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xx Contributors
https://t.me/med1917
Richard A. Marottoli, MD, MPH
Associate Professor of Medicine, Department of Internal Medicine (Geriatrics)
Yale University School of Medicine, VA Connecticut Healthcare System,
New Haven, CT, USA
Gary T. Marshall, MD
Assistant Professor of Surgery, Department of Trauma Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, USA
Guy P. Marti, MD
Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
Manuel Martínez-Maldonado, MD
Executive Vice President for Research, University of Louisville; Professor of Medicine,
Professor of Pharmacology and Toxicology, University of Louisville Medical School,
Louisville, KY, USA
Marcus A. McFerren, MD, PhD
Resident Physician, Yale New Haven Hospital, Department of Dermatology,
Yale University School of Medicine, New Haven, CT, USA
Marcia L. McGory, MD
Resident Surgeon, Department of Surgery, David Geffen School of Medicine at the
University of California, Los Angeles, CA, USA
Mary H. McGrath, MD, MPH, FACS
Assistant Professor of Surgery, Division of Plastic Surgery,
University of California San Francisco, San Francisco, CA, USA
George H. Meier, MD
Professor and Chief, Department of Vascular Surgery, University Hospital of Cincinnati,
Cincinnati, OH, USA
Jay Menaker, MD
Assistant Professor, Department of Surgery, University of Maryland Medical Center,
R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
Manuel Mendizabal, MD
Staff Hepatologist, Division of Hepatology and Liver Transplantation, Austral University
Hospital Pilar, Buenos Aires, Argentina
William Min, MD, MS, MBA
Resident, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases,
New York, NY, USA
Monica Morrow, MD
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center,
New York, NY, USA
Leigh Neumayer, MD, MS
Professor of Surgery, Department of Surgery, University of Utah and Huntsman
Cancer Hospital, Salt Lake City, UT, USA
Mark A. Newell, MD
Assistant Professor, Department of Surgery, Brody School of Medicine, East Carolina
University, Pitt County Memorial Hospital, Greenville, NC, USA
Andrew D. Norden, MD
Department of Neurology, Center for Neuro-Oncology, Dana-Farber Cancer Institute,
Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
Jack R. Oak, MD
https://t.me/med1917
Vascular Surgery Fellow, Department of Vascular Surgery, Barnes-Jewish Hospital,
University of Washington School of Medicine, St. Louis, MO, USA
Pat O’Donnell, MD
Department of Surgery, University of Arkansas for Medical Sciences,
Little Rock, AR, USA
Aundrea L. Oliver, MD
Resident, Department of Surgery, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA, USA
John M. Olsewski, MD, FACS
Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery,
Albert Einstein College of Medicine, Bronx, NY, USA
Babak J. Orandi, MC, MSc
Halsted Surgery Resident, Department of Surgery, Johns Hopkins Hospital, Baltimore,
MD, USA
Darin L. Passer, MD
General Surgery Resident, Department of Surgery, University of South Carolina,
Palmetto Health Richland, Columbia, SC, USA
Toral R. Patel, MD
Neurosurgery Resident, Yale-New Haven Hospital, Yale University School of Medicine,
New Haven, CT, USA
xxiContributors
Melissa F. Perkal, MD
Assistant Professor, Department of Surgery, Yale University School of Medicine,
West Haven, CT, USA; Surgical Service, Department of Veterans Affairs, VA Connecticut
Healthcare System, West Haven, CT, USA
Kitt F. Petersen, MD
Associate Professor, Department of Internal Medicine (Endocrinology), Yale University
School of Medicine, New Haven, CT, USA
Roshini C. Pinto-Powell, MD
Assistant Professor of Medicine, Department of General Internal Medicine, Dartmouth
Medical School, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
Walter E. Pofahl, MD
Vice Chairman, Department of Surgery, Brody School of Medicine, East Carolina University,
Pitt County Memorial Hospital, Greenville, NC, USA
Gregory N. Postma, MD
Director, Center for Voice and Swallowing Disorders; Professor, Department of
Otolaryngology, Medical College of Georgia, Augusta, GA, USA
Susan Pugliese, DDS, RN
Department of Dentistry, University Hospital of Brooklyn, State University of New York,
Downstate Medical Center, Brooklyn, NY, USA
Priyamvada Rai, PhD
Assistant Professor, Department of Medicine, Division of Gerontology and Geriatric
Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
Philip A. Rascoe, MD
Department of Thoracic Surgery, University of Pennsylvania,
Philadelphia, PA, USA
xxii Contributors
