Recognizing accomplishments in Research and Innovation in the Department of Surgery, University of Manitoba

7:45 am—8:45 am Department of Surgery Grand Rounds

Theatre C — Bannatyne Campus

9:00 am—5:00 pm Research Day Program

Ambassador A — Canad Inns-HSC

GRAND ROUNDS SPEAKER

Dr Hans Kreder Head, Orthopaedic Division

Program Chief, Holland Musculoskeletal Program University of Toronto

KEYNOTE SPEAKER

Dr Allan Okrainec Head, Division of General Surgery

Peter A. Crossgrove Chair in General Surgery University of Toronto

i

Annual Department of Surgery

Research Day 2015

Acknowledgements

The 2015 Surgery Research Planning Committee would like to

acknowledge the Pan Am Clinic Foundation and Department of Surgery

Research Advisory Committee members for their support in the plan-

ning of our Annual Surgery Research Day 2015.

Department of Surgery GFT Surgeons

The Wayne Beecroft Western Surgical Lectureship Fund

Sponsored by

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Table of Contents

Research Day Sponsors ............................................................. i

Acknowledgements ................................................................... i

Maintenance of Certificate Program Event Information ......... ii

Visiting Professor Bio ................................................................ iii

Keynote Speaker Bio.................................................................. iv

Judges, Research Day 2015 Planning Committee ..................... v

Disclosure .................................................................................. v

Research Day 2015 Objectives .................................................. vi

Evaluation & Certificate of Attendance ..................................... vi

Program Details—Morning ....................................................... vii

Program Details—Afternoon ..................................................... viii

Abstracts .................................................................................... 1-33

Participant’s Abstract Index ...................................................... 34

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Phy-sicians and Surgeons of Canada and approved by the CPD Medicine Pro-gram, University of Manitoba for a maximum of 7.0 credits.

Participants should only claim credit for the actual number of hours attended.

iii

VISITING PROFESSOR

Dr Hans Kreder

Head, Orthopaedic Division Program Chief, Holland Musculoskeletal Program

Professor, University of Toronto

Dr. Kreder, Head of the Orthopaedic Division and Program Chief of the Hol-land Musculoskeletal Program, has a subspecialty practice in pelvic and ace-tabular reconstruction and hip and knee joint replacement.

He is the first recipient of the Marvin Tile Chair in Orthopaedic Surgery, a member of the Departments of Surgery (Division of Orthopaedics) and Health Policy Evaluation & Management at the University, and an Adjunct Scientist, ICES.

Dr. Kreder is a Professor HPME (Health Policy, Management and Evaluation), Faculty of Medicine, University of Toronto as well as a Professor, Orthopae-dic Surgery, University of Toronto. He works with the Core Faculty, Clinical Epidemiology Program, University of Toronto. He is an AO Trustee, AO North America, and Chair, Medical Advisory Committee.

Dr. Kreder's main research interests involve the measurement of function and other outcomes following traumatic musculoskeletal injuries, arthritic conditions and metastatic disease, as well as policy issues regarding access to care and the effect of provider experience and volume on patient outcome.

iv

KEYNOTE SPEAKER

Dr Allan Okrainec

Head, Division of General Surgery Peter A. Crossgrove Chair in General Surgery

Associate Professor, University of Toronto

Dr. Allan Okrainec is Head of the Division of General Surgery, and Peter A. Crossgrove Chair in General Surgery at the University Health Network. He is an Associate Professor in the Department of Surgery at the University of To-ronto. His clinical practice specializes in minimally invasive gastrointestinal and bariatric surgery.

Dr. Okrainec is the Director of the Temerty/Chang International Centre for Telesimulation and Innovation in Medical Education. His research interests include the use of simulation and telesimulation for the teaching and assess-ment of laparoscopic skills and the assessment of clinical outcomes and en-hanced recovery programs after surgery. He has published widely and has given numerous invited lectures both nationally and internationally. His work is supported by several research grants, including the Center of Excel-lence in Surgical Education, Research and Training, and Grand Challenges Canada Stars in Global Health.

Dr. Okrainec has leadership roles in several national and international surgi-cal societies. He currently serves on the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons.

v

Judges

Dr Allan Okrainec

Associate Professor Department of Surgery, University of Toronto Dr Hans Kreder

Professor Department of Surgery, University of Calgary Dr Markus Ziesmann

General Surgery Resident Department of Surgery, University of Manitoba

Research Day 2015 Planning Committee

Dr Ted Tufescu, Co-Chair

Dr Krista Hardy, Co-Chair

Dr Richard Keijzer, Thorlakson Chair in Surgical Research

Dr Christopher White, Resident Representative

Mary Brychka, Administrator

Disclosure

Before each presentation, speakers will disclose on their first slide any significant relationships that may be a perceived or apparent conflict of interest to the subject of the proposed CME/CPD activity.

Each member of the Research Day 2015 Planning Committee were asked to disclose any significant relationships with the manufacturer of any commercial product that may have a direct or indirect conflict of interest in the program content. All members reported no conflicts

vi

Research Day 2015 Objectives

At the end of the Department of Surgery Annual Research Day, participants will be able to:

Discuss the findings from surgical research conducted in the Depart-ment of Surgery at the University of Manitoba with colleagues and translate knowledge into clinical practice, patient care and academic teaching.

Understand why simulation is an important component in surgical training; describe the benefits of distance learning in resource-restricted settings; and outline both successes and challenges in es-tablishing an international surgical education and research program.

Understand the effect of surgical skill on outcomes; how to monitor and improve quality; and to consider possible educational models to address the learning curve.

Evaluation & Certificate of Attendance

The Royal College’s Maintenance of Certification program requires that all

accredited activities be evaluated. Your input is invaluable to help us

know this event met your expectations; where there is room to improve;

and to enrich the Department of Surgery’s Annual Research Day for sur-

geons, fellows, residents, medical students, researchers and staff.

Upon completion of your evaluation, the Certificate of Attendance will be

accessible to print for your records. Instructions have been provided on

the website and an email reminder will be sent to all participants following

the event.

We appreciate your support and thank you for your time and collabora-

tion.

Thank you.

Today’s sessions will be evaluated electronically through the Department of

Surgery website:

http://umanitoba.ca/faculties/medicine/units/surgery/8768.html

vii

7:45 DEPARTMENT OF SURGERY GRAND ROUNDS Visiting Professor: Dr Hans Kreder, University of Toronto Surgical complications & outcomes: The effect of surgeons, hospitals and systems of care Theatre C – Bannatyne Campus—University of Manitoba

9:00 OPENING REMARKS - Dr Ted Tufescu (Co-Chair) Ambassador Room A (second floor) Canad Inns – Destination Health Sciences Centre

PLENARY SESSION Moderator: Dr Sadeesh Srinathan

Time Abstract Title Presenter

9:15 General vs. technique specific technical skills assessments – The wheel rein-vented

Sarah Steigerwald* General Surgery

9:26 Outcomes in adult survivors of childhood burn injuries as compared to matched controls

James Stone* Plastic Surgery

9:37 Vestibulo-ocular dysfunction in pediatric sports-related concussion Michael Ellis Neurosurgery

9:48 Comparison of left and right laparoscopic living donor nephrectomies: A Cana-dian single centre experience

Claire Gardiner* Urology

9:59 The DISCERN Study: Mid-term follow-up of post-operative health-related quality of life and mental health status in patients undergoing cardiac surgery

Quyen Nguyen* Cardiac Surgery

10:10 Targeting HMGA2-mediated chemoresistance in GB using DNA minor groove binding drugs

Suchitra Natarajan* Human Anatomy

10:21 The AVATAR Trial: Applying VAcuum To Accomplish Reduced wound infections in laparoscopic pediatric surgery

Robin Visser* Pediatric Surgery

10:32 COFFEE BREAK (15 minutes)

PLENARY SESSION Moderator: Dr Rakesh Arora

Time Abstract Title Presenter

10:47 Avoidance of profound hypothermia during initial reperfusion improves the functional recovery of DCD hearts

Christopher White* Cardiac Surgery

10:58 Normalizing miR-200b expression in vivo improves nitrofen-induced lung hypoplasia in the rat model of congenital diaphragmatic hernia

Naghmeh Khoshgoo* Pediatric Surgery

11:09 Microsurgical reconstruction with ambulation preservation following lower extremity sarcoma resection

Colin McInnes* Plastic Surgery

11:20 Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteers

Patrick Goeres* General Surgery

11:31 Renal nephrometry score and predictors of pathologic upstaging in patients undergoing partial and radical nephrectomies

Deepak Pruthi* Urology

11:42 Comparison of percutaneous fixation versus open reduction and internal plate fixation for the treatment of calcaneal fractures

Ricky Muller Moran* Orthopedic Surgery

11:53 Genesis II SPC / Legion mid-term survivorship Alistair Ross Demcoe* Orthopedic Surgery

12:04 The effect of rater training on trainee assessments in medical education: A systematic review

Reagan Maniar* General Surgery

12:15 LUNCH

12:45 AWARDS CEREMONY Presented by Dr Jack McPherson, Head & Dr Richard Keijzer, Thorlakson Chair in Surgical Research 2014 Resident Research Awards & 2014 Annual Department of Surgery GFT Research Awards

* Speaker eligible for a presentation award

viii

1:00 INTRODUCTION Dr Krista Hardy (Co-Chair) KEYNOTE SPEAKER Dr Allan Okrainec, University of Toronto Developing & delivering an international surgical education program: Lessons learned from around the world

BRIEF SESSION Moderator: Dr Ashley Vergis

Time Abstract Title Presenter

2:00 Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics and aortic matrix metalloproteinases

Annie Ducas* Vascular Surgery

2:05 Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden

Jennifer Bjazevic* Urology

2:10 Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity?

