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Stony Brook Surgery Blog

Posted by Stony Brook Surgery on January 21, 2019

He Lived and Breathed Our Department and Medical Center until the End

Cedric J. Priebe Jr., MD
Dr. Cedric J. Priebe Jr.

Pediatric surgeon Cedric J. Priebe Jr., MD, professor emeritus of surgery, passed away on Saturday, January 19, at the age of 88 (three weeks shy of his 89th birthday). The founder of our Pediatric Surgery Division, Dr. Priebe had dedicated himself to the advancement of the surgical care of children and the Department of Surgery for nearly four decades.

Dr. Priebe joined our faculty in 1982 as professor of surgery and chief of pediatric surgery. In 2007, after 25 years of distinguished service at Stony Brook, he retired from our full-time faculty.

However, not wanting to quit entirely, Dr. Priebe continued to serve on a part-time basis, contributing to our quality assurance initiatives and also to our educational programs. Right up to very recently, he would routinely attend our weekly pediatric surgical conference.

Dr. Priebe began his distinguished career as an academic pediatric surgeon during the period when the specialty of pediatric surgery was originally developed, in the decades following the Second World War.

Dr. Priebe's sustained desire to constantly improve the surgical care of children was the dominant force guiding his life.

He received his MD in 1955 from Cornell Medical College, and went on to complete his general surgical residency at Roosevelt Hospital in New York City (treats guy in ER that Mickey Mantle punched). He then served in the United States Air Force as a general surgeon for five years.

After caring for a number of complicated pediatric surgical patients, he was stimulated to enter a two-year fellowship in pediatric surgery at Ohio State University's Columbus Children's Hospital under the direction of H. William Clatworthy Jr., MD, that ended in 1967.

Following this training in pediatric surgery, Dr. Priebe returned to practice at Roosevelt Hospital and serve on the faculty at Columbia University. There he developed an academic career and rose to be an associate professor of surgery.

After 12 years he then became a full professor and chief of pediatric surgery at Louisiana State Medical Center and Charity Hospital and director of surgical education at Children's Hospital in New Orleans.

Our Founding Chief of Pediatric Surgery

In 1982, when Stony Brook University Hospital was new, and the Department of Surgery was transforming from a group of "generalists" into groups with more specialized skills, Dr. Priebe became the founding chief of the Division of Pediatric Surgery.

Dr. Priebe with Patient
Dr. Priebe with Patient

At Stony Brook, Dr. Priebe developed a strong patient care service, and was recognized as a meticulous surgeon, tireless teacher, and a mentor of surgical faculty, residents, and medical students.

Now, with more than 3,000 outpatient visits and more than 1,000 surgeries annually, we have the largest pediatric surgery program in Suffolk County.

Longtime colleague Richard J. Scriven, MD, who worked closely with Dr. Priebe since 2001 when he joined our Pediatric Surgery Division, remembers: "Dr. Priebe was loved by his patients. For a complicated child, it was not unusual for him to spend hours with them on the ward or in the office.

"Dr. Priebe was a model for the next generation. He believed it was the highest honor for a parent to entrust their most precious gift to us for their surgical care."

During Dr. Priebe's academic career he had been active in research involving the causes of intestinal ischemia that may occur in premature newborn infants. His pediatric surgical interests focused on newborn congenital anomalies, pediatric tumors, and childhood trauma.

He always envisioned a hospital dedicated to caring for children that would further distinguish Stony Brook Medicine.

Dr. Priebe served on multiple national committees of pediatric surgical societies, and published articles on numerous pediatric surgical topics. Following his retirement from out full-time faculty, he continued to serve as an editorial consultant for the Journal of Pediatric Surgery, the leading journal in the field.

In 2010, to further support our mission of excellence in education, Dr. Priebe became the principal donor of the fund and leader of our campaign to establish the Cedric J. Priebe Jr., MD, Endowed Pediatric Surgery Lectureship.

The Priebe Lectureship fund now supports an annual visiting professor's presentation centering on a current clinical or research issue in pediatric surgery. This lecture presentation, given as part of our Surgical Grand Rounds program, focuses on new methods to improve patient care, as well as new research in the field of pediatric surgery.

This lectureship was one of Dr. Priebe's dreams — to help advance the education at Stony Brook of surgeons caring for children — and it remains part of his legacy in the Department of Surgery.

Beyond that, Dr. Priebe desired to have his legacy grow not only through the pediatric surgery lectureship but also through the creation of a dedicated children's hospital here at Stony Brook — a hospital just for kids that offers every clinical specialty and that would be competitive with similar hospitals throughout the country.

This dream of Dr. Priebe's has finally been realized. Stony Brook Children's Hospital is the first of its kind in Suffolk County, offering the most advanced pediatric specialty care in the region. It occupies two floors in the sparkling new Hospital Pavilion.

Our present chief of pediatric surgery Christopher S. Muratore, MD, adds: "Dr. Priebe really wanted to see the formal opening of our new Children's Hospital, which will take place in the near future but too late for him. He long thought a hospital dedicated to caring for children would be critical for our growth, expansion of services, and potential to optimize children- and family-centered healthcare."

Visitation will be on Tuesday, January 22, 2019 from 2:00 to 4:00 pm and from 7:00 to 9:00 pm at the Bryant Funeral Home, 411 Old Town Road, East Setauket, NY. Funeral mass will be held on Wednesday, January 23, 2019, at 9:30 am at St. James RC Church, 429 Route 25A, East Setauket, NY.

To honor Dr. Priebe and help ensure the longevity of the Priebe Lectureship, donations are encouraged. Make a gift to it online, or call the Stony Brook Medicine Advancement Office at 631-444-2899.

Posted by Stony Brook Surgery on January 16, 2019

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Dr. Aaron R. Sasson (left) and Dr. Georgios V. Georgakis

Pancreatic cancer is the devastating cancer that over time took the lives of Luciano Pavarotti, Simone Signoret, Dizzy Gillespie, Patrick Swayze, Juliet Prowse, and Anne Francis. The images of the faces of these public figures toward the end of their lives tell what terrible tolls on the body this cancer brings about.

According to the American Cancer Society, about 55,440 people (29,200 men and 26,240 women) will be diagnosed with pancreatic cancer this year, and fewer than one in five of these cancers are caught early enough to be surgically removed.

Even when diagnosed early, pancreatic cancer typically spreads rapidly, and is seldom detected in its early stages. Signs and symptoms may not appear until the cancer is quite advanced.

For all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 8%.

Survival rates are low because fewer than 10% of patients' tumors are confined to the pancreas at the time of the diagnosis; in most cases, the malignancy has already progressed to the point where surgical removal is impossible.

At Stony Brook, we offer state-of-the-art diagnosis and treatment of pancreatic cancer, including innovative surgical options. In 2009, we pioneered the procedure called irreversible electroporation (IRE), which had never before been used for pancreatic cancer; specifically, the ablation (destruction) of pancreas tumors.

Since then, we have added new techniques that help patients in their quest for better cancer care, such as robotic pancreatic surgery. With the addition of our new state-of-the-art Cancer Center, we can provide our patients the best treatment options available internationally.

Here, our surgical oncologists Aaron R. Sasson, MD, and Georgios V. Georgakis, MD, PhD, both pancreas specialists with expertise in IRE, answer frequently asked questions about this new technology and its use in treating pancreatic cancer.

Q: What is IRE?

A: IRE is a surgical technique that kills the cancer by using electrical fields to generate pores in the tumor cells. It kills tumor cells without causing collateral damage to adjacent tissue. The NanoKnife, a computerized system used for the procedure, uses brief and controlled electrical impulses to open microscopic pores in a targeted area.

By increasing the number, strength, and duration of the electrical pulses, pores in the cells remain open permanently, causing microscopic damage. The cells then die, and the body rids itself of these dead cells.

IRE is very useful in treating complex tumors that involve vital structures, such as arteries and veins, that otherwise would not be able to be treated without sacrificing such structures.

The Stony Brook Cancer Center is the first center on Long Island to be
designated by the National Pancreas Foundation as a Pancreatic Cancer Center.

Q: What are the benefits of IRE?

A: IRE does not generate heat or cold, which could damage normal, adjacent tissues. For example, when a pancreatic cancer is deemed inoperable because it involves the artery that feeds the bowel, or the artery that supplies the liver, this tumor can be treated with IRE, and be destroyed. The main benefit of IRE is that it gives us the potential to offer treatment to some patients who previously had no options.

This breakthrough technology, however, is not viable for those patients where the cancer has metastasized, or spread elsewhere in the body. But, for those patients who are candidates, the procedure may result in a major improvement in quality of life and extended time beyond the anticipated few months associated with the advanced level of disease.

Q: Can IRE destroy an entire pancreas tumor?

A: IRE cannot destroy the tumor, in the same way that radical surgery does. IRE destroys the majority of the tumor, and it allows other modalities, such as chemotherapy, to have a better effect, prolonging patient survival effectively.

Q: Can IRE alone be used instead of conventional surgery to treat pancreatic cancer?

A: IRE can be used either along with conventional surgery, to maximize the potential of possible cure in patients whose tumors can be removed surgically, or it can be used alone in cases where the tumors cannot be removed. It cannot be used instead of conventional surgery.

Q: Has the safety of IRE ablation of pancreas tumors been established?

A: Yes, there are multiple published studies establishing the safety of IRE ablation of the pancreas in people.

Patients with pancreatic cancer who come to Stony Brook can be assured
they will receive the most sophisticated and compassionate care available today.

Q: How do patients tolerate the IRE procedure? Is it easy or hard to undergo?

A: IRE ablation for pancreatic tumors is applied surgically most of the times; that is, it needs a surgical procedure, either through small or big incision. Because there is nothing removed during these procedures, the recovery time is significantly shortened compared to the classic operations for pancreatic cancer.

Q: What are the side effects of IRE when used to treat pancreatic cancer?

A: The most common side effect is self-limiting pain. This pain typically lasts for a few days and passes without any major interventions. Other side effects can include pancreatitis, bleeding around the site of application, and leak of pancreatic or biliary juices.

Q: How long — in terms of years — has IRE treatment been shown to extend survival?

A: The median survival of patients who have been through IRE ablation of their inoperable tumors can be up to 27 months, according to published data.

Q: Is IRE for pancreatic cancer widely available?

A: Unfortunately, it is not. IRE is only available at select centers, including Stony Brook Cancer Center.

Q: What is the benefit of having IRE pancreas tumor ablation treatment at Stony Brook Cancer Center?

A: At Stony Brook Cancer Center, we provide world-class patient care from highly specialized doctors, using cutting-edge technology, in the heart of Long Island. We provide comprehensive diagnosis and multidisciplinary treatment for pancreatic cancer, and are leading the way in patient care.

Our center is designated by the National Pancreas Foundation (NPF) as a Pancreatic Cancer Center. It is the first NPF Cancer Center on Long Island. The NPF offers this distinction only to those institutions that treat the "whole patient" and that offer some of the best outcomes and improved quality of life for patients with pancreatic cancer.

Patients with pancreatic cancer who come to Stony Brook can be assured they will receive the most sophisticated and compassionate care available today, and that IRE may indeed be a life-extending option for them.

Learn more about pancreatic cancer from the American Cancer Society. For consultations/appointments with our surgical oncologists, please call 631-444-8086. To see how IRE is done, watch this animation (1:03 min):

Posted by Stony Brook Surgery on January 9, 2019

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Dr. Henry J. Tannous

Mediastinal tumors are benign or cancerous growths that form in the mediastinum; that is, the area in the middle of the chest between the sternum (breastbone) and spinal column.

The mediastinum, which separates the lungs, houses the heart, esophagus, trachea, great vessels, thymus, and lymph nodes.

Mediastinal tumors are relatively uncommon. They tend to be more common in young and middle-aged adults, but they may affect people of all ages.

These tumors develop in one of three areas of the mediastinum: the anterior (front), the middle, or the posterior (back). Different tumors are more common in certain age groups.

Children usually develop tumors in the back of the mediastinum, and they are often benign tumors. Adults usually develop them in the front, and these tumors can be cancerous.

Mediastinal tumors often pose a diagnostic and therapeutic challenge to thoracic surgeons. Surgical skill and experience, thus, are critical to successful treatment outcomes.

Here, Henry J. Tannous, MD, a specialist in mediastinal tumors and member of our Cardiothoracic Surgery Division, answers frequently asked questions about these tumors and their management.

Q: What causes mediastinal tumors to form?

A: Depending on etiology, a mediastinal tumor can be caused by an enlarged lymph node, or a gland such as the thymus, thyroid, or parathyroid. It can also be caused by a cyst originating from the pericardium (the sac that houses the heart), the bronchus, or the esophagus. Another cause of a mediastinal tumor can be a cancer that has spread into the mediastinum.

Q: How many different kinds of mediastinal tumors are there?

A: Mediastinal tumors can be classified by location (anterior, middle, and posterior) or by benign versus malignant. An anterior mass is the most common, and it could represent a thymoma, a lymphoma, a germ cell tumor, or a thyroid mass.

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Left side view of the mediastinum (Gray's Anatomy, 1918; click on image to enlarge.)

Q: What are the common mediastinal tumors?

A: Thymomas are the most common mediastinal tumors. They start in the thymus, which is a small organ in the front part of the chest under the breastbone. They represent one third of anterior mediastinal tumors and 15-20% of all tumors.

Thymomas could be associated with myasthenia gravis, which is a disease of the neuromuscular junctions causing weakness, and which is present in about half of all patients with thymoma at some stage.

Thymomas grow slowly and invade surrounding structures; consequently, these tumors require surgical removal with a good cure rate. A rarer but more invasive type, thymic carcinoma, is harder to manage and could require surgery, chemotherapy, and/or radiation.

Lymphomas are the second most common mediastinal tumor, and account for one fourth of all anterior mediastinal tumors. The most common types are Hodgkin lymphoma and B-cell lymphoma.

Q: What complications are associated with mediastinal tumors?

A: Complications of mediastinal tumors may include spinal cord compression (numbness, pain, weakness) and the spread of either benign or malignant tumors to nearby structures such as the heart and great vessels (aorta and vena cava).

Q: What are the symptoms of mediastinal tumors?

A: Sixty percent of patients with mediastinal tumors experience symptoms. These include cough, feeling of fullness in the chest, shortness of breath, substernal pain, and weight loss.

Other possible symptoms include fever/chills, night sweats, coughing up blood, swollen lymph nodes, respiratory blockage, and hoarseness.

At Stony Brook University Hospital, we provide leading-edge multidisciplinary care
to give all patients with mediastinal tumors the best possible outcomes.

Q: How are mediastinal tumors diagnosed?

A: A CT scan of the chest is the most commonly used imaging study to define the mediastinal tumor size and extension. Once the tumor mass is confirmed, a biopsy is usually indicated.

A CT-guided needle biopsy is occasionally possible and sufficient to make a diagnosis.

A cervical mediastinoscopy is another diagnostic technique. It consists of a small incision made at the base of the neck. It allows the visualization and biopsy of any growths around the airway (via direct vision or with the help of a miniature camera).

Other diagnostic surgeries include an endobronchial ultrasound-guided biopsy, or a thoracoscopic biopsy (usually excisional).

Q: How are mediastinal tumors treated?