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Pooja R. Raval, BA
Newark Beth Israel Hospital, Warren, NJ, USA
Maura Reinblatt, MD
Assistant Professor, Department of Plastic Surgery, John’s Hopkins Bayview Medical Center,
Baltimore, MD, USA
Jerry G. Reves, MD
Vice President for Medical Affairs; Dean, College of Medicine; Professor,
Department of Anesthesia and Perioperative Medicine, Cell and Molecular Pharmacology
& Experimental Therapeutic, Medical University of South Carolina, Charleston, SC, USA
Holly E. Richter, PhD, MD
Professor, Department of Obstetrics and Gynecology, Division Director, Women’s Pelvic
Medicine and Reconstructive Surgery, University of Alabama at Birmingham Medical
Center, Birmingham, AL, USA
David Rispler, MD
Assistant Professor, Michigan State Orthopedic Residency Program, Grand Rapids
Orthopedic Residency Program, Grand Rapids,
MI, USA
Sanziana A. Roman, MD
Chief, Endocrine Surgery, Associate Professor, Yale University School of Medicine,
New Haven, CT, USA
Carlos Rosales, MD
Vascular Surgery Fellow, Department of Vascular Surgery, University of Cincinnati,
Cincinnati, OH, USA
Klara Rosenquist, MD
Department of Internal Medicine (Endocrinology), Yale University School of Medicine,
New Haven, CT, USA
Ronnie A. Rosenthal, MD
Professor, Department of SurgeryYale University School of Medicine, New Haven; Chief
Surgical Service, Department of Veterans Affairs, VA Connecticut Healthcare System, West
Haven, CT, USA
Jesse Roth, MD
Professor of Medicine; Investigator; Former Professor and Chief, Geriatric Medicine
and Gerontology; Former Scientific Director and Chief, Diabetes Branch,
Feinstein Institute for Medical Research, Albert Einstein College of Medicine, North
Shore-Long Island Jewish Health System, Whitestone, NY, USA`
Thomas J. Rutherford, MD, PhD
Associate Professor, Department of Obstetrics and Gynecology/Gynecologic Oncology,
Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT, USA
Thomas M. Scalea, MD
Physician in Chief, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
Peter E. Schwartz, MD
Professor, Department of Obstetrics and Gynecology/Gynecologic Oncology, Yale
University School of Medicine/Yale New Haven Hospital, New Haven, CT, USA
Seymour I. Schwartz, MD, FACS
Distinguished Alumni Professor of Surgery, Department of Surgery, University of Rochester,
Strong Memorial Hospital, Rochester, NY, USA
xxiiiContributors
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Dorry L. Segev, MD, PhD
Associate Professor of Surgery, Department of Transplant Surgery, Johns Hopkins Hospital,
Baltimore, MD, USA
Neal E. Seymour, MD
Division Chief General Surgery; Professor, Department of Surgery, Baystate Medical Center,
Springfield, MA, USA; Tufts University School of Medicine, Springfield, MA, USA
Ashok R. Shaha, MD
Attending Surgeon, Professor of Surgery, Department of Surgery,
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abraham Shaked, MD, PhD
Professor of Surgery, Division of Surgery; Director, University of Pennsylvania
Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Vadim Sherman, MD, MSc, FRCSC
Assistant Professor of Surgery, Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, TX, USA
Gregorio A. Sicard, MD
Professor of Surgery, Vice Chair of the Department of Surgery, Barnes-Jewish Memorial
Hospital/Washington University School of Medicine, St. Louis, MO, USA
Frederick E. Sieber, MD
Associate Professor; Chairman, Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
Dan-Arin Silasi, MD
Assistant Professor, Department of Obstetrics and Gynecology/Gynecologic Oncology,
Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT, USA
Samir K. Sinha, MD, DPhil, FRCPC
Director of Geriatrics, Mount Sinai and the University Health Network Hospitals,
Division of Geriatric Medicine, University of Toronto, Suite 475 - 600 University Avenue,
Toronto, Ontario CANADA, M5G 1X5
James Slover, MD, MS
Assistant Professor, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases,
New York, NY, USA
Kelley A. Sookraj, MD
Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
Julie Ann Sosa, MA, MD
Associate Professor of Surgery, Department of Surgery, Maine Medical Center, Portland,
ME, USA
Dennis Spencer, MD
Harvey and Kate Cushing Professor and Chair, Department of Neurosurgery,
Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
Raymond P. Stowe, PhD
Senior Scientist, Microgen Laboratories, La Marque, TX, USA
Catherine M. Straub, BS, MD
Department of General Surgery, University of Utah, Salt Lake City, UT, USA
John A. Taylor III, MD