Mohamed Sharaf Eldin* Head & Neck Surgery

2:15 Impact of necrotizing fasciitis on quality of life Robert Strazar* Plastic Surgery

2:20 Classification of facial pain: A 13-year population-based longitudinal study Lyra de Fatima Barchet* Neurosurgery

2:25 In vivo micromotion comparison of keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study

Peter MacDonald Orthopedic Surgery

2:30 Transanal endoscopic microsurgery for giant rectal polyps Courtney Chernos* General Surgery

2:35 Early and late continence after bladder neck sparing radical prostatectomy Chun Huang* Urology

2:40 Comparison of physical fitness between surgical and non-surgical residents David Perrin* Orthopedic Surgery

2:45 A randomized clinical trial comparing the breast and abdominal related morbidity of DIEP and SIEA flaps

Blair Peters* Plastic Surgery

2:50 Neuro-imaging findings in pediatric sports-related concussions: A clinical study

Thomas Hall* Neurosurgery

2:55 The impact of body position and walking on neurophysiological outcome measure

Mina Aziz* Orthopedic Surgery

3:00 COFFEE BREAK (15 minutes)

PLENARY SESSION Moderator: Dr Patricia Larouche

Time Abstract Title Presenter

3:15 Characteristics, long-term survival and predictors of mortality of patients needing prolonged intensive unit care stay post cardiac surgery

Rizwan Manji Cardiac Surgery

3:26 Shit happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families

Kendall Hobbs-Murison Pediatric Surgery

3:37 Mental and physical health outcomes in parents of children with burn injuries as compared to matched controls

Jessica Enns* Plastic Surgery

3:48 The impact of lumbar spinal stenosis on lower extremity motor control: A pre-surgical study

Austin Enright* Orthopedic Surgery

3:59 Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies

Ruchi Chhibba* Urology

4:10 Arthroscopic versus open lateral release for the treatment of lateral epicon-dylitis: A prospective randomized controlled trial

Jamie Dubberley Orthopedic Surgery

4:30 RESEARCH DAY RECEPTION & PRESENTATION AWARDS Presented Dr Richard Keijzer, Thorlakson Chair in Surgical Research Come and celebrate with the winners of today’s top presentations

1

General vs. technique specific technical skills assessments –

The wheel reinvented

Sarah Steigerwald, Jason park, Krista Hardy, Lawrence Gillman, Ashley Vergis

(Section of General Surgery, Department of Surgery, University of Manitoba)

Introduction

Reliable and valid methods of evaluating operative performance are essential for

surgical training programs and education research. Laparoscopic surgery entails a

unique skill set, but it is unclear whether it requires a specific assessment form or

whether more general assessment tools can be applied. The purpose of this study

was to assess the reliability and construct and concurrent validity of two previously

validated assessment scales. One of these scales was designed specifically to assess

laparoscopic skills, and the other to assess more general surgical skills.

Methods

32 PGY 1 – 5 general surgery and urology residents performed a live human laparo-

scopic cholecystectomy. Three attending surgeon raters scored their performance

using the previously well-validated Objective Structured Assessment of Technical

Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) global

rating scales.

Results

OSATS and GOALS demonstrated reliability with a Cronbach’s alpha of 0.958 and

0.959 respectively. Construct validity was demonstrated for both GOALS and OSATS

with senior residents demonstrating significantly higher scores than the junior group

(p<0.001). Pearson’s correlation coefficient between GOALS and OSATS was 0.975

(p=0.01).

Conclusion

Reliability and construct validity were confirmed for both GOALS and OSATS global

rating scales. The near total correlation between the two scales questions the need

for separate laparoscopic assessment tools. This study highlights the real strengths

of the original OSATS forms, the use of which allows for more consistent nomencla-

ture and standardized skills assessment across surgical platforms.

2

Outcomes in adult survivors of childhood burn injuries as compared to matched controls

James Stone1, JP Gawaziuk2,3, S Khan4, D Chateau4, J Bolton5, J Sareen5, J Enns1, M Doupe4,

M Brownell4, S Logsetty2,3

(1BSc Med Program, 2Manitoba Firefighters Burn Unit, 3Department of Surgery (Section of Plastic Surgery), 4Manitoba Centre for Health Policy, 5Department of Psychiatry)

Introduction

Limited research exists examining long-term mental and physical health outcomes in

adult survivors of pediatric burn injuries. We examine the post-injury lifetime preva-

lence of common DSM-IV mental and physical disorders in a population based pedi-

atric burn cohort compared to matched controls.

Methods

748 survivors of childhood burns were identified from the Winnipeg Children’s Hos-

pital burn registry (between April 1, 1988 - March 31, 2010 with burn TBSA >1%).

These individuals were matched 1:5 to children from the Manitoba general popula-

tion based on age, sex and geographic residence. Post-burn prevalence and Odds

Ratio (OR) comparisons of common Axis 1 mental and physical disorders were done.

The diagnoses were made through physician billings, hospital claims and clinical data

housed at the Manitoba Center for Health Policy Data Repository.

Results

The burn cohort was 5.43 ± 5.02 years old (mean ± SD) with a % TBSA of 11.94 ±

12.03 (mean ± SD). In burn survivors, anxiety was the most prevalent Axis 1 mental

disorder (22.59%), followed by major depression (14.17%), substance abuse/

dependence (3.21%) and suicide attempts (1.2%). Total respiratory morbidity was

the most prevalent physical disorder in burn survivors (51.34%), followed by arthritis

(36.50%), fractures (30.21%), diabetes (3.61%) and cancer (1.47%). Compared to

controls, the burn cohort showed a significant increase in major depression (OR =

1.76; CI 1.39-2.22), anxiety (OR=1.74; CI 1.44-2.12), substance abuse/dependence

(OR=2.85; CI 1.71-4.73), suicide attempts (OR=5.68; CI 2.18-14.7), arthritis (OR=1.33;

CI 1.13-1.56), cancer (OR=2.05; CI 1.01-4.16), diabetes (OR=1.71; CI 1.09-2.67), frac-

tures (OR=1.73; CI 1.46-2.07) and total respiratory morbidity (OR=1.57; CI 1.32-1.84).

Conclusion

Adult survivors of childhood burns injury report significantly more frequent Axis 1

mental and physical health outcomes. Screening for these illnesses is essential when

caring for this population.

3

Vestibulo-ocular dysfunction in pediatric sports-related concussion

Michael J Ellis1,3,4,5, Dean Cordingley4, Sara Vis4, Karen Reimer4, Jeff Leiter1,4, Kelly Russell2,5

(1Department of Surgery, 2Department of Pediatrics & Child Health, 3Section of Neurosurgery, 4Pan Am Clinic,

5Children’s Hospital Research Institute of Manitoba, Canada North Concussion Network)

Introduction

The objective of the present study was two-fold: 1.) to examine the prevalence of

vestibulo-ocular dysfunction (VOD) among children and adolescents with sports-

related concussion(SRC) or post-concussion syndrome (PCS) referred to a multi-

disciplinary pediatric concussion program. 2.) to determine if VOD is associated with

the development of PCS in this cohort.

Methods

We conducted a retrospective review of all SRC (presenting 30 days or less post-

injury) and PCS patients(3 or more symptoms for at least 1 month) referred to a

multi-disciplinary pediatric concussion program between September 2013 and July

2014. Initial assessment included clinical history, physical examination, and Post-

Concussion Symptom Scale assessment. Patients were also assessed for VOD defined

as more than one subjective vestibular and oculomotor complaint (dizziness, blurred

vision etc.) and more than one objective physical examination finding (abnormal

smooth pursuits, saccades, vestibulo-ocular reflex etc.). This study was approved by

the local institutional ethics review board.

Results

101 patients (mean age= 14.2 years, SD= 2.3; 63 male, 38 female) participated in-

cluding 77(76.2%) SRC and 24(23.8%) PCS patients. 22/77 (28.6%) of SRC and 15/24

(62.5%) of PCS patients met the clinical criteria for VOD. The median duration of

symptoms was 40 days (IQR: 28.5, 54) for SRC patients with VOD compared with 21

days (IQR: 13, 32) for those without VOD (p=0.0001). There was a statistically signifi-

cant increase in the adjusted odds of developing PCS among acute SRC patients with

VOD compared with those without VOD (aOR: 4.10; 95% CI: 1.04, 16.16).

Conclusion

Evidence of VOD was detected in a significant proportion of children and adoles-

cents with SRC and PCS referred to a multi-disciplinary pediatric concussion pro-

gram. This clinical feature was a significant risk factor for the subsequent develop-

ment of PCS in this pediatric SRC cohort.

4

Comparison of left and right laparoscopic living donor nephrectomies: A Canadian single centre experience

Clare Gardiner, Thomas McGregor

(Section of Urology, Department of Surgery, University of Manitoba)

Introduction

Laparoscopic living donor nephrectomy is the standard of care at high volume renal

transplant centres. There is still reticence to harvest the right kidney laparoscopically

because of concerns regarding shorter right renal vein length, higher complexity of

the dissection and potentially worse renal allograft outcomes and complication

rates. We performed a retrospective analysis of our single centre laparoscopic donor

nephrectomy series with regard to side harvested and outcomes of both donors and

recipients.

Methods

Following ethics approval by the University of Manitoba, we retrospectively re-

viewed 72 consecutive living donor nephrectomies (LDN) between May 2011 and

July 2014. There were a total of 144 patients when taking into account the donor

and recipient pair. All donor nephrectomies were performed laparoscopically at a

single centre by a single surgeon. Donor and recipient demographics, intra-operative

data and graft outcomes were assessed comparing right to left donor side and differ-

ences analyzed utilizing appropriate statistics.

Results

Of the 72 LDN cases, 56 were left sided and 16 right sided. There was no significant

difference in donor demographics, donor estimated blood loss, warm ischemic time,

complications and length of stay between right and left LDN groups. Recipient mean

serum creatinine levels were equivalent between the right and left laparoscopic

donor groups at 0, 1 and 6 weeks post-operatively. Finally, rejection and delayed

graft function rates in the recipients were no different whether the transplanted

kidney was from a right or a left LDN.

Conclusion

This single centre study shows comparable donor operative parameters and recipi-

ent post-operative outcomes in left and right laparoscopic donor nephrectomies.

Harvesting the right kidney laparoscopically is safe and does not have a negative

impact on donor recovery or long term graft function in the recipient.

