Medicine and Health Sciences Commons^™

Soft Tissue Profile Response In Extraction Versus Non-Extraction Orthodontic Treatment, Munizeh Khan, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare changes occurring in the soft tissue profile with orthodontic treatment in extraction versus nonextraction cases, and to determine the hard and soft tissue parameters that show significant correlations to understand the factors influencing the response to tooth movement. Study Design: Quasi-experimental. Place and Duration of Study: Dental Section, The Aga Khan University Hospital, Karachi, from 2005 to 2008. Methodology: Pre- and post-treatment lateral cephalographs of 34 subjects were assessed. For half of the patients (n=17), treatment included the extraction of 4 premolars, whereas the other half were treated by the non-extraction approach. Incisal and soft tissue effects …

Modification And Implementation Of Nccn Guidelines On Prostate Cancer In The Middle East And North Africa Region., Waleed A. Hassen, Farrok A. Karsan, Farhat Abbas

Department of Surgery

Abstract

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines …

Anaesthetic Management Of Two Patients With Beta-Thalassaemia Intermedia, Shahnawaz Ali, Fauzia Khan

Department of Anaesthesia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia.

Management Of Devastating Ocular Trauma--Experience Of Maxillofacial Surgeons Deployed To A Forward Field Hospital, M. J. Ansell, J. Breeze, Vivian C. Mcalister, M. D. Williams

Surgery Publications

Combat-related eye injuries continue to increase in frequency and are generally secondary to Improvised Explosive Devices. Many ocular injuries are potentially preventable by the wearing of ballistic eye protection. The management of penetrating eye trauma is normally outside the routine practice of maxillofacial surgeons in the UK. The aim of this paper is to describe the surgical techniques used in the modern management of devastating ocular trauma including selected case examples managed by British military maxillofacial surgeons deployed to Afghanistan.

Initial Experience With A Miniaturized Multiplane Transesophageal Probe In Small Infants Undergoing Cardiac Operations., Sinai C. Zyblewski, Girish S. Shirali, Geoffrey A. Forbus, Tain-Yen Hsia, Scott M. Bradley, Andrew M. Atz, Meryl S. Cohen, Eric M. Graham

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

DESCRIPTION: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

EVALUATION: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE …

Optimal Technical Management Of Stump Closure Following Distal Pancreatectomy: A Retrospective Review Of 215 Cases., Lisa J. Harris, Hamid Abdollahi, Timothy Newhook, Patricia K. Sauter, Albert G. Crawford, Karen A. Chojnacki, Ernest L. Rosato, Eugene P. Kennedy, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic fistula (PF) is a major source of morbidity following distal pancreatectomy (DP). Our aim was to identify risk factors related to PF following DP and to determine the impact of technique of transection and stump closure.

METHODS: We performed a retrospective review of 215 consecutive patients who underwent DP. Perioperative and postoperative data were collected and analyzed with attention to PF as defined by the International Study Group of Pancreatic Fistula.

RESULTS: PF developed in 36 patients (16.7%); fistulas were classified as Grade A (44.4%), B (44.4%), or C (11.1%). The pancreas was transected with stapler (n = …

Correlation Of C2 Fractures And Vertebral Artery Injury., Tao Ding, Mitchell Maltenfort, Huilin Yang, Harvey Smith, John Ratliff, Alexander Vaccaro, D Greg Anderson, James Harrop

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective review of prospectively collected data.

SUMMARY OF BACKGROUND DATA: Vertebral artery injuries (VAI) occur commonly after cervical spine trauma. No study has yet examined the association between VAI and specific variants of C2 fractures.

OBJECTIVE: To evaluate the incidence of VAI (as defined by magnetic resonance imaging/angiography [MRI/A]) in subtypes of C2 fractures. To define the association between the incidence, morphology, and severity of C2 fractures, based on fracture angulation and comminution, and the occurrence of VAI.

