Spiros G. Frangos, M.D.

Alcohol use by pedestrians who are struck by motor vehicles: how drinking influences behaviors, medical management, and outcomes
Dultz, Linda A; Frangos, Spiros; Foltin, George; Marr, Mollie; Simon, Ronald; Bholat, Omar; Levine, Deborah A; Slaughter-Larkem, Dekeya; Jacko, Sally; Ayoung-Chee, Patricia; Pachter, H Leon
2011 Nov;71(5):1252-1257, Journal of trauma
BACKGROUND: : Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in large cities. The purpose of this study is to investigate the demographics of alcohol users who are struck by motor vehicles and to assess the effects of alcohol on pedestrian crossing patterns, medical management, and outcomes. METHODS: : Data were prospectively collected between December 2008 to September 2010 on all pedestrians who presented to a Level I trauma center after being struck by a motor vehicle. Variables were obtained by interviewing patients, scene witnesses, first responders, and medical records. RESULTS: : Pedestrians who used alcohol were less likely to cross the street in the crosswalk with the signal (22.6% vs. 64.7%) and more likely to cross either in the crosswalk against the signal (22.6% vs. 12.4%) or midblock (54.8% vs. 22.8%). Alcohol use was associated with more initial computed tomography imaging studies compared with no alcohol involvement. Alcohol use was associated with a higher Injury Severity Score (8.82 vs. 4.85; p < 0.001) and hospital length of stay (3.89 days vs. 1.82 days; p < 0.001) compared with those with no alcohol involvement. Patients who used alcohol had a lower average Glasgow Coma Scale score (13.80 vs. 14.76; p < 0.001) and a higher rate of head and neck, face, chest, abdomen, and extremity/pelvic girdle injuries (based on Abbreviated Injury Scale) than those with no alcohol involvement. CONCLUSION: : Alcohol use is a significant risk factor for pedestrians who are struck by motor vehicles. These patients are more likely to cross the street in an unsafe manner and sustain more serious injuries. Traffic safety and injury prevention programs must address irresponsible alcohol use by pedestrians
— id: 141084, year: 2011, vol: 71, page: 1252, stat: Journal Article,

Safer streets NYC: Pilot pediatric data from a novel, comprehensive database of pedestrians/cyclists struck by motor vehicles presenting to the bellevue hospital emergency department
Levine D.A.; Slaughter-Larkem D.; Frangos S.G.; Simon R.; Jacko S.; McStay C.; Tunik M.; Foltin G.
2011 ;18(5 SUPPL 1):S139-S139, Academic emergency medicine
Background: In NYC, pediatric pedestrians struck by motor vehicles account for thousands of visits to pediatric emergency departments. In 2007, approximately 60 children were killed due to this mechanism of injury. Currently, NY State collects retrospective information of admitted pediatric pedestrians injured. Objectives: Our goal is to collect comprehensive information prospectively of all children injured as a pedestrian or cyclist vs. motor vehicle. This novel project will allow better delineation of risk factors to target injury prevention. Methods: We have developed a prospective database of all pedestrians/cyclists injured or killed by motor vehicles from December 22, 2008 until present. A pediatric patient is defined as age < 18 years. Information regarding circumstances of incident, injury information, and hospital course were obtained from patient, guardian, emergency responders (paramedics, police, fire officers), and other sources (witnesses and medical record). Results: of 1000 patients, 116 (12%) were pediatric patients. The mean age was 11 years, with 40% of patients in the 6-12 age range. There was a male predominance. Eighty-five percent were pedestrians. One quarter of the cyclists were wearing a helmet. Fifty-two percent did not have adult supervision at the time of the incident. Five percent of incidents occurred within two blocks of school. Forty-two percent of patients were struck mid-block, 25% were darting out into the street, and two patients were boarding a bus. Eleven percent of patients were using an electronic device at time of injury. One patient reported cocaine and one patient was ethanol intoxicated. Twenty percent of patients had loss of consciousness and 6% had a GCS < 15 upon arrival. The injury severity score was greater than 10 in 9% of patients. Twenty-eight percent of patients were admitted. There were no mortalities. Conclusion: Pediatric pedestrians and cyclists struck by motor vehicles are a public health hazard. The majority of injuries are low acuity and result in few hospitalizations. Injury prevention strategies should focus on improving traffic safety knowledge and safety gear wearing in children. (Table Presented)
— id: 135606, year: 2011, vol: 18, page: S139, stat: Journal Article,

