Medicine and Health Sciences Commons^™

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar Mbbs, Fcps, Syed Ather Enam Md, Phd, Frcs, Facs

Muhammad Babar Khan

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.

Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …

Analysis United Kingdom And United States Healthcare, Joyce K. Kutin

Joyce K Kutin RN, MSN, MOL

United Kingdom and the United States are two dissimilar health systems each having uniquely differing focuses, where the primary differences are a parliamentary verses a republic government application toward the socioeconomic requirements of the populace. The United Kingdom’s National Health Service interprets health care as a public service rather than the commodity. The United States healthcare system is riddled with disparities regarding quality, access and cost. The socioeconomic poor and or homeless are less likely to utilize the healthcare system when compared to others who are more fortunate. Health care systems are facing the same challenges around the world with …

Help! My Dog Was Diagnosed With A Liver Problem! Understanding Common Liver Disorders In Yorkshire Terriers & Other Toy Breeds, Karen M. Tobias

Karen M. Tobias DVM, DACVS, College of Veterinary Medicine

No abstract provided.

Computerized Tomography Providing Definitive Diagnosis Of Colonic Lipoma: A Case Series, Osama M. Moussa Mr, Sanaa Arshad Dr, Ming Tee Dr, Aref U. Khan Mr, Chelliah R. Selvasekar Mr

Osama M Moussa Mr

Lipomas are common benign mesenchymal tumors. They can develop in virtually all organs throughout the body. Colonic lipomas are uncommon, benign, submucosal adipose tumors that are usually asymptomatic. Large lipomas can cause symptoms such as constipation, abdominal pain, rectal bleeding and intussusception. We report a case series of two colonic submucosal lipomas with different presentations, elaborating the importance of computerised tomography (CT) imaging in the diagnosis.

A Preliminary Study Comparing The Use Of Allogenic Chondrogenic Pre-Differentiated And Undifferentiated Mesenchymal Stem Cells For The Repair Of Full Thickness Articular Cartilage Defects In Rabbits, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Chondrogenic differentiated mesenchymal stem cells (CMSCs) have been shown to produce superior chondrogenic expression markers in vitro. However, the use of these cells in vivo has not been fully explored. In this study, in vivo assessment of cartilage repair potential between allogenic-derived chondrogenic pre-differentiated mesenchymal stem cells and undifferentiated MSCs (MSCs) were compared. Bilateral full thickness cartilage defects were created on the medial femoral condyles of 12 rabbits (n = 12). Rabbits were divided into two groups. In one group, the defects in the right knees were repaired using alginate encapsulated MSCs while in the second group, CMSCs were used. …

Platelet-Rich Plasma (Prp) Enhances Bone Healing In Non-United Critical-Sized Defects: A Preliminary Study Involving Rabbit Models, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Introduction: The use of bone grafts in treating non- or delayed unions as the result of large bone loss is well established. However, despite good outcomes, the time to achieve complete union is still considerably long. To overcome this problem, the use of platelet-rich plasma (PRP) has been advocated albeit with varying success. To determine the true effectiveness of PRP in treating non-/delayed unions, a study was conducted using (n = 12) rabbit models. Methods and materials: Critical-sized defects measuring 2 cm created in the midshaft of the right rabbit tibias were stabilised using 2.7-mm small fragment plates. A spacer …

A Preliminary Study Of The Effects Of Glucosamine Sulphate And Chondroitin Sulphate On Surgically Treated And Untreated Focal Cartilage Damage, Tunku Kamarul Zaman

Tunku Kamarul Zaman

The effects of Glucosamine Sulphate (GS) and Chondroitin Sulphate (CS) on the healing of damaged and repaired articular cartilage were investigated. This study was conducted using 18 New Zealand white rabbits as experimental models. Focal cartilage defects, surgically created in the medial femoral condyle, were either treated by means of autologous chondrocyte implantation (ACI) or left untreated as controls. Rabbits were then divided into groups which received either GS+/-CS or no pharmacotherapy. Three rabbits from each group were sacrificed at 12 and 24 weeks post-surgery. Knees dissected from rabbits were then evaluated using gross quantification of repair tissue, glycosaminoglycan (GAG) …

Medical Malpractice From A Surgeons Surgical Instruments, Andre77 S. Brown

andre77 S Brown

Hello, My name is Andre Brown and I’m a medical researcher for HNM Medical. I’ve written an article about medical malpractice that I would like to share you to post on your site. You may have full reprint rights to this article as long as you include the 3 links with do follow attributes that I have included in the body. - Please see the attachment for the article

Survey Of Biosecurity Practices Utilized By Veterinarians Working With Farm Animal Species, David E. Anderson

David Edgar Anderson, DVM, MS, DACVS

Biosecurity programs can be discussed from many perspectives. In many cases, biosecurity may be regulated state or federal programs with law enforcement - the goals of which are to protect the "national" livestock resources and protect consumer interests. Alternatively, these programs may be producer level programs that are voluntarily established for protection of personal livestock investments. A core principle in the definition of "biosecurity" is the desire to prevent the introduction of disease. When infectious disease is present on a farm or in a region, the term "biocontainment" may be used to describe programs aimed at confinement of the diseases …