5

The DISCERN Study: Mid-term follow-up of post-operative health-related quality of life and mental health status in patients undergoing

cardiac surgery

Quyen Nguyen, Rakesh Arora1, Navdeep Tangri2 (1Section of Cardiac Surgery, 2Section of Nephrology, Department of Internal Medicine)

Introduction

Delirium is the most common neurological complication post cardiac surgery with

incidence varying between 10-60%, but can be as high as 73% in the elderly. Our

study objectives were to examine the effects of: 1) post-operative delirium on mid-

term (6-9 months) health-related quality of life (HRQoL), 2) post-operative delirium

on mental health, 3) and to determine risk factors for each of these conditions.

Methods

A prospective observational cohort study was carried out in consecutive cardiac

surgery patients between July 2013 and July 2014. 197 patients were interviewed via

telephone 6-9 months post-cardiac surgery. HRQoL was assessed using the Short

Form-12 (SF-12v2) and EuroQoL-5D (EQ-5D). Mood disorders were assessed using

the Patient Health Questionnaire (PHQ-9). Cognition was assessed using the

Memory Impairment Screen (MIS) and Category Fluency Test (CFT).

Results

The rate of post-operative delirium was 21.1% in elective and 30.8% in urgent or

emergent cardiac surgery patients. Pre-operative predictors of delirium were higher

EuroSCORE II, previous cardiovascular procedure, older age, less than high school

education and left ventricular ejection fraction of <35%. Intra-operative predictors

were increased cardiopulmonary pump time, acute kidney injury, returning to the

OR due to post-operative bleeding and new cerebrovascular accident. Delirious pa-

tients remained in the ICU almost 4 times longer than non-delirious patients and

were hospitalized 5 days longer. Patients who suffered from post-operative delirium

were 2 times more likely to score below average in the physical health aspect of the

SF-12v2 and were nearly 3 times more likely to report having anxiety or depression.

Conclusion

Post-operative delirium in cardiac surgery patients is associated with decreased mid-

term physical functions and mental health status. Pre-operative and intra-operative

predictors could be utilized to identify patients at risk of post-operative delirium.

6

Targeting HMGA2-mediated chemoresistance in GB using DNA minor groove binding drugs

Suchitra Natarajan,1 Amy Rommel2, Thatchawan Thanasupawat1, Marshall Pitz3,4, Jerry Kreck1,5, Inder M. Verma2, Sabine Hombach-Klonisch1,6, Thomas Klonisch1,7

(1Departments of Human Anatomy & Cell Science, 2Internal Medicine, 6Obstetrics, Gynecology & Reproductive Medicine, 7Medical Microbiology & Infectious Diseases, 5Surgery; 4CancerCare Manitoba;

2Laboratory of Genetics, Salk Institute for Biological Studies)

Introduction

Temozolomide (TMZ) is an alkylating drug commonly used in glioblastoma (GB)

treatment. TMZ-induced DNA damage is repaired by Base Excision Repair (BER)

mechanism. We previously showed that stem cell factor and non-histone AT-rich

chromatin binding HMGA2 (High Mobility Group AT-hook-2) plays important roles in

BER and contributes to cancer chemoresistance.

Methods

We employed RT-PCR for mRNA detection, Western blot, immunofluorescence and

immunohistochemistry for protein detection of HMGA2 in patient primary, mouse

GB cells and human GB cell lines (U87 and U251). Patient cells were isolates from

surgical GB tumor tissues and mouse cells were GFP positive NF53 cells derived from

this mouse model of GB. WST and caspase assays were used to measure cell survival

and cell death, respectively.

Results

We observed HMGA2 expression in patient and mouse GB (stem) cells, and in estab-

lished human GB cell lines. HMGA2 was exclusively nuclear in GB cells. Presence of

HMGA2 significantly decreased recruitment of DNA damage response marker

γH2AX, indicating reduced TMZ-induced DNA damage in HMGA2-expressing human

and mouse GB cells. HMGA2 knockdown increased the number of DNA strand

breaks assessed by increased γH2AX nuclear foci, reduced the cell survival and in-

creased the caspase 3/7-mediated GB cell death suggesting HMGA2 to reduce TMZ-

induced killing in GB cells. Netropsin, Pentamidine and Dovitinib, three known DNA

minor groove binders were found to compete with and attenuate HMGA2-mediated

chemoresistance. The combination of either netropsin or pentamidine or dovitinib

with TMZ accelerated GB cell death when compared to individual treatment with

TMZ.

Conclusion

We utilized the ability of DNA minor groove binders to compete with HMGA2 for

DNA binding and knocking down its chemoresistive action. Our results point towards

the development of a new combinatorial therapeutic strategy that significantly en-

hanced the ability of TMZ to induce GB cell death.

7

The AVATAR Trial: Applying VAcuum To Accomplish Reduced wound infec-tions in laparoscopic pediatric surgery

Robin Visser, Kris Milbrandt, Suyin Lum Min, Nathan Wiseman, BJ Hancock, Melanie Morris, Richard Keijzer

(Department of Surgery, Division of Pediatric Surgery, University of Manitoba; and Children’s Hospital Research Institute of Manitoba)

Introduction

Surgical site infections are the most common complication of surgery yet very little

literature has addressed their prevention in pediatrics. Negative pressure wound

therapy is used to treat complex wounds by removing local edema, improving vascu-

lar and lymphatic flow, decreasing bacterial density, and promoting angiogenesis

and formation of granulation tissue. We hypothesized that this principle may also be

applied to simple uncomplicated wounds in a prophylactic manner to reduce the

incidence of wound infections following laparoscopic surgery. The aim of this study

was to test this in a randomized controlled clinical trial.

Methods

In this randomized controlled trial, pediatric patients undergoing emergent or elec-

tive laparoscopic surgery requiring an umbilical port site were recruited and divided

into 2 treatment arms: standard dressing vs simple vacuum dressing. Umbilical port

site wounds were inspected between post-operative days 7-10 by a research nurse

unaware of the treatment arm. A surgical site infection was diagnosed using the

American Center for Disease Control criteria. Data comparison was performed using

a Fisher exact test with P<0.05 being set as significant.

Results

Ninety patients were recruited over 2 years; 35 were assigned to the vacuum or

treatment arm and 30 assigned to the control arm. We observed a 2.8% (N=1) infec-

tion rate in the vacuum study group and 3.3% (N=1) in the control group. (p = 1.0) .

Conclusion

Due to its limited numbers, this study was unable to prove that our simple vacuum

dressing reduces postoperative wound infections in uncomplicated surgical wounds.

A fully powered investigation using our validated methodology is needed to defini-

tively answer this question. To achieve this, a multi-institutional approach would be

required. We believe this is warranted, despite the relatively low rates of infection

(~3%) since SSIs continue to be one of the leading causes of morbidity and mortality

following surgery.

8

Avoidance of profound hypothermia during initial reperfusion improves the functional recovery of DCD hearts

Christopher W. White, Yun Li, Alison Müller, Emma Ambrose, Hoa Le, James Thliveris, Trevor W. Lee, Rakesh C.

Arora, Ganghong Tian, Jayan Nagendran, Larry Hryshko, Darren H. Freed

(Section of Cardiac Surgery, Department of Surgery, University of Manitoba)

Introduction

Donor hearts following circulatory death (DCD) have been proposed as an alterna-

tive source of organs for transplant. DCD hearts experience significant ischemia dur-

ing the hypoxemic cardiac arrest and warm-ischemic standoff period that ethically

define death. Subsequent initial reperfusion (IR) causes intracellular calcium over-

load and ischemia-reperfusion injury. IR with an oxygenated cardioplegia may facili-

tate restoration of energy stores and calcium homeostasis prior to myocardial con-

traction, and minimize ischemia-reperfusion injury. These reparative processes may

be inhibited under hypothermic conditions; therefore, we investigated the impact of

IR temperature on the functional of DCD hearts.

Methods

Eighteen pigs sustained a hypoxemic cardiac arrest and 15-minute warm-ischemic

standoff period. Hearts were then procured and reperfused with a cardioplegic solu-

tion for 3 minutes at 3 different temperatures (5°C; N=6, 25°C; N=5, and 35°C; N=7).

Myocardial function was then assessed ex vivo by measuring the cardiac index (mL/

minute/gram heart tissue) achieved at a left atrial pressure of 8 mmHg.

Results

Hearts sustained an equivalent period of warm ischemia (5°C=28±1, 25°C=29±1, 35°

C=27±1 minutes, p=0.50) prior to IR. During IR coronary blood flow (5°C=483±53,

25°C=722±60, 35°C=906±36 mL/min, p<0.01) differed among treatment groups.

Greater preservation of endothelial cell integrity (electron microscopy endothelial

injury score: 5°C=3.2±0.5, 25°C=1.8±0.2, 35°C=1.7±0.3, p=0.01) and less myocardial

injury (troponin I: 5°C=91±6, 25°C=64±16, 35°C=57±7 pg/mL/gram, p=0.04) were

evident in hearts reperfused at warmer temperatures. IR under profoundly hypo-

thermic conditions impaired the recovery of indexed cardiac output (5°C=3.9±0.8,

25°C=6.2±0.4, 35°C=6.5±0.0.6 mL/min/gram, p<0.01).

Conclusion

Avoidance of profound hypothermia during IR minimizes injury and improves the

functional recovery of DCD hearts.

9

Normalizing miR-200b expression in vivo improves nitrofen-induced lung hypoplasia in the rat model of congenital diaphragmatic hernia

Naghmeh, Khoshgoo1,2,3, Patricia Terra1,2, Barbara Iwasiow1,2, Fuqin Zhu1,2, Robin Visser1,2, Vinaya Siragam1,2, Richard Keijzer1,2,3

(1Children’s Hospital Research Institute of Manitoba, 2Department of Surgery, 3Department of Physiology & Pathophysiology)

Introduction

We have previously discovered that microRNA miR-200b expression is lower in nitro-

fen-induced hypoplastic lungs. In this study we test the hypothesis that normalizing

miR-200b expression improves lung development in the nitrofen rat model for con-

genital diaphragmatic hernia (CDH).