Aeromonas septicemia after medicinal leech use following replantation of severed digits
Levine, Steven M; Frangos, Spiros G; Hanna, Bruce; Colen, Kari; Levine, Jamie P
2010 Sep;19(5):469-471, American journal of critical care
Medicinal leeches are used to control venous congestion. Aeromonas in the leech gut are essential for digestion of blood. This case report describes a patient who had Aeromonas bacteremia develop after leeching. He had an injury to his hand that required replantation of his thumb. Following the surgery, leech therapy was started with ampicillin-sulbactam prophylaxis. Sepsis developed. Blood cultures were positive for Aeromonas that were resistant to ampicillin-sulbactam. The antibiotic was changed to ciprofloxacin on the basis of the sensitivity profile of the organisms. Cultures from the leech bathwater confirmed it as the source of the Aeromonas. Clinicians who use leech therapy must be aware that leeches can harbor Aeromonas species resistant to accepted prophylactic antibiotics and that sepsis may occur
— id: 138377, year: 2010, vol: 19, page: 469, stat: Journal Article,

U.S. surgeon and medical student attitudes toward organ donation
Hobeika, Mark J; Simon, Ronald; Malik, Rajesh; Pachter, H Leon; Frangos, Spiros; Bholat, Omar; Teperman, Sheldon; Teperman, Lewis
2009 Aug;67(2):372-375, Journal of trauma
BACKGROUND: Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential organ donors may reduce the organ shortage. Physician attitudes toward organ donation may influence donation rates; however, the attitudes of U.S. physicians have not been formally evaluated. METHODS: Anonymous questionnaires were distributed to surgical attendings, surgical residents, and medical students at two academic medical centers. Willingness to donate one's own organs and family member's organs was examined, as well as experience with transplant procedures and religious views regarding organ donation. RESULTS: A total of 106 surveys were returned. Sixty-four percent of responders were willing to donate their own organs, and 49% had signed an organ donor card. Willingness to donate inversely correlated with professional experience. Eighty-four percent of those surveyed would agree to donate the organs of a family member, including 55% of those who refused to donate their own organs. Experience on the transplant service influenced 16% of those refusing donation, with the procurement procedure cited by 83% of this group. Sixteen percent refused organ donation on the basis of religious beliefs. CONCLUSIONS: The surveyed U.S. physicians are less willing to donate their organs compared with the general public. Despite understanding the critical need for organs, less than half of physicians surveyed had signed organ donor cards. Previous experiences with the procurement procedure influenced several responders to refuse organ donation. As the lay public traditionally looks to physicians for guidance, efforts must be made to improve physician attitudes toward organ donation with the hope of increasing donation rates
— id: 101453, year: 2009, vol: 67, page: 372, stat: Journal Article,

Hypopharyngeal rupture associated with Hangman's fracture after blunt trauma
Wolf J; Miller G; Sultan R; Miglietta M; Frangos S
2007 Dec;:571-573, Surgical rounds
— id: 105480, year: 2007, vol: , page: 571, stat: Journal Article,

Pancreaticoureteral fistula following penetrating abdominal trauma
Wolf, Joshua H; Miller, George; Ashinoff, Russell; Dave, Jasmine; Lefleur, Richard S; Frangos, Spiros G; Miglietta, Maurizio A
2007 ;8(5):613-616, JOP: journal of the pancreas
CONTEXT: The main pancreatic duct can form a fistulous communication with another epithelium in the setting of prolonged inflammation, operative manipulation, or direct trauma. We present a rare complication of a pancreaticoureteral fistula following a trauma nephrectomy. CASE REPORT: A 17-year-old male who sustained a gunshot wound to the back arrived to our Emergency Room hyopotensive, tachycardic, and with free intraperitoneal fluid on focused assessment sonography for trauma (FAST) exam. He was taken to the operating room for an exploratory laporatomy where a left nephrectomy was performed to control active bleeding from the left renal hilum. Significant bleeding was also encountered at the portal venous confluence. After packing and damage control laparotomy, the periportal/pancreatic bleeding was controlled during a second procedure 6 hours later. After one month in the Intensive Care Unit with an open abdomen, a computed tomography (CT) scan revealed a fluid collection in the splenic fossa which was drained by catheter. Persistent drainage revealed a high amylase concentration (greater than 50,000 U/L). A fistulogram revealed interruption of the main pancreatic duct, and a fluid collection by the tail of the pancreas that was in communication with the left ureter. The patient's urine amylase was also elevated. The patient was treated non-operatively given the healing open abdomen and controlled fistula. He had an otherwise uncomplicated recovery. CONCLUSIONS: This is the second report of a pancreaticoureteral fistula in the literature. Treatment of this communication should be similar to that of other pancreatic fistulae
— id: 74304, year: 2007, vol: 8, page: 613, stat: Journal Article,

