Medicine and Health Sciences Commons^™

Stem Cells For Spinal Cord Regeneration: Current Status, Zain A. Sobani, Syed A. Quadri, Ather Enam

Section of Neurosurgery

Background: Nearly 11,000 cases of spinal cord injury (SCI) are reported in the United States annually. Current management options give a median survival time of 38 years, however, no rehabilitative measures are available. Stem cells have been under constant research given their ability to differentiate into neural cell lines replacing non functional tissue. Efforts have been made to establish new synapses and provide a conducive environment, by grafting cells from autologous and fetal sources, including embryonic or adult stem cells, Schwann cells, genetically modified fibroblasts, bone stromal cells, and olfactory ensheathing cells and combinations/ variants thereof.
Methods: In order to …

Microdiscectomy For Lumbosacral Disc Herniation And Frequency Of Failed Disc Surgery, Muhammad Shahzad Shamim, Maria Adnan Parekh, Muhammad Ehsan Bari, Ather Enam, Faraz Khursheed

Section of Neurosurgery

Background: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The Patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including Patient demographics. Failed disc surgery refers to failure of improvement in Patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of Patients. To date, no study form Pakistan has looked into Patient demographics and failed disc surgery rates within the local context.
Objective:The aim of this study was to review the demographics of the Patient population presenting for surgical treatment of lumbosacral …

Portable Ultrasonography In Mass Casualty Incidents: The Caveat Examination, Stanislaw P. Stawicki, James M. Howard, John P. Pryor, David P. Bahner, Melissa L. Whitmill, Anthony J. Dean

Department of Surgery Faculty Publications

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use …

Complete Omental Torsion Associated With Left Inguinal Hernia: Case Report And Review Of The Literature, Patty T. Liu Md, Erik J. Teicher Md, Dale A. Dangleben Md

Department of Surgery

No abstract provided.

Caval Agenesis With Hypoplastic Left Kidney In A Trauma Patient On Warfarin For Deep Vein Thrombosis (Poster), Ryan A. Lawless Md, Dale A. Dangleben Md

Department of Surgery

No abstract provided.

Intracranial Cavernous Angiomas, Syed Faraz Kazim, Atta-Ul-Aleem Bhatti, Ather Enam

Section of Neurosurgery

Objective: To describe the clinical presentation, diagnosis, and management of patients presenting with intracranial cavernous angiomas (CAs) at a tertiary care hospital in Pakistan.
Study Design: Case series. Place and Duration of Study: Section of Neurosurgery, The Aga Khan University Hospital (AKUH), Karachi, from January 1990 to September 2008.
Methodology: A retrospective case note review of all patients diagnosed with intracranial CAs at AKUH during the study period. The studied variables included patient demographics, clinical presentation, family history of intracranial CAs or other space occupying lesions, modality of diagnosis, management, and outcome. Results were described as frequency percentages.
Results: During …

Pp32 (Anp32a) Expression Inhibits Pancreatic Cancer Cell Growth And Induces Gemcitabine Resistance By Disrupting Hur Binding To Mrnas., Timothy K Williams, Christina L Costantino, Nikolai A Bildzukewicz, Nathan G Richards, David W Rittenhouse, Lisa Einstein, Joseph A Cozzitorto, Judith C Keen, Abhijit Dasgupta, Myriam Gorospe, Gregory E Gonye, Charles J Yeo, Agnieszka K Witkiewicz, Jonathan R Brody

Department of Surgery Faculty Papers

The expression of protein phosphatase 32 (PP32, ANP32A) is low in poorly differentiated pancreatic cancers and is linked to the levels of HuR (ELAV1), a predictive marker for gemcitabine response. In pancreatic cancer cells, exogenous overexpression of pp32 inhibited cell growth, supporting its long-recognized role as a tumor suppressor in pancreatic cancer. In chemotherapeutic sensitivity screening assays, cells overexpressing pp32 were selectively resistant to the nucleoside analogs gemcitabine and cytarabine (ARA-C), but were sensitized to 5-fluorouracil; conversely, silencing pp32 in pancreatic cancer cells enhanced gemcitabine sensitivity. The cytoplasmic levels of pp32 increased after cancer cells are treated with certain stressors, …

Should We Be Concerned About Jejunoileal Atresia During Repair Of Duodenal Atresia?, Shawn D. St Peter, Danny C. Little, Katherine A. Barsness, Daniel R. Copeland, Casey M. Calkins, Suzanne Yoder, Steve S. Rothenberg, Saleem Islam, Kuojen Tsao, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: During repair for duodenal atresia, it has been emphasized that inspection of the small bowel to identify a second atresia is required. The laparoscopic approach for repair of duodenal atresia has been criticized for its limitation to perform this step. Given that duodenal atresia and jejunoileal atresias do not share common embryologic origins, we question the validity of this concern. Therefore, we conducted a multicenter retrospective review of duodenal atresia patients to quantify the incidence of jejunoileal atresia in this population.

METHODS: After institutional review board approval (IRB #07-12-187X), a retrospective review was conducted on all patients who have …

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Section of Cardiothoracic Surgery

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the commonest in …

Grown Up Congenital Heart Disease Patient Presenting For Non Cardiac Surgery: Anaesthetic Implications, Mohammad Hamid, Mansoor Ahmed Khan, Mohammad Irfan Akhtar, Hameedullah, Saleemullah, Khalid Samad, Fazal Hameed Khan

Department of Anaesthesia

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies.