Assistant Professor, Division of Urology, Department of Surgery, University of Connecticut
Health Center, Farmington, CT, USA
xxiv Contributors
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Roby C. Thompson Jr., MD
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
Scott C. Thornton, MD, FACS, FASCRS
Assistant Clinical Professor of Surgery, Department of General Surgery,
Bridgeport Hospital, Yale University, Bridgeport, CT, USA
Pedro J. Torrico, MD
Resident, Department of Neurology, SUNY Downstate Medical Center, Whitestone,
NY, USA
Courtney M. Townsend Jr., MD
Professor and John Woods Harris Distinguished Chairman, Department of Surgery,
University of Texas Medical Branch, Galveston, TX, USA
Bruce R. Troen, MD
Department of Medicine, Division of Gerontology and Geriatric Medicine,
Leonard M. Miller School of Medicine, University of Miami, Miami VA GRECC,
Miami, FL, USA
Donald D. Trunkey, MD
Professor Emeritus, Department of Surgery, Oregon Health & Science University,
Portland, OR, USA
Edward M. Uchio, MD
Chief of Urology; Assistant Professor of Surgery, Section of Urology, VA Connecticut
Healthcare System, West Haven, CT, USA; Department of Surgery, Yale University
School of Medicine, New Haven, CT, USA
Robert Udelsman, MD, MBA
William H. Carmalt Professor of Surgery and Oncology Chairman, Department of Surgery,
Yale University School of Medicine, New Haven, CT, USA
Frank J. Veith, MD, FACS
Professor of Surgery, Department of Surgery, New York University, Bronx, NY, USA
Selwyn M. Vickers, MD
Jay Phillips Professor and Chairman, Department of Surgery, University of Minnesota,
Minneapolis, MN, USA
Jennifer F. Waljee, MD, MPH, MS
House Officer, Plastic and Reconstructive Surgery, Department of Surgery,
University of Michigan Medical Center, Ann Arbor, MI, USA
Lisa M. Walke, MD
Associate Professor; Chief, Geriatrics Consult Service, Geriatrics & Extended Care Service,
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;
VA Connecticut Healthcare System, West Haven, CT, USA
Barbara A. Ward, MD
Medical Director, Department of Surgery, The Breast Center at Greenwich Hospital,
Greenwich, CT, USA
Jennifer A. Wargo, MD
Instructor of Surgery; Assistant in Surgery, Division of Surgical Oncology, Harvard Medical
School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
Samuel A. Wells, Jr. MD
Professor of Surgery, Department of Surgery, Washington University Medical Center,
St. Louis, MO, USA
Thomas Wheeler II, MD, MSPH
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Assistant Professor, Division of Women’s Pelvic Medicine and Reconstructive Surgery,
Department of Obstetrics and Gynecology, University of Alabama at Birmingham Medical
Center, Birmingham, AL, USA
Lisa S. Wiechmann, MD
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Michael Wilderman, MD
Vascular Fellow, Division of Vascular Surgery, Barnes Jewish Hospital,
Washington University, St. Louis, MO, USA
Earle W. Wilkins, Jr. MD
Clinical Professor of Surgery, Department of Surgery, Massachusetts General Hospital,
Boston, MA, USA
Hugh L. Willcox, III MD
Resident, Department of General Surgery, Palmetto Health Richland Hospital, Columbia,
SC, USA
Aaron M. Winnick, MD
Fellow, Department of Transplant Surgery, SUNY Downstate Medical Center, Brooklyn,
NY, USA
Jordan M. Winter, MD
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
xxvContributors
Bruce G. Wolff, MD
Professor of Surgery, Department of Surgery; Chair, Division of Colon and Rectal Surgery,
College of Medicine Mayo Clinic, Rochester, MN, USA
Leslie S. Wu, MD
Clinical Fellow, Department of Surgery, Maine Medical Center, Portland, ME, USA
Dongmei Xing, MD, PhD
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Arash Yaghoobian, MD
Orthopaedic Resident, Department of Orthopaedic Surgery, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, NY, USA
Michael E. Zenilman, MD, FACS
School of Public Health, SUNY Downstate, Brooklyn, NY; Department of Surgery, Johns
Hopkins School of Medicine, Baltimore, MD
Xianjie Zhang, MD, PhD
Post-doctoral Fellow, Department of Surgery, Johns Hopkins School of Medicine,
Baltimore, MD, USA
Joseph D. Zuckerman, MD
Walter A. L. Thompson Professor of Orthopaedic Surgery and Chairman,
Department of Orthopaedics, NYU Hospital for Joint Diseases,
New York, NY, USA
https://t.me/med1917
Section I
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Physiology of Aging
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Chapter 1
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Invited Commentary
Jesse Roth
Get in league with the future.
Horace Greeley
The Future
By reading this piece, you are identifying yourself as a part
of the vanguard in geriatric surgery. Textbooks of surgery
and textbooks of geriatrics cover geriatric surgery very
sparingly. You have chosen to tackle a textbook on geriatric
surgery.
Demographics and Dollars
The elderly are the fastest growing segment of the population, with the so-called old–old in the lead. The elderly are
highly overrepresented in the hospital population and in the
medical expenses column. The application more widely of
basic well-established principles of care for the elderly will
almost certainly reduce the number of elderly in the hospital
and increase the return on money spent. Most important, we
can expect better outcomes for the elderly patients, especially for those who were hospitalized. Hospitalization and
surgery are each serious threats for the elderly patient.
Geriatrics Is a Frontier
“Go West, young man,” [1] was an exhortation to move from
the built up to the new, the frontier, the so-called cutting edge.
Geriatrics as a branch of medicine is young and is having a
J. Roth ()
Feinstein Institute for Medical Research, Albert Einstein College
of Medicine, North Shore-Long Island Jewish Health System,
149-37 Powells Cove Blvd, Whitestone 11357, NY, USA
e-mail: jesserothmd@hotmail.com
growth spurt. The subspecialties in medicine are increasing
their attention to issues related to care for the elderly. In geriatric surgery, the frontiers are open.
History provides us with some models. Harvey Cushing
was one of the twentieth century’s giants, a pioneer. In the
early years of the twentieth century, with great daring and
deep thought, he took principles of general surgery and very
meticulously applied them to the brain. In addition to his
skills in the operating theater, he gave his patients extraordinarily attentive care, before surgery as well as after. Indeed,
infection rates on his patients in the pre-antibiotic area,
would win a commendation medal today. Today we revere
him as the father of neurosurgery [
Pediatrics emerged from adult medicine at about the same
time [3]. Now pediatrics has a complete array of sub-specialists
covering all aspects of care for the young. When I was a medical student 50 years ago, pediatric surgery was just coming into
its own. Now it is a well-established subspecialty.
2].
Quest for Excellence
As the age of the patient increases, the gap grows that separates the good physician from the excellent physician. A simi-
lar gap shows itself as the age of the child decreases. The
premature baby and the frail elderly share many features. One
very big difference – pediatrics, pediatric surgery, pediatric
nursing, neonatology, pediatric gastroenterology, pediatric
endocrinology, and their cousins are well-developed areas of
expertise with highly trained practitioners. Their counterparts
in the care of the elderly are fewer and are less deeply trained.
It is much more difficult for physicians involved in the care of
an elderly patient to get expert help than it is for the doctor
caring for a child. Worse yet, the adult physicians (and other
medical providers) who are inadequately trained in geriatric
care are often unaware of their deficiencies.
R.A. Rosenthal et al. (eds.), Principles and Practice of Geriatric Surgery,
DOI 10.1007/978-1-4419-6999-6_1, © Springer Science+Business Media, LLC 2011
3
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