Methods

We induced pulmonary hypoplasia and CDH by gavaging five pregnant Sprague-

Dawley rats with 100 mg/ml nitrofen in olive oil. Two control rats were treated with

olive oil alone. Immediately after this treatment, we injected the pregnant nitrofen-

treated rats with 5 mg/kg miR-200b mimics in normal saline (three) or normal saline

alone (two). Newborn rats were euthanized when in distress or one hour after birth.

Lungs were insufflation-fixated with 4% PFA and processed for morphometry and

immunohistochemistry. Statistical comparisons were done using a one-way ANOVA-

Bonferroni test (p<0.05 was significant).

Results

We observed a 70% CDH incidence in the nitrofen pups treated with normal saline.

This was reduced to 15% in the nitrofen rats treated with miR-200b mimics. The

majority of the nitrofen pups treated with saline were suffering from severe respira-

tory distress and euthanized within 10 minutes, whereas all pups treated with miR-

200b mimics displayed no respiratory distress and were euthanized after 10

minutes. Histology and morphology of lungs in nitrofen pups treated with miR-200b

mimics improved. Radial alveolar count was significantly higher (p=0.016) after miR-

200b treatment.

Conclusion

Normalizing miR-200b expression in pregnant rats treated with nitrofen improves

lung development in the offspring clinically and morphologically. Translational stud-

ies in larger animal models should reveal if these promising results could eventually

be extrapolated to human clinical trials.

10

Microsurgical reconstruction with ambulation preservation following lower extremity sarcoma resection

Colin McInnes, I. MacArthur, Edward W. Buchel, Thomas Hayakawa

(Section of Plastic Surgery, Department of Surgery, University of Manitoba)

Introduction

Lower extremity sarcoma treatment has evolved from primarily amputation towards

limb salvage when possible to preserve ambulation. Sarcoma resections frequently

result in massive soft tissue defects which usually require microsurgical reconstruc-

tion. Traditionally, success has been defined as having flap survival in the hostile

conditions of a radiated surgical field. This series investigates whether these tissue

defects can be reliably reconstructed with preservation of ambulation, and moreo-

ver, if immediate functional muscle free-flap reconstructions can be successful when

required to preserve ambulation.

Methods

A 5-year retrospective review of microsurgical reconstruction for limb salvage in

lower extremity sarcoma patients was conducted at the University of Manitoba.

Outcome measures included limb salvage rates, type of flap(s) utilized, ambulation

preservation and patient function utilizing the Toronto Extremity Salvage Score

(TESS), and complications, among others.

Results

Over a five-year period, 22 patients (average age 52 years) underwent free flap re-

construction following lower extremity sarcoma resection with an average follow-up

of 14 months. Of those, 85% underwent neo-adjuvant radiation therapy. The thigh

was the most common tumour site (57%) and 3 different muscles were resected on

average. Perforator flaps were used in the majority of reconstructions (68%), and

functional muscle transfers or immediate tendon transfers were used in 3 patients.

The average TESS scores was 84. There were no flap failures, and all patients

achieved ambulation. Two patients in the series died from metastatic disease (not

local recurrence).

Conclusion

Microsurgical reconstruction of lower extremity sarcoma defects enabling preserva-

tion of ambulation is usually successful and must be considered the gold standard,

replacing the traditional goal of achieving adequate soft tissue coverage alone.

Preservation of function utilizing functional microsurgical reconstructions should

now be considered safe, effective, and as first line treatment in limb salvage proce-

dures. These results may expand the indications for limb salvage in otherwise bor-

derline cases.

11

Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteers

Patrick Goeres1, Frederick A. Zeiler2, Bertram Unger,3 Lawrence M. Gillman4

(1UGME-University of Manitoba, 2Section of Neurosurgery, 3Department of Medical Education, 4Section of General Surgery)

Introduction

Ultrasonic assessment of optic nerve sheath diameter (ONSD) has been suggested as

a potential non-invasive technique for the measurement of intracranial pressure

(ICP). Numerous small studies exist defining its validity as a means to quickly deter-

mine elevated ICP. However, discrepancy exists around what a normal value is for

ONSD due to a lack of standardized measurement technique, and only a small num-

ber of studies mostly in unhealthy patients with normal invasive ICP measurements.

In this study we sought to define a normal value range for ONSD in a large popula-

tion of healthy adult volunteers using a standardized measurement technique.

Methods

ONSD was measured using a standardized technique in healthy adult volunteers and

a normal range was defined using descriptive statistics. Pearson’s correlation was

used to determine relationship between ONSD measurements and sex, age, height

and weight.

Results

62 adults were recruited ranging in age from 19 to 65 (mean 29.5) with 50% being

male. Mean ONSD was 38.3 (33.1-45.8 95% confidence Interval (CI)) in the left eye,

and 38.0 (31.8-44.4 95% CI) in the right eye. Mean ONSD did not vary with age but

did vary significantly with weight, height and sex. However, when controlling for sex,

weight and height no longer contributed to ONSD measurements. Mean ONSD

measurements for males were 39.8 (34.9-45.8 95% CI) compared with 36.5 (28.6-

41.0 95% CI) for females.

Conclusion

This study has defined the range of ONSD in a healthy cohort of volunteers. The

determined range and lack of relationship to age, weight and height is similar to

other studies in the literature but this is the first study to find a difference in sex

amongst ONSD measurements suggesting the possible need for modified reference

ranges for males and females.

12

Renal nephrometry score and predictors of pathologic upstaging in patients undergoing partial and radical nephrectomies

Deepak Pruthi1, Ruchi Chhibba2, Darrel E. Drachenberg1, Thomas B. McGregor1

(1Section of Urology-Department of Surgery and 2UGME-College of Medicine, University of Manitoba)

Introduction

To examine the predictive capability of pre-operative anatomic imaging characteriza-

tion using the R.E.N.A.L. Nephrometry Score (RNS) in assessing pathologic upstaging

of clinical T1 (cT1) lesions to pathologic T3 (pT3) in partial and radical nephrectomy

specimens.

Methods

A retrospective review of all patients undergoing radical and partial nephrectomies

between January 1, 2011 and May 31, 2014 for cT1 renal masses. All pre-operative

imaging scans were reviewed and the R.E.N.AL. Nephrometry score (radius for tumor

size as maximal diameter, exophytic/endophytic tumor properties, nearness of

deepest portion of tumor to collecting system or sinus, anterior/posterior descriptor

and location relative to polar line) was applied to each scan. Chi-square, Fisher exact

test, and Student t test were utilized to examine associations.

Results

Of the 229 patients who underwent partial or radical nephrectomy for cT1, 124

(54%) underwent partial nephrectomy. On pathologic evaluation 195 (85%) patients

had malignancy. Of all tumors 26 (13%) were pathologically upstaged to pT3 with

the majority attributable to renal sinus/fat (35%) or perinephric fat (31%) involve-

ment. High RNS (>10) was significant in predicting pathologic T3 upstaging (p=0.039)

but did not predict high grade (Furhman grade 3-4) disease (p=0.803). While a high

nephrometry score trended toward predicting malignancy vs benign disease

(p=0.086), a higher mean nephrometry score (7.81 vs 6.84) significantly predicted

malignancy (p=0.015). When controlled for cT1a lesions, tumor location relative to

polar lines (L=3 vs L1+2) was predictive of pT3 upstaging (24 vs 6%, p=0.03). Age >65

was significantly associated with upstaging (26 vs 7%, p=0.0001).

Conclusion

Surveillance of small renal masses is common but high RNS and age >65 significantly

predicted upstaging. Mean nephrometry score was also useful in predicting malig-

nancy. Nephrometry score may aid in deciding on early surgical intervention.

13

Comparison of percutaneous fixation versus open reduction and internal plate fixation for the treatment of calcaneal fractures

Ricky Muller Moran, Ted Tufescu, Allan Hammond

(Section of Orthopedic Surgery, Department of Surgery, University of Manitoba)

Introduction

Although calcaneal fractures are common and often associated with significant mor-

bidity, there is a controversy between open reduction and internal fixation using a

calcaneal plate (ORIF), versus minimally invasive techniques of percutaneous fixation

(PF) as the superior operative treatment method. The primary objective of this study

was to measure the rate of post-operative complications with both types of treat-

ment. Secondary objectives included measuring the quality and maintenance of

fracture reduction with each technique, and clinical outcome of patients who re-

ceived each type of treatment.

Methods

A retrospective review of 82 consecutive patients treated for calcaneal fractures at a

level I trauma centre during the years of 2011 to 2014 was conducted. Radiographic

outcomes were measured pre-operatively, peri-operatively (defined as either intra-

operatively or up to three weeks post-operatively), and at last follow-up. This includ-

ed measuring Bohler’s angle at all three time points and assessment of the subtalar

joint at the latter two time points. Functional outcomes were measured using the

Short-Form 12, Foot Function Index, and Foot & Ankle Ability Measure health sur-

veys.

Results

Of the 82 consecutive patients, three did not meet the inclusion criteria. 87 calcane-

al fractures were identified in the remaining 79 patients (ORIF n = 18, PF n = 69). No

significant difference was found between the two operative groups in terms of ei-

ther radiographic or functional outcome. Time to surgery was significantly higher in

the ORIF group (10.6 days ORIF versus 3.27 days PF, P = 0.0002). Post-operative com-

plication rates were 40% with ORIF versus 7.41% with PF; this was not a statistically

significant difference (P = 0.11).

Conclusion

The trend that we have identified supports the hypothesis that PF is associated with

a lower complication rate. This study was limited by the small ORIF group; further

investigation with a larger sample size is warranted.

14

Genesis II SPC / Legion mid-term survivorship

Alistair Ross Demcoe, Thomas Turgeon, Colin Burnell, Eric Bohm

(Concordia Hip & Knee Institute, Section of Orthopedic Surgery, Department of Surgery,

University of Manitoba)

Introduction

The Genesis II total knee implant system was released to the general market in 1996

and experienced good overall performance. Design variations were introduced into

the system in 2005, which utilized a symmetrical posterior condyle design. This sys-

tem, initially known as the Genesis II SPC, and later as the Legion Primary, has not

been evaluated for implant performance and survival. The aim of this study was to

report on the mid term survivalship of the Genesis II SPC/Legion primary TKA at a

single institution.

