Medicine and Health Sciences Commons^™

Down Syndrome Associated Moyamoya May Worsen Epilepsy Control And Can Benefit From Surgical Revascularization., Sarah R Garson, Stephen J Monteith, Sheila D Smith, Bart P Keogh, Ryder P Gwinn, Michael J Doherty

Articles, Abstracts, and Reports

Objectives: To examine outcome of bilateral extracranial to intracranial (EC-IC) bypass surgeries for a Down syndrome patient with hard-to-treat epilepsy and moyamoya.

Materials and methods: Superficial temporal arteries were anastamosed using an indirect bypass technique to middle cerebral arteries bilaterally to help limit perfusion deficits and seizure controls.

Results: Two superficial temporal to middle cerebral artery indirect bypass surgeries were performed within 3 months. Post-revascularization improvements included seizure control, gait, perfusion, wakefulness, language and quality of life.

Conclusion: In patients with Down syndrome and moyamoya, improvements in seizure control and quality of life may occur with EC-IC bypass procedures.

Distal Corporoplasty Using An Autologous Tunica In The Management Of Penile Prosthesis Pseudo Aneurysm, Michel Apoj, Elizabeth A. Phillips

Articles

Inflatable penile prosthesis placement is an effective and safe treatment option for erectile dysfunction. The 5-year revision rate is low (7%) and revisions are most likely due to infection or mechanical problems with the device.

Penile prosthesis aneurysm is a rare complication that is managed surgically. The choice of graft used during tunical reinforcement is critical to avoid subsequent complications. The use of autologous grafts from distant tissue often leads to deformations of penile tissue in addition to the increase in operative time, morbidity, and cost of the operation. The use of synthetics increases the susceptibility to infection and decreases …

Successful Brace Treatment Of Pectus Carinatum In Osteogenesis Imperfecta Using The Dynamic Compression System., Beth A. Orrick, Amy L. Pierce, Charles L. Snyder, Uri S. Alon

Manuscripts, Articles, Book Chapters and Other Papers

Osteogenesis imperfecta (OI) is a genetic disorder of collagen resulting in a "fragile" skeleton with increased fracture risk and other complications, dependent on the specific variant. Pectus deformities of the chest wall, while not common, can be associated with OI. The use of a pectus carinatum brace in a patient with OI poses unknown risks for fractures and adverse treatment outcomes. We successfully applied external compression bracing using the dynamic compression system to one such patient. This case illustrates the ability to treat an OI patient with pectus carinatum using a nonsurgical brace, without complications, resulting in an excellent cosmetic …

Family Medicine Resident Education On Perioperative Management Of Patients On Anticoagulation, Hanna Mathers

Family Medicine Clerkship Student Projects

Family Medicine residents at CMMC in Lewiston, Maine manage patients in an outpatient clinic as well as on an inpatient family medicine teaching service. Many patients in the community are anticoagulated for native valve atrial fibrillation and undergo surgical procedures both in the inpatient and outpatient setting. Residents are often asked on to determine the necessity and timing of anticoagulation discontinuation for patients that they see. With patients on newer oral anticoagulants and various degrees of risk, it can be a challenge to make an informed choice. Residents have found that they would feel more confident in perioperative management of …

A Systematic Review Of Observational Studies, Demonstrating Smoking Among School Going Adolescents, Shafquat Rozi, Gillian Lancaster, Sadia Mahmud, Zahid Ahmad Butt, Talat Roome, Nida Zahid

Community Health Sciences

Objective: To characterize the methods of design and analysis currently adopted in survey research of school-based observational studies for smoking, and to identify the common pitfalls made by researchers.
Methods: The systematic review was conducted in 2009 and consisted of observational studies in school settings published between January 2005 and January 2009. Smoking status was the main outcome of interest. Following Cochrane style, five steps were followed: setting selection criteria for studies and conducting a literature search; review of abstracts; review of complete articles; data extraction and quality assessment of included studies; and, finally, synthesis of studies.
Results: Of the …

Implantable Biomaterials To Provide Local Immunotherapy Following Surgical Resection., Michael J Gough, Jason R Baird, R Bryan Bell

Articles, Abstracts, and Reports

No abstract provided.