Human Amnion As A Novel Cell Delivery Vehicle For Chondrogenic Mesenchymal Stem Cells, Tunku Kamarul Zaman

Tunku Kamarul Zaman

This study investigates the feasibility of processed human amnion (HAM) as a substrate for chondrogenic differentiation of mesenchymal stem cells (MSCs). HAM preparations processed by air drying (AD) and freeze drying (FD) underwent histological examination and MSC seeding in chondrogenic medium for 15 days. Monolayer cultures were used as control for chondrogenic differentiation and HAMs without cell seeding were used as negative control. Qualitative observations were made using scanning electron microscopy analysis and quantitative analyses were based on the sulfated glycosaminoglycans (GAG) assays performed on day 1 and day 15. Histological examination of HAM substrates before seeding revealed a smooth …

The Efficacy Of Topical Antibiofilm Agents In A Sheep Model Of Rhinosinusitis, Peter-John Wormald

Peter-John Wormald

Background: Biofilms have been shown to be resistant to conventional antibiotic treatment. This study uses a sheep biofilm model developed by our department to investigate several novel topical anti-biofilm treatments. Methods: Staphylococcal biofilms were grown in 54 sheep frontal sinuses over 8 days: Each sinus was randomized to (1) no intervention, (2) single mupirocin flush, (3) regular 12-hourly mupirocin flushes for 5 days, (4) Citric Acid Zwitterionic Surfactant (CAZS) via hydrodebrider, (5) gallium nitrate, (6) CAZS with gallium nitrate, (7) CAZS with mupirocin, and (8) saline regular flushes. Sheep were sacrificed and the sinus mucosa harvested 1 or 8 days …

The Role Of Itraconazole In Recalcitrant Fungal Sinusitis, K Seiberling, Peter-John Wormald

Peter-John Wormald

Background: Oral itraconazole is an antifungal that has been shown to be of benefit to patients with allergic bronchopulmonary aspergillus (ABPA). It is hypothesized that itraconazole may similarly benefit patients with allergic fungal sinusitis (AFS), a disease similar to ABPA. This study was designed to evaluate the therapeutic response of itraconazole in patients with refractory chronic fungal sinusitis who have failed maximal medical and surgical therapy. Methods: A retrospective chart review was performed of 23 patients with AFS and nonallergic eosinophilic fungal sinusitis treated with oral itraconazole. Charts were reviewed for patient demographics, comorbidities, allergies, fungal cultures, type of surgery …

Efficacy Of Different Techniques Of Sinonasal Irrigation After Modified Lothrop Procedure., A Beule, T Athanasiadis, E Athanasiadis, J Field, Peter-John Wormald

Peter-John Wormald

Background: Post-operative irrigation after endoscopic sinus surgery and endoscopic Lothrop procedure is used to remove nasal crusts and to improve wound healing. To evaluate the optimal application protocol for irrigation of the frontal sinus, a prospective cadaver study was performed. Methods: An endoscopic modified Lothrop procedure and complete sphenoethmoidectomy were performed in 19 heads. Each was irrigated with a 1.5% solution of water and different colours using nasal spray and a squeeze bottle filles with 50, 100 and 200 mL. Intensity of local staining and percentage of area were documented using standardized videoendoscopy after irrigation in 'bending over the sink' …

Endoscopic Management Of Frontal Sinus Osteomas Revisited, K Seiberling, S Floreani, S Robinson, Peter-John Wormald

Peter-John Wormald

Background: recent articles have published guidelines regarding the role of endoscopic surgery in the removal of frontal sinus osteomas. These guidelines recommend the endoscopic approach for small ostoemas but recommend an osteoplastic flap for larger tumors. This study presents a series of endoscopically resected tumors both large and small. Methods: retrospective chart reviews were performed. Charts were reviewed of all patients who underwent surgical resection of a frontal sinus osteoma from 1998 to 2008. Sinus CT scans were reviewed and each tumor was staged according to Kennedy's grading system proposed in 2005. Results: Twenty-three patients, 8 with a grade IV …

Immunomodulatory Effect Of Cytosine-Phosphate-Guanosine (Cpg)-Oligonucleotides In Nonasthmatic Chronic Rhinosinusitis: An Explant Model, L Tan, T Rogers, N Hatzirodos, L Baker, E Ooi, Peter-John Wormald

Peter-John Wormald

Background: The use of cytosine-phosphate-guanosine-oligodeoxynucleotides (CpG-ODNs) or immunostimulatory sequences (ISSs) in the treatment of airway diseases is gaining interest. Binding of the CpG-ODN ligand to Toll-like receptor 9 (TLR9) triggers a shift from a Th2- to a Th1-type response in the target tissue. In this study, we explored the potential use of CpG-ODN to dampen the predominantly Th2-driven chronic inflammatory state in our cohort of patients. Methods: An in vitro explant model comprising of sinonasal tissue from patients with asthma (n=12) and without asthma (n=11) were stimulated with CpG-ODN or Staphylococcus aureus enterotoxin B (SEB) or CpG-ODN in combination with …