Are resident work-hour limitations beneficial to the trauma profession?
Abraham, Tara; Freitas, Marilee; Frangos, Spiros; Frankel, Heidi L; Rabinovici, Reuven
2006 Jan;72(1):35-41, American surgeon
In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts > 30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 +/- 0.5 vs Likert score 2.5 +/- 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with < 1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/ resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively
— id: 62580, year: 2006, vol: 72, page: 35, stat: Journal Article,

Thoracic stab wound with impaled knife
Frangos, Spiros G; Ben-Arie, Eyal; Bernstein, Mark P; Miglietta, Maurizio A
2006 Jun;60(6):1379-1379, Journal of trauma
— id: 64775, year: 2006, vol: 60, page: 1379, stat: Journal Article,

The status of ultrasonography training and use in general surgery residency programs
Freitas, Marilee L; Frangos, Spiros G; Frankel, Heidi L
2006 Mar;202(3):453-458, Journal of the American College of Surgeons
BACKGROUND: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical residents exists. This study assesses the current status of US training in general surgery residency programs. STUDY DESIGN: A survey was mailed to the directors of 255 Accreditation Council for Graduate Medical Education-accredited general surgery residency programs. It questioned whether and how US was taught, who performed the examinations, and the types of US performed. Data were analyzed using chi-square tests comparing university versus community programs and training and practice in trauma US versus training in other US modalities. RESULTS: The response rate was 51% (130 of 255). Ninety-six percent of the programs responding taught US, with no differences between university- and community-based training programs in presence of training. Focused Assessment for the Sonography of Trauma (FAST) instruction was done by 79% (hands-on) and 68% (didactic) of programs that responded. Abdominal, laparoscopic, breast, endocrine, and vascular US were each taught less frequently (22% to 55%). Program directors at university programs reported that their attending surgeons performed FAST and abdominal US more often than their community counterparts (71% and 31% versus 47% and 14%). Program directors reported that university trainees performed laparoscopic, endocrine, and vascular US more often than community surgery residents (47%, 17%, 35% versus 29%, 3%, 19%). Program directors reported that surgery attendings or residents performed trauma and laparoscopic US more often than their radiology counterparts, and radiology attendings or residents performed more abdominal, breast, endocrine, and vascular US. CONCLUSIONS: The majority of general surgery residency programs whose directors responded to this survey are teaching US, but most of the training is in FAST. There is no difference in the reported presence of overall US training between university and community programs. But university programs report that their surgeons or residents performed more US in all areas (other than breast) than their community counterparts reported
— id: 62579, year: 2006, vol: 202, page: 453, stat: Journal Article,

Image of the month. Splenic artery pseudoaneurysm
Gave, Asaf A; Frangos, Spiros G; Frankel, Heidi; Rabinovici, Reuven
2006 Nov;141(11):1141-1142, Archives of Surgery (Chicago)
— id: 96091, year: 2006, vol: 141, page: 1141, stat: Journal Article,

Hepatic artery transection after blunt trauma: case presentation and review of the literature
Miglietta, Maurizio A; Moore, Jason A; Bernstein, Mark P; Frangos, Spiros G; Ginsburg, Howard; Pachter, H Leon
2006 Sep;41(9):1604-1606, Journal of pediatric surgery
Hepatic artery injuries sustained as a result of blunt abdominal trauma are rare. This case represents the first reported hepatic artery transection and the second hepatic artery injury described in children. Hepatic artery injuries are associated with high mortality, and their management is complex and controversial
— id: 68784, year: 2006, vol: 41, page: 1604, stat: Journal Article,

Continuous positive airway pressure and postoperative hypoxemia
Frangos, Spiros G; Schwartz, David R
2005 Jun 8;293(22):2714-2714, JAMA
— id: 62581, year: 2005, vol: 293, page: 2714, stat: Journal Article,

Clinical review: Acid-base abnormalities in the intensive care unit -- part II
Kaplan, Lewis J; Frangos, Spiros
2005 Apr;9(2):198-203, Critical care
Acid-base abnormalities are common in the critically ill. The traditional classification of acid-base abnormalities and a modern physico-chemical method of categorizing them will be explored. Specific disorders relating to mortality prediction in the intensive care unit are examined in detail. Lactic acidosis, base excess, and a strong ion gap are highlighted as markers for increased risk of death
— id: 55661, year: 2005, vol: 9, page: 198, stat: Journal Article,