A: Depending on the cause, a mediastinal tumor can be watched (an asymptomatic and non-enlarging cyst). Once a diagnosis is confirmed, the treatment can range from surgical removal (thymic tumors) to chemotherapy (lymphomas or germ cell tumors).

Q: What kind of surgery is used to treat them?

A: Once a decision is made to surgically remove a mediastinal tumor, there generally are two approaches that are used: an anterior approach done through a cut in the front of the chest and breastbone (sternum), called a sternotomy; or a lateral approach done through tiny incisions on the side of the chest, in between ribs, with a minimally invasive procedure called VATS.

VATS stands for video-assisted thoracoscopic surgery (learn more). A thoracoscope is a tiny video camera that transmits images of the inside of the chest onto a video monitor, guiding the surgeon in performing the procedure.

VATS might be performed with a surgical robot; that is, a high-tech instrument the surgeon may use to achieve the most precise surgery. Robotically-assisted VATS require not only the technology but special expertise on the part of the surgeon.

Our thoracic surgeons at Stony Brook Medicine use the latest technology,
and they have many years of experience in treating patients with mediastinal tumors.

Q: What are the risks of surgery for mediastinal tumors?

A: As with any surgery, there is always a small risk of bleeding or infection. However, due to the location of the mediastinal tumors, there is an extra layer of surgical complexity due to the proximity of vital structures such as the heart and esophagus that have to be preserved.

Q: What is the survival rate for patients with cancerous mediastinal tumors?

A: Most surgically removed mediastinal tumors have a favorable outcome. The kind of tumor, the stage, and the surgical margins status dictate the ultimate outcome. Non-surgical tumors like lymphomas also respond readily to chemotherapy.

Q: What is the advantage of having mediastinal tumors treated at Stony Brook Medicine?

A: At Stony Brook University Hospital, we provide leading-edge multidisciplinary care to give patients with mediastinal tumors the best possible outcomes. Our surgeons use the latest technology, and have many years of experience in treating patients with these tumors.

Patients can undergo video-assisted thoracoscopic surgery (VATS) for the removal of mediastinal tumors. This approach uses small incisions, and provides faster recovery than traditional procedures that require large incisions and opening the chest.

If the tumor is more extensive or potentially invading vascular structures, a sternotomy (incision in middle of chest) or hemi-sternotomy (incision in upper half of chest) is commonly used.

Rarely, the removal of the tumor requires placing the patient on cardiopulmonary bypass — a procedure used for open heart surgery to temporarily bypass the heart function — to allow for a more aggressive surgery to take out the tumor.

In less sophisticated hospitals without bypass machines, these tumors would be deemed inoperable and, instead of surgery, patients would be treated with chemotherapy or radiation. Such an approach may be less than ideal because surgery has been shown to provide the best outcomes.

Learn more about mediastinal tumors from the Society of Thoracic Surgeons. For consultations/appointments with our thoracic surgeons who specialize in these tumors, please call 631-444-1820.

Posted by Stony Brook Surgery on January 7, 2019

New Access to Our Vascular Care Benefits Patients on South Shore

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Our vascular specialists at Long Island Community Hospital: (l to r) Drs. Mohsen Bannazadeh, Pamela S. Kim, and Nicholas Sikalas.

We are very pleased to announce that our Vascular and Endovascular Surgery Division is now offering its diverse clinical services in Patchogue at Long Island Community Hospital.

This clinical relationship with Long Island Community Hospital will benefit the growing South Shore community, and comes just a year after the start of a similar relationship with our trauma services.

Our vascular team provides diagnostic and therapeutic services for the entire spectrum of vascular disorders. Our surgeons perform a wide array of open and endovascular procedures for management of arterial and venous diseases. They have special expertise in:

  • Open and endovascular repair of aortic aneurysms and aortic dissections
  • Surgery and stenting for stroke prevention (carotid endarterectomy; carotid stenting; transcarotid artery revascularization)
  • Treatment of peripheral arterial disease (PAD) with open and minimally invasive techniques
  • Repair of traumatic arterial and venous injuries
  • Surgery for diabetic foot ulcers
  • Open and endovascular procedures for hemodialysis access
  • Minimally invasive surgery for varicose veins and venous obstruction

About the addition of our vascular services at Long Island Community Hospital, Richard T. Margulis, president and chief executive officer there, says:

"We couldn't be more proud to work with these incredible physicians who will be helping us to expand the services we offer to the community. Our top priority is always the serving community and offering this new life-saving care without the delay of transfer is a benefit that is beyond measurement."

Stony Brook Surgical Associates is now offering in Patchogue at Long Island Community Hospital
a scope of diagnostic and treatment options for vascular care unique in Suffolk County.

Apostolos K. Tassiopoulos, MD, professor of surgery, vice chair for quality and outcomes, and chief of our Vascular and Endovascular Surgery Division, says:

"Our goal is to bring the most sophisticated vascular care closer to patients. By expanding our practice to Long Island Community Hospital, we will provide easier access to the latest and most advanced vascular and endovascular therapies for patients living on the South Shore, and will enhance the cardiology and trauma services currently offered there."

Our program in minimally invasive endovascular surgery offers a broad scope of diagnostic and treatment options which are unique in Suffolk County. Our team of nationally and internationally recognized expert physicians will now be providing daily these state-of–the-art services in the Patchogue area.

As part of our vascular services, patients in Long Island Community Hospital will also have access to the services of our Center for Vein Care, which is fully accredited by the Intersocietal Accreditation Commission. Our vein care specialists provide treatment for:

  • Acute deep vein thrombosis
  • Chronic venous thrombosis
  • Pelvic congestion syndrome
  • Varicose and spider veins
  • Venous ulcerations

Our specialists use the latest surgical and non-surgical techniques to treat varicose veins and spider veins of the leg, including new minimally invasive "endovenous" techniques that let patients get back to their normal activities in usually just a couple of days. No general anesthesia or hospitalization is required.

Our vascular surgeons have been recognized for many years for their clinical excellence by selection for inclusion in the Castle Connolly Guide, Top Doctors: New York Metro Area, representing the top 10% of physicians in the New York Metropolitan area.

Patients can be seen at our Patchogue office, which is just across the street from Long Island Community Hospital, at 100 Hospital Road, Suite 203 (map/directions).

Learn more about our vascular services. For consultations/appointments with our vascular specialists at Long Island Community Hospital, please call 631-638-1670.

Posted by Stony Brook Surgery on January 2, 2019

Our Thyroid Specialists Use a Multidisciplinary Approach to Managing Thyroid Disorders

The Thyroid Grand | January Is Thyroid Awareness Month
The thyroid is just below the Adam's apple.

An estimated 20 million Americans suffer from a thyroid disorder, and many more go undiagnosed every year. Now is a good time to become aware of your thyroid and its relationship to your health — and how best to take care of it.

Thyroid nodules and enlarged thyroid glands are common problems, and they can harbor cancers within them. They require proper evaluation and treatment.

When detected, patients with these thyroid disorders are usually referred for further work-up to an endocrinologist, or to an experienced head and neck surgeon, like one of the head and neck surgeons at Stony Brook Medicine.

January is national Thyroid Awareness Month that aims to bring to the public's attention the need to take good care of this important tiny gland in the neck.

Following a thorough work-up, the patient may need to undergo thyroidectomy (removal of part or all of the thyroid gland) for several reasons — for removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, treatment of a hyperactive thyroid gland, or an enlarged thyroid gland that is causing breathing or swallowing difficulties.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. Ensuring that the thyroid gland is healthy and functioning properly is important to the body's overall well-being.

Surgical intervention is the gold standard in thyroid cancer; there are no other options to cure it.

Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes which may contain metastatic cancer.

In the hands of a highly-skilled, experienced surgeon, the procedure can usually be done on an outpatient basis and with a low risk of complications. Depending on the type of cancer, some patients may require treatment with radioactive iodine after surgery.

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Our thyroid specialists, (l to r) Drs. Lukasz Czerwonka, Melissa M. Mortensen, and Ghassan J. Samara.

Also essential is close follow-up by the patient's endocrinologist for tumor surveillance and regulation of the thyroid hormone.

Our thyroid specialists take a multidisciplinary approach to providing care for patients with thyroid disorders. The team of physicians consists of surgeons, endocrinologists, radiation oncologists, radiologists, and pathologists.

Management decisions are often made jointly among the team members. Such a team approach has ensured long-term successful outcomes for our patients at Stony Brook Medicine.

Hyperthyroidism is a sustained overly active thyroid gland, which may result in anxiety, nervousness, rapid heartbeat, weight loss, and high blood pressure. The causes of hyperthyroidism include Grave's disease and toxic nodular goiter. This condition is treated with medications, radioactive iodine, or thyroidectomy.

The advantage of surgery is that the condition can be treated quickly and effectively, minimizing the risk of recurrence. In the past, non-surgical treatment has been the primary approach to patient care because of potential complications associated with the surgery. Now, with surgical expertise and advances in technology at Stony Brook Medicine, more patients are undergoing surgery with minimal complications.

In the past, goiter was treated with medication, but that was proved not to be effective. Patients with goiter now have surgery to alleviate the pressure symptoms on the trachea and the esophagus.

Thyroidectomy is performed for nodules and cancer of the thyroid gland. It is also performed in some patients with overactive thyroid glands.

Stony Brook Medicine provides patients state-of-the-art thyroid care using the multidisciplinary team approach, distinguished by highly experienced surgical specialists capable of treating all forms of thyroid conditions.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. The blue paisley ribbon icon is the universal symbol of thyroid disease awareness and advocacy. Paisley was chosen because it resembles a cross-section of thyroid follicles, the tiny spheres that the thyroid gland is made of.

Perform the do-it-yourself thyroid neck check. Watch this video (1:00 min) about thyroid awareness from the American Association of Clinical Endocrinologists:

Posted by Stony Brook Surgery on January 1, 2019

Williams Demonstrates the Poetic Can Be Found Everywhere around Us

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William Carlos Williams as intern at Nursery and Child's Hospital.

"January Morning" is one of the most famous poems by America's great physician-poet William Carlos Williams (1883–1963). A masterpiece of modernist verse, this poetic sequence — he subtitled it "Suite" — presents moments in his daily life, including his life as a pediatrician and obstetrican at Passaic General Hospital in Passaic, NJ.

The poem first appeared in Williams's book, Al Que Quiere! (1917; "To Him Who Wants It!"; Centennial Edition published from New Directions). His voice in it remains totally vibrant. The New York Review of Books recently said, "It seems clear that Williams is the 20th-century poet who has done most to influence our very conception of what poetry should do."

The young doctor is dancing with happiness / in the sparkling wind, alone / at the prow of the ferry!

"January Morning" demonstrates beautifully Williams's poetic method using concrete images, which he later summarized in the phrase "No ideas but in things." His command of language in his verse made him a leader of the modernist revolution against the popular sentimental poetry using vague abstractions. Indeed, it was a revolution against the poetry his friend Ezra Pound said "flies away into the circumambient gas." Williams's poetry is grounded in the world around us.

Williams lived his entire life in Rutherford, NJ, the small town where he was born and raised. It is where he maintained his medical office in his home — where most people knew him simply as "Doc" without knowing he was a man of letters and leader of modernism. He often spent time in Manhattan with fellow artists, crossing the Hudson River by ferry. Al Que Quiere! was his third book but the first to present his unique poetic voice, as found in "January Morning."

All told, Williams published during his lifetime some 20 books of poetry as well as 17 books of prose, including novels, and he delivered more than 3,000 babies. Throughout his career he used his clinical gaze to his advantage as a poet:

January Morning (Suite)


I have discovered that most of
the beauties of travel are due to
the strange hours we keep to see them:

the domes of the Church of
the Paulist Fathers in Weehawken
against a smoky dawn—the heart stirred—
are beautiful as Saint Peters
approached after years of anticipation.


Though the operation was postponed
I saw the tall probationers*
in their tan uniforms
                                  hurrying to breakfast!


—and from basement entries
neatly coiffed, middle aged gentlemen
with orderly moustaches and
well-brushed coats


—and the sun, dipping into the avenues
streaking the tops of
the irregular red houselets,
the gay shadows dropping and dropping.


—and a young horse with a green bed-quilt
on his withers shaking his head:
bared teeth and nozzle high in the air!


—and a semicircle of dirt-colored men
about a fire bursting from an old
ash can,


                       —and the worn,
blue car rails (like the sky!)
gleaming among the cobbles!


—and the rickety ferry-boat "Arden"!
What an object to be called "Arden"
among the great piers,—on the
ever new river!
                         "Put me a Touchstone
at the wheel, white gulls, and we'll
follow the ghost of the Half Moon
to the North West Passage—and through!
(at Albany!) for all that!"


Exquisite brown waves—long
circlets of silver moving over you!
enough with crumbling ice crusts among you!
The sky has come down to you,
lighter than tiny bubbles, face to
face with you!
                        His spirit is
a white gull with delicate pink feet
and a snowy breast for you to
hold to your lips delicately!

The young doctor is dancing with happiness
in the sparkling wind, alone
at the prow of the ferry! He notices
the curdy barnacles and broken ice crusts
left at the slip's base by the low tide
and thinks of summer and green
shell-crusted ledges among
                                the emerald eel-grass!


Who knows the Palisades as I do
knows the river breaks east from them
above the city—but they continue south
—under the sky—to bear a crest of
little peering houses that brighten
with dawn behind the moody
water-loving giants of Manhattan.


Long yellow rushes bending
above the white snow patches;
purple and gold ribbon
of the distant wood:
                      what an angle
you make with each other as
you lie there in contemplation.


Work hard all your young days
and they'll find you too, some morning
staring up under
your chiffonier at its warped
bass-wood bottom and your soul—
—among the little sparrows
behind the shutter.


—and the flapping flags are at
half-mast for the dead admiral.


All this—
                was for you, old woman.
I wanted to write a poem
that you would understand.
For what good is it to me
if you can't understand it?
                But you got to try hard—
            Well, you know how
the young girls run giggling
on Park Avenue after dark
when they ought to be home in bed?
that's the way it is with me somehow.

* Nursing students.
WCW's mother, who rejected his modernist poetry.
Street in Rutherford, NJ, near WCW's home.

William Carlos Williams practiced pediatrics and obstetrics for over 40 years. He was a physician of immense integrity, who regarded allegiance to humanism as important as excellence in medical science. He now serves as a role model, and medical students read him (The Doctor Stories) to learn how he labored to get the "right picture" of patients — much like artists do with paint on canvas, and photographers with cameras; what today we call the holistic approach.

At Stony Brook Medicine, Williams is read in The Center for Medical Humanities, Compassionate Care, and Bioethics. Established in 2008 to expand and succeed the Institute for Medicine in Contemporary Society, the Center is dedicated to furthering the School of Medicine's long tradition of emphasizing humanism in medical education, and serving as "a place where the human side of medicine is elevated, examined, and revered."

Listen to Allen Ginsberg (4:16 min), whom Williams mentored, reading from and commenting on "January Morning." For more biographical info, see our post "Remembering William Carlos Williams."

Posted by Stony Brook Surgery on December 28, 2018

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Dietitian nutritionist Marianna Dayre

Celebrations like New Year's Eve and other holiday parties are commonly associated with drinking alcohol. Eggnog cocktails and champagne are traditional festive drinks.

Alcohol — the intoxicating ingredient found in beer, wine, and liquor — is produced by the fermentation of grains, fruits, or other sources of sugar.