Methods

The institution’s ethics review board approved the study. Legion/Genesis II SPC TKAs

implanted at the study centre from March 2007 to August 2012 by four fellowship

trained arthroplasty surgeons were included. Patients were consented and enrolled

into a prospective database. Patient’s age at time of surgery, height and weight were

all recorded. The database was retrospectively reviewed and survival analysis was

undertaken using Kaplan-Meier techniques.

Results

There were 2170 patients with 2814 primary total knee arthroplasties with a mini-

mum of 2 year follow up available in the database for analysis. The mean age was

64.6 (19.2-102.0) years, average BMI was 34.9 (14.8-75.7), and 63.0% of the knees

were performed in female patients. The Kaplan-Meier analysis demonstrated a 2-

year survival of 98.2% (95 % CI 97.7-98.6%) for failure for any reason, and a 5 year

survival rate of 97.0% (95% CI 96.2-97.7%).

Conclusion

The Genesis II SPC/Legion Primary system offers excellent midterm survivorship.

Confirmation of these findings using registry data is warranted.

15

The effect of rater training on trainee assessments in medical education: A systematic review

Reagan Maniar, Ashley Vergis, Lawrence Gillman, Krista Hardy, Jason Park

(Section of General Surgery, Department of Surgery, University of Manitoba)

Introduction

Rater training is commonly used in non-medical disciplines to improve the reliability

and accuracy of assessments. Many standardized assessment tools have been devel-

oped for medical education purposes but the benefit of rater training in this context

is unclear. We conducted a systemic review to examine the effect of rater training

on trainee assessments in the medical education literature.

Methods

We searched PubMed, MEDLINE, EMBASE, The Cochrane Library, CINHL, ERIC and

PsychInfo for original publications until March 2014. Inclusion criteria were: prospec-

tive studies with rater training for physicians as a primary intervention compared to

some type of controls.

Results

Eleven studies met the inclusion criteria. The studies evaluated rater training on a

wide variety of skills and assessment tools, with marked heterogeneity in the meth-

ods and type of rater training. Five studies examined inter-rater reliability, four ex-

amined accuracy, one examined construct validity, and two examined evaluation

quality. Four studies showed a significant effect of rater training on reliability, accu-

racy and quality (two studies). Most studies were of low to moderate quality, but

one high quality RCT showed a significant effect of rater training on the inter-rater

reliability of clinical skill evaluations that persisted for eight months.

Conclusion

The effect of rater training on assessments of medical trainees remains unclear given

the current evidence. Additional high quality studies are warranted to determine if

rater training can improve assessments in medical and surgical education, such as

those for technical skills assessments.

16

Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics

and aortic matrix metallopreteinases

Annie Ducas1, Richard Lozowy2, David Kuhn,3 Thomas Klonisch4, April Boyd1

(1Section of Vascular Surgery, Department of Surgery, 2PhD candidate, 3Faculty of Engineering, 4Department of Human anatomy & Cell Sciences)

Introduction

Currently, there is no truly reliable way to evaluate the susceptibility of particular

abdominal aortic aneurysms (AAA) to rupture. In order to elucidate the pathogene-

sis of AAA, a correlation of aortic blood flow with aortic wall composition might vast-

ly improve understanding the development, growth and rupture of AAA.

Methods

We numerically simulated aortic blood flow in non-ruptured AAA using Open-Foam

computational fluid dynamics software. Intra-aortic areas of high and low wall shear

stress (WSS) were identified in laminar and pulsatile flow states. At the time of open

repair, redundant aortic tissue and thrombus samples were harvested throughout

the aorta. Tissue was assessed histologically for inflammatory cell content, as well

as collagen and elastin content. Immunohistochemistry was used to identify Matrix

Metalloproteinase—9 (MMP-9) levels active and non-active forms. Colorimetric and

Western-blot analysis was used to quantify MMP-9 enzymes at different locations in

the aorta. The composition of the AAA wall at sampling sites was correlated with

WSS at each location.

Results

To date, 16 patients have been enrolled in the study and aortic tissue samples have

been collected. Analysis of histological changes and MMP-9 levels are underway.

The computational fluid dynamics models have been generated for each AAA

demonstrating the regions of high and low WSS under pulsatile flow conditions.

Conclusion This work may improve our understanding of the interaction between the me-chanical effect of shear and the local biological factors responsible for AAA wall de-generation and rupture.

17

Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden

Jennifer Bjazevic, Kamaljot Singh Kaler, Rebekah Rittberg, Jeffery Walter Saranchuk, Darrel E. Drachenberg

(Section of Urology, Department of Surgery, University of Manitoba)

Introduction

Magnetic resonance imaging (MRI) of the prostate is becoming increasingly utilized

in the preoperative assessment of patients prior to radical prostatectomy (RP) for

prostate adenocarcinoma. However, the predictive ability of prostate MRI to detect

disease extent varies significantly in the published literature. Following its introduc-

tion at a single institution, we evaluated the predictive capability of MRI prostate to

determine burden of disease.

Methods

24 patients who underwent preoperative MRI prostate imaging prior to RP were

retrospectively reviewed. Imaging was completed at the discretion of the surgeon

based on clinical and pathological features. All MRIs were reviewed for positive

findings and correlated with final pathologic specimens. Sensitivity and specificity of

MRI in predicting tumor location, extracapsular extension (ECE), seminal vesicle

invasion (SVI), and lymphadenopathy was calculated.

Results

21 (87.5%) patients had carcinoma of the prostate present on MRI imaging. MRI

correctly predicted positive lymphadenopathy in a single patient; however, 10

(41.7%) patients with no lymphadenopathy on MRI had positive pelvic lymph nodes.

MRI predicted 4 (16.7%) patients had SVI, and 2 (50%) of these patients had positive

SVI on pathology. 7 (29.2%) patients were not predicted to have SVI on MRI and had

positive seminal vesicles. For SVI, preoperative MRI had a sensitivity and specificity

of 22.2% and 86.7% respectively. 6 (25.0%) patients had ECE present on MRI and 5

(83.3%) of these patients were confirmed to have ECE on final pathology. 10

(41.7%) patients with no evidence of ECE on MRI had positive ECE. MRI imaging has

a sensitivity of 33.3% and a specificity of 88.9% for predicting ECE.

Conclusion

Preoperative prostate MRI can provide valuable information for treatment decisions

and operative planning. However, the ability of MRI to accurately predict ECE, SVI,

and lymphadenopathy is still limited.

18

Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity?

Mohamed Sharaf Eldin1, Ahmed Tawfik2, Shady Awny3, Fayez Shahatto3, Sherif Kotb3

(1Head & Neck Surgical Oncology Fellowship Program, 2Mansoura University, 3Mansoura Oncology Centre)

Introduction

Ultrasound imaging criteria for cervical lymph nodes were set mainly to increase

sensitivity. However, unlike the lateral neck compartment, the challenge in the cen-

tral compartment is the low sensitivity of Ultrasonography. We performed this study

to evaluate whether the sensitivity of Ultrasonography could be increased by consid-

ering any detected lymph node in the central compartment as malignant.

Methods

Forty one patients with differentiated thyroid cancer underwent dedicated pre-

operative Ultrasonography by one radiologist for detection of metastatic lymph

nodes in the central compartment. Any lymph node detected was considered posi-

tive regardless of Ultrasound morphologic criteria. All patients underwent thyroidec-

tomy with central node dissection (CND), unilateral in 31 and bilateral in 10 cases,

based on tumor size and laterality. Ultrasound imaging results were compared to

hitopathologic results.

Results

The number of true positive cases by Ultrasonography was 13, false negative cases

8, true negative 15 and false positive 5 cases. The sensitivity of US was 61.9%, the

specificity 75%, the positive predictive value 72.2% and the negative predictive value

65.2%.

Conclusion

The sensitivity of Ultrasonography for detection of metastatic lymph nodes in the

central compartment in patients with DTC may be increased, compared to previous-

ly published data, by considering every detected node as positive rather than using

the routine criteria for lymph node metastases in other neck levels.

19

Impact of necrotizing fasciitis on quality of life

Robert Strazar1, Justin Gawaziuk2, Sarvesh Logsetty1,2

(1Section of Plastic Surgery, Department of Surgery, University of Manitoba

and 2Manitoba Firefighters’ Burn Unit)

Introduction

Improved management of necrotizing fasciitis (NF) has resulted in prolonged surviv-

al. However long-term outcomes in survivors of NF are not well studied. The goal of

this study is to assess self-reported mental and physical health, and self-perceived

appearance in NF patients using existing self-reported surveys.

Methods

Surveys include: Short Form (SF)-36 examines physical (PCS) and mental well-being

(MCS) and Derriford Appearance Scale (DAS)-24 for concern of appearance. Follow-

ing ethics approval, surveys were mailed to NF patients who survived discharge from

our hospital between 2004-2014 (n=200).

Results

Forty five (26 male, 19 female) completed the study. Age was 46.8 yr ± 14.2, TBSA

was 6% ± 7.6, number of surgeries was 2.8 ± 1.3, length of hospital stay (LOS) 40

days ± 48, and days since NF was 1945 ± 933. Overall, NF resulted in worse PCS 36.3

vs. MCS 46.6. Both are worse than normative data for age 45-54 (PCS 49.62, MCS

50.54). Mean DAS-24 score of 43 ± 18 indicates distress over appearance. Age was

inversely correlated with DAS-24 score (p = 0.03) and MCS (p < 0.01), but not PCS.

There was a significant difference between men and women (p =0.01) for MCS, but

not PCS. DAS-24 trended towards a difference (p = 0.067). There was no significant

correlation with number of surgeries or days since NF. PCS was negatively correlated

with %TBSA (p < 0.01) and LOS (p = 0.02), whereas MCS was not.