Transfusion trigger: a careless term that disregards pathophysiology
Frangos, Spiros G
2004 Jul;24(7):950-951, Pharmacotherapy
— id: 55662, year: 2004, vol: 24, page: 950, stat: Journal Article,

Effect of gender on outcome following infrainguinal bypass graft surgery: a systematic review
Frangos, Spiros G; Kilaru, Sashi; Sumpio, Bauer E; Gahtan, Vivian
2002 Mar;66(3):137-144, Connecticut medicine
— id: 55663, year: 2002, vol: 66, page: 137, stat: Journal Article,

Intermittent pneumatic compression devices -- physiological mechanisms of action
Chen AH; Frangos SG; Kilaru S; Sumpio BE
2001 May;21(5):383-392, European journal of vascular & endovascular surgery
There are many reports of how IPC is used effectively in the clinical setting; including the prevention of deep venous thrombosis, improvement of circulation in patients with lower extremity arterial diseases, reduction of lymphoedema, and the healing of venous ulcers. However, despite the widely accepted use of IPC, it is still unclear how IPC actually exerts its beneficial effects. The exact physiological mechanisms of action are unknown. The clinical utility of IPC and the putative mechanisms by which IPC could exert its therapeutic effect will be reviewed. The paper will examine the mechanical effects of IPC exerted on the lower extremity, and the subsequent biochemical changes in the circulation. In vitro studies of the effects of mechanical stress such as compressive strain and shear on cultured endothelial cells, and their clinical relevance to IPC will also be reviewed
— id: 62585, year: 2001, vol: 21, page: 383, stat: Journal Article,

Cyclic strain activates the pro-survival Akt protein kinase in bovine aortic smooth muscle cells
Chen AH; Gortler DS; Kilaru S; Araim O; Frangos SG; Sumpio BE
2001 Aug;130(2):378-381, Surgery
BACKGROUND: Pulsatile pressure induced by the beating heart causes cyclic strain on arterial endothelial cells and smooth muscle cells (SMCs). This study examined whether Akt, a serine/threonine protein kinase known to promote cell survival by inhibiting apoptosis, is activated by cyclic strain in bovine aortic SMCs. METHODS: Bovine aortic SMCs were cultured on flexible-bottomed membranes and then serum-starved for 24 to 36 hours. The cells were then exposed to 150-mm Hg repetitive deformations, which created an average of 10% strain on the monolayer SMCs at a frequency of 60 cycles/minute for 0 (negative control) and 30 minutes. Platelet-derived growth factor (PDGF)--stimulated SMCs were used as positive controls. Phosphorylation of Akt was determined by means of Western blot analysis. An apoptosis assay (TUNEL) was also performed on SMCs exposed to cyclic strain. RESULTS: Akt phosphorylation was significantly increased over that of the negative control after 30 minutes of cyclic strain and in the PDGF group. Cyclic strain did not increase the prevalence of apoptosis in SMCs over the control. CONCLUSIONS: Cyclic strain activated the pro-survival Akt kinase. The pro-survival function was supported by the fact that cyclic strain did not increase apoptosis in bovine aortic SMCs. This experiment suggests that cyclic strain may induce arterial wall thickening by tipping the balance toward arterial SMC proliferation through the inhibition of apoptosis
— id: 62583, year: 2001, vol: 130, page: 378, stat: Journal Article,

The fastest, simplest, and safest method for removing a thoracostomy tube unassisted
Frangos SG
2001 ;57:504-504, Contemporary surgery
— id: 62592, year: 2001, vol: 57, page: 504, stat: Journal Article,

Classification of diabetic foot ulcers: improving communication
Frangos SG; Kilaru S; Blume PA; Shin J; Sumpio B
2001 ;10:1-7, International angiology
— id: 62593, year: 2001, vol: 10, page: 1, stat: Journal Article,

The integrin-mediated cyclic strain-induced signaling pathway in vascular endothelial cells
Frangos SG; Knox R; Yano Y; Chen E; Di Luozzo G; Chen AH; Sumpio BE
2001 ;8(1):1-10, Endothelium
The irregular distribution of plaque in the vasculature results from the interaction of local hemodynamic forces with the vessel wall. One well-characterized force is cyclic circumferential strain, the repetitive pulsatile pressure distention on the arterial wall. This review summarizes current research, which has aimed to elicit the signal transduction pathway by which cyclic strain elicits functional and structural responses in endothelial cells; specifically, it summarizes the signaling pathway that begins with the reorganization of integrins. One method by which these extracellular matrix receptors affect signal transduction is through their ability to initiate the process of phosphorylation on tyrosine residues of cytoplasmic protein kinases, including focal adhesion kinase. The strain-induced pathway appears to also involve ras and the mitogen-activated protein kinase family of enzymes, and preliminary data suggests a role for src as well. Ultimately, it is the regulation of gene expression through the modulation of transcription factors that allows endothelial cells to respond to changes in local hemodynamics
— id: 62584, year: 2001, vol: 8, page: 1, stat: Journal Article,