Nasal Polyp Cell Populations And Fungal-Specific Peripheral Blood Lymphocyte Proliferation In Allergic Fungal Sinusitis, H Pant, D Beroukas, F Kette, W Smith, Peter-John Wormald, P Macardle

Peter-John Wormald

Background: Allergic fungal sinusitis (AFS) is considered a different disease from other polypoid chronic rhinosinusitis diseases (CRS) with eosinophilic mucus (EM) termed eosinophilic mucus chronic rhinosinusitis (EMCRS). To substantiate this, studies on cellular responses to fungi and sinus mucosal inflammatory cell populations in AFS and other EMCRS diseases are required. This study was designed to examine polyp inflammatory cell populations and peripheral blood fungal-specific T cell responses in AFS, other EMCRS subgroups (defined later) and polypoid CRS without EM. Methods: A prospective study was performed. Clinical characteristics, including CRS symptoms, sinus computed tomography (CT) scans, allergy status, intraoperative endoscopy, presence …

A Randomized Controlled Pilot Study Of Epsilon-Aminocaproic Acid As A Topical Hemostatic Agent For Postoperative Bleeding In The Sheep Model Of Chronic Sinusitis, Devika C. Thomas, Peter-John Wormald

Peter-John Wormald

Background: Significant bleeding with blood clot formation in the postoperative period may predispose to the formation of postoperative adhesions. A topical hemostatic agent would potentially improve postoperative comfort and lessen adhesion formation. This pilot study was performed to evaluate the effects of a novel topical agent AMICAR (ε-aminocaproic acid; Xanodyne Pharmacal, Inc., Florence, KY) on postoperative bleeding after endoscopic sinus surgery (ESS). Methods: In a prospective randomized controlled pilot study full thickness mucosal injuries were created on the lateral nasal wall, ethmoturbinal and the maxillary ostium on both sides of 10 sheep. Eosinophilic chronic sinusitis was confirmed both by endoscopy …

A Prospective Controlled Trial Of Pulsed Nasal Nebulizer In Maximally Dissected Cadavers., Rowan J. Valentine, Theo Athanasiadis, May Thwin, Deepti Singhal, Erik K. Weitzel, Peter-John Wormald

Peter-John Wormald

Background: Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model. Methods: Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf 111, wide maxillary antroslomy, or media maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200ml. nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions …

Innate Immunity In The Paranasal Sinuses: A Review Of Nasal Host Defenses., Eng Hooi Ooi, Peter-John Wormald, Lor Wai Tan

Peter-John Wormald

Background: Chronic rhinosinusitis (CSR) is a common inflammatory disorder of the paranasal sinuses. An abnormal host response to common bacterial or fungal pathogens is thought to be an important factor in the disease process. Host sinonasal epithelium plays an important role in initially recognizing the presence of microbes and responding by increasing production of antimicrobial peptides and cytokines, with recruitment of phagocytes and lymphocytes of the adaptive immune system, to eliminate the infection. Recently, the innate immune system and its complex interplay with the adaptive immune system are increasingly being recognized as important in the pathogenesis of chronic inflammatory diseases …

The Effect Of Bacterial Biofilms On Post-Sinus Surgical Outcomes, Alkis J. Psaltis, Erik K. Weitzel, Kien R. Ha, Peter-John Wormald

Peter-John Wormald

Background: Although the existence of biofilms on the sinus mucosa with chronic rhinosinusitis (CRS) is now well established, the role that these structures play remains unclear. It is thought that biofilms may contribute to the recalcitrant and persistent nature that characterizes CRS, but little research exits documenting the effect that they have on postoperative mucosal outcomes. This article presents a retrospective analysis of sinus surgical patients and correlates the presence of biofilms with mucosal outcomes. This study was performed to evaluate the role that bacterial biofilms have on post-sinus surgical outcomes. Methods: A retrospective analysis of prospectively collected data was …

Review Of Natural Orifice Translumenal Endoscopic Surgery (Notes) For Intra-Abdominal Surgery: Experimental Models, Techniques And Applicability To The Clinical Setting, E Della Flora, T G. Wilson, I J. Martin, N A. O'Rourke, Guy Maddern

Guy Maddern

Objective: Evaluation of models, techniques, outcomes, pitfalls and applicability to the clinical setting of natural orifice translumenal endoscopic surgery (NOTES) for performing intra-abdominal surgery through a systematic review of the literature. Summary Background Data: NOTES has attracted much recent attention for its potentail to allow traditional surgical procedures to be performed entirely through a natural orifice. Amid the excitement for potentially scar-free surgery and abolishment of dermal incision-related complications, the safety and efficacy of this new surgical technology must be evaluated. Methods: studies were identified by searching MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Library, Entrez PubMed, Clinical Trials Database, National …