Whether a holiday party or not, alcohol consumption is very popular in the United States. In fact, it's fair to call it a favorite national pastime.

According to a study published last year in JAMA Psychiatry, more Americans are drinking alcohol than before, and they are drinking greater amounts than before (see abstract).

Some people say alcohol consumption causes weight gain, and others say that's a myth. Some even say drinking alcohol actually causes a decrease in weight.

There are websites claiming that alcohol is an energizer that can help burn calories, and be a practical way to achieve weight loss.

The many medical problems associated with having too much weight are well known. So, understanding the relevance of drinking alcohol and gaining weight makes a lot of sense.

Here, bariatric registered dietitian nutritionist Marianna Dayre, MS, RD, CDN, CDE, of the Stony Brook Bariatric and Metabolic Weight Loss Center, answers frequently asked questions about alcohol consumption and weight gain.

Q: Does drinking alcohol affect your weight and shape?

A: Yes. If you are drinking more than the recommended one alcoholic drink per day for a woman and two alcohol drinks per day for a man, the additional calories consumed could lead to weight gain.

If you've had one too many drinks, this can lead to poor decision-making when it comes to meal and snack choices. Studies show that those who engage in heavy drinking tend to consume diets higher in calories, sodium, and fats than those who do not drink.

Excessive drinking could cause an individual to develop more of an "apple" body shape, where a higher level of body fat is distributed in the abdominal region.

Having an increased amount of belly fat is associated with a higher risk of developing chronic health problems down the road, including diabetes, high blood pressure, and certain types of cancers.

Dietitians at the Stony Brook Bariatric and Metabolic Weight Loss Center tailor diets for the individual based on their health needs, dietary preferences, and weight loss goals.

Q: Some scientific studies say alcohol consumption decreases body mass index. How can this be, if increased BMI is associated with weight gain?

A: Increased BMI is not necessarily associated with weight gain. Many individuals that engage in muscle building activity have above-normal BMIs due to the fact that they have higher percentages of muscle mass.

Chronic alcohol use has been linked to reduced protein synthesis which in turn leads to reduced muscle mass leading to a lower BMI. Even though someone who engages in heavy drinking could be gaining weight, specifically, fat mass, they can also be losing muscle mass, which will lower their BMI.

Q: What does alcohol do to the body that's related to weight gain?

A: When you drink alcohol, it's broken down into acetate which the body will burn before any other calorie you've consumed or stored, including fat or even sugar.

So if you drink and consume more calories than you need, you're more likely to store the fat from the pizza you ate and the sugar from the Coke you drank because your body is getting all its energy from the acetate in the beer you sucked down.

Further, studies show that alcohol temporarily inhibits "lipid oxidation" — in other words, when alcohol is in your system, it's harder for your body to burn fat that's already there.

Q: What are the lowest-calorie alcoholic drinks?

A: 1) Rum: 98 calories in 1.5 ounces; 2) vodka: 100 calories in 1.5 ounces of distilled 80 proof; 3) whiskey: 100 calories in 1.5 ounces of 86 proof; 3) gin: 115 calories in 1.5 ounces of 90 proof; 5) tequila: 100 calories in 1.5 ounces.

Cocktail tip: Choose low-calories mixers such as club soda with lemon or lime, and avoid overly sugary juices and mixers.

And here's a beer tip: look for "light" or low-calorie options.

If you are someone who engages in drinking and want to lose weight, our dietitians will help you find a way to incorporate drinking into your lifestyle without sabotaging weight loss goals.

Q: What are the highest-calorie alcoholic drinks?

A: 1) Long Island iced tea: serving size of 7 ounces = up to 780 calories; 2) margarita: serving size of 8.5 ounces = up to 740 calories; 3) piña colada: serving size of 6 ounces = up to 644 calories; 4) mai tai: serving size of 9 ounces = up to 620 calories; 5) mudslide: serving size of 12.5 ounces = up to 594 calories.

Remember that the highest-calorie drinks are usually those concentrated sugar mixers and fruit juices.

Q: Are darker beers and other drinks higher in calories?

A: This is actually a myth. Most people believe that the darker the color a beer is the more calories it is, but, believe it or not, some darker beers are actually lower in calories than your traditional "lager."

For example, a 12-ounce bottle of Guinness has 125 calories. This is actually lower in calories than most beers like Bud, Miller, and Coors, which have closer to 150 calories for the same serving size.

Remember to read nutrition facts labels if printed on the box or bottle when selecting a beer.

Q: What's the best way to drink when trying to lose weight?

A: Moderation is key. Sticking to the recommended guidelines of one drink per day for a woman and two drinks per day for man is ideal if you are a drinker.

However, if you are someone who is really looking to lose those extra pounds, it is advised that you enjoy an alcoholic beverage no more than 1-2 times a week.

When selecting an alcoholic beverage, opt for a lower calorie option cocktail, glass of red wine, light beer, and avoid drinks made with sugary mixes.

Q: How can the Stony Brook Bariatric and Metabolic Weight Loss Center help someone who likes to drink to stay on the path to any necessary weight loss?

A: The dietitians at the Stony Brook Bariatric and Metabolic Weight Loss Center tailor diets for the individual based on their health needs, dietary preferences, and weight loss goals.

The dietitians at the center believe that there is not a one-size-fits-all approach to weight loss.

If you are someone who engages in drinking and want to lose weight, the dietitians will help you find a way to incorporate drinking into your lifestyle without sabotaging weight loss goals.

For consultations/appointments with the dietitians and other specialists at the Stony Brook Bariatric and Metabolic Weight Loss Center, please call 631-444-BARI (2274).

Posted by Stony Brook Surgery on December 17, 2018

By Brian J. O'Hea, MD, Chief of Breast Surgery and Director of the Carol M. Baldwin Breast Care Center

Our Breast Surgeons Are Participating in National Trial to Help Advance Patient Care

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Our breast surgeons, (l to r) Drs. Patricia A. Farrelly, Brian J. O'Hea, and Anastasia Bakoulis.

Historically, all patients with invasive breast cancer have had the lymph nodes in their axilla (armpit) area removed as part of their surgical treatment.

Lymph node removal was established as the standard of care at the end of the 19th century as part of radical mastectomy, and remained so for most of the 20th century until its therapeutic role was challenged by a clinical trial in the 1970s.

The operation typically removed two thirds of the lymph nodes in the axilla, and greatly reduced cancer recurrence rates in the axilla.

In addition, the pathology information gained from it gave important prognostic information about the cancer in the breast(s).

The pathology information — cancer in lymph nodes or not — provides the oncologist (cancer specialist) with vital information that helped to determine the need for chemotherapy.

For these reasons, the removal of axillary lymph nodes has been an important part of the surgical treatment of breast cancer.

Stony Brook breast surgeons were the first surgeons on Long Island
to offer the less invasive lymph node removal procedure.

While most patients recover very well from this procedure, some suffer long-term consequences such as pain, numbness, arm swelling (lymphedema), and even nerve damage.

In the 1990s, sentinel node biopsy emerged as a minimally invasive, less extensive armpit operation.

Breast and Adjacent Lymph Nodes
Breast and adjacent lymph nodes (illustration courtesy of National Cancer Institute).

Patients who had cancer-positive sentinel nodes continued to have complete removal of their axillary lymph nodes. However, patients who had negative sentinel nodes could be spared the full node removal, and the possible negative consequences associated with it.

At that time, Stony Brook University breast surgeons were the first surgeons on Long Island to offer sentinel node biopsy as a less invasive procedure, which then became widely accepted as standard of care.

More recently, randomized trials have confirmed the safety of avoiding lymph node removal in patients treated by lumpectomy, even if there are one or two positive sentinel nodes.

Once again, Stony Brook breast surgeons, in conjunction with our multidisciplinary team, are taking the lead on this, focusing on patients who have positive lymph nodes at the time of cancer diagnosis.

These patients, who require neoadjuvant (preoperative) chemotherapy, are given the opportunity to enroll in a large national clinical trial called Alliance A011202.

In this trial, after receiving preoperative chemotherapy, enrolled patients will have definitive surgery including sentinel node biopsy with simultaneous removal of the previously positive node.

If the previously positive lymph node has been rendered cancer-free by preoperative chemotherapy, no further surgery is performed, and the patient is removed from the study group.

However, if it is determined in the operating room that the lymph node still has cancer, patients are randomized to lymph node removal or not, expecting both groups would get radiation anyway.

The goal of the trial is to determine whether or not radiation without axillary lymph node removal is as effective as both together, as well as monitoring complication rates and arm problems (pain, swelling, functional disability, range of motion) in each treatment group.

We are committed to doing research to find new and better treatments for our patients. Our clinical trials enable us to use the most advanced treatments — long before they're available to other physicians. Participation in our clinical trials is always completely voluntary and never interferes with the normal standards for patient care. Our goal is to give patients the chance to be in trials of new treatments without long-distance travel. Patients participate in them only after they receive a complete explanation of their options from their surgeon.

Learn more about the Alliance A011202 trial. For more information about the trial at Stony Brook's Carol M. Baldwin Breast Care Center, please call 631-638-0709, and ask for our breast cancer navigator.

Posted by Stony Brook Surgery on December 10, 2018

Many of the Burns Associated with the Holiday Season Can Be Prevented

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Dr. Steven Sandoval

The holiday season is one of the busiest times of the year for the Suffolk County Volunteer Firefighters Burn Center at Stony Brook University Hospital.

As the holidays approach, doctors at our Burn Center are urging people to take extra precautions and to eliminate potential dangers that could lead to serious burn injuries.

"Between Thanksgiving and New Year's Day, we see a significant increase in patients coming in with burns," says Steven Sandoval, MD, assistant professor of surgery and medical director of the Suffolk County Volunteer Firefighters Burn Center.

"Holiday celebrations should be full of joy, but if not careful, could quickly turn tragic." Dr. Sandoval says many of these burns and injuries can be preventable and shares some tips for a safe holiday season.

Meals and the holidays go hand and hand, but Dr. Sandoval says the Burn Center sees more and more cooking injuries each year.

"People aren't used to cooking such large meals on a regular basis," says Dr. Sandoval.

"Scalding is one of the most common burn injuries patients come in with. From large pots filled with boiling water, to boiling hot juices spilling out of meat pans, people need to take extra precautions in the kitchen."

Take extra precautions and eliminate potential dangers that could lead to serious burn injuries.

Some cooking safety tips:

  • Keep potholders, wooden utensils, towels, and food packaging away from the stovetop.
  • Deep-fried turkeys have become increasingly popular, but extreme caution should be exercised when choosing this method. Turkey fryers should be used outdoors and kept a safe distance away from homes and structures. Never leave the fryer unattended, and do not overfill it with oil.
  • Keep children away from chaffing dishes filled with hot water and gel-fueled burners.
  • Take extra precautions when removing large dishes out of the oven; they are often heavier than we're used to and can spill over burning hands, forearms, or others.

Each year, Christmas trees are involved in hundreds of fires. According to the U.S. Fire Administration, Christmas tree fires are not common but are likely to be serious, resulting in deaths, injuries, and property loss and damage. (Fact: One of every three home Christmas tree fires is caused by electrical problems.)

Some tips for preventing Christmas tree fires:

  • When purchasing an artificial tree, look for a "fire resistant" label.
  • Check for freshness when purchasing a live tree. A fresh tree is green; the needles are hard to pull; the trunk should be sticky with resin; and when hit, the tree should not lose many needles.
  • Heated rooms will dry live trees quickly, so keep the stand filled with water. A well-watered tree is usually safe, but dry trees can be ablaze in seconds.
  • Place trees at least 3 feet away from all heat sources, including fireplaces, radiators, and space heaters.
  • Don't use electrical ornaments or light strings on artificial trees with metallic leaves or branch coverings.
  • Make sure lights aren't damaged: look for cracked cords, loose connections, damaged sockets, and loose or bare wires. Throw away any strands that are in poor condition.
  • No more than three strands of incandescent lights should be strung together at a time.
  • Make sure to spread lights across multiple electrical outlets to ease the wattage load on them.
  • Make sure anything that requires electricity has been tested for safety. Safe holiday decorations will have a label from one of the independent testing laboratories, such as Underwriters Laboratories (see list of federally recognized labs).

Other reminders to have a safe and prevent burns this holiday season:

  • Do not burn wrapping paper in the fireplace, as it can ignite suddenly and burn intensely.
  • Never leave candles unattended, and place them away from trees and other decorations where they cannot be knocked over, and out of reach from children and pets. (Fact: December is the peak time of year for home candle fires.)
  • Keep children away from fireplaces. Many families will place enclosures to keep children away, but those can heat up quickly and little hands can get burned if touched.
  • Throughout the year, test smoke detector batteries and always have a fire extinguisher within easy reach.
  • Use clips, not nails, to hang lights so the cords don't get damaged.
  • Keep matches and lighters up high in a locked cabinet.
  • Blow out lit candles when you leave the room or go to bed.

First-aid for burns: The first-aid treatment for first-degree burns (skin is reddened) and second-degree burns (it's blistered) is the same, according to the American Academy of Family Physicians: Soothe the burn under cool running water long enough to reduce the pain, usually 15 to 20 minutes. Don't put ice directly on a burn. Once the burn cools, apply a moisturizer to the area, but don't use butter, which can cause infection. Cover the burn with sterile gauze. Take an over-the-counter pain reliever. Don't break blisters.

Watch this video (1:31 min) that shows just how quickly Christmas tree fires can turn devastating and deadly:

        A live Christmas tree burn conducted by the U.S. Consumer Product Safety Commission shows just how quickly a dried out Christmas tree fire burns, with flashover occurring in less than 1 minute, as compared to a well-watered tree, which burns at a much slower rate.

Posted by Stony Brook Surgery on December 3, 2018

Magnets Are Associated with an Alarming Increase in Pediatric Ingestion Injuries

Chest X-Ray of Little Boy Showing Toy Part Lodged in His Esophagus
X-ray of 4-year-old boy showing toy part
(arrow) lodged in his esophagus.

Children's toys are potentially dangerous, and it's that time of the year to be especially mindful of this fact. Listen to our chief of pediatric surgery Christopher S. Muratore, MD, who in a WSHU radio interview offers advice to parents and caregivers.

Foreign body ingestion by children represents a major challenge to the treating physicians and to the parents/guardians. Diagnosis can often be challenging because not all ingested objects can be seen by routine x-ray exams.

Only metallic objects can be seen by x-ray. Objects made out of plastic and glass can be easily missed. Diagnosis, therefore, is often made by direct observation with a history of choking, or new onset of certain symptoms.

Of the many ingestion injuries treated by our Pediatric Surgery Division, one involved a little boy who had sudden chest pain and was brought to our ER: he had swallowed a toy part that lodged in his esophagus (see x-ray at right).

Treatment of a swallowed or inhaled foreign body is dependent on the location and the type of the foreign body. In the digestive tract, if the object is stuck in the esophagus and fails to pass into the stomach, it must be removed using endoscopic techniques.

A foreign body that passes into the stomach can be observed without intervention, because it will usually pass through the intestine and exit with stool. Even sharp objects such as pins can pass without perforating the intestine. The passage into stool can take up to one to two weeks.

Certain types of ingested objects represent a major concern: button batteries and supermagnets (neodymium magnets; typically 10 to 20 times stronger than traditional magnets) are two of the most common types.