METHODS: Patients admitted to the hospital with C2 fractures between October 2006 and December 2008 to a tertiary care referral …

Intricacies In The Surgical Management Of Appendiceal Mucinous Cystadenoma: A Case Report And Review Of The Literature., Muhammad Rizwan Khan, Rashida Ahmed, Taimur Saleem

Department of Surgery

Introduction:Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy) or the best surgical approach (laparoscopic versus laparotomy). Case Presentation: We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the …

In-Theater Peritoneal Dialysis For Combat-Related Renal Failure, Joseph S. Pina, Soraya Moghadam, Howard M. Cushner, Greg J. Beilman, Vivian C. Mcalister

Surgery Publications

BACKGROUND: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units. METHODS: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials. RESULTS: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial …

Immunosuppressive Therapy For Autoimmune Disease And Pregnancy Outcomes, Karolina Paziana, Faith Carlin, Lisa A. Corcia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Cyclosporine exposure during pregnancy in the transplant population does appear to be associated with premature delivery and low infant birthweight.

Data from the NPR show that cyclosporine exposure during pregnancy in women with psoriasis does not appear to be associated with low gestational age or low infant birthweight.

Maternal comorbidities or other factors, such as multiple drug regimens, likely play a role in the higher rates of premature delivery and low birthweight infants in the kidney transplant population.

Further investigation is warranted to evaluate the impact of comorbidities and other factors on pregnancy outcomes of women taking Neoral®.

Acute Mesenteric, Portal And Inferior Vena Cava, Venous Thrombosis, Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Section of Cardiothoracic Surgery

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Solid-Organ Transplant Recipients And Breastfeeding While On Immunosuppression, Schweta Arakali, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The relatively small amount of drug transferred in breast milk and the lack of reported adverse effects along with the known benefits of breastfeeding may outweigh the risk of drug exposures in the transplant population.

The threshold for determining the level of exposure of an immunosuppressive agent that is acceptable is not known at present.

Continued study and follow-up of all breast-fed transplant recipient offspring is warranted.

Centers are encouraged to report all pregnancies in transplant recipients to the NTRR.

The Type 1 Insulin-Like Growth Factor Receptor In Hepatocellular Carcinoma Cell Lines, Zhengyu Wei, Phd, Tiziana Deangelis, M.S., Reginald Hurtt, B.S., Renato Baserga, M.D., Cataldo Doria, M.D., Ph.D

Department of Surgery Faculty Papers

Summary:

1. Human HCC cells have higher expression levels of IGF-1R, IRS1, and c-Met.

2. IRS1 interacts with c-Met. The role of IGF-1R in human HCC should be revisited.

3. Lentivirus-mediated shRNA delivery system targeting IGF-1R showed significant suppressive effects on HCC cell growth, promising a potential therapeutic treatment for human HCC.

Pregnancy Outcomes In Pancreas-Kidney Vs. Kidney-Alone Diabetic Female Transplant Recipients, Lyuba Gitman, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The high incidences of hypertension, preeclampsia, and infection during pregnancy underscore the high-risk nature of pregnancy in both pancreas-kidney and kidney alone recipients.

Although overall offspring outcomes are similar in both PK and K groups, pregnancy in PK recipients may be associated with higher incidences of maternal infections and overall graft loss.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Endoscopic Repair Of High-Flow Cranial Base Defects Using A Bilayer Button., Adam J. Luginbuhl, Peter G. Campbell, James Evans, Marc Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.

STUDY DESIGN: Retrospective review.

METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion …

Pregnancy Outcomes In Female Liver Recipients Transplanted Under The Age Of 21, Carlo B. Ramirez, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Michael J. Moritz, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.

Pregnancy Outcomes In Female Lung Transplant Recipients, Julie Shaner, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Female lung recipients appear to face higher risks related to pregnancy when compared to other solid organ transplant recipients.

