IU Indianapolis ScholarWorks :: Browsing by Author "Tholpady, Sunil S."

Browsing by Author "Tholpady, Sunil S."

Now showing 1 - 10 of 19

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer
(American Medical Association, 2018-04-01) Chauhan, Ruvi; Munger, Brook N.; Chu, Michael W.; Munshi, Imtiaz; Cohen, Adam C.; Wooden, William A.; Tholpady, Sunil S.; Surgery, School of Medicine
Facial nonmelanoma skin cancers (fNMSCs), consisting of basal cell carcinoma and squamous cell carcinoma, are the most common cancers diagnosed worldwide and increase with age. Standard treatment for fNMSCs requires biopsy for pathological confirmation, followed by excision. Excision can lead to a pathological diagnosis of no residual carcinoma (NRC) due to no identifiable carcinoma within the excisional specimen. This situation can occur owing to wound healing in the specimen clearing the carcinoma or to the original biopsy shaving off the entire lesion. This study assesses the utility of excising fNMSCs according to age, with the hypothesis that the indolent nature of fNMSCs and the high NRC rate, coupled with increasing age-related all-cause mortality, should cause the surgeon to counsel patients differently. Such counseling may prevent surgery among elderly patients (>90 years) who may never see a benefit from fNMSC excision.
Analysis of Cases inWhich a Biopsy Specimen Is Positive and an Excised Lesion Is Negative for Nonmelanoma Skin Cancer
(JAMA, 2016-05) Han, Jane; Nosrati, Naveed N.; Soleimani, Tahereh; Munshi, Imtiaz A.; Flores, Roberto L.; Tholpady, Sunil S.; Department of Surgery, IU School of Medicine
Nonmelanoma skin cancers (NMSCs), including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), are the most common types of cancer with the fastest-growing treatment costs in the United States.1 Standard treatment requires biopsy for histologic confirmation, followed by excision. Oftentimes, no residual carcinoma is detected, implying spontaneous clearance at rates reported to vary from 24% to 76%.2- 5 These types of lesions have been investigated by others2- 5 and are not fully understood. Our study aims to determine the lesion and patient characteristics that would most strongly predict a histologically negative result for an excised lesion after a biopsy specimen had positive margins.
Assessing the Necessity of Stopping Antithrombotic Agents Before Wide-Awake Hand Surgery
(American Medical Association, 2018-03-01) Sasor, Sarah E.; Evans, Tyler A.; Cook, Julia A.; Lucich, Elizabeth A.; Wooden, William A.; Tholpady, Sunil S.; Chu, Michael W.; Surgery, School of Medicine
This review of 304 carpal tunnel release procedures examines the necessity of stopping antithrombotic medications prior to carpal tunnel release surgery.
Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs
(Lippincott, Williams & Wilkins, 2018-05-14) Bowling, Jay; Davidson, Darrell D.; Tholpady, Sunil S.; Park, Kinam; Eckert, George J.; Katona, Terrence; Chu, Tien-Min G.; Barco, Clark T.; Periodontology, School of Dentistry
Background: Soft-tissue deficiencies pose a challenge in a variety of disease processes when the end result is exposure of underlying tissue. Although multiple surgical techniques exist, the transposition of tissue from one location to another can cause donor-site morbidity, long incisions prone to dehiscence, and poor patient outcomes as a result. Use of tissue expansion prior to grafting procedures has been shown to have success in increasing available soft tissue to aid in repairing wounds. However, the current tissue expanders have biomechanical limits to the extent and rate of expansion that usually exceeds the tissue capacity, leading to incisional dehiscence or expander extrusion. Understanding the baseline biomechanical properties of the tissue to be expanded would provide useful information regarding surgical protocol employed for a given anatomical location. Therefore, the aim of this study was to test and compare the baseline (preexpansion) biomechanical properties of different common expansion sites in dogs. Methods: Four samples measuring approximately 20 × 15 × 1 mm were harvested from 8 dogs. The samples were collected from the hard palate, alveolar mucosa, scalp, and chest of the animal and analyzed for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength using a Texture Technologies TA.XT texture analyzer with corresponding biomechanical measurement software. Samples were compared as to their baseline biomechanical properties prior to any soft-tissue expansion. Histological sections of the samples were analyzed using hematoxylin eosin in an attempt to correlate the histological description to the