below 4.1 mgm/dl. Treatment included administration of large amounts of calcium, both intravenously and by subsechar injection, to replenish the biologically active calcium and to bind fluoride. This report describes successful treatment of two survivors, apparently the first two, of severe hypocalcemia caused by hydrofluoric acid.

    Title Adrenalectomy Abolishes and Cortisol Restores Naloxone's Beneficial Effects on Cardiovascular Function and Survival in Canine Hemorrhagic Shock.
    Date November 1983
    Journal Circulatory Shock
    Excerpt

    Endogenous opioid substances are activated in and may contribute to the cardiovascular depression of hemorrhagic shock. In order to determine the importance of the adrenal gland in the beneficial effects of the opiate antagonist naloxone in shock we studied 23 adrenalectomized dogs subjected to hemorrhagic shock. Adrenalectomy abolished the salubrious cardiovascular responses to naloxone. Naloxone responses (increased mean arterial pressure, cardiac output, and left ventricular contractility) were restored by giving hydrocortisone 50 mg intravenously before naloxone. Survival was also prolonged in animals receiving naloxone and hydrocortisone compared to naloxone or saline alone; hydrocortisone alone decreased survival. The adrenal glands are necessary for naloxone's beneficial effects, probably via adrenal corticosteroid secretion.

    Title Body Weight and Its Effect on Immunoreactive Parathyroid Hormone Levels.
    Date September 1983
    Journal Mineral and Electrolyte Metabolism
    Excerpt

    Immunoreactive parathyroid hormone (iPTH) levels were measured in 12 obese subjects (140-272% ideal body weight) and 10 normal lean volunteers (93-100% ideal body weight). iPTH values were not significantly different in the two groups and tubular maximum phosphate reabsorption (TmP) was comparable in lean subjects and the 4 obese patients tested. 4 obese subjects were evaluated after an average of 6.7% body weight loss, and neither iPTH levels nor TmP were affected. The data indicate that the biological effects of PTH are not enhanced in the massively obese.

    Title Vigorous Supplementation of a Hypocaloric Diet Prevents Cardiac Arrhythmias and Mineral Depletion.
    Date July 1983
    Journal The American Journal of Medicine
    Excerpt

    We have previously demonstrated that a hypocaloric, nutritionally deficient, liquid protein diet is associated with potentially life-threatening cardiac arrhythmias, which increased in frequency and complexity over the duration of the study. The present investigation was designed to evaluate the metabolic and cardiac changes associated with a hypocaloric, but otherwise nutritionally complete, diet. Six healthy, obese females from 154 to 182 percent of ideal body weight were evaluated in a metabolic ward for 48 days. The subjects ingested a weight maintenance diet during an eight-day period, which was followed by 40 days of an experimental diet containing 472 kcal of a mixture of protein (60 percent of calories), carbohydrate (25 percent), and fat (15 percent). This diet equaled or exceeded the recommended daily allowances for minerals, trace elements, vitamins, and essential fatty acids. The subjects were monitored for balances of nitrogen and minerals, as well as for the appearance of cardiac arrhythmias by 24-hour electrocardiographic recordings. Nitrogen balance was positive, and the previously demonstrated negative balances for potassium, sodium, calcium, magnesium, and phosphorus were either reversed or markedly decreased. In contrast to our previous study, no arrhythmias were observed in subjects ingesting the present experimental diet, and no significant change in cardiac rhythm was found in 13 obese, but otherwise healthy, outpatients. The data, based on a limited number of subjects, suggest that a hypocaloric diet vigorously supplemented with essential elements, micronutrients, and vitamins appears to be safer than the once popular, incomplete liquid protein preparation.

    Title Hyperprolactinemia and Delayed Puberty: a Report of Three Cases and Their Response to Therapy.
    Date May 1983
    Journal Pediatrics
    Excerpt

    Delayed puberty occurred in three patients (aged 15 to 22 years) with elevated prolactin levels. Despite the varying etiologies, their clinical presentations were marked by absence of galactorrhea, prepubertal genitalia (2/3), and short stature (1/3). Except for hyperprolactinemia, endocrinologic evaluation was normal in two patients. Bromocriptine restored prolactin levels to normal in all three patients, two of whom had prior transsphenoidal surgery, and resulted in initiation of menses in one girl and pubertal development in both boys. The 22-year-old male patient with the empty sella syndrome has progressed through puberty after the addition of oral testosterone.

    Title Endocrine Ophthalmomyopathy in Adolescence.
    Date June 1982
    Journal Journal of Pediatric Ophthalmology and Strabismus
    Excerpt

    A 17-year-old girl presented with euthyroid Graves' disease. Diplopia and extensive limitation of ocular motility bilaterally were the most remarkable features of this case. Even though the patient also had juvenile diabetes mellitus, treatment with systemic steroids was accomplished safely with complete recovery of ocular motility and the disappearance of diplopia in all fields of gaze.

    Title Electrotonic Conduction in the Optic Nerves of Planorbid Snails.
    Date March 1974
    Journal The Journal of Experimental Biology
    Title Review of Contraception in Ungulate Species.
    Date
    Journal Zoo Biology
    Excerpt

    Most ungulate species are herd animals. In captivity, and increasingly so in the wild, space constraints limit natural behaviors associated with group dynamics, possibly resulting in inbreeding and/or overpopulation. This situation has necessitated research regarding contraception of various species of hoofstock. Differing management situations mandate different contraception protocols to achieve optimal results. Fertility control in hoofstock has been achieved through a number of different contraceptive methods predominantly surgical sterilization, mechanical contraception, synthetic steroid hormones, and immunocontraception. In this study successes and limitations of these techniques are reviewed. Zoo Biol 26:311-326, 2007. (c) 2007 Wiley-Liss, Inc.

    Title Extracorporeal Life Support.
    Date
    Journal Journal of Burn Care & Research : Official Publication of the American Burn Association

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