Interpersonal Violence In Peacetime Malawi., Rebecca G. Maine, Brittney Williams, Jennifer A. Kincaid, Gift Mulima, Carlos Varela, Jared R. Gallaher, Trista D. Reid, Anthony G. Charles

Department of Surgery Faculty Papers

Background: The contribution of interpersonal violence (IPV) to trauma burden varies greatly by region. The high rates of IPV in sub-Saharan Africa are thought to relate in part to the high rates of collective violence. Malawi, a country with no history of internal collective violence, provides an excellent setting to evaluate whether collective violence drives the high rates of IPV in this region.

Methods: This is a retrospective review of a prospective trauma registry from 2009 through 2016 at Kamuzu Central Hospital in Lilongwe, Malawi. Adult (>16 years) victims of IPV were compared with non-intentional trauma victims. Log binomial …

The Addition Of Simvastatin Administration To Cold Storage Solution Of Explanted Whole Liver Grafts For Facing Ischemia/Reperfusion Injury In An Area With A Low Rate Of Deceased Donation: A Monocentric Randomized Controlled Double-Blinded Phase 2 Study., Duilio Pagano, Elisabetta Oliva, Simone Khouzam, Fabio Tuzzolino, Davide Cintorino, Sergio Li Petri, Fabrizio Di Francesco, Calogero Ricotta, Pasquale Bonsignore, Alessandro Tropea, Sergio Calamia, Federico Costanzo, Angelo Luca, Salvatore Gruttadauria

Student Papers, Posters & Projects

BACKGROUND: Liver transplantation is the best treatment for end-stage liver disease. The interruption of the blood supply to the donor liver during cold storage damages the liver, affecting how well the liver will function after transplant. The drug Simvastatin may help to protect donor livers against this damage and improve outcomes for transplant recipients. The aim of this study is to evaluate the benefits of treating the donor liver with Simvastatin compared with the standard transplant procedure.

PATIENT AND METHODS: We propose a prospective, double-blinded, randomized phase 2 study of 2 parallel groups of eligible adult patients. We will compare …

The Current Understanding Of Microrna's Therapeutic, Diagnostic, And Prognostic Role In Chordomas: A Review Of The Literature., Paul J Choi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Chordomas are primary low-grade bone tumors derived from the embryonic notochord that make up less than 5% of all osseous malignancies and commonly affect the spine at its vertebral body and at its two ends i.e., skull base and the sacrum. Although histologically defined to be low-grade, chordoma is locally destructive, metastatic, and has a serious recurrence rate, which all contribute to the dismal median survival rate of six years. Its locally destructive nature places the adjacent vital neurovascular structures at risk, making an en-bloc resection a challenge. This tumor is also known to show high resistance to currently available …

Transgenic Mice Overexpressing Human Tnf-Α Experience Early Onset Spontaneous Intervertebral Disc Herniation In The Absence Of Overt Degeneration., Deborah J. Gorth, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

There is a well-established link between cytokine expression and the progression of intervertebral disc degeneration. Among these cytokines, interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) are the most commonly studied. To investigate whether systemic hTNF-α overexpression affects intervertebral disc health, we studied the spine phenotype of Tg197 mice, a widely used hTNF-α transgenic line. These mice were studied at 12-16 weeks of age using comprehensive histochemical and immunohistological analysis of the spinal motion segment. Micro-CT analysis was performed to quantify vertebral trabecular bone architecture. The Tg197 mice evidenced spontaneous annular tears and herniation with increased vascularity in subchondral bone and …

Isolated Gonococcal Extensor Tenosynovitis, Cory Lebowitz, Jonas Matzon

Department of Orthopaedic Surgery Faculty Papers

Neisseria gonorrhoeae is a mucosal infection that has the propensity to disseminate, causing symptoms that commonly include arthralgias, skin lesions, fevers, chills, dysuria, genital discharge, septic arthritis, and/or tenosynovitis. Typically, gonococcal tenosynovitis affects the flexor sheath and is associated with arthralgias, skin lesions, or both. To the best of our knowledge, there has not been a documented case of isolated gonococcal extensor tenosynovitis. We report the case of a 16-year-old boy with isolated left upper-extremity gonococcal extensor tenosynovitis who was successfully treated with surgical debridement and antibiotic therapy.