biomechanical properties seen during testing. Summary statistics (mean, standard deviation, standard error, range) are reported for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength and for the histological parameters by intraoral site. Analysis of variance was used to compare the biomechanical and histological parameters among the 4 locations while accounting for multiple measurements from each dog. Results: The scalp had significantly higher maximum stress (σmax) than chest, mucosa, and palate (P < 0.0001), with no differences among the other 3 locations (P > 0.63). Scalp site also had significantly higher maximum tangential modulus (ε) than chest, mucosa, and palate (P < 0.006), with no differences among the other 3 locations (P > 0.17). The locations did not have significantly different maximum tangential stiffness (k; P = 0.72). Histologically, 2 separate patterns of collagen disruption were evident. Conclusion: Although different results were obtained than theorized, this study showed that the scalp had the greatest resiliency to expand prior to tearing, and the highest tangential modulus, with all sites having statistically similar modulus of elasticity. Based on this study, the scalp could be expanded more aggressively compared with the other sites.
Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers
(American Medical Association, 2018-02-01) Evans, Tyler A.; Sasor, Sarah; Duquette, Stephen; Chu, Michael W.; Munshi, Imtiaz; Soleimani, Tahereh; Tholpady, Sunil S.; Medicine, School of Medicine
This study compares postcrash prevalences of neurological and head and neck injuries in motorcycle drivers and passengers, stratified by helmet use.
Design and biofabrication of dermal regeneration scaffolds: role of oligomeric collagen fibril density and architecture
(Future Science Group, 2020-02) Sohutskay, David O.; Buno, Kevin P.; Tholpady, Sunil S.; Nier, Samantha J.; Voytik-Harbin, Sherry L.; Surgery, School of Medicine
Aim: To evaluate dermal regeneration scaffolds custom-fabricated from fibril-forming oligomeric collagen where the total content and spatial gradient of collagen fibrils was specified. Materials & methods: Microstructural and mechanical features were verified by electron microscopy and tensile testing. The ability of dermal scaffolds to induce regeneration of rat full-thickness skin wounds was determined and compared with no fill control, autograft skin and a commercial collagen dressing. Results: Increasing fibril content of oligomer scaffolds inhibited wound contraction and decreased myofibroblast marker expression. Cellular and vascular infiltration of scaffolds over the 14-day period varied with the graded density and orientation of fibrils. Conclusion: Fibril content, spatial gradient and orientation are important collagen scaffold design considerations for promoting vascularization and dermal regeneration while reducing wound contraction.
Hand Surgery Resources Exceed American Health Literacy
(SAGE, 2018-09) Cook, Julia A.; Sasor, Sarah E.; Tholpady, Sunil S.; Momeni, Arash; Chu, Michael W.; Otolaryngology -- Head and Neck Surgery, School of Medicine
BACKGROUND: The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites. METHODS: An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Index, Gunning Fog Score, Automated Readability Index, and Coleman-Liau Index. A 2-tailed z test was used to compare means. RESULTS: Seventy-six institutions with both plastic and orthopedic surgery training programs were identified; 42 had educational material available online. The average readability for all hand-related information was at the 11.92 grade reading level. Information regarding de Quervain tenosynovitis had the highest grade level for all plastic surgery procedures (13.45). Hand arthritis had the highest grade level for all orthopedic surgery procedures (12.82). Ganglion cysts had the lowest grade level for both plastic and orthopedic surgery (10.15 and 11.01, respectively; P = .12). Carpal tunnel release was the most commonly described procedure overall. There were no differences in text complexity among geographic regions. CONCLUSIONS: Online patient resources for common hand ailments are too complex for the average patient to understand. Efforts should be made to provide materials at the recommended sixth-grade reading level to improve patient education and improve the physician-patient relationship.
Insulin‐like growth factor‐1 receptor regulates repair of ultraviolet B‐induced DNA damage in human keratinocytes in vivo
(Wiley, 2016-10) Loesch, Mathew M.; Collier, Ann E.; Southern, David H.; Ward, Rachel E.; Tholpady, Sunil S.; Lewis, Davina A.; Travers, Jeffrey B.; Spandau, Dan F.; Dermatology, School of Medicine