Conclusion

Our results indicate that NF has an impact on long-term mental and physical health,

and distress regarding self-perceived appearance. Compared to older, younger pa-

tients tended to have worse mental well-being, although better physical. Severity

related factors, %TBSA and LOS, are related to worse physical well-being but surpris-

ing not a worse mental well-being. This study highlights the need for a holistic ap-

proach for NF rehabilitation irrespective of disease severity, taking into account age

and both mental and physical health of the NF patient.

20

Classification of facial pain: A 13-year population-based longitudinal study

Lyra de Fatima Barchet1, Anthony M Kaufmann2

(1BSc Med Student Program and

2Section of Neurosurgery, Department of Surgery, University of Manitoba)

Introduction

Accurate diagnosis of facial pain (FP) is critical for appropriate assignment of poten-

tial surgical treatments, avoidance of misdirected interventions and study of out-

comes. There are, however, inconsistencies between commonly applied diagnostic

criteria, particularly for trigeminal neuralgia. Our aim was to compare various FP

classification schemes applied to patients presenting to neurosurgery.

Methods

All residents of Manitoba (population 1.25 million) presenting to neurosurgery with

a primary complaint of FP were assigned to a diagnostic category: typical trigeminal

neuralgia (tTN), atypical trigeminal (aTN), idiopathic painful trigeminal neuropathy

(iTn), MS- or tumor-related trigeminal neuropathy, idiopathic or atypical facial pain

(IFP), and a variety of other craniofacial pain conditions. For this study we reviewed

clinical records and further assigned diagnoses according to published classification

schemes for comparisons.

Results

A total of 544 FP patients were assessed. The most common diagnosis was tTN in

301 patients (55%) with diagnostic criteria equivalent to IHS-III classical trigeminal

neuralgia, purely paroxysmal (13.1.1.1) and IASP trigeminal neuralgia (tic doulou-

reux) (II-1). An additional 24 patients (4%) had aTN, equivalent to IHS-III classical

trigeminal neuralgia with concomitant persistent facial pain (13.1.1.2). Additional 39

patients (7%) had iTn without corresponding criteria in IHS-III or IASP. The Burchiel

classifications of TN-1and TN-2 had criteria encompassing but not differentiating

tTN, aTN and iTn. Other diagnoses included MS-related trigeminal neuralgia in 5%

(not differentiated from tTN in IASP), tumor-related trigeminal neuralgia in 1%, IFP in

10% and other craniofacial pain diagnoses in 18%.

Conclusion

Classification of FP is optimally based upon the underlying pathophysiology. The IHS-III is closest to achieving this aim among the published criteria, although does not account for iTn. Neurosurgeons offering trigeminal neuralgia treatment must be well versed in the differential diagnoses of FP, as only two-thirds of referred patients had conditions potentially amenable to surgical intervention.

21

In vivo micromotion comparison of a keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study

Peter MacDonald1, Sheila Mcrae1, Trevor Gascoyne2, Jeff Leiter1, Martin Petrak2, Eric Bohm2

(1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba and 2Concordia Hip & Knee Institute)

Introduction

Our primary objectives were:

- To establish the validity and reliability of RSA to measure glenoid micromotion;

-To measure the translational and rotational micromotion of the glenoid compo-

nents of the pegged and keeled design as measured by RSA;

- Compare the two groups with respect to patient reported quality of life.

Methods

An RSA phantom study was performed prior to the clinical trial to determine appro-

priate marker placement and accuracy of the system. Then, fifteen participants (1

bilateral) were randomized to receive either the pre-marked pegged or keeled gle-

noid design (Biomet Orthopaedics, Warsaw, IN). Five to ten tantalum markers were

inserted during surgery. RSA exams, physical assessment, and three subjective out-

come scores were completed at 6 weeks, 6-, 12-, and 24-months post-surgery. Sig-

nificance was set as p < 0.05.

Results

From the TSA phantom, the translational precision and accuracy was better than 20

microns in any direction and the precision (zero-displacement between glenoid com-

ponent and scapula) was better than 10 microns in any direction. Ten men (one

bilateral) and five women with mean age of 64 years participated. No differences

were detected between the pegged versus keeled designs in terms of rotation or

translation. Some patients showed high early migration of the glenoid component;

however, this may be a result of a lack of visible markers causing large errors in mo-

tion. All subjective outcome scores (WOOS, ASES, SST), improved significantly for

both study groups from pre- to post-surgery. No differences in subjective measures

between groups were detected at any post-surgery time points.

Conclusion

No statistical differences were found between the pegged versus keeled glenoid

fixation styles in patient quality of life, which is consistent with one previous study,

but not another. Overall, we were not able to infer any trends or patterns in vivo

motion for either component.

22

Transanal endoscopic microsurgery for giant rectal polyps

Courtney Chernos1, Elise Crocker2, David J. Hochman1

(1Section of General Surgery, Department of Surgery, University of Manitoba

and 2BSC Med Student Program)

Introduction

Historically, patients with complex rectal lesions not amenable to complete endo-

scopic resections required radical surgical excision. Giant polyps, defined in the liter-

ature as lesions greater than 4 x 4 cm in dimension, are a particularly difficult subset

of polyps. With the advent of Transanal Endoscopic Microsurgery (TEM) surgery we

are now able to achieve full curative resection with a minimally invasive surgical

technique. This case series examines the outcomes of patients with giant rectal

polyps following TEM resection.

Methods

Between May 2009, and February 2014, 164 patients underwent TEM surgery for

rectal lesions in Manitoba. All patients who met the criteria of a giant rectal lesion,

defined as lesions greater than 16 cm² in area were included in the analysis, focusing

on completeness of resection, quality of specimen excision and recurrence rates.

Results

80 patients (48.8%) underwent TEM surgery for a giant rectal lesion. The average

size of the lesions was 31.1 cm2 in area (16.2 - 73.5). The average height of the le-

sion from the anal verge was 9.6 cm. Lesions were removed with full thickness exci-

sion in 77 (96%) cases and had negative resection margins in 67 (84%). Pathology

identified unanticipated malignancy in 16 patients (20%). Recurrences were noted in

7 (8.8%) cases, mean time to recurrence was 17 months (8-25). The mean follow-up

interval was 8 months (0-34). Procedural complications occurred in a total of 3 pa-

tients (3.8%), and consisted of postoperative bleeding.

Conclusion

Compared to current literature, we demonstrate a higher rate of TEM resections of

giant rectal polyps. In spite of their size, these lesions were successfully removed

with clear margins in the majority of cases. These large polyps also contained a high

percentage of unrecognized malignancies. Overall, TEM has been found to be a safe

alternative to radical surgical excision of giant rectal polyps, with both low complica-

tion and recurrence rates.

23

Early and late continence after bladder neck sparing radical prostatectomy

Chun Huang, Jennifer Bjazevic, Darrel Drachenberg

(Section of Urology, Department of Surgery, University of Manitoba)

Introduction

Urinary incontinence is a well-recognized side effect of radical prostatectomy. It has

been demonstrated that laparoscopic and robotic prostatectomy result in improved

early return to continence with a bladder neck sparing (BNS) technique.

Methods

A retrospective chart review was performed, looking at early and late continence

results of BNS surgery in open radical prostatectomy compared to non-BNS surgery

between April 2013 and Dec 2014. 42 patients have been reviewed and 12 BNS cases

identified. Data reviewed include age, stage, grade of tumour, pathologic stage,

positive margin rate, immediate, early, and late continence, measured by use of

incontinence pads. Tumor pathology and surgical margins were observed and corre-

lated to margin positivity rates.

Results

BNS patients had improved early return to continence at 3 and 6-month follow up

(66% vs. 26%) but no change in over-all continence at 1-year with 75% of BNS pa-

tients achieving one pad or less per day and 80% of the non-BNS patients achieving

similar levels of continence. There were 3 positive margins identified in the BNS

group while 1 positive margin was identified in the non-BNS cohort.

Conclusion

This study demonstrates return to early continence associated with bladder neck

sparing surgery. There does not appear to be a long-term benefit. While there is a

suggested higher rate of positive margins with the BNS approach, other studies have

not shown significant effect of margin positivity on over-all survival in organ-

confined disease. Thus, BNS approach to radical prostatectomy can be considered

for select patients.

24

Comparison of physical fitness between surgical and non-surgical residents

David Perrin1, Dean Cordingley2, Jeff Leiter2

(1Section of Plastic Surgery, Department of Surgery, University of Manitoba,

2Pan Am Clinic)

Introduction

Although every residency program can be physically, emotionally and intellectually

challenging, it is well known that the demands of surgical residency training offer

strenuous working hours, sleep deprivation and poor eating. Given the nature of

surgical residency training, physical deconditioning would be expected to be greater

amongst surgical residents than non-surgical residents. The purpose of this study is

to evaluate and compare physical fitness levels between surgical and non-surgical

residents. The hypothesis is that surgical residents would have inferior physical fit-

ness scores compared to non-surgical residents.

Methods

This was a comparative study. Residents of all programs at the University of Manito-

ba were invited to participate. Participant gender, age, weekly work hours, and year

of residency were obtained. Maximal VO2 testing was used to evaluate aerobic ca-

pacity. Anthropometric and strength testing were performed including BMI, body

composition, resting blood pressure, resting heart rate, grip strength and a sit-up

test. Differences in scores between both groups were evaluated using a t-test. Corre-

lation analysis was used to identify any association between Maximal VO2 scores

and year of residency.

Results

A total of 45 residents volunteered to participate in this study and were grouped

into surgical (n=21) and non-surgical (n=24) groups. Surgical residents demonstrated

longer working hours (p<0.05), lower aerobic fitness levels (p<0.02) and higher BMI

(p<0.02) compared to the non-surgical residents. No additional differences were

found between the groups in other anthropometric or strength measures. No corre-

lation was found between year of residency and aerobic capacity.

Conclusion

Surgical residents have longer working hours, inferior aerobic fitness levels and high-

er BMI compared to non-surgical residents.