Nicotine: a review of its role in atherosclerosis
Kilaru S; Frangos SG; Chen AH; Gortler D; Dhadwal AK; Araim O; Sumpio BE
2001 Nov;193(5):538-546, Journal of the American College of Surgeons
— id: 62582, year: 2001, vol: 193, page: 538, stat: Journal Article,

Cyclic strain induces RhoA activation in bovine aortic endothelial cells
Chen AH; Li S; Frangos SG; Di Luozzo G; Dhadwal A; Sumpio BE
2000 ;93:366-366, Journal of surgical research
— id: 62590, year: 2000, vol: 93, page: 366, stat: Journal Article,

Endothelial cells exposed to nicotine act as a chemoattractant for vascular smooth muscle cell migration
Di Luozzo G; Dhadwal AK; Frangos SG; Chen AH; Jeffries BW; Dudrick SJ; Sumpio BE
2000 ;51:373-375, Surgical forum
— id: 62591, year: 2000, vol: 51, page: 373, stat: Journal Article,

Vascular drugs in the new millennium
Frangos SG; Chen AH; Sumpio B
2000 Jul;191(1):76-92, Journal of the American College of Surgeons
— id: 62586, year: 2000, vol: 191, page: 76, stat: Journal Article,

Gender does not impact infrainguinal vein bypass graft outcome
Frangos SG; Karimi S; Kerstein MD; Harpavat M; Sumpio B; Roberts AB; Gahtan V
2000 Jun;127(6):679-686, Surgery
BACKGROUND: The percentage of women requiring infrainguinal bypass graft operations continues to increase, whereas the effect of gender on postoperative outcome remains unclear. The purpose of this study was to assess the influence of gender on patient selection and outcome in patients requiring infrainguinal vein bypass grafting procedures. METHODS: This retrospective study reviewed 217 infrainguinal vein bypass grafts performed over an 8-year period. Medical records and patient interviews were used to determine study measures and outcomes. Gender and multiple covariables affecting patient survival were analyzed; postoperative complications and graft patencies were examined. Bivariate and life-table analyses were conducted, followed by multivariate analysis with the Cox proportional hazards model. RESULTS: No statistical differences existed between men and women for age, diabetes, cardiac disease, tobacco use, hypertension, stroke, renal disease, or prior contralateral bypass or major amputation. Women were more likely to be black (P =.014) and have a spliced vein graft (P =.035). No differences were noted between the 2 groups for 30-day morbidity rates-except women had more incisional complications (P =.01)-or for survival (P =.45), primary-patency (P =.57), secondary-patency (P =. 79), or limb-salvage rates (P =.40). Multivariate analysis showed that gender had no role in affecting survival rates. CONCLUSIONS: Gender does not affect graft patency, limb salvage, or survival rates. There should be no introduction of a gender bias into management of infrainguinal occlusive disease
— id: 62587, year: 2000, vol: 127, page: 679, stat: Journal Article,

Localization of atherosclerosis: role of hemodynamics
Frangos SG; Gahtan V; Sumpio B
1999 Oct;134(10):1142-1149, Archives of Surgery (Chicago)
Atherosclerosis is a chronic disease attributed to risk factors that are systemic in nature. Yet the lesions involved do not occur in random fashion. The coronary arteries, the major branches of the aortic arch, and the abdominal aorta and its visceral and major lower extremity branches are particularly susceptible sites. Hemodynamic forces interacting with an active vascular endothelium are responsible for localizing lesions in a nonrandom pattern of distribution. Shear stress and cyclic circumferential strain are the predominant forces that have been characterized. The modification of endothelial cell structure and function by these mechanical forces sheds insight into the vasculature's propensity for atherogenesis
— id: 62589, year: 1999, vol: 134, page: 1142, stat: Journal Article,

Recurrent Celiac Artery Compression Syndrome
Frangos SG; Steinthorsson G; Sumpio B
1999 Jun;8(3):150-153, International journal of angiology
The celiac artery compression syndrome (CACS) is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. We present a patient with CACS who suffered a recurrence of her original abdominal complaints.http://link.springer-ny.com/link/service/journals/00547/bibs/8n 3p150.html
— id: 62588, year: 1999, vol: 8, page: 150, stat: Journal Article,