Button batteries can be easily swallowed, and these batteries release corrosive chemicals that can erode through the esophagus and intestine if they fail to move. Therefore, our Pediatric Surgery Division tries to remove all of such batteries when seen in the esophagus. Once a battery passes into the intestine, it can only be watched, with the hope it will pass out with the stool without damaging result.

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The majority (72%) of pediatric magnet ingestions occurred after the year 2010. ("Surgical Management and Morbidity of Pediatric Magnet Ingestions.")

Magnets are another type of object that has been identified as especially dangerous. In recent years, many reports of ingested small magnets eroding through the bowel by magnetic force have appeared in the medical literature.

A 2015 study, titled "Surgical Management and Morbidity of Pediatric Magnet Ingestions," demonstrated "the increasing need for magnet regulations and public awareness to prevent potentially serious complications.

Another recent study, titled "Pediatric Magnet Ingestions: The Dark Side of the Force," published in the American Journal of Surgery, found that injuries caused by children ingesting magnets are increasing. The authors conclude that "magnet safety standards are needed to decrease risk to children."

Stony Brook Children's is the only hospital in Suffolk County with board-certified pediatric surgeons who treat children with toys ingested into the airway and digestive tract.

Magnets that are swallowed can clump together on opposite sides of the intestinal wall, and their pinching action can be so tight that holes are made in the intestine, thus creating a dangerous problem.

The current standard of care for children who have more than one magnet is to consider performing emergency abdominal surgery.

A foreign body inhaled into the airway by children is a surgical emergency. Many objects have been identified as high risk for inhalation by young children. These include popcorn seeds, peanuts, latex balloons, etc. Unusual inhaled objects seen at Stony Brook Children's include a broken Monopoly piece and a screw.

Observing choking with an object in the mouth may be the only history. Sometimes, it is a child with new onset wheezing. Chest x-ray may not necessarily make the diagnosis. Rigid bronchoscopy is the utilized for both diagnosis and treatment.

Children's Toys May Be Hazardous to Their Health; Prevent Ingestion Injuries During the holiday season, children's gifts need to be age appropriate for many reasons. Prevention of foreign body aerodigestive ingestion is one of them. However, this is a problem seen throughout the entire year at Stony Brook Children's Hospital.

Stony Brook Children's is the only hospital in Suffolk County with a team of fellowship-trained pediatric surgeons who treat children with toys ingested into the airway and digestive tract. We also have specialists from our pediatric emergency department who can make the diagnosis, and pediatric otolarygologists who can perform all of the above procedures in children.

Foreign body ingestion injuries related to toys often happen when parents overestimate their child’s level of development and make the mistake of buying a toy beyond the suggested age range: toys designed for older children may contain parts that are choking hazards.

A compelling study of foreign body ingestion injuries in children ("Toys in the Upper Aerodigestive Tract") found that despite the adoption of preventive strategies, including product modification by manufacturers, which have decreased the mortality rate due to choking, preventive strategies imposing regulations on industrial production, even if fundamental, are not sufficient.

In addition to these strategies, it was concluded that what's needed is other preventive intervention aimed at improving parents' awareness of foreign body ingestion injuries and at increasing their watchfulness of their children.

Harmful If Swallowed

Here's a very partial list of toy types/parts that young children have swallowed and that have sent them to the emergency room:

  • Ball bearings
  • Board game pieces
  • Button batteries
  • Doll shoes
  • Lego-type toys (interlocking bricks)
  • Round small toys
  • Toy insects
  • Toy soldiers
  • Toy train signs
  • Wheels of toy cars & other vehicles
ALERT: Children under the age of 3 should not play with toys that could fit inside a toilet paper roll. Read magnets safety alert of U.S. Consumer Product Safety Commission. Check to make sure your children's toys are not recalled products.

Watch this video (1:03 min) about a toddler who swallowed 42 magnets and was saved because of prompt diagnosis and treatment:

Ask your teenager to watch this video (just over half a minute) about magnet safety produced by the U.S. Consumer Product Safety Commission:

Posted by Stony Brook Surgery on November 26, 2018

American Diabetes Month Is a Good Time to Share How Surgery Can Help

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Denise at one-year post-op (and 50+ pounds less) with Dr. Konstantinos Spaniolas.

November is American Diabetes Month, and an opportunity to provide exciting information about this often life-altering disease, which is no longer hopeless.

Type 2 diabetes is a very common condition, affecting 10% of adults in New York State alone. It is often linked to obesity, and has a significant impact in cardiovascular health, kidney function, vision, and the nervous system.

Type 2 diabetes is a disease that affects the entire body and can have serious limitations in overall health and quality of life.

Traditionally managed with injectable insulin and other medications alone to control blood glucose, diabetic patients with extra weight now have the opportunity to further control their disease status and even experience 'remission' with surgical options.

Metabolic surgery procedures (also known as weight loss or bariatric surgery), like laparoscopic sleeve gastrectomy and gastric bypass, by changing the intestinal pathways, can lead to powerful hormonal alterations, and represent the most potent way to control and often resolve type 2 diabetes.

Recently, numerous studies comparing metabolic surgery to intensive medical therapy have consistently shown three to six times higher chance for glucose control, and up to 90% chance for "remission."

Metabolic surgery represents the most potent way to control and often resolve type 2 diabetes.

Closely evaluating all this new evidence, a group of international diabetes organizations (including the American Diabetes Association) recommended "inclusion of metabolic surgery among antidiabetes interventions for people with T2D and even just mild obesity" (read more).

This recommendation has been endorsed by 45 leading professional societies in the field.

At the Stony Brook Bariatric and Metabolic Weight Loss Center, our bariatric specialists see the powerful impact of metabolic surgery on a daily basis.

Patients with diabetes and excess weight are evaluated by a multidisciplinary team of experts that includes bariatric surgeons, endocrinologists, dieticians, and psychologists, who work closely together to provide patient-centered care.

"I am finally doing all these things I wasn't able to do the last 20 years. I tell everyone I know …"

Denise is one of those patients. She had been diagnosed with diabetes for the past ten years. Now at the age of 66, she had been dealing with many aspects of the metabolic syndrome.

She came across the experts at Stony Brook Medicine who helped her through her journey.

In December 2017, Denise underwent laparoscopic sleeve gastrectomy with Konstantinos Spaniolas, MD, associate professor of surgery and associate director of our Bariatric and Metabolic Weight Loss Center. She was discharged home the following day.

One year later, Denise has already lost more than 50 pounds. Most important, her blood glucose is under excellent control, without any need for medications.

"I am finally doing all these things I wasn't able to do the last 20 years," Denise says when describing her experience. "I tell everyone I know: you have options, you don't have to suffer."

Denise was just seen for her one-year visit after surgery with Dr. Spaniolas. She has already lost more than 25% of her initial weight, and she recently checked off "Visit Hawaii" from her bucket list!

Our team is so grateful to be part of such a journey. That's what do at our Bariatric and Metabolic Weight Loss Center.

Type 2 diabetes is a long-term metabolic disorder where the body produces insulin, but resists it. Insulin is necessary for the body to utilize sugar. Studies have shown that the majority of patients who have gastric bypass surgery experience complete resolution of their diabetes. Results also have been good for gastric banding. In addition, patients who had bariatric surgery experienced lower insulin resistance, and their risk for metabolic syndrome, high blood pressure, and high cholesterol also decreased.

Metabolic surgery quickly improves blood sugar control in people with type 2 diabetes, and should be recommended or considered as a treatment for certain obese people with diabetes, according to a joint statement endorsed by 45 international professional organizations, which appears in the June 2016 issue of the journal Diabetes Care (summary). The new guidelines, based on the results of multiple clinical studies, are the first guidelines recommending surgery as a treatment option specifically for diabetes.

Learn about obesity and diabetes and different treatment options from the Obesity Action Coalition. Learn about surgical and non-surgical options at the Stony Brook Bariatric and Metabolic Weight Loss Center.

Posted by Stony Brook Surgery on November 21, 2018

How to Avoid a Gallbladder Attack from All the Delicious Thanksgiving Food

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Dr. Mark A. Talamini

Most surgeons on-call during the Thanksgiving holiday and the subsequent holiday season are not surprised when a patient visits the ER complaining of upper right side, abdominal pain, and tenderness radiating through to the back.

There are also no surprises when an ultrasound shows a dilated gallbladder, possibly with a thickened wall, and gallstones ranging from the size of a pebble to the size of a marble or even an egg. At this point, surgery is the next logical step — a cholecystectomy, or gallbladder removal, which is one of the most common surgical procedures in the United States.

At Stony Brook University Hospital, we usually see a spike in the number of emergency cholecystectomies that are performed over the Thanksgiving holiday weekend.

Here, Mark A. Talamini, MD, MBA, professor and chairman of surgery and chief of surgical services at Stony Brook Medicine, who is a renowned gastrointestinal (GI) surgeon, shares a few practical tips on how to prevent a visit to the ER, and keep you at home with your family during the Thanksgiving holiday:

  • Eat smaller portions of high-fat, high-sugar foods: Thanksgiving celebrations are traditionally filled with buttery mashed potatoes, festively fatty appetizers, gooey desserts, and cheerfully spirited cocktails. Take it easy at the Thanksgiving dinner; not only will it spare you a possible trip to the hospital, but you will avoid packing on those extra end-of-the-year pounds. Researchers say many gallbladder symptoms stem from our Western diet, full of refined carbohydrates and saturated fats. "If you're having symptoms from gallstones, it's because as your gallbladder tries to squeeze, some of the gallstones are blocking the outflow of bile that is stored in your gallbladder," Dr. Talamini says. "You're basically squeezing against a closed door, and that's where the pain comes from. When you eat fatty foods that makes the gallbladder squeeze more."
  • Stay hydrated: During the cold months, our indoor environment is often warm and dry, making us sweat more fluid than we might expect, therefore causing dehydration. Overdoing it on holiday cocktails can accentuate dehydration. Staying hydrated also keeps the blood flowing to all organs, including the gallbladder.
  • Eat more fruits and vegetables: Eating fruits and vegetables increases the ratio of fiber to nutrients, which improves overall digestion and decreases the proportion of fat. Fat will stimulate the gallbladder.
  • Get some exercise: Exercise increases overall blood flow and motility, the ability to move food through the gut. After your Thanksgiving meal, get out with the family for a walk!
  • Understand your gallbladder: Watch this video (1:48 min).

According to the National Institute of Diabetes and Digestive and Kidney Diseases, 20 million Americans have gallstones. The majority of those people are unaware of the disease, and show no symptoms.

The average American has one gallbladder attack in their life that typically lasts 1 to 4 hours. However, if the attack is severe or there is a second attack, it may put the person at risk for having future attacks. Three common treatments for gallstones are a "wait and see" approach, nonsurgical removal of the stones, or cholecystectomy.

A visit to the ER may be indicated if you have the following symptoms of a serious gallbladder attack:

  • Abdominal pain that lasts more than 5 hours
  • Clay-colored stools
  • Fever or chills
  • Nausea and vomiting
  • Yellowish color of the skin or of the whites of the eyes

In case of an emergency. The ER at the Stony Brook Trauma Center is here to help around the clock. With the establishment of the Department of Surgery's exigent general surgery (XGS) service, there is a special protocol in place for patients with acute cholecystitis, or gallbladder attack.

Patients with acute cholecystitis are streamlined from initial presentation in the ER, to XGS evaluation, to a dedicated XGS operating room during daytime hours, then to the post-anesthesia care unit and discharge home within 24 hours.

For more complicated patients, the XGS service is able to direct preoperative optimization so that the time-interval to surgery may be decreased. Our goal is to overall decrease patient duration until surgery, length of stay, and hospital costs, while providing the best care for the patient.

Learn more about gallstones and how to prevent a gallbladder attack. And don't let heartburn be a GI holiday spoiler, either: see our prevention tips blog for GERD Awareness Week, which is Thanksgiving week.

Posted by Stony Brook Surgery on October 24, 2018

We Can Reduce Mortality through Awareness and Bystander Interventions

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Click on image to download (enlarge) infographic. PRINT OUT AND SHARE WITH ALL YOU KNOW.

Sudden cardiac arrest is the leading cause of death in the United States, taking the lives of more than 356,000 people every year. It strikes seemingly healthy people of all ages, even children and teens. In 95% of cases, the victim is lost.

Most cases of sudden cardiac arrest occur outside of hospitals. It happens most often in a home or residence (68.5%), followed by public settings (21%) and nursing homes (10.5%), according to the Centers for Disease Control and Prevention.

The need to raise awareness about sudden cardiac arrest is critical. People need to be educated about prevention strategies and how to take immediate action in the case of a cardiac emergency.

Sudden cardiac arrest is not a heart attack, which is caused by impeded blood flow through the heart.

Sudden cardiac arrest can result from cardiac causes (abnormalities of the heart muscle or the heart's electrical system), external causes (drowning, trauma, asphyxia, electrocution, drug overdose, blows to the chest), and other medical causes such as inflammation of the heart muscle due to infection.

Cardiac arrest is a public health issue with widespread incidence
and severe impact on human health and well-being.

Early warning signs of sudden cardiac arrest may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But it often occurs with no warning at all.

When sudden cardiac arrest happens, the victim collapses, becomes unresponsive, and is not breathing normally. They may appear to be gasping, choking, or having a seizure.

To survive sudden cardiac arrest, the victim must receive life-saving defibrillation from an automated external defibrillator (AED) within the first four to six minutes.

Every minute that passes without a shock from an AED decreases the chance of survival by 10%. Administering hands-only cardiopulmonary resuscitation (CPR) can be a bridge to life until an AED arrives.

AEDs — increasingly available in public places and homes — are designed for use by laypersons, and provide visual and voice prompts. They will not shock the heart unless shocks are needed to restore a healthy heartbeat.

The survival rate has remained stagnant for three decades because people outside of hospitals aren't as prepared as they should be to save a life.

The estimated burden to society of death from cardiac arrest is 2 million years of life lost for men and 1.3 million years for women, greater than estimates for all individual cancers and most leading causes of death.

Take-Away Message: You can save a life. First, be prepared. Learn CPR and how to use an AED. Then, here's what to do if sudden cardiac arrest strikes:
  • Call 9-1-1 and follow dispatcher instructions.
  • Start CPR. Press hard and fast on the center of the chest at a rate of 100-120 beats per minute.
  • Use the nearest AED as quickly as possible.

Learn more from the Sudden Cardiac Arrest Foundation. For consultations/appointments with our specialists at Stony Brook University Heart Institute, please call 631-44-HEART (444-3278). Watch this video (1:25 min):

Posted by Stony Brook Surgery on October 10, 2018

Focusing on Global Education of Risk Factors, Signs, and Symptoms of Thrombosis

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Click on image to learn the basics about thrombosis.

The deep vein thrombosis (DVT) team of the Stony Brook Vascular Center supports the World Thrombosis Day campaign to raise awareness about the serious condition of thrombosis.

The Stony Brook Vascular Center joins more than 1,300 organizations from 98 countries in a united effort to raise awareness of thrombosis — the underlying cause of the world's top three cardiovascular killers: heart attack, stroke, and venous thromboembolism (VTE).

VTE is a condition in which blood clots form most often in the deep veins of the leg (see our DVT FAQs page) and can travel in the circulation and lodge in the lungs (known as pulmonary embolism, PE).