25

A randomized clinical trail comparing the breast and abdominal related morbidity of DIEP and DIEA flaps

Blair Peters, Leif Sigurdson, Edward Buchel, Kimberly Dalke

(Section of Plastic Surgery, Department of Surgery, University of Manitoba)

Introduction

The DIEP flap is the current standard of care in abdominal-based breast reconstruc-

tion. The SIEA flap is felt to be an improvement as it does not damage the ab-

dominal wall. The SIEA flap is reported to be a more difficult dissection with smaller

vessels which put the flap at higher risk of complication. Due to this uncertainty, we

aimed to evaluate the abdominal and breast related morbidity associated with DIEP

and SIEA flaps.

Methods

A double blinded, randomized clinical trial is being performed involving breast can-

cer patients undergoing autologous tissue reconstruction. Women are randomized

to either receive the DIEP or SIEA flap procedure. Objective isokinetic abdominal

testing is done pre-operatively and 3, 6 and 12 months post-operatively. A validated

questionnaire is administered pre-operatively and at 3 and 12 months post. Second-

ary outcomes include flap and donor site complications.

Results

109 patients have enrolled in the study. Preliminary analyses shows post-operative

decreases in abdominal strength in both groups at 3 months. This decrease initially

appears larger in the DIEP group and is trending towards significance. There is pre-

liminary evidence that this strength deficit returns to normal at 1 year. There are no

significant differences in all flap and abdominal complications. There is also no differ-

ence in post-operative pain. There are no significant differences in the intra-

operative findings between groups with an adequate SIEA present in over 60% of

patients.

Conclusion

We have gone further than others in determining the risks and benefits of each

procedure. The frequency and size of the SIEA vessels found as well as the absence

of increased complication rates challenge the assumption that the superficial vessels

are too small to support a tissue flap and suggest that more patients are candidates

for the SIEA flap than once thought.

26

Neuro-imaging findings in pediatric sports-related concussions: A clinical study

Thomas Hall4, Jeff Leiter4, Patrick J. McDonald1, Scott Sawyer2,4, Norm Silver2,4, Martin Bunge3,

Marco Essig3, Michael J. Ellis1,4

(1Section of Neurosurgery, Department of Surgery, University of Manitoba; 2Department of Pediatric & Child Health; 3Diagnostic Imaging; 4Pan Am Clinic, Canada North Concussion Network)

Introduction

The objective of this study was to summarize the results of clinical neuroimaging

studies performed in sports-related concussion patients referred to a multi-

disciplinary pediatric concussion program.

Methods

We conducted a retrospective review of medical records and neuroimaging findings

for all patients referred to a multi-disciplinary pediatric concussion program be-

tween September 2013 and July 2014. Inclusion criteria included: 1.) age ≤ 19 years

of age, 2.) physician-diagnosed SRC. All patients underwent evaluation by one neuro-

surgeon. The two outcomes examined in this study were the frequency of neuroim-

aging studies performed in this population, including computerized tomography (CT)

and magnetic resonance (MRI) studies, and the findings of those studies. Clinical

indications for neuroimaging were summarized. This study was approved by the

local institutional ethics review board.

Results

151 patients (mean age=14 years, 59% female) were included this study. Overall,

24% of patients underwent neuroimaging studies of which 78% were normal. 16% of

patients underwent CT imaging which was normal in 79% of cases. Abnormal CT

findings included: arachnoid cyst(1 patient), skull fracture(2 patients), suspected

intracranial hemorrhage(1 patient), suspected hemorrhage into an arachnoid cyst(1

patient). 11% of patients underwent MRI, which was normal in 75% of cases. Abnor-

mal MRI findings included: intraparenchymal hemorrhage and sylvian fissure arach-

noid cyst(1 patient), non-hemorrhagic contusion(1 patient), demyelinating disease(1

patient), posterior fossa arachnoid cyst, cerebellar volume loss, and non-specific

white matter changes(1 patient).

Conclusion

Clinical neuroimaging studies are normal in the majority of pediatric patients with

SRC. However, in selected cases neuroimaging can provide information that impacts

return to play and retirement decision-making.

27

The impact of body position and walking on neurophysiological outcome measure

Mina Aziz1, Michael Johnson1, Michael Goytan1, Jeff Leiter2, Jeanmarie Burke3, Mary Balliett3,

Paul Dogherty3, Steven Passmore3 (1Section of Orthopedic Surgery, Department of Surgery, University of Manitoba; 2Pan Am Clinic;

3New York Chiropractic College)

Introduction

Lumbar spinal stenosis is a common condition that is characterized by activity in-

duced neurological symptoms which are influenced by body position.The purpose of

the study was to establish whether a change in body position or exercise impacts the

integrity of the descending motor pathway or spinal reflexes in a healthy population

as assessed by Transcranial magnetic stimulation (TMS) and H-reflex. Acute exercise

will reduce latencies and amplitudes of central and peripheral neurophysiological

outcome measures.Body position changes may impact the amplitudes and latencies

of neurophysiological outcome measures.

Methods

Healthy participants were recruited (N=16),8 of whom were female.Single TMS puls-

es to evoke motor evoked potentials (MEPs) were presented and MEPs were record-

ed using surface EMG collected from the abductor hallucis.The tibial nerve H-reflex

methodology outlined by Hugon (1973) was used to record H-reflex responses from

the soleus muscle of the right leg.A progressive exercise treadmill test was used to

induce the effects of acute exercise.Both MEPs and H-reflexes were collected in the

supine, and seated positions,pre- and post-walking.Data analyzed included the mean

amplitude and latency for both MEPs and H-reflexes.The statistical approach used

was a repeated measures ANOVA.

Results

TMS data yielded no statistically significant changes in amplitude and latency with

exercise or changes in position.H-reflex data yielded no statistically significant

changes in amplitude with changes in position. A statistically significant decrease in

H-reflex amplitude was noted post exercise F(1,12)=4.880,p=0.047.H-reflex latency

was noted to be longer in the seated position F(1,12)=5.633,p=0.035 and pre exer-

cise F(1,12)=14.141,p=0.003 respectively.

Conclusion

Neurophysiological outcome differences attributed to acute exercise in a healthy

population are due to peripheral factors. Position changes only impacted peripheral

reflex latency.

28

Characteristics, long-term survival and predictors of mortality of patients needing prolonged intensive unit care stay post cardiac surgery

Rizwan A. Manji1, Brett M. Hiebert2, Rakesh C. Arora1, Michael C. Moon1, Darren H. Freed1, Alan H. Menkis1

(1Section of Cardiac Surgery, Department of Surgery, University of Manitoba and 2Cardiac Sciences Program, WRHA)

Introduction

Long term survival and predictors of mortality for patients needing prolonged length

of stay in the ICU (prLOSICU) - defined as stay ≥ 5 days post cardiac surgery (CS) – are

not well defined.

Methods

Data of patients with prLOSICU from Jan 1, 2000 - Sept 30, 2011 was extracted from

clinical and provincial databases. Cox proportional regression analysis was done to

determine predictors of mortality post discharge home.

Results

There were 862 out of a total 9711 CS patients (8.9%) who had prLOSICU and

790/862 (91.6%) patients survived to ICU discharge. The patients had many co-

morbidities (including mental illness), were acutely ill (high risk score), came from

lower income quintile neighborhoods within the province, and primarily had CABG

or CABG + Valve procedures done. Post ICU hospital survival rate was 88.5%, and 1,

3 and 5 year post discharge home survival rates were 88.6%, 78.7% and 72.6% re-

spectively. Cox proportional hazard regression analysis revealed factors associated

with mortality post discharge home were (n=699): preoperative cardiac arrest

(OR=2.52, 95% CI [1.53-4.16], p<0.001), preoperative social assistance requirement

(OR=2.22, 95% CI [1.13-4.34], p=0.021), preoperative infection (OR=1.80, 95% CI

[1.18-2.76], p=0.007), diabetes mellitus (OR=1.49, 95% CI [1.12-1.99], p=0.006),

COPD (OR=1.47, 95% CI [1.03-2.11], p=0.036), congestive heart failure (OR=1.41,

95% CI [1.02-1.94], p=0.036), and age (OR=1.02, 95% CI [1.01-1.04], p=0.005 for

each year of age since surgery).

Conclusion

Following cardiac surgery, 8.9% of patients have prLOSICU with reasonable long

term survival rates. Long term mortality is related more to co-morbidities, initial

presentation (eg. preoperative cardiac arrest) and socioeconomic status rather than

having a complex cardiac operation. This information may prove useful in determin-

ing goals of care in “sick” cardiac surgery patients “struggling” in the ICU.

29

Shits happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families

Kendall Hobbs-Murison1,2,3, M. Morris2,3,8, K. Wittmeier3,7,8, C. Holland1, E. Crawford4, J. Elson5, C. Beauchamp5,

B. Milne5, H. Loewen6, A. Abou-Setta7, R. Keijzer2,3.8

(1Child Health Program, Health Science Centre, 2Department of Surgery, University of Manitoba, 3Children’s Hospital Research Institute of Manitoba, 4Swish Productions Ltd., 5Direct Focus Marketing Communications

Inc., 6NJ Maclean Health Sciences Library and 7Centre for Healthcare Innovation, University of Manitoba)

Introduction

Collaboration between knowledge users and providers is fundamental to integrated

Knowledge Translation (iKT). We hypothesized that iKT can be used to guide re-

search questions in rare diseases. Our primary aim was to use social media to priori-

tize information needs of Hirschsprung’s Disease (HD) families and our secondary

aim to compare congruency between information needs of HD families and pediatric

surgeons.

Methods

Partnering with a parent-created social media campaign (Facebook, Twitter and

blog) titled “Shit Happens,” we surveyed families and patients to prioritize infor-

mation needs. Concurrently, using an online tool we surveyed the Canadian Associa-

tion of Paediatric Surgeons (CAPS) to understand i) the most common problems

encountered in their HD practice, and subsequently ii) what information methods

are used to guide clinical management. Surveys were independently analyzed to

determine themes and to rank priorities. We used a modified Delphi approach to

combine results and achieve consensus on a prioritized list of knowledge needs.