Metabolic Dependencies In Pancreatic Cancer., Ali Vaziri-Gohar, Mahsa Zarei, Jonathan R. Brody, Jordan M. Winter

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDA) is a highly lethal cancer with a long-term survival rate under 10%. Available cytotoxic chemotherapies have significant side effects, and only marginal therapeutic efficacy. FDA approved drugs currently used against PDA target DNA metabolism and DNA integrity. However, alternative metabolic targets beyond DNA may prove to be much more effective. PDA cells are forced to live within a particularly severe microenvironment characterized by relative hypovascularity, hypoxia, and nutrient deprivation. Thus, PDA cells must possess biochemical flexibility in order to adapt to austere conditions. A better understanding of the metabolic dependencies required by PDA to survive and …

Taking Free Flap Surgery Abroad: A Collaborative Approach To A Complex Surgical Problem., Brian Swendseid, Md, Patrick Tassone, Md, Patrick Jean Gilles, Md, Magda Pavrette, Md, Matthew Stewart, Mercy Batatope, Donald Weed, Md, David Cognetti, Md, Adam J. Luginbuhl, Md, Joseph Curry, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. …

Assessment Of Patient-Centered Approaches To Collect Sexual Orientation And Gender Identity Information In The Emergency Department: The Equality Study, Adil H. Haider, Rachel R. Adler, Eric Schneider, Tarsicio Uribe Leitz, Anju Ranjit, Christina Ta, Adele Levine, Omar Harfouch, Danielle Pelaez, Lisa Kodadek

Section of General Surgery

Importance: Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.
Objective: To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting.
Design, setting, and participants: This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to …

Ongoing Evaluation Of The Impact Of A Post-Operative Atrial Fibrillation Prevention Protocol For Patients Undergoing Cardiothoracic Surgery, Kamarena Sankar, Jonatha Kline, Heidi Clarke, Radhan Gopalani, Faaria Quadri

All Publications

No abstract provided.

Frontoethmoidal Encephalocele Presenting In Concert With Schizencephaly, Asra Tanwir, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Schizencephaly is a rare defect which is identified as clefts that are lined with grey matter extending from the ependyma of the cerebral ventricles to the pia mater. An encephalocele occurs due to failure of neural tube closure resulting in a gap through which cerebrospinal fluid and meninges can bulge into a pouch. There have been rare instances when these two defects have presented simultaneously.
Case description: We report a case of a 17-year-old child who was brought by his parents with complaint of swelling over his nose and forehead and aggressive behavior since birth. Magnetic resonance imaging findings …

Preservation Of Hearing And Facial Nerve Function With The Microsurgical Excision Of Large Vestibular Schwannomas: Experience With The Retrosigmoid Approach, Muhammad Shaheryar Ahmed Rajput, Ahmad Nawaz Ahmad, Asif Ali Arain, Muhammad Adeel, Syed Akram, Mohammad Sohail Awan, Muhammad Ehsan Bari

Section of Neurosurgery

Introduction: Vestibular schwannomas (VS) are the most common benign neoplasms of a cerebellopontine angle (CPA), which arise from the Schwann cells of the vestibulocochlear nerve. Eighty percent of CPA tumors are VS followed by meningioma as the second common mass lesion in this critical potential space. Treatment options range from watchful waiting with serial imaging studies to radiosurgery or a microsurgical excision or a combination of surgery and radiation therapy. The primary objective of the study was to assess hearing and facial nerve status before and after the surgery via the retrosigmoid approach.
Methods: The database of Aga Khan University …

Traumatic Complications Of Inpatient Massage Therapy: Case Report And Literature Review, Ishna Sharma, D'Andrea Joseph, Orlando Kirton

Abington Jefferson Health Papers

No abstract provided.