Although successful pregnancies have been reported in female lung recipients, analyses of larger numbers of cases may help to identify pre-pregnancy factors predictive of adverse outcomes.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Pregnancy Outcomes With Exposure To The Mycophenolic Acid Products (Mpa), To Dung K. Nguyen, Faith Carlin, Lisa A. Coscia, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Reports to NTPR to date continue to reveal an increased incidence of birth defects in transplant recipients maintained on MPA products during gestation compared to those not maintained on these agents.

Structural birth defects consisting of microtia (ear deformity) and facial defects suggest a pattern of malformations.

Evaluation of the higher incidence of non-viable outcomes requires further study in this cohort.

Centers are encouraged to report all pregnancy exposures in transplant recipients to the NTPR.

Acute Mesenteric, Portal And Inferior Vena Cava (Ivc) Venous Thrombosis: Optimal Outcome Achieved With Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Department of Surgery

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Preoperative Drainage In Pancreatic Cancer., Eugene P Kennedy, Ernest L Rosato, Charles J Yeo

Department of Surgery Faculty Papers

Van der Gaag et al. conclude that preoperative biliary drainage in patients undergoing surgery for cancer of the head of the pancreas increases complications. Previous studies have shown that stenting is associated with a doubling in the risk of wound infection and an overall slightly increased risk of any complication.

Is Early Correction Of Congenital Ventricular Septal Defect A Better Option In A Developing Country, Awais Ashfaq, Hassaan Ashraf Zia, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

OBJECTIVE: To assess and evaluate the effectiveness of early ventricular septal defect (VSD) repair in a developing country by comparing the outcomes in two age groups.

METHODS: A total of 39 patients underwent VSD repair at a tertiary care hospital in Karachi over a period of 2.5 years. Patients were divided into Group 1 (years) and Group 2 (2-18 yrs). Perioperative and postoperative variables were reviewed retrospectively for each patient and compared with the development of complications and the effect on postoperative recovery times. The data was analyzed using Mann Whitney test for continuous variables and Fischer's exact test for …

Occipital Nerve Stimulator Systems: Review Of Complications And Surgical Techniques, Steven Falowski, Dajie Wang, Arvind Sabesan, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Introduction: Stimulation of the occipital nerves is becoming more widely accepted in the treatment of occipital neuritis and migraine disorders.

Objective: Presently, equipment available for spinal cord stimulation is adapted for insertion into the subcutaneous space over the occipital nerves. Many technical factors need to be reassessed to optimize the therapy.

Methods: We performed a retrospective review of patients implanted from 2003 to 2007 at a single center. We aimed to analyze the rate of surgical complications related to implantation technique. A total of 28 patients were present for analysis. Patients were followed up to 60 months with a mean …

Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah

Department of Anaesthesia

BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

On Pump Coronary Surgical Revascularization In A Patient With Chronic Immune Thrombocytopenic Purpura, Saulat Fatimi, Danesh K Kella, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

We performed on-pump coronary artery bypass graft surgery on a 54-year-old female, known case of chronic Idiopathic Thrombocytopenic Purpura (ITP), hypertension and dyslipidaemia who had presented to us with progressive exertional shortness of breath and chest pain. The decision of going on with CABG was made after two weeks of preoperative treatment with prednisolone. Her platelet counts pre-operatively and on the 4th post-operative day were 135 x 10(9)/L and 32 x 10(9)/L. She had an unremarkable post-operative recovery, without requiring whole blood or platelet transfusions. We recommend preoperative steroid treatment in patients with chronic ITP undergoing CABG.

Acellular Dermal Regeneration Template For Soft Tissue Reconstruction Of The Digits., John S. Taras, Anthony Sapienza, Josh B. Roach, John P. Taras

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects.

METHODS: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had …

Impact Study Of A Central Lines Simulation Training Program Using Kirkpatrick’S Four-Level Evaluation Model, James P. Orlando Edd, Andrew C. Miller Do, William Bond Md, Ms, Valerie A. Rupp Rn, Bsn, Bryan G. Kane Md, Cindy Umbrell Rn, Msn, Michael Pasquale Md

Department of Emergency Medicine

No abstract provided.

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan

Section of General Surgery

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases.
Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed.
Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …