2011 Scholarship Winners

Each year the ICS-US Section conducts a research scholarship competition for surgical residents, fellows in training and medical students. The winners were selected based on their submitted research papers as well as their oral presentations made during the Annual Surgical Update in Portland. Following are the winners and abstracts of their papers.


Intra-Tumoral Acetic Acid Injection Eradicates Human Prostate Cancer Tumors In A Murine Model
Jasneet Singh Bhullar MD
Resident- General Surgery, Department of General Surgery, Providence Hospital & Medical Centers, Southfield, MI
Coaututhors: Gokulakkrishna Subhas MD; Erina Kansakar MD; Boris Silberberg MD; Jacqueline Tilak BS; Lee Andrus LVT BIS; Milessa Decker LVT; Patrick Hurley MD; Jeffrey O’Connor MD;  Vijay K. Mittal MD
Prostate cancer treatment is associated with substantial morbidity. Ideal treatment of localized prostate cancer would be an effective local therapy with minimal morbidity. Direct injections have been used to treat benign prostatic hyperplasia without major complications, but in limited cases. We evaluated the local oncotoxic effects of acetic acid in a prostate cancer xenograft murine model.
PC3 and LNCaP human prostate cancer cell lines were used to grow subcutaneous tumors in SCID mice. For each cell line, 14 mice underwent tumor injection with 25% acetic acid (0.05 ml/100 cm3 of tumor) after the tumor was >300 mm3. Post treatment one mouse/group was euthanized after 6 hrs, 24 hrs, 1 week and 2 weeks; remaining mice (n=10) were sacrificed at 120 days. Control mice (8/group) were euthanized after they met the humane criteria for tumor burden and overall health.
Tumor necrosis was noted immediately post injection; by 24 hrs, ulceration and crusting of overlying skin were noted, which healed into scars by 23±5 days. Histological examination showed tumor degeneration and necrosis with feeding vessel obstruction. Ten treated mice in both groups survived for 120 days, which was much longer than the mean survival of PC3 (40±9 days) and LNCaP (56±10) control mice.
Direct injection of acetic acid successfully eradicated both tumors. This treatment option could potentially be used in humans for treatment of early localized prostate cancer and non-operative management of locally advanced cases. This is the first report of successful local chemical therapy for prostate cancer.


Clinicopathological Significance Of Expression Of Estrogen Receptor-Beta (Erß), Progesterone Receptor(PR) And Vascular Endothelial Growth Factor-A (VEGF-A) In Colorectal Cancer
Deepa Taggarshe, MD, MRCS, M Phil
Resident in General Surgery, Providence Hospital and Medical Centers, Southfield, MI
Coauthors: Catherine Lobocki MS; Alasdair McKendrick MD FACS; Vijay K Mittal MD, FACS
Estrogen-receptor-beta (ERß), Progesterone-receptor (PR) and Vascular- endothelial-growth-factor-A have been implicated to have a role in colorectal cancer. The expression of these markers and the clinicopathological significance of the same remain unclear. The purpose of this study was to determine the expression of these biological markers in colorectal cancer cells and their prognostic significance.
Immunohistochemical assay of ERß, PR and VEGF-A was performed in 72 colonic adenocarcinoma cases. The correlation of the presence of these markers with other clinicopathological features and survival was then determined.
None of the cases showed ERß or PR expression by malignant cells in the tumor, but, in two cases, ERß was detected in the normal colonic mucosa. VEGF-A was expressed strongly in the malignant cells in 64 cases, compared to 10 cases of normal mucosa. VEGF- A expression was observed in 37/40(92%) patients with Stage III or Stage IV disease and in 24/27(88.8%) patients with Stage I or II disease. Strong VEGF-A expression did not correlate with tumor-grade, angiolymphatic-involvement, stage, disease-free and overall survival. Strong VEGF-A expression was seen in 23/26(88.4%) patients with recurrence and 41/47(87.2%) patients with no recurrence.
Colorectal cancers do not express ERß or PR. Absence of ERß expression by normal mucosa contests the previous reports of a protective effect of ERß with decreased levels associated with colorectal tumorigenesis in females. VEGF-A expression in colorectal cancer compared to normal mucosa indicates that it may have a role in tumorigenesis. However VEGF-A expression cannot be used as a prognostic marker.


Gabriela Vargas MD
4th year Surgery Resident, University of Utah, Department of Surgery, Salt Lake City, Utah
Coauthor: Raymond R. Price, MD, FACS, Director Graduate Surgical Education, Intermountain Medical Center, Intermountain Healthcare, Salt Lake City,Utah, Adjunct Associate Clinical Professor of Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
Laparoscopic surgery was introduced in Mongolia in 1994, yet due to difficult geography and extremely limited resources the benefits of laparoscopic surgery have not been available to the majority of the country. A capacity building approach was initiated for sustainable trans-cultural and trans-professional transfer of knowledge for laparoscopic cholecystectomy throughout the four rural regional diagnostic referral centers in Mongolia.
Laparoscopic cholecystectomy training was initiated by the local Mongolian surgical community. A private NGO collaborated and together developed a comprehensive laparoscopic cholecystectomy course. The course included a didactic one day course followed by an intensive 2-week practical operating experience. 
Improved access for laparoscopic cholecystectomy has been implemented into three of the four regional diagnostic referral centers in Mongolia. Increased collaboration between urban and rural Mongolian surgeons has increased. Mongolian surgeons have had the opportunity to developed new skills and become leaders in the advancement of laparoscopy in their local communities. Keys to sustainable capacity building included developing trusting relationships, incorporating comprehensive surgical training with appropriate infrastructure development, and multiple repeat training visits.
This program has been successful in creating a self-sustaining practice of training and advancement of surgical skills in Mongolia. The traditional surgical approach to gallbladder disease has been challenged and has in turn been a stimulus for local improvement in the medical community.






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