Femoroacetabular Impingement As A Complication Of Acetabular Fracture Fixation, David A. Zuelzer, Christopher B. Hayes, Raymond D. Wright, Stephen T. Duncan

Orthopaedic Surgery and Sports Medicine Faculty Publications

Case

We present the case of a thirteen-year-old female who sustained a posterior wall acetabular fracture dislocation. She underwent urgent closed reduction and subsequent uncomplicated open reduction and internal fixation. Post reduction computed tomography demonstrated a concentrically reduced hip joint with no evidence of femoroacetabular impingement (FAI). She subsequently healed her fracture and returned to running activities; however, one year later presented with aching pain in her thigh. Radiographs demonstrated the development of a large osseous prominence on her anterolateral femoral neck consistent with femoroacetabular impingement. Based on these findings she was evaluated by a hip preservation specialist. She subsequently …

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

Role Of Stereotactic Radiosurgery In The Treatment Of Acromegaly, Komal Naeem, Aneela Darbar, Muhammad Shahzad Shamim

Section of Neurosurgery

Acromegaly is a rare, indolent disease due to overproduction of growth hormone. Surgery is identified as primary treatment, but has its limitation, thus frequently requiring alternate treatment options as adjunct to surgery. Stereotactic radiosurgery (SRS) has been used as adjuvant and alternate therapy in patients with inoperable or residual disease; or those not fit for surgery. It has shown reasonable results for treating macroadenoma and tumours invading cavernous sinuses with significant reduction in tumour size and durable endocrinological remission. Factors favouring better outcomes include time from last resection to SRS, older age, peri-procedural withdrawal of medication, higher margin and maximum …

The Impact Of Obesity Surgery On Psychosocial Health, Sibel Taze, Oya Gumuskaya, Mustafa Taşkın

Journal of Perioperative Nursing

Background: As obesity affects different dimensions of health, psychosocial wellbeing of patients can be predicted to significantly improve after bariatric surgery.

Method: This qualitative study focused on determining the experience of patients who underwent bariatric surgery and the psychosocial impact of it on their daily lives and provides nurses with detailed information regarding patients’ experience. While some of these outcomes were in line with the literature, they have also revealed new aspects and provided deeper understanding regarding individuals’ experiences.

Results: Five themes were identified: limitations in physical activity, social isolation due to negative body image, increased self-esteem, change in romantic …

Pressure Injury Prevention In The Perioperative Setting: An Integrative Review, Isabel Wang, Rachel Walker, Brigid M. Gillespie Phd

Journal of Perioperative Nursing

Background: Pressure injury (PI) has a significant impact on patients and their families, and is costly to health care institutions. Perioperative PI remains problematic, although little is reported about current perioperative pressure injury prevention (PIP) strategies.

Aim: To identify the key perioperative PIP strategies, following a systematic review of published research, to describe existing gaps in the literature, and to inform the development of subsequent observational study.

Design:An integrative literature review method developed by Whittemore and Knafl was used.

Method: Research inclusion and exclusion criteria were identified a priori. Six data bases were searched and search terms included pressure …

Using The Acorn Standards: An Exploration Of Claims, Concerns And Issues, Carollyn Williams, Jed Duff Dr, Pat Nicholson, Lois Hamlin Rn, Brigid M. Gillespie Phd

Journal of Perioperative Nursing

An interactive action research workshop was offered during the ACORN & ASIORNA Conference which was held in Adelaide in 2018. The purpose of the workshop was to explore the research evidence supporting ACORN’s Standards for Perioperative Nursing in Australia, to identify gaps in the evidence related to standards and to explore challenges associated with the implementation of standards in clinical practice. The workshop also provided perioperative nurses with the opportunity to discuss their research interests and ask questions about undertaking research-focused degrees. Workshop participants provided an eclectic and credible range of issues related to the development and implementation of standards, …