VTE is a life-threatening but often preventable condition that affects millions of people worldwide.

Now in its fifth year, World Thrombosis Day's focus is Know Thrombosis, which encourages the general public, healthcare professionals, and key decision-makers to know the risk factors, signs, and symptoms of the condition.

Hospitalization is a top risk factor for VTE, with up to 60% of all VTEs occurring during or after hospitalization. VTE is the leading preventable cause of hospital death.

Our multi-specialty DVT team, led by Antonios P. Gasparis, MD, provides a hospital-wide program for patient assessment and DVT prophylaxis.

One in four people worldwide are dying from conditions caused by thrombosis, but many are unaware of the risks. That's why raising awareness of VTE and its prevention and treatment is crucial to ultimately saving lives.

Risk factors for thrombosis in veins may include:

  • A family history and/or personal history of DVT
  • Hormone therapy or birth control pills
  • Pregnancy
  • Injury to a vein, such as from surgery, a broken bone, or other trauma
  • Lack of movement, such as after surgery or on a long trip
  • Inherited blood-clotting disorders
  • A central venous catheter
  • Older age
  • Smoking
  • Being overweight or obese
  • Some health conditions, such as cancer, heart disease, lung disease, or Crohn's disease

Risk factors for thrombosis in arteries may include:

  • Smoking
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Lack of activity and obesity
  • Poor diet
  • Family history of arterial thrombosis
  • Lack of movement, such as after surgery or on a long trip
  • Older age

Observed on October 13, World Thrombosis Day is an annual event led by the International Society on Thrombosis and Haemostasis and carried out by hundreds of organizations holding more than 9,000 events worldwide. Healthcare professionals should see this VTE Infographic.

Learn about thrombosis. For consultations/appointments with our vascular specialists, please call 631-638-1670. Watch this video (3:53 min):

Posted by Stony Brook Surgery on October 1, 2018

Promoting Breast Health Education and the Importance of Early Detection

Dr. Brian J. O'Hea Reading a Mammogram
Dr. Brian J. O'Hea reading a mammogram.

October is National Breast Cancer Awareness Month and a special time for us to promote breast cancer awareness and provide information on the disease.

Established in 1985, this awareness month, now an international health observance, has from the start aimed to promote mammography as the most effective weapon in the fight against breast cancer. Since then, breast cancer research has also become an important weapon in this fight.

At Stony Brook Medicine, breast cancer is the focus of a comprehensive, academic program — the only one of its kind on Long Island. At its core is our multidisciplinary breast cancer team.

Here, Brian J. O'Hea, MD, chief of breast surgery and director of Stony Brook's Carol M. Baldwin Breast Care Center, answers some of the frequently asked questions women raise after they have been diagnosed with breast cancer. The bottom line is that every woman's situation is different, and treatment needs to be tailored to the type of cancer, personal and family history, tolerance levels for treatment, and personal preferences.

Dr. O'Hea's perspective, as one of the area's premier breast cancer surgeons, gives women information to serve as discussion points with their doctors.

Breast cancer is the most common cancer among American women, other than skin cancer.

Q: What is a lumpectomy and is it safe?

A: A lumpectomy is the removal of a tumor from the breast along with some of the surrounding normal tissue.

When a lumpectomy is recommended, many women consider whether a mastectomy might be a safer choice in terms of recurrence and survival. Long-term studies have demonstrated that a lumpectomy provides survival rates equivalent to a mastectomy while preserving the breast.

A lumpectomy is often recommended to treat a single tumor that is small to medium in size. Patients with a large tumor or multiple tumors are often treated with a mastectomy. Also, the location, type of tumor, and other factors all must be considered with your doctor when making this important treatment decision.

Q: Why do lumpectomies require follow-up radiation?

A: Even when lumpectomies show totally “clean" (cancer-free) margins after surgery, radiation is required because of the natural distribution pattern that breast cancer takes. Not all the cancer stays together.

Some tiny, isolated cells may migrate to other parts of the breast beyond the scope of the surgery. This has nothing to do with the skill of your surgeon, but everything to do with the nature of breast cancer and how it manifests.

Q: Is chemotherapy after breast cancer surgery always required?

A: No. Although some women may also need chemotherapy, many may not. A special test called Oncotype DX can now be performed on a patient's tumor after surgery. The Oncotype DX test can help decide whether or not chemotherapy is needed, although the test is mostly only useful in patients with estrogen-positive tumors and negative lymph nodes.

The results of the Oncotype DX test may identify women who were traditionally offered chemotherapy, but really don't need it. The test analyzes the activity of 21 genes that can influence how likely a cancer is to grow and respond to treatment. It's a form of personalized medicine.

Are you worried about the cost of mammography? CDC offers free or low-cost mammograms.

Q: If a doctor recommends a mastectomy on just one breast, wouldn't it be safer to have a bilateral mastectomy (removal of both breasts)?

A: Long-term studies show that there is a 15% risk of a woman developing cancer in the opposite breast. However, women at higher risk may need to consider the bilateral mastectomy because their odds of developing cancer in the healthy breast are much higher.

These risk factors include a strong family history of breast cancer and the presence of the BRCA gene, which indicates a genetic disposition to breast cancer.

Q: Are there any new options when it comes to reconstruction?

A: Fortunately, because of dramatic improvements in imaging and screening technology, we are more able to find cancer in its earliest stages, which offers some women an opportunity for breast conservation instead of mastectomy.

At Stony Brook, 65% of the women treated for breast cancer have breast preservation surgery. Our surgeons work closely with plastic and reconstructive surgeons to maximize cosmetic outcomes.

Techniques include inserting AlloDerm®, a type of collagen, along with the tissue expander to give a more natural shape to the breast; smaller and more limited incisions that preserve as much of the natural breast skin as possible to facilitate a more natural reconstruction; and a new total skin- and nipple-sparing technique that leaves all of the breast skin in place, which also helps achieve the most natural result available.

However, the nipple-sparing technique is possible in only a small group of highly selected patients requiring a mastectomy [see our FAQs about nipple-sparing mastectomy].

As an academic medical center and accredited breast care center, Stony Brook works to continually refine techniques to make them more widely available for more patients.

Four Important Things Every Woman Can Do about Breast Cancer:
1. Be scrupulous about scheduling annual screening mammograms and clinical exams after the age of 40.
2. Perform monthly breast self-examinations.
3. If you have a strong family history of breast or ovarian cancer, seek BRCA genetic testing. Once you know your risk, you can take preventive measures and risk-reduction steps that may prevent cancer from occurring.
4. If you are scheduled to have a surgical biopsy, inquire about having a needle biopsy instead. Core needle biopsy is the preferred initial breast biopsy method.

Community Update: The Latest Treatments for Patients with Breast Cancer
Hear Stony Brook physicians discuss the latest treatment and surgical advances, including minimally invasive techniques and reconstructive surgery. Hosted by Dr. O'Hea. Community members, patients, family members, caregivers, and healthcare professionals are welcome. Tuesday, October 23, 6 to 9 pm, at the Hilton Garden Inn on the campus of Stony Brook University (see map). Free. Includes buffet dinner. Reservation required. RSVP to 631-444-4000 (register by October 16).

Learn more about breast cancer and how to avoid it from the American Cancer Society. Find out how to help find a cure for breast cancer: The Carol M. Baldwin Breast Cancer Research Fund.

Posted by Stony Brook Surgery on September 28, 2018

When Advanced Multidisciplinary Surgery Is Needed, Stony Brook Medicine Is the Answer

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Plastic and reconstructive surgeon Dr. Jason C. Ganz (l) with Delaney Unger and orthopedic oncologist Dr. Fazel A. Khan at their news conference on September 10.

Delaney Unger has always met the world with a smile. And the talented young dancer is known for her energy and drive. So it was a shock when Delaney was diagnosed with a rare type of bone cancer.

For a while, it looked like 12-year-old Delaney might never dance again. But now she's dancing and pursuing her dreams, thanks to a surgical procedure at Stony Brook Children's Hospital that transformed her ankle into a knee and preserved her mobility.

Delaney was diagnosed with osteosarcoma, a rare type of bone cancer, in her left leg just above the knee. While still reeling from the diagnosis, she and her parents Noah and Melissa had to decide on treatment options.

Delaney herself, with support from her parents and physicians, chose to undergo a 13-hour rotationplasty surgery, which took place in April 2017. First the bottom of her thigh bone, knee, and part of her lower leg were surgically removed.

Then her lower leg, rotated 180 degrees with its foot facing backward, was attached to her thigh bone. Her ankle joint was placed in the position of the knee to create a natural, functioning knee joint.

Delaney received a prosthesis which fits over the backwards foot and extends up the thigh. This allowed her to have motor power to walk, jump, dance and play. The toes provide important sensory feedback to the brain.

First performed in 1930 and subsequently modified in the 1990s,
rotationplasty surgery converts the knee into a hip and the ankle into a knee.

Her surgery required a multidisciplinary team effort involving Jason C. Ganz, MD, of our Plastic and Reconstructive Surgery Division, and two orthopedic specialists Fazel A. Khan, MD, and Nicholas Divaris, MD.

Dr. Ganz, whose expertise includes limb reattachment, explains there was careful pre-surgical planning, to ensure that Delaney's incisions would heal properly after the surgery and that her ankle would function well in its new role as her knee.

"At this point, it's incredibly rewarding to see her as a normal kid again," says Dr. Ganz.

Speaking about her recovery, Delaney says, "Having a backwards foot is definitely different, but now it feels normal." She danced in a recital earlier this year, performing lyrical, hip hop, and jazz dance routines.

"What Delaney's achieved is amazing and she'll get stronger and stronger as she gets back to her life," says Dr. Khan.

Delaney will continue to visit Stony Brook Children's for follow-up appointments during the next five years.

Her parents, Noah and Melissa, say it was a relief to have Delaney treated at Stony Brook, so close to their Selden home. The proximity allowed one parent to be home with Delaney's twin brother, Cameron, while the other parent stayed at the hospital with Delaney.

Inspired by her own cancer journey, Delaney wants to become a pediatric oncologist when she is older.

When asked how she maintains a positive attitude, she says, "Keep up with your passion. Don't give up on anything you want to do, and don't let one thing that's in your life ruin your whole life."

For consultations/appointments with Dr. Ganz, please call 631-444-4666. Watch this video (2:36 min) of Delaney's surgery press conference:

Posted by Stony Brook Surgery on September 20, 2018

Study of More Than 4,000 Patients Reveals Better Survival Compared to Standard Care

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Dr. Thomas V. Bilfinger

Lung cancer remains the leading cause of cancer death worldwide with a five-year survival rate of 17%. The need for ways to improve survival is clear.

A new study of short- and long-term survival outcomes of more than 4,000 lung cancer patients reveals that patients treated under a multidisciplinary model of care have significantly higher survival rates at one, three, five, and 10 years post diagnosis compared to patients treated with a standard or traditional model of care.

The study — titled "Survival Outcomes Among Lung Cancer Patients Treated Using a Multidisciplinary Team Approach" and published online in Clinical Lung Cancer (see report) — was conducted by Thomas V. Bilfinger, MD, ScD, professor of surgery and director of the Lung Cancer Evaluation Center (LCEC), and his colleagues at Stony Brook Medicine.

This study represents the first large-scale published investigation in the United States documenting the significant survival benefit of a multidisciplinary care approach to the diagnosis and treatment of patients with lung cancer.

Stony Brook's Lung Cancer Evaluation Center was established in 2000 to implement
the multidisciplinary care approach to evaluate, treat, and monitor patients with lung cancer.

Hospitals nationwide typically use a standard model of care when treating lung cancer patients. While this model offers multiple services to patients such as surgical, radiation oncology, oncology, and imaging services, the responsibility of care generally falls on the patient and communication and coordination between all groups is often segmented.

The LCEC multidisciplinary model of care coordinates all aspect of patient care through a core group that meets regularly to plan each patient's care on an individual basis.

The core group involves specialists from multiple departments involved in patient care, such as medical oncology, surgery, radiation oncology, pathology, imaging, pulmonology, and nutrition. Patients' primary care physicians are also involved in the coordinated care, and cancer database experts are involved to investigate outcomes measures on a case-by-case patient basis.

"There is near universal interest in deploying multidisciplinary structures of care to improve outcomes in lung cancer, but to date implementation of such models has been slow because of the lack of supporting data," says Dr. Bilfinger.

"Our findings show data that outcomes are improved with a multidisciplinary care and communications model and should be considered as a 'best practice' guideline for treating all lung cancer patients."

The findings from the Stony Brook study add to a limited but increasing evidence base
supporting the use of the multidisciplinary approach in cancer care and its survival benefits.

The researchers used the Stony Brook University Cancer Center registry to identify patients diagnosed and treated from 2002 to 2016. They compared 1,956 patients participating in the multidisciplinary care model and 2,315 patients receiving traditional care.

After adjusting for biases and matching data, they found that, overall, participating in the multidisciplinary process patients had a one-third survival advantage out to 10 years.

The five-year survival rates for those receiving the multidisciplinary model form of care was 33.6%, compared to 23.0% for those receiving the traditional care approach — a finding that illustrates patients are living longer with the multidisciplinary model of care.

Dr. Bilfinger and colleagues also point out that this model may be particularly effective when diagnosing lung cancer at an earlier stage.

For patients diagnosed in stage one of disease, the one-year survival rate is 92.4% with the multidisciplinary model versus 79.2% with standard care. The five-year survival rates for stage one diagnosed patients are 52.5% and 32.8%, respectively.

Co-authors of the study are Barbara Nemesure, PhD, of the Department of Family, Population and Preventive Medicine; Roger Keresztes, MD, of the Department of Medicine; Denise Albano, DNP, of the Department of Surgery, and Muhammed Perwaiz, MD, of the Department of Medicine.

The LCEC continues to build its multidisciplinary team model for treating and monitoring lung cancer patients and expects to expand this practice at other Stony Brook-affiliated hospitals and clinics.

"We sought to determine whether a multidisciplinary team (MDT) approach to lung cancer care yields superior outcomes to a traditional care model. The present investigation included more than 4,000 patients and compared the survival outcomes between lung cancer patients participating in an MDT program and those receiving traditional care. The results suggest a significant survival benefit with the MDT approach for the diagnosis and treatment of lung cancer." — Bilfinger et al.

Learn more about the Lung Cancer Evaluation Center. To make an appointment at the center, please call 631-444-2981 (see information).

Posted by Stony Brook Surgery on September 12, 2018

Designation by National Pancreas Foundation Is Respected Seal of Approval

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Dr. Aaron R. Sasson is director of the Pancreatic Cancer Center.

Stony Brook University Cancer Center has just been designated by the National Pancreas Foundation (NPF) as a Pancreatic Cancer Center. It is the first NPF Cancer Center on Long Island, and one of only six in New York State.

Aaron R. Sasson, MD, professor of surgery and chief of our Surgical Oncology Division, directed the initiative and preparation for the screening process to gain the special NPF designation.

About the Pancreatic Cancer Center, Dr. Sasson is quoted in an article published by TBR News Media: "As opposed to one person leading this, there are many people here who are required to have an interest in pancreatic cancer."

"We are not only looking to build a great infrastructure for the treatment of pancreatic cancer, but we’re also looking to build a team for research on pancreatic cancer."

Dr. Sasson points out that the Stony Brook Cancer Center already has a number of scientists pursuing research on pancreatic cancer, plus a record of using leading-edge treatments for it.