The activation status of the insulin‐like growth factor‐1 receptor (IGF‐1R) regulates the cellular response of keratinocytes to ultraviolet B (UVB) exposure, both in vitro and in vivo. Geriatric skin is deficient in IGF‐1 expression resulting in an aberrant IGF‐1R‐dependent UVB response which contributes to the development of aging‐associated squamous cell carcinoma. Furthermore, our lab and others have reported that geriatric keratinocytes repair UVB‐induced DNA damage less efficiently than young adult keratinocytes. Here, we show that IGF‐1R activation influences DNA damage repair in UVB‐irradiated keratinocytes. Specifically, in the absence of IGF‐1R activation, the rate of DNA damage repair following UVB‐irradiation was significantly slowed (using immortalized human keratinocytes) or inhibited (using primary human keratinocytes). Furthermore, inhibition of IGF‐1R activity in human skin, using either ex vivo explant cultures or in vivo xenograft models, suppressed DNA damage repair. Primary keratinocytes with an inactivated IGF‐1R also exhibited lower steady‐state levels of nucleotide excision repair mRNAs. These results suggest that deficient UVB‐induced DNA repair in geriatric keratinocytes is due in part to silenced IGF‐1R activation in geriatric skin and provide a mechanism for how the IGF‐1 pathway plays a role in the initiation of squamous cell carcinoma in geriatric patients., IGF‐1R is necessary for optimal repair of UVB‐induced DNA damage in keratinocytes.Novel separation technique allows study specifically in basal layer keratinocytes.IGF‐1R activation enhances the expression of nucleotide excision repair genes.
Management of the Pressure Injury Patient with Osteomyelitis: An Algorithm
(Elsevier, 2017) Nicksic, Peter J.; Sasor, Sarah E.; Tholpady, Sunil S.; Wooden, William A.; Gutwein, Luke G.; Department of Surgery, School of Medicine
Pressure injury (PI) is a common complication of inpatient care, affecting an estimated 3 million patients annually in the US. Risk factors include immobility, compromised sensation, malnutrition, urinary or fecal incontinence, and chronic medical illness. Compliance with established guidelines (pressure off-loading, skin care, and frequent inspection) is imperative for the prevention of hospital-acquired PI. Unavoidable PI does occur at times, and is often related to advanced medical illness. Pressure injury complicated by osteomyelitis (OM) can develop in patients with physiologic, behavioral, or treatment-related risk factors, despite the adherence to current standards of prevention.
Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction
(Wolters Kluwer, 2017-08-28) Barwinska, Daria; Garner, John; Davidson, Darrell D.; Cook, Todd G.; Eckert, George J.; Tholpady, Sunil S.; March, Keith L.; Park, Kinam; Barco, Clark T.; Cellular and Integrative Physiology, School of Medicine
Background: There are few methods for expanding oral mucosa, and these often cause complications such as tissue necrosis and expander eruption. This study examines mucosal blood perfusion following insertion of a novel shapeable hydrogel tissue expander (HTE). The canine model used subgingival insertion of HTE following tooth extraction and alveolar bone reduction. The primary goal of this study was to gain understanding of epithelial perfusion and reparative responses of gingival mucosa during HTE expansion. Methods: Nine Beagle dogs underwent bilateral premolar maxillary and mandibular tooth extraction. Three to four months later, HTE-contoured inserts were implanted submucosally under the buccal surface of the alveolar ridge. After removal and following a 6- to 7-month period of healing, new HTE implants were inserted at the same sites. The area was assessed weekly for tissue perfusion and volume of expansion. Biopsies for histological analysis were performed at the time of expander removal. Results: Within 2 weeks following the second insertion, blood flow returned to baseline (defined as the values of perfusion measurements at the presurgery assessment) and remained normal until hydrogel full expansion and removal. Volume expansion analysis revealed that the hydrogel doubled in volume. Histological assessment showed no macrophage or inflammatory infiltration of the mucosa. No superficial fibrosis, decreased vascularity, or mucosal change was seen. Conclusion: Maintenance of adequate tissue perfusion is a clinically important aspect of tissue expander performance to reduce risk of device loss or injury to the patient, particularly for areas with a history of previous surgeries.

Browsing by Author "Tholpady, Sunil S."

Results Per Page

Sort Options