Bilateral Sternocleidomastoid Variant With Six Distinct Insertions Along The Superior Nuchal Line., Graham Dupont, Joe Iwanaga, Juan J Altafulla, Stefan Lachkar, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Anatomical variations of the sternocleidomastoid muscle (SCM) have been observed to occupy multiple origins and insertion points and have supernumerary heads, sometimes varying in thickness. During routine dissection, a SCM was observed to have six distinct insertions that interface with the course of the superior nuchal line, ending at the midline, bilaterally. This variation was also seen to receive innervation from the accessory nerve as well as the great auricular nerve. To our knowledge, this variant of supernumerary insertions and nerve innervations has not yet been reported. These variants may pose as problematic during surgical approaches to the upper neck …

Cost-Utility Of Revisions For Cervical Deformity Correction Warrants Minimization Of Reoperations., Samantha R Horn, Peter G Passias, Aaron Hockley, Renaud Lafage, Virginie Lafage, Hamid Hassanzadeh, Jason A Horowitz, Cole A Bortz, Frank A Segreto, Avery E Brown, Justin S Smith, Daniel M Sciubba, Gregory M Mundis, Michael P Kelley, Alan H Daniels, Douglas C Burton, Robert A Hart, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Richard A Hostin, Christopher P Ames

Articles, Abstracts, and Reports

Background: Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction.

Methods: Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) …

Trends And Costs Of External Electrical Bone Stimulators And Grafting Materials In Anterior Lumbar Interbody Fusion., Anthony D'Oro, Zorica Buser, Darrel Scott Brodke, Jong-Beom Park, Sangwook Tim Yoon, Jim Aimen Youssef, Hans-Joerg Meisel, Kristen Radcliff, Patrick Hsieh, Jeffrey Chun Wang

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective review.

PURPOSE: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery.

OVERVIEW OF LITERATURE: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion.

METHODS: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were …

Perioperative Handover Using Isbar At Two Sites: A Quality Improvement Project, Patricia Kitney

Journal of Perioperative Nursing

Background:The use of ISBAR handover principles assists in enabling the provision of best care to perioperative patients1. Reviews of post-operative handover research studies confirm the positive association between the quality of handovers and the decrease in adverse patient events2,3. Other reviews identify that globally handovers can be highly unpredictable and unreliable3–6. Therefore, the argument for standardised handovers to reduce the probability of adverse patient events in comparison to unstructured handovers, which have been shown to increase the chances of adverse patient events, is worth investigating.

Method:The method used was a multisite quasi-experimental design involving audits of perioperative handovers …

Spinal Infections: From Prevention To Cure, James Harrop

Department of Neurosurgery Faculty Papers

AOSpine North America (AOSNA) is honored to have the ability to present this focused issue on spinal infections. As we are all aware, spinal infections are a prevalent part of our daily treatment regimen as spine surgeons—whether these infections are in our elective practice or emergencies.

Sofosbuvir, Velpatasvir, And Voxilaprevir For Treatment Of Recurrent Hepatitis C Virus Infection After Liver Transplantation., Maria G Cardona-Gonzalez, Jason D Goldman, Lawrence Narayan, Diana M Brainard, Kris V Kowdley

Articles, Abstracts, and Reports

There are limited data on direct-acting antiviral (DAA) treatment options for previously treated patients with recurrent genotype 3 (GT3) hepatitis C virus (HCV) after liver transplantation. Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is currently approved for treatment of HCV in patients with prior treatment with DAAs. We report the first published experience using SOF/VEL/VOX after liver transplantation for a DAA-experienced patient with severe hepatitis due to early recurrent GT3 HCV. The patient was treated with SOF/VEL/VOX that was extended to a total duration of 16 weeks and was intensified with ribavirin (RBV) starting at week 8 due to persistent viremia during treatment. Sustained virologic …