In addition to our surgical oncologists who specialize in the management of this disease, the Cancer Center's multidisciplinary Gastrointestinal Oncology Team includes a range of specialists in medical hematology/oncology, radiation oncology, gastroenterology, pathology, and radiology.

Other specialists at the Cancer Center who provide care for patients with pancreatic cancer include nutritionists and social workers.

NPF designation means we provide multidisciplinary care for the “whole patient” with a focus on the best possible outcomes and an improved quality of life.

Pancreatic cancer is a deadly disease. It is estimated that more than 55,000 people will be diagnosed with this cancer in the United States this year, according to the American Cancer Society, and that about 44,000 people will die of it.

Pancreatic cancer tends to go undetected until it is advanced. It grows fast in most cases. By the time symptoms of the cancer occur, diagnosing it is usually relatively straightforward.

Patients with this cancer have only an 8% survival rate five years after diagnosis. Survival rates are low because fewer than 10% of patients' tumors are confined to the pancreas at the time of the diagnosis.

In most cases, the malignancy has already progressed to the point where surgical removal is impossible.

A widely respected specialist in pancreatic cancer, Dr. Sasson is interested in screening and early detection as well as biomarkers. At least half of his work is related to pancreatic cancer. He has been selected for inclusion in the Castle Connolly Guide, America's Top Doctors for Cancer, as well as the Best Doctors in America database.

Approved NPF Cancer Centers have to go through an extensive auditing process and meet the criteria developed by a task force made up of invited subject matter experts and patient advocates.

NPF designation also means we are committed to advancing the treatment of pancreatic cancer through basic and clinical research to save more lives.

The criteria include having the required expert physician specialties such as pancreas surgeons, gastroenterologists, and interventional radiologists, along with more patient-focused programs such as a pain management service, psychosocial support, and more.

For patients and families coping with pancreatic cancer, there are inconsistencies in the level of care they receive at various hospitals. The NPF Cancer Centers designation helps to facilitate the development of high-quality, multidisciplinary care approaches for the field.

NPF-designated centers also seek to advance research and lead the way for heightened awareness and understanding of pancreatic cancer among community physicians, allied health professionals, patients, families, and the general public.

A nonprofit organization founded in 1997, the NPF provides hope for those suffering from pancreatitis and pancreatic cancer through funding cutting-edge research, advocating for new and better therapies, and providing support and education for patients, caregivers, and healthcare professionals.

The NPF goes through an extensive screening process to designate Pancreatic Cancer Centers, recognizing those that focus on multidisciplinary treatment of pancreatic cancer.

The NPF offers this distinction only to those institutions that treat the "whole patient" and that offer some of the best outcomes and improved quality of life for patients with pancreatic cancer.

"[Dr. Aaron R. Sasson] had a patient who was about 80 at the time of his diagnosis. His primary doctor told him to get his affairs in order. 'We operated on him and he lived another six or seven years,' Sasson recalls. 'He was grateful to see his grandchildren graduate and to see his great-grandbabies being born.' While every patient is unlikely to have the same outcome, Sasson said surrendering to the disease and preparing for the inevitable may not be the only option, as there may be other courses of action." — TBR News Media (read more)

Learn more about pancreatic cancer. For consultations/appointments with our surgical oncologists who specialize in this cancer, please call 631-444-8086.

Posted by Stony Brook Surgery on September 5, 2018

We Know How to Help Kids Achieve a Healthy Weight and Stay That Way

Variations in Body Fat in Children
We must recognize the problem and do everything we can to solve it.

Childhood obesity keeps growing at an epidemic rate, along with that of adults.

More than one-third (40%) of U.S. adults have obesity, according to the latest numbers provided by the Centers for Disease Control. Nationwide, 13.7 million children and adolescents aged 2 to 19 are obese.

Nearly one-fifth of kids are obese. How terribly sad! The obesity prevalence is around 14% among 2- to 5-year-olds, 18% among 6- to 11-year-olds, and 21% among 12- to 19-year-olds.

Since 1980, the childhood obesity rates (ages 2 to 19) have tripled — with the rates of obese 6- to 11-year-olds more than doubling (from 7% to 18%) and rates of obese adolescents (ages 12 to 19) quadrupling from 5% to 20%.

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on body mass index, known as BMI. (Click here to use the CDC online BMI calculator for children.)

One out of five children in the United States has obesity now — and that's cause for alarm.

In Suffolk County alone, there are more than 5,000 obese students in middle and high school.

Obese children often have adult diseases, such as type 2 diabetes, high blood pressure, and heart disease, because of their extra body weight. In such cases, treatment becomes more urgent.

Stony Brook Children's multidisciplinary Healthy Weight and Wellness Center is dedicated to providing a range of treatment options, from diet change to surgery performed by our bariatric specialists.

Commenting on obesity in adolescents and the benefit of bariatric surgery, Konstantinos Spaniolas, MD, associate professor surgery and associate director of our Bariatric and Metabolic Weight Loss Center, says:

"Obesity and associated diseases (metabolic, psychologic, orthopedic, etc.) have a deleterious effect in adolescents with severe future cardiovascular risks. It is likely that an early intervention in this age group can disrupt the progression of disease, and lead to long-lasting benefit.

"Recent published evidence demonstrates profound and sustained weight loss in adolescents that is maintained at least 3 years after metabolic surgery. Importantly, 95% of adolescents with type 2 diabetes experience lasting remission at 3 years."

At present, weight loss surgery provides the only effective, lasting relief from severe obesity.

Obesity most commonly begins between the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an obese adult.

Obesity increases the risks of morbidity and mortality because of the diseases and conditions that are commonly associated with it, such as type 2 diabetes, hypertension, and cardiovascular disease, among other health risks.

Therefore, the American College of Surgeons believes it is of utmost importance to extend its quality initiatives to accrediting bariatric surgery centers so that it can assist the public in identifying those facilities that provide optimal surgical care for patients who undergo this surgical procedure.

In 2014, Stony Brook Medicine was first granted full accreditation as a comprehensive bariatric facility by the MBSAQIP, then a newly established program of the American College of Surgeons and American Society of Metabolic and Bariatric Surgery.

Every member of our large multidisciplinary team is committed to our program, and this commitment is the key of our success. We are all extremely proud of the work we do, and proud of our continued recognition by the MBSAQIP.

Our mission is to help children and adults who have issues with too much extra weight to achieve a healthy weight and stay that way.

Individualized assessment and care are crucial for the long-term success of weight loss treatment. At Stony Brook Medicine, our bariatric specialists welcome any pediatric/adolescent patient over the age of 12 for evaluation. With the close involvement of specialized pediatricians, dieticians, and psychologists, a thorough assessment of patient and family allows for proper guidance. We offer the full gamut of weight loss options, and many patients will be successful with lifestyle and behavioral modification alone. Bariatric surgery or other interventions are sometimes offered to further assist with weight loss and control of co-existing medical problems.

For consultations/appointments with our bariatric specialists, please call 631-444-BARI (2274). Watch the News 12 L.I. video (2:47 min) of the weight loss story of a teenager treated by our team:

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Posted by Stony Brook Surgery on August 28, 2018

Read about How We Are Leading the Way in Patient Care, Education, and Research

an image is here POST-OP, our semi-annual newsletter, provides an update on all kinds of new developments in our department, plus health news of interest to the Long Island community and beyond:
  • Performing Prenatal/Fetal Surgery to Give New Lives a Chance
  • Joining the Elite for Heart Bypass in the United States and Canada
  • Introducing Our New Oral & Maxillofacial Surgeon Oncology Specialist
  • Performing Long Island's First Fully Robotic Whipple to Treat Pancreatic Cancer
  • Using New State-of-the-Art Hybrid Operating Rooms for Cardiac & Vascular Surgeries
  • Multidisciplinary Appointments Offer Quality-of-Life Benefits to Patients with Head/Neck Cancer
  • Bariatric Surgery Program Earns Blue Distinction Designation — Before/After Photos Tell It All
  • Residency Update & Alumni News
  • Division Briefs … Plus More!

"This is an exciting season of growth for Stony Brook Medicine and for the Department of Surgery. We have watched over the previous months as two large, sparkling new buildings — the eight-story Medical and Research Translation (MART) Building and 10-story Hospital Pavilion — take their final shape beside our current buildings, creating a new and unique landscape. For the Department of Surgery, these two new buildings represent a leap forward in our ability to provide excellent and innovative care, and further grow our clinical programs." — From the "Chairman's Message" by Mark A. Talamini, MD, MBA

Read POST-OP online now. To receive a complimentary free subscription to the print edition of POST-OP, please send request with your complete postal mailing address.

Posted by Stony Brook Surgery on August 10, 2018

Learn about This Poorly Understood Motility Condition Affecting Millions

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Click on image to download poster.

August is National Gastroparesis Awareness Month. First listed on the U.S. National Health Observances Calendar in 2016 with sponsorship by the International Foundation for Functional Gastrointestinal Disorders, this awareness initiative aims to focus attention on diagnosis, treatment, and quality of life issues associated with this poorly understood motility condition that prevents the stomach from properly emptying.

Gastroparesis, or delayed gastric emptying, is a stomach disorder in which food moves through the stomach into the intestines slower than normal. (The etymology of "gastroparesis" is: gastro- from ancient Greek γαστήρ gaster, "stomach" and πάρεσις -paresis, "partial paralysis.")

Patients often experience chronic nausea, vomiting, bloating, feeling full too soon after starting to eat, and weight loss. It is a debilitating condition, at times requiring hospitalization, and can significantly affect a person's quality of life.

Common causes include diabetes and previous surgery. Diabetes has been noted to be a cause in 30% of gastroparesis cases. However, neurological disease, collagen vascular disorders, viral infection, and drugs have all been blamed.

The Stony Brook Gastroparesis Center offers state-of-the art treatment.

Gastroparesis is believed to occur in 9.6 per 100,000 people in men and 37.8 per 100,000 people in women. A recent study has also demonstrated an increase in gastroparesis-related hospital admissions by nearly 300% over a 16-year period.

Gastroparesis may result in the following complications, which, in addition to potentially problematic symptoms, justify treatment:

  • Severe dehydration: This condition is due to chronic vomiting.
  • Malnutrition: Patients tend to have poor appetites and cannot meet their daily caloric requirements.
  • Poor glucose control: Poor control over the amount and rate of food passing from the stomach to the small bowel can cause poorly controlled blood sugar levels.
  • Poor quality of life: Symptoms can make it difficult to maintain a normal quality of life and may affect a patient's work and social life.

Gastroparesis, if not cured, requires management with a long-term care plan.

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The Stony Brook Gastroparesis Center, established earlier this year under the direction of Salvatore Docimo Jr., DO, MS, offers a multidisciplinary approach that brings together experts in the areas of surgery, gastroenterology, psychology, and nutrition.

Our center's goal is to provide patients with digestive disorders, especially gastroparesis, a wide spectrum of diagnostic and treatment options under one roof.

This past May, Dr. Docimo performed Suffolk County's first per-oral pyloromyotomy (POP) — a novel, minimally invasive procedure to treat gastroparesis.

Now at the forefront of gastroparesis treatment, the POP procedure (also known as G-POEM that stands for gastric per-oral endoscopic myotomy) is a newly developed treatment offering patients attractive benefits, compared with other surgical therapies for gastroparesis.

It was in July 2016 that U.S. Senator Tammy Baldwin (WI) introduced a statement for the record on behalf of the millions of Americans affected by gastroparesis recognizing National Gastroparesis Awareness Month.

Senator Baldwin said: "Unfortunately, gastroparesis is a poorly understood condition, and so patients often suffer from delayed diagnosis, treatment, and management of this disorder. As such, further research and education are needed to improve quality of life for this patient population."

Senator Baldwin urged her fellow colleagues to join her "in recognizing August as National Gastroparesis Awareness Month in an effort to improve our understanding and awareness of this condition, as well as support increased research for effective treatments for gastroparesis" (read her entire statement).

She succeeded in Congress, and so August now is National Gastroparesis Awareness Month, a good time to learn about this poorly understood motility condition affecting millions and apparently on the rise.

The newly established Stony Brook Gastroparesis Center, under the direction of Dr. Salvatore Docimo Jr., offers a multidisciplinary approach that brings together experts in the areas of surgery, gastroenterology, psychology, and nutrition. The center's goal is to provide patients with digestive disorders, especially gastroparesis, a wide spectrum of diagnostic and treatment options under one roof.

Learn more about gastroparesis. For consultations/appointments with the specialists of the Gastroparesis Center, please call 631-444-8330/-2274.

Posted by Stony Brook Surgery on July 27, 2018

Gastroschisis Is on the Rise in Our Region and across the Nation

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Baby Christian Rojas with his mother and father and Dr. Christopher S. Muratore (center) yesterday at Stony Brook Children's Hospital.

Christian Rojas, of Port Jefferson Station, was born at Stony Brook Children's Hospital on May 5th at 35 weeks with a life-threatening condition of the abdominal (belly) wall called gastroschisis (pronounced gas-troh-skee-sis).

Through a series of operations, Christopher S. Muratore, MD, chief of pediatric surgery, and his team at Stony Brook Children's Hospital, were able to save the baby, untwist the bowel, and rescue him in time.

Now the baby is being prepared to go home soon from the hospital.

Today, Christian's story is featured in Newsday, our regional newspaper, where the headline is "Stony Brook Helps Infant Survive Congenital Disorder" (read it; login required).

Christian weighed in at a low birth weight of 5 pounds 7 ounces but is now nearly 11 pounds and hitting some key targets. More good news!

Gastroschisis is a birth defect of the abdominal wall. The baby's intestines are found outside of its body, exiting through a hole beside the belly button. The hole can be small or large and sometimes other organs, such as the stomach and liver, can also be found outside of the baby's body.

Gastroschisis requires surgical repair soon after birth, and is associated with an increased risk for medical complications and mortality during infancy.

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Baby with gastroschisis (illustration courtesy of the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities).

The Centers for Disease Control and Prevention (CDC) estimates that about 1,871 babies are born each year in the United States with gastroschisis, but several studies show that recently this birth defect has become more common, particularly among younger mothers.

CDC researchers recently found that over 18 years, the prevalence of gastroschisis more than doubled in the United States. More research is needed to understand what is causing the increase.

The Newsday article, written by Delthia Ricks, highlights Dr. Muratore's description of the baby's case as "extraordinarily complicated and marked by an extreme twist in the bowel, a condition called midgut volvulus; the contortion threatened the bowel's blood supply."

"Many babies with gastroschisis will suffer the consequence of intestinal failure," Dr. Muratore is quoted as saying. Soon after Christian was born, Dr. Muratore and his pediatric surgery team embarked on a series of surgeries to save the baby's life.

"When we recognized the intestine was twisted, we did what we needed to do to untwist it," he explains. He worked closely with a team of five surgeons, 10 neonatologists — newborn care specialists — and a squad of nurses. Christian has been monitored around the clock since arriving in Stony Brook Children's neonatal intensive care unit (NICU).

Dr. Muratore points out that he and his Stony Brook colleagues have seen a number of babies in our area with gastroschisis. Stony Brook Children's treats about 10 cases of it annually.