Results

89 HD family participants responded to the survey; 66.3% of these within 7 days.

23.9% of CAPS members responded to the survey. Overlapping priorities included

bowel management issues, treating perineal irritation, recognition and management

of enterocolitis. Discordant priorities between families and surgeons included nutri-

tion/growth and diagnostics. Of 21.1% of CAPS survey respondents; 84% use their

expert opinion to guide management, 81% use collegial expert opinion, 76% indicate

guidance from HD literature, and 54% in the literature related to HD while 32% rely

on practice guidelines.

Conclusion

iKT research combining a parent research partner with social media can identify and

prioritize knowledge needs for families dealing with rare diseases such as HD in an

efficient manner. Results of this study are currently guiding knowledge synthesis and

where sufficient, resource development to assist parents.

30

Mental and physical health outcomes in parents of children with burn injuries as compared to matched controls

Jessica Enns1, J.P. Gawaziuk23, S. Khan4, D. Chateau4, J. Bolton5, J. Sareen5, J. Stone1, M. Doupe4, S. Logsetty2,3

(1BSc Med Program, College of Medicine, University of Manitoba, 2Manitoba Firefighters Burn Unit, 3Department of Surgery, University of Manitoba, 4Manitoba Centre for Health Policy

and 5Department of Psychiatry, University of Manitoba0

Introduction

Pediatric burn-injuries are common and the stress of caring for them can affect care-

giver’s health. The objective of this study was to examine the rates of mental and

physical disorders of parents of burn-injured children (Cases) compared to matched

controls (Controls).

Methods

This population-based study links the Winnipeg Children’s Hospital Pediatric burn

registry with health information at the Manitoba Centre for Health Policy. Pediatric

burn cases were matched 1:5 with control children from the general population

based on age, sex and geographical location. 1029 parental Cases and 4923 Controls

were identified. ICD codes were used to identify diagnoses of common mental and

physical disorders, comparing rates of disease 2 years prior to and 2 years following

the date of burn. The changes in the relative rates of health outcomes (pre-injury to

post-injury) were compared between the cases and the controls. This methodology

is an important strength of this study as this allows for correction of changes in rates

due to aging or other factors.

Results

The prevalence of substance abuse disorder 2 years prior to burn date was 3.0%

among cases rising to 10.4% postburn; in controls this change was from 2.11% to

6.03%. There was an absolute rate increase of 7.38% for cases compared to 3.92%

for the controls (a relative increase of over 20%). Similarly there was an absolute

increase of 3.5% and a relative increase of 36% more fractures in the Cases. There

were no significant differences found in other Axis one mental, or physical disorders.

Conclusion

Increased rates of substance use disorder and fractures in the parents of burn-

injured children compared to the matched controls has important clinical implica-

tions for the care of parents who have a burn-injured child.

31

The impact of lumbar spinal stenosis on lower extremity motor control: A pre-surgical study

Austin Enright, Michael Johnson, Valerie Pelleck, Dean Kriellaars, Cheryl Glazebrook Steven Passmore

(Section of Orthopedic Surgery, Department of Surgery, University of Manitoba)

Introduction

Objective outcome measures are lacking for the progression, impairment and man-

agement of degenerative lumbar spinal stenosis (LSS). The most common reason for

adults over 65 to proceed to spine surgery is LSS. Fitts’ Law is an established motor

paradigm that may provide a novel approach to outcome measurement since task

difficulty is easily manipulated, and performance on Fitts’ Law tasks are resistant to

learning. Hypothesis: We predict that pre-surgical LSS patients will be demonstrate

performance that is more adversely impacted than healthy control participants

when measuring their physical ability to perform a motor task. Study Design: Cross-

sectional between groups experimental design.

Method

Participants with degenerative LSS (N=12) and healthy controls (N=12) performed

pointing movements with their great toe to a series of squares that appeared on a

touchscreen monitor. Three dimensional motion analysis recorded movement. Be-

havioural measures included reaction time and movement time (MT), kinematic

performance measures were also recorded. The Health Research Ethics Board ap-

proved all protocols and procedures.

Results

Significant interactions for MT [F(5,110) = 3.17, p<.05] and kinematic variables time

to peak velocity [F(5,110) = 5.51 p<.05] and peak velocity [F(5,110) = 9.61 p<.05 ]

respectively revealed that the LSS group’s movements were more adversely impact-

ed by increasing task ID.

Conclusion

A lower extremity Fitts’ Law task is useful in measuring differences between healthy

and pre-surgical LSS populations. In the future it may be applied in LSS surgical in-

tervention studies considering motor performance measurement as a quantitative

outcome measure.

32

Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies

Ruchi Chhibba1, Deepak K. Pruthi2, Thomas B. McGregor2

(1UGME-College of Medicine, University of Manitoba,

and 2Section of Urology, Department of Surgery, University of Manitoba)

Introduction

To identify predictors of post-operative renal insufficiency by analyzing clinical co-

morbidities and the pathologic changes in the non-neoplastic kidney (NNK) speci-

mens of patients undergoing radical nephrectomy (RN).

Methods

We retrospectively reviewed all patients undergoing RN for suspected RCC from

January 2011-May 2014. Estimated glomerular filtration rate (eGFR) was calculated

employing the modified diet in renal disease (MDRD) formula using the 6 month

creatinine value. Pathologic reports were reviewed to assess for any glomerular,

tubulointerstitial and arterial/arteriolar (GTA) changes. Univariant analysis was em-

ployed.

Results

Of the 147 patients undergoing RN, 57 (39%) had changes in the NNK, 57 (39%) had

unremarkable changes and 33 (22%) had no specific comments on the NNK. Fourty-

two patients had specific changes to the GTA architecture; of these 42, 51% had

more than one GTA change. Patients with GTA changes were not more likely to have

declines in post-operative (PsO) renal function compared to those with unremarka-

ble findings (p=0.15). However, those with pre-operative (PrO) eGFR > 60/ml/

min/1.73m2 had a greater decrease in PsO renal function than those with PrO eGFR

of <60 (-26 vs -6ml/min/1.73m2, p<0.0001). Overall, patients with GTA changes were

more likely to have a lower PrO eGFR (<60 vs >60 ml/min/1.73m2, p=0.009) than

those with unremarkable changes. Patients with a tumor size < 10 cm had a greater

decrease in PsO renal function compared with a tumor size >10 cm (-25 vs -14 ml/

min/1.73m2, p=0.011). New onset stage 3 CKD or greater occurred in 65% of pa-

tients. Diabetes, hypertension, smoking status, and age (>60) were not statistically

significant in predicting PsO renal function.

Conclusion

Smaller tumor size and higher PrO eGFR were associated with greater decline in PsO

renal function. NNK changes did not predict renal functional outcome in this series.

New CKDIII occurred in over half of all patients.

33

Arthroscopic versus open lateral release for the treatment of lateral epicondylitis; A prospective randomized controlled trial

Jamie Dubberley1, Tod Clark1, Sheila Mcrae2, Jeff Leiter2, Peter MacDonald1

(1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba;

and 2Pan Am Clinic Foundation)

Introduction

The primary objective of this study was to determine if quality of life and function

are different following arthroscopic versus open tennis elbow release surgery.

Based on retrospective studies, both approaches have been found to be beneficial,

but no prospective randomized comparison has been conducted to date.

Methods

Following a minimum six-months of conservative treatment, seventy-one patients

(>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or

open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder

and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength.

Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery.

Comparisons between groups and within groups over time were conducted with

p<0.05.

Results

No pre-surgery differences were found between groups based on age, sex, DASH or

VAS scores. Fifteen women and 19 men underwent the open procedure with mean

age 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with

mean age of 45.0 (6.9). Both groups demonstrated a significant improvement in all

measures following surgery, and no significant differences were found between

groups at any time point. The DASH, our primary outcome, decreased from a mean

(SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open

group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores

followed a similar pattern. Grip strength increased on the affected side from 23.6

(14.9) kg to 29.3 (16.3) and 21.4 (15.4) kg to 29.8 (15.4) for Open and Arthroscopic

groups, respectively.

Conclusion

Based on this study, there is no difference in patient quality of life and function be-

tween arthroscopic and open tennis elbow release surgery. More detailed analysis

of the impact of third party claims, sex, and smoking status would be beneficial.

34

Participant’s Abstract Index

Aziz, Mina ........................................................................................................................... 27

Barchet, Lyra de Fatima ..................................................................................................... 20

Bjazevic, Jennifer ................................................................................................................ 17

Chernos, Courtney ............................................................................................................. 22

Chhibba, Ruchi ................................................................................................................... 32

Demcoe, Alistair Ross ......................................................................................................... 14

Dubberley, Jamie ............................................................................................................... 33

Ducas, Annie ...................................................................................................................... 16

Eldin, Mohamed Sharaf ...................................................................................................... 18

Ellis, Michael ...................................................................................................................... 3

Enns, Jessica ....................................................................................................................... 30

Enright, Austin ................................................................................................................... 31

Gardiner, Claire .................................................................................................................. 4

Goeres, Patrick ................................................................................................................... 11

Hall, Thomas ...................................................................................................................... 26

Hobbs-Murison, Kendall ..................................................................................................... 29

Huang, Chun ....................................................................................................................... 23

Khoshgoo, Naghmeh .......................................................................................................... 9

MacDonald, Peter ............................................................................................................... 21

Maniar, Reagan .................................................................................................................. 15

Manji, Rizwan ..................................................................................................................... 28

McInnes, Colin ................................................................................................................... 10

Muller-Moran, Ricky .......................................................................................................... 13

Natarajan, Suchitra ............................................................................................................. 6

Nguyen, Quyen .................................................................................................................. 5

Perrin, David ...................................................................................................................... 24

Peters, Blair ........................................................................................................................ 25

Pruthi, Deepak ................................................................................................................... 12

Steigerwald, Sarah .............................................................................................................. 1

Stone, James ...................................................................................................................... 2

Strazar, Robert ................................................................................................................... 19

Visser, Robin ....................................................................................................................... 7

White, Christopher ............................................................................................................. 8

Annual Department of Surgery Research Day 2015