Outcomes in gastroschisis have changed dramatically in the past four decades, with the advent of improved neonatal intensive care unit, surgical, obstetric, and nutritional care. Overall, survival went from 50% to 60% in the 1960s to greater than 90% currently.… The improved survival and diminished morbidity from gastroschisis may be noted from the fact that up to 60% of children will report psychological stress at the absence of a normal umbilicus, and this may be the most prevalent long-term issue requiring reconstruction in some cases. — "Advances in Surgery for Abdominal Wall Defects," Clinics in Perinatology (2012)

Learn more about gastroschisis from the Centers for Disease Control and Prevention. Watch the News12 piece (2:08 min) about Baby Christian:

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Posted by Stony Brook Surgery on July 17, 2018

Achieving the Highest Star Rating for Outcomes and Quality

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Our cardiothoracic surgeons: (left to right) Drs. Allison J. McLarty, Thomas V. Bilfinger, Vinay M. Tak, Joanna Chikwe, and Henry J. Tannous.

We are very pleased to announce that our Cardiothoracic Surgery Division has earned the highest quality rating of three stars from the Society of Thoracic Surgeons (STS) for its overall patient care and outcomes in isolated coronary artery bypass graft (CABG) procedures, based on the latest analysis of data from January to December 2017.

This achievement places us among the elite for heart bypass surgery in the United States and Canada.

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in healthcare, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada.

The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database participant.

The three-star rating, which denotes the highest category of quality, places us among the elite for heart bypass surgery in the United States and Canada.

Historically, approximately 10% to 15% of participants receive the three-star rating for isolated CABG surgery.

"The Society of Thoracic Surgeons congratulates STS National Database participants who have received three-star ratings," says David M. Shahian, MD, chair of the STS Council on Quality, Research, and Patient Safety.

"Participation in the database and public reporting demonstrates a commitment to quality improvement in healthcare delivery, and helps provide patients and their families with meaningful information to help them make informed decisions about healthcare."

"Knowing which hospitals have superior results is a huge advantage for patients," says Joanna Chikwe, MD, chief of cardiothoracic surgery and director of the Stony Brook Heart Institute. They can have peace of mind knowing they're getting care from one of the top-rated facilities in the nation."

"Everybody recognizes that the STS standards reflect overall best practices in cardiac surgery, and our achievement of top performance in isolated CABG surgery reflects our approach to all types of cardiac surgery," says Martin Griffel, MD, chief medical officer, Stony Brook Medicine.

Knowing which hospitals have superior results is a huge advantage for patients, who can have peace of mind knowing they're getting care from one of the top-rated facilities.

Dr. Chikwe adds: "This is a huge accomplishment by the entire cardiac team. Each year only a handful of heart surgery centers in the whole of New York State claim this top rating for outcomes and quality in coronary bypass surgery.

"This is the first time we have participated, and our team can feel extremely proud of this important recognition of the truly superb care our patients receive here.

"The quality of the team is the most important contributing factor as how a patient is going to feel, not just tomorrow but in a week's time and a year's time and in 10 years' time. We want patients to have the best quality of life and the longest life possible."

There are around 300 people on the Heart Institute team, including nurses and nurse practitioners, perfusionists, physician assistants, physiotherapists, respiratory support technicians, residents and attending physicians in the cardiac surgery operating rooms, anesthesia and critical care, cardiology and cardiac surgery stepdown floors and outpatient clinics; as well as care coordinators, dieticians, social workers, and administrative, technical, and housekeeping support in cardiology and cardiac surgery.

"Additionally, we draw heavily on the support of a wide range of services outside the Heart Institute," says Dr. Chikwe, "including vascular and general surgery, pulmonology, nephrology, neurology, radiology, and endocrinology."

The STS is a not-for-profit organization that represents more than 7,300 surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest.

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Our new state-of-the-art cardiac surgery unit — opening this fall in the new Hospital Pavilion adjoined to University Hospital — will further enhance the care provided by our Cardiothoracic Surgery Division. It will include an entirely new intensive care unit (ICU) with 10 rooms designed especially for patients having cardiothoracic procedures, plus 16 contiguous stepdown rooms. The current ICU will become new cardiac operating rooms (ORs) to go with the new hybrid ORs that are already up and running.

For consultations/appointments with our heart surgeons, please call 631-444-1820. The new STS star ratings will be posted on the STS website in August 2018.

Posted by Stony Brook Surgery on July 2, 2018

Offering a New Patient-Friendly Solution to Treat Delayed Gastric Emptying

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Dr. Salvatore Docimo Jr.

Salvatore Docimo Jr., DO, MS, of our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, has just performed Suffolk County's first per-oral pyloromyotomy (POP) — a novel, minimally invasive procedure to treat gastroparesis.

The POP procedure, also known as G-POEM that stands for gastric per-oral endoscopic myotomy, is a newly developed treatment offering patients attractive benefits, compared with other surgical therapies for gastroparesis.

Gastroparesis, or delayed gastric emptying, is a stomach disorder in which food moves through the stomach into the intestines slower than normal. (The etymology of "gastroparesis" is: gastro- from ancient Greek γαστήρ gaster, "stomach" and πάρεσις -paresis, "partial paralysis.")

Patients often experience chronic nausea, vomiting, bloating, feeling full too soon after starting to eat, and weight loss. It is a debilitating condition, at times requiring hospitalization, and can significantly affect a person's quality of life.

Common causes include diabetes and previous surgery. Diabetes has been noted to be a cause in 30% of gastroparesis cases. However, neurological disease, collagen vascular disorders, viral infection, and drugs have all been blamed.

POP is a novel, minimally invasive procedure at the forefront of gastroparesis treatment.

Gastroparesis is believed to occur in 9.6 per 100,000 people in men and 37.8 per 100,000 people in women. A recent study has also demonstrated an increase in gastroparesis-related hospital admissions by nearly 300% over a 16-year period.

"POP is a novel, minimally invasive procedure that is at the forefront of gastroparesis treatment. We are excited to offer the POP procedure as an option for our patients," says Dr. Docimo.

Gastroparesis may result in the following complications, which, in addition to potentially problematic symptoms, justify treatment:

  • Severe dehydration: This condition is due to chronic vomiting.
  • Malnutrition: Patients tend to have poor appetites and cannot meet their daily caloric requirements.
  • Poor glucose control: Poor control over the amount and rate of food passing from the stomach to the small bowel can cause poorly controlled blood sugar levels.
  • Poor quality of life: Symptoms can make it difficult to maintain a normal quality of life and may affect a patient's work and social life.

Surgical treatment options for gastroparesis are reserved for patients with symptoms that have not responded well to lifestyle/dietary modifications and medical management.

The surgical options include implantation of a gastric electrical stimulator, placement of feeding tubes, pyloroplasty (open or laparoscopic), total gastrectomy (removal of the stomach), and the POP procedure (read more).

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The stomach showing location of pylorus (red circle); source, Henry Gray's Anatomy of the Human Body (1918). (Click on image to enlarge.)

POP is the most minimally invasive surgical option, using an endoscope (thin flexible tube). It is an alternative to more conventional pyloroplasty, in which the pylorus — a disc-shaped muscle that allows emptying of the stomach — is cut.

The cutting of this muscle aims to improve passage of food contents from the stomach into the small intestine.

With POP, there generally are no incisions made on the body, as everything is done through an endoscope that is passed through the mouth, into the esophagus, and down into the stomach.

The physician uses a small knife at the tip of the endoscope to create a tunnel to the pylorus, which is then cut, and the tunnel is closed.

The POP procedure offers an option for patients who need to avoid the problems associated with surgery. Most patients will be in the hospital for one day and require a post-procedural upper gastrointestinal study to ensure the effectiveness of the procedure.

The newly established Stony Brook Gastroparesis Center, under the direction of Dr. Salvatore Docimo Jr., offers a multidisciplinary approach that brings together experts in the areas of surgery, gastroenterology, psychology, and nutrition. The center's goal is to provide patients with digestive disorders, especially gastroparesis, a wide spectrum of diagnostic and treatment options under one roof.

Learn more about gastroparesis. For consultations/appointments with Dr. Docimo to discuss treatments for gastroparesis, please call 631-444-8330/-2274.

Posted by Stony Brook Surgery on June 25, 2018

Research by Our Bariatric Team Helps Make Weight Loss Surgery Safer

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Roux-en-Y gastric bypass showing the gastrojejunal anastomosis (red circle) where ulcers might occur.

Bariatric surgery is the most effective treatment for obesity, leading to long-term weight loss, improvements in quality of life, and reduction of obesity-associated medical problems, such as diabetes, sleep apnea, high blood pressure, high cholesterol, venous stasis disease (collection of blood in the lower limbs), and soft-tissue infections.

However, the surgery is associated with possible long-term complications.

Concerns about such complications represent a considerable barrier for eligible patients who consider bariatric surgery. One known long-term post-op complication for the Roux-en-Y gastric bypass (RYGB) procedure is anastomotic ulceration (AU). Symptoms of ulcer disease include abdominal pain (possibly severe) and nausea, among others.

The RYGB procedure, which currently is the most common bariatric procedure performed in the United States, uses a combination of restriction and malabsorption to reduce calories. During the procedure, the surgeon creates a smaller, egg-sized stomach pouch, using about 5% of the patient's stomach and separating off the rest (see illustration). The surgeon then attaches a section of the small intestine directly to the pouch.

AU is a condition in which ulcers develop where the small intestine is attached to the stomach pouch. Most ulcers of this kind respond to medical therapy, but complicated or complex lesions may require further surgery.

Tobacco-smoking has been implicated in the development of AU, but its role has not been well understood. The questions about it motivated the study just published in JAMA Surgery conducted by faculty in our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division.

A significant long-term risk of anastomotic ulceration after Roux-en-Y gastric bypass is associated with passage of time and history of tobacco use.

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Dr. Konstantinos Spaniolas

The title of the study is "Association of Long-term Anastomotic Ulceration after Roux-en-Y Gastric Bypass with Tobacco Smoking" (see preview). The first author of the study is Konstantinos Spaniolas, MD, associate professor of surgery and associate director of the Stony Brook Bariatric and Metabolic Weight Loss Center.

The aim of this study, according to the authors, was to describe the epidemiology of AU after RYGB and measure the association of tobacco smoking with long-term AU incidence.

The Statewide Planning and Research Cooperative System database of the Department of Health of New York State was used to identify 35,075 adult patients who underwent laparoscopic or open RYGB for obesity in the state of New York in 2005 through 2010.

The study found that 17.8% of patients with a history of tobacco use at the time of RYGB surgery developed AU within eight years. These findings emphasize the need for proper patient and bariatric procedure selection.

The authors conclude: "The findings of this study underline that the incidence of AU after RYGB is more common than previously reported and that it progressively increases over time.

"Despite the limitations of the retrospective design, the lack of bariatric-specific granular data, and the possibility of missing patients with AU who were diagnosed and managed exclusively outside the hospital setting, the long-term effect of tobacco use on this complication is profound.

"Such information can potentially aid in procedure selection at the time of initial bariatric surgery or guide patient selection for targeted AU preventive and surveillance strategies."

Dr. Spaniolas told Reuters Health, "The findings can be used to tailor procedure selection for patients with exposure to tobacco, potentially steering them away from gastric bypass and towards other bariatric procedures, or extending ulcer prophylaxis measures lifelong for such individuals who undergo gastric bypass.

"Additionally, [our study] reinforces the possible value of long-term bariatric follow up, specifically in an attempt to identify and aggressively treat (these ulcerations) early in their stage of development."

Studies like this conducted by our faculty demonstrate that not only do they take care of patients, they make surgery better through research. This is what sets us apart.

Stony Brook Medicine is shaping the future of bariatric surgery on multiple fronts. Reflecting the vision and leadership of its founder and director, Aurora Pryor, MD, and associate director, Konstantinos Spaniolas, MD, the Bariatric and Metabolic Weight Loss Center has become a leader nationally and internationally through advanced clinical care, research, advocacy, and mentorship of the next generation of surgeons (read more).

Read about a case of AU after gastric bypass. For consultations/appointments with our specialists at the Bariatric and Metabolic Weight Loss Center, please call 631-444-BARI (2274).

Posted by Stony Brook Surgery on June 21, 2018

REMINDER: Summer Injuries and ER Visits Are Often Avoidable

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Today is the first day of summer! For many, the summer months — when school is out and families take vacations — mean lots of fun in the sun. But with all the pleasures of the season come injuries and increased visits to the emergency room.

"During the summer, we treat more patients with injuries from burns, drownings, boating accidents, and motor vehicle crashes, than at any other time of the year," says James A. Vosswinkel, MD, chief of our Division of Trauma, Emergency Surgery, and Surgical Critical Care, and medical director of Stony Brook Trauma Center.

"We want Long Islanders to get out and enjoy the warm summer months, but to take a moment to first think about safety and precautionary measures they can take when planning outdoor activities. Many of the accidents and deaths that we see are avoidable."

Watch Fireworks from a Distance, Don't Set Off at Home, and Practice Outdoor Fire Safety Tips: Nearly 10,000 Americans are injured by fireworks each year, according to the National Council of Fireworks Safety. Most of these injuries occur during the Fourth of July holiday and include serious burns, loss of fingers, and blindness.

"Each year, we treat adults and children injured by fireworks," says Steven Sandoval, MD, director of the Suffolk County Volunteer Firefighters Burn Center at Stony Brook Medicine. He recommends enjoying public firework displays, which are handled by professionals, from a safe distance — rather than setting them off at home.

And summertime burns also result from outdoor grills, both charcoal and propane, which cause hundreds of injuries and thousands of fires every year. "In addition, we treat at least a few injuries from fire pits and campfires every summer," says Dr. Sandoval. Fire safety tips include:

  • Keep a bucket of sand and/or a garden hose nearby in case the fire grows.
  • Place the fire pit away from trees, branches, and foliage in order to prevent catching fire.
  • Be sure your BBQ is well maintained and cleaned regularly.

Dr. Sandoval reminds Long Islanders that flammable liquids, like lighter fluid or gasoline, should never be used to start a fire. "Unfortunately, the Burn Center treats flash burns to the face and torso when these agents have been used," Dr. Sandoval advises.

Closely Supervise Children around Fires: Around outdoor fires, Dr. Sandoval advises that children should be far enough away to prevent a burn injury. Remember to keep all barbecue accessories, including charcoal, lighter fluid, and propane gas tanks, well out of the reach of kids.

Keep a Watchful Eye on Swimming Children: Drowning is the leading cause of unintentional injury and death for children ages one to four, and drowning can occur in as little as two inches of water. "Parents should know that children can drown without making a sound, and that drowning deaths can occur even when children are left unattended for just a few minutes," says Dr. Vosswinkel.

Kristi L. Ladowski, MPH, injury prevention and outreach coordinator on our trauma team, provides the following water safety tips for people of all ages:

Tips to Keep Young Children Safe during Water Activities:

  • It's all about supervision: always know where your children are, and never leave them alone near water, not even for a second:
    • Designate a "water watcher" when children are swimming. The "water watcher" should not engage in any social distractions (conversation, phones, reading, etc.), they should only be watching the children in the pool for a set amount of time. Rotate the "water watcher" position so that the supervision remains fresh.
    • Install physical barriers to keep children out of pool/spa areas: fences that children cannot climb with self-latching doors.
    • Install door and/or pool alarms to notify you if a child is in or near the pool/spa.
    • Do not use flotation devices (water wing, floaties) as a substitute for supervision.
    • An adult should always be within arm's reach of infants and toddlers when they are in or around water:
      • If a child goes missing, check the water first.
      • Keep pools and spas covered when not in use, empty all other containers of water after use (buckets, inflatable pools).
      • Remove all toys from in and around the pool when not in use.

Water Safety Tips for Adults and Older Children:

  • Never swim alone, use the buddy system.
  • If swimming in open bodies of water (oceans and lakes), only swim in designated areas and obey all instructions and orders from lifeguards.
  • Do not dive into open bodies of water.
  • Never swim under the influence of drugs or alcohol.
  • Know how to safely get out of rip currents. If you're caught in a rip current:
    • Stay calm.
    • Don't fight the current.
    • Escape the current by swimming in a direction following the shoreline (parallel to shore). When free of the current, swim at an angle — away from the current — toward shore.
    • If you are unable to escape by swimming, float or tread water. When the current weakens, swim at an angle away from the current toward shore.
    • If at any time you feel you will be unable to reach shore, draw attention to yourself: face the shore, call or wave for help.

Water Safety Tips for Everyone:

  • Learn to swim.
  • Learn CPR.
  • Keep a cell phone nearby to call for help if needed.
  • Take a water safety and rescue course.
  • Keep rescue equipment nearby (life-saver ring, shepherd's hook).
  • Wear a life jacket when boating. In 2016, 80% of boating deaths were caused by drowning and 83% of those who drowned were not wearing a life jacket.

Alcohol and Water Don't Mix: According to the U.S. Coast Guard and the National Association of State Boating Law Administrators, alcohol can impair judgment, balance, vision, and reaction time. It can also increase fatigue and susceptibility to the effects of cold-water immersion. For boaters, intoxication can lead to slips on deck, falls overboard, or accidents at the dock.

"Alcohol impairs judgment and increases risk-taking, a dangerous combination for swimmers," says Dr. Vosswinkel. "Even experienced swimmers may venture farther than they should and not be able to return to shore, or they may not notice how chilled they're getting and develop hypothermia. Even around a pool, alcohol can have deadly consequences. Inebriated divers may collide with the diving board, or dive where the water is too shallow."


"Overall, the good news is that many injuries that commonly occur during the summer are avoidable — or at least the risk of serious injury can be significantly reduced — if recommended safety precautions are taken," says Dr. Vosswinkel. "We encourage Long Islanders to keep safe and have a great summer!"

"But if an accident does occur, call 911 and go to the nearest emergency room," says Dr. Vosswinkel.

Learn about the Stony Brook Trauma Center and how we can help in case of summer accidents, if you live on Long Island. Visit the website of the CDC for more tips for a safe summer.

Posted by Stony Brook Surgery on June 4, 2018

Our Residency Programs Train Physician-Scientists to Both Practice and Advance Surgery

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Winner of Outstanding Poster Competition (click on image to download & read).

This year's Research Day program took place last Thursday at Stony Brook University's Charles B. Wang Center, and was another great success, as the event continues to grow, with more research presentations and increased attendance.

The morning forum showcased ongoing and completed research projects by way of oral platform presentations, as well as a poster competition by our residents, medical students, and faculty.

Opening the program, Kenneth Kaushansky, MD, dean of the School of Medicine and senior vice president of health sciences, said:

"I have attended virtually every Research Day since its inception, and I am very pleased to see the quality of research grow and the amount of research grow, together with the new horizons of research on display here today."

Stony Brook Medicine is committed to making research happen, says Mark A. Talamini, MD, professor and chairman of surgery and chief of surgical services at Stony Brook Medicine.

Our Research Day celebrates our discoveries, and also demonstrates that as academic surgeons our faculty not only has the job to take care of patients, but to make surgery better. This is what sets us apart from private-practice surgeons, Dr. Talamini is quick to point out.

Research Day demonstrates how we're making surgery better and what sets us apart.

The program included 50 posters presenting study abstracts, plus five oral presentations moderated by faculty discussants, and it attracted over a hundred attendees from Stony Brook Medicine and the University community.

The keynote speaker was Jeffrey B. Matthews, MD, Dallas B. Phemister professor of surgery and chairman of the Department of Surgery at the University of Chicago.

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Dr. Jeffrey B. Matthews

Dr. Matthews's address, titled "Truth and Truthiness in Surgery," was a thought-provoking examination of the validity of scientific evidence applied to clinical practice.

Early in his talk, Dr. Matthews made the compelling statement that "the current practice of surgery is an accumulated wisdom, mixing fact, opinion, and magical thinking in unknown proportions."

He showed that truth and truthiness — the preference for concepts or facts one wishes to be true rather than concepts or facts known to be true — coexist in the world of medicine.

He argued that it's okay to learn to trust one's gut; evidence is elusive and fluid; and knowledge is inseparable from experience.

Ultimately, Dr. Matthews stressed to the audience that evidence-based medicine inadequately accounts for the complexity of individual clinical decisions and the omnipresence of uncertainty. Experience and gut truthiness, not science alone, are essential for successful patient care.

Commenting on the purpose of Research Day, A. Laurie W. Shroyer, PhD, MSHA, professor of surgery and vice chair for research, who oversees the event, says: "Research Day shows the commitment of our department to advancing scientific knowledge in order to improve patient care and population health.

"Residents and fellows, as well as junior faculty, utilize their research projects to address important clinical questions that they face each day, fostering their curiosity and building their excitement and enthusiasm for current and future biomedical research.

"By networking at events such as Research Day, they gain new opportunities for collaborative multidisciplinary team projects. Most important, our Research Day lights the pathway for trainees to envision a future career in academics."

Research Day lights the pathway for trainees to envision a future career in academics.

All categorical residents in our general surgery residency program are required to conduct at least one research project each year, and to present their studies at the Research Day program.

All of our residency programs are committed to training physician-scientists who can both practice and advance surgery in their careers after they graduate from Stony Brook.

Established in 2010, Research Day is an opportunity for our residents as well as our faculty and medical students to present their surgical research. The focus of the program is moving the science of surgery forward.

The Research Day program offers continuing medical education (CME) credit; this activity is designated for a maximum of 3.0 AMA PRA Category 1 Credits™.

2018 Research Day Posters

Here are the titles/authors of the posters exhibited at this year's Research Day. Together, they demonstrate the broad range of research activity within the Department of Surgery, and the impressive productivity of our residents and students:

  • Abdominal wall reconstruction utilizing biologic meshes: comparison of outcomes and risk for readmission between three different meshes | Cary E, Jou C, Marquez J, Shih J, Klein G, Khan S.
  • ABO blood group and prevalence of pulmonary embolism | Kim P, Tassiopoulos A, Probeck K, Elitharp D, Labropoulos N.
  • Acellular dermal matrix sterility: does it affect microbial and clinical outcomes following implantation for breast reconstruction | Klein G, Singh G, Gebre M, Barry R, Trostler M, Marquez J, Huston T, Ganz J, Khan S, Dagum A, Bui D. Oral Presentation.
  • α-Gal: antibody-stimulated, macrophage-directed wound healing | Kaymakcalan O, Dong X, Jin J, Akintayo R, Galili U, Spector J.
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  • Analysis on postoperative ileus after colectomy in patient with inflammatory bowel disease under ERAS protocol: retrospective study | Choi H, Denoya P.
  • Antithrombotic agent use in older adult blunt trauma patients: prevalent and deadly | Chantachote C, Garry J, Singh G, Sikalas N, Labropoulos N. Finalist in Outstanding Poster Competition.
  • Assessment of vascularized constructs within hard and soft tissues | Singh G, Kaymakcalan O, Uddin S, Wiles B, Cordero J, Rafailovich M, Simon M, Bui D. Finalist in Outstanding Poster Competition.
  • Bedside ultrasounds in conjunction with spirometry in the assessment of diaphragm function following blunt traumatic rib fractures: a feasibility study | O’Hara D, Ahmad S, Pasternak D, Huang E, Jawa R.
  • Comparing superior versus inferior pedicle reduction mammoplasty: evaluation of clinical outcome — a single surgeon’s experience over 10 years | Bader A, Tembelis M, Marquez J, Klein G, Zhu C, Bui D.
  • Current technology and devices for port closure: review | Basishvili G.
  • Does bilateral reduction mammoplasty facilitate subsequent weight loss? | Groves D, Marquez J, Trostler M, Pamen L, Medrano C, Kapadia K, Huston T.
  • Does substance abuse increase risk for post-surgical complications in bariatric patients? | Bates A, Yang J, Altieri M, Karim S, Talamini M, Pryor A.
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  • Early ambulation after surgery in the age of fitness tracking | Weller R.
  • Early predictive factors affecting risk of pneumonia, SICU length of stay and hospital length of stay in trauma patients with isolated rib fractures | Fleury M, Masson R.
  • Endovascular thoracic aortic repair for catheter associated aortic injury during thoracentesis | Skripochnik E, Tak V, Bilfinger T, Tassiopoulos A, Bannazedeh M.
  • Estimating the incidence of stray energy burns during laparoscopic surgery based on two statewide databases and retrospective rates: an opportunity to improve patient safety | Guzman C, Forrester J, Fuchshuber P, Eakin J.
  • Examining gender disparities in surgical case volumes in the state of New York | Altieri M, Yang J, Bevilacqua L, Zhu C, Talamini M, Pryor A.
  • Impact of ongoing CPR on VA-ECMO outcomes | Rabenstein A, Fujita KJ, Chiu K, Chiu R, Seifert F, McLarty A. Oral Presentation.
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  • Incidence, outcomes and recidivism of elderly patients admitted for isolated hip fractures | Cabalatungan S, Divaris N, McCormack J, Huang E, Kamadoli R, Abdullah R, Vosswinkel J, Jawa R.
  • Increased incidence of surgical site infection with a body mass index of >35 following abdominal wall reconstruction with open component separation | Svestka, M, Docimo S, Spaniolas K, Bates A, Sbayi S, Schnur J, Talamini M, Pryor A.
  • Increased parathyroid hormone assay use not improved surgical outcomes | Ferrara A, Frenkel C, Yang J, Park J, Samara G.
  • Initial single-center experience with gallium-68 DOTATATE scans for neuroendocrine cancers | Hirai K, Lin M, Georgakis G, Chimpiri R, Matthews R, Franceschi D, Sasson A, Kim J. Finalist in Outstanding Poster Competition.
  • Investigation of the role of the etiology of deep venous thrombosis in the degree of recanalization and reflux development in the deep venous system in order to define the optimal duration of anti-coagulation after an episode of acute deep venous thrombosis | Volteas P.
  • Laparoscopic paraesophageal hiatal hernia repair in a 13-month-old infant | Sosulski A, Burjonrappa S, Coren C, Brathwaite C.
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  • Late proximal neck failure after EVAR | Ribner A, Labropoulos N, Tassiopoulos A.
  • Location, location, location! Stepping up to reach seniors for fall prevention | Ladowski K, Fantal S, Vosswinkel J, Jawa R.
  • Lung cancer and aortic aneurysms: evidence for an inherent linkage | Wiles B, Comito M, Labropoulos N, Bilfinger T. Winner of Outstanding Poster Competition.
  • Machine learning to reduce errors and time in patient admissions/consults | Connolly R.
  • Marginal ulcer continues to be a major source of morbidity over the time following gastric bypass | Pyke O, Spaniolas K. Docimo S, Talamini M, Bates A, Pryor A.
  • Outcomes of anti-reflux procedures in adolescents | Hesketh A, Yang J, Zhu C, Talamini M, Pryor A.
  • Patterns of clinical manifestations and management of intestinal aspergillosis | Yelika S, Lung B, Crean A, Denoya P.
  • Personalized medicine applications for endoscopic derived gastric cancer organoids | Lin M, Kirai K, Buscaglia J, Davis J, Powers S, Rao M, Georgakis G, Sasson A. Oral Presentation.
  • Presentation, diagnosis, and treatment modalities for cecal bascule | Lung B, Yelika S, Denoya P.
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  • Proportion of laparoscopic versus open inguinal herniorrhaphy by year and patient age: the New York state experience | Bates A, Tembelis M, Marquez J, Klein G, Zhu C, Bui D.
  • Regional patters of fluid accumulation and fat hypertrophy in patients with lower extremity lymphedema: an MRA (magnetic resonance angiography)-based staging system | Dayan J, Verma R, Shen J, Talati N, Goldman D, Mehrara B, Smith M, Kagan A.
  • Secondary intention healing after Mohs surgery: evaluation of wound characteristics and cosmetic outcomes | Liu K, Silvestri B, Huston T.
  • Sleeve gastrectomy — the first three years: evaluation of re-operating, emergency department visits and readmissions for 14,080 patients in New York state | Altieri M, Gulamhusein T, Yang J, Obeid N, Park J, Talamini M, Pryor A.
  • Spatial characterization of fibrin with an evolving venous thrombus | Chandrashekar A, Garry J, Gurtej S, Sikalas N, Labropoulos N. Oral Presentation.
  • Spontaneous celiac artery dissection complicated by gallbladder wall necrosis. A case report and literature review | Drakos P, Monastiriotis S, Skripochnik E, Esarko P, Tassiopoulos A.
  • Surgical boot camp for fourth year medical students: Impact on objective skills and subjective confidence | Bevilacqua L, Simon J, Rutigliano D, Sorrento J, Docimo S Jr., Verma R, Wackett A, Chandran L, Talamini M.
  • Surgical boot camp for fourth-year medical students: impact on surgical skills and confidence | Simon J, Bevilacqua L, Docimo S, Rutigliano D, Chandran L, Wackett A.
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  • Surgical trainee impact on bariatric surgery safety | Goldberg I, Talamini M, Pryor A, Docimo S, Bates A, Park J, Yang J, Spaniolas K. Oral Presentation.
  • The novel treatment of traumatic submandibular gland fracture with placement of sialo endoscopic stent | Svestka M, Laskowski R, Samara G.
  • The rush to pre-hospital cervical spine clearance: are we at breakneck speed? | Laskowski R, Jawa R, Mc Cormack J, Huang E, Vosswinkel J, Chaudhary N.
  • Treatment of high-risk patients with carotid artery stenosis using transcarotid artery revascularization in a single academic center | Jasinski P, Panagiotis D, Tzavellas G, Tassiopoulos A, Loh S, Koullias G, Kokkosis A.
  • Trends in diagnosis and management of cecal diverticulitis | Crean A, Lung B, Yelika S, Lung K, Denoya P.
  • The use of computed tomography versus clinical acumen in diagnosing appendicitis in the pediatric population — interim report | Lacy R, El-Gohary Y, Gulamhussein T, Scriven R, Shapiro M.
  • Use of flow-diverting stents in the treatment of complex visceral arterial aneurysms | Monastiriotis S, Jasinski P, Koullias G, Landau D, Fiorella D, Tassiopoulos A.
  • The use of indocyanine green angiography in post-mastectomy reconstruction: do outcomes improve over time? | Diep G, Schelomo M, Kizy S, Huang JL, Jensen EH, Portschy P, Cunningham B, Choudry U, Tuttle TM, Hui JC.
  • The use of radiofrequency ablation in treatment of anal fistula | Dickler C, Lee K.
Next year's Research Day will take place on Thursday, May 30, 2019, from 8:00 am to noon, at the Medical and Research Translation (MART) Building. For more information, please call 631-444-1820.