Back To The Suture: The Two 5 Mm Port Laparoscopic Appendectomy, James Lee Md, Margaret Moore Md, Dale A. Dangleben Md

Department of Surgery

No abstract provided.

A Severe Case Of Necrotizing Fasciitis Of The Abdomen: A Survivor Story, Karin Mcconville Md, Dale A. Dangleben Md, Rovinder S. Sandhu Md

Department of Surgery

No abstract provided.

Research-Retreat-Recovery: A Potential Model For Organization And Completion Of Research Projects. Experience From A Neurosurgery Department In A Developing Country, Saniya Siraj Godil, Syed Faraz Kazim, Muhammad Shahzad Shamim

Medical College Documents

Background: In the current era of biomedical research, it is imperative that every research study at an institution is properly organized, and frequently audited to streamline efforts and maintain standards. Recently, a research retreat was organized by the Section of Neurosurgery at Aga Khan University Hospital, Karachi, Pakistan, and following that a recovery team was made with the aim of recovering "lost in translation" research projects. In the realm of our experience, the current model is being proposed as a means for organization of departmental research.
Methods: The "research" component of the model comprised compilation of an abstract book of …

Developmental Dysplasia Of The Hip., Shahryar Noordin, Masood Umer, Kamran Hafeez, Haq Nawaz

Department of Surgery

Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with …

Primary Chiasmal Sarcoid Granuloma Masquerading As Glioma Of The Optic Chiasm, Muhammad Zubair Tahir, Farheen Shaikh, Arshad Ali Siddiqui

Section of Neurosurgery

A 37-year-old woman presented with a 6 months history of headaches and memory impairment. Examination showed no neurological deficit with normal vision. MRI scans showed an enlarged optic chiasm. There was no dural or leptomeningeal enhancement or hydrocephalus. Open biopsy of the suprasellar mass showed non-caseating chronic granulomatous inflammation compatible with sarcoidosis. Systemic features of sarcoid were absent. Patient showed marked improvement on steroid therapy.

Mediastinal Seminoma Presenting As Superior Vena Cava Syndrome And Tracheal Obstruction, Saulat Hasnain Fatimi, Basma Shahid, Hashim Muhammad Hanif, Marium Muzaffar

Section of Cardiothoracic Surgery

Malignant germ cell tumours of the mediastinum are rare, presenting mostly in young males. These are bulky tumours, mostly intrathoracic, infiltrating into adjacent structures early in the growth process. Patients may present with symptoms of compression. Occasionally, mediastinal adenopathy and superior vena cava (SVC) syndrome may occur. We discuss a case of a 19 year old boy with six weeks history of progressively worsening shortness of breath and mid-sternal chest heaviness and one month history of swelling of the face and upper limbs. The entire face and upper extremities were grossly oedematous with engorged veins suggesting SVC syndrome. CT scan …

Congenital Bilateral Choanal Atresia, Ali Faisal Saleem, Shabina Arif, Nadeem Aslam, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Abstract: Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal …

Pregnancy Outcomes In Female Liver Transplant Recipients With A Transplant-To-Conception Interval >- 5 Years, Carlo B. Ramirez, Adam Frank, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Successful pregnancy outcomes have been reported in female liver recipients with a transplant-to-conception interval greater than or equal to 5 years. Long-term graft survival should be discussed with recipients as a component of preconception counseling. All transplant centers are encouraged to report pregnancies to the NTPR.

Impact Of A Comprehensive Nutrition And Lifestyle Education Intervention On Body Weight And Health-Related Outcomes In Morbidly-Obese Hispanic-Americans Following Laparoscopic Roux-En Y Gastric Bypass, Monica Petasne Nijamkin

FIU Electronic Theses and Dissertations

As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic-Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical …

Are Roadside Pedestrian Injury Patterns Predictable In A Densely Populated, Urban Setting?, Niels D. Martin, Daniel J. Grabo, Lili Tang, Jacqueline Sullivan, Kris R. Kaulback, Michael S. Weinstein, Gary A. Lindenbaum, Murray J. Cohen

Department of Surgery Faculty Papers

BACKGROUND: Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demographics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age.

MATERIALS AND METHODS: All patients with roadside pedestrian injuries evaluated at our urban, level one trauma center from January 2006 through December 2008 were retrospectively reviewed. Data were collected from the institutional trauma registry. Age was used as an independent variable and compared with injury type, substance abuse, discharge setting, and mortality.

RESULTS: There were 226 roadside …

A Case Study Of Appendicitis At Antanimalandy Lutheran Hospital, Jennifer Gemmell

Independent Study Project (ISP) Collection

From the introduction:

The island of Madagascar houses a total of 19,159,000 people who spend only $34 per person per year on health care (“Madagascar,” 2008). The government claims to have “committed itself to the principle that good health is a right of each Malagasy citizen, and has made significant studies in the area of health care,” according to the country study for the Library of Congress. However, with political corruption, political crisis after political crisis, and lack of international support, the government does not dispense the funds necessary to support this commitment (Metz, 1994). For example, in 1976 the …

Chemical Dependency: An Occupational Hazard In The Field Of Anaesthesia, Samina Ismail

Department of Anaesthesia

The medical personnel are vulnerable to substance abuse and dependence due to ready access to substance of abuse. Addiction is considered as an occupational hazard for those involved in the practice of anaesthesia for the same reason. Substance abuse is defined as a psychosocial biogenetic disease, which results from dynamic interplay between a susceptible host and favourable environment. According to the 5th and the last National Survey on Drug Abuse (NSDA) in 1993 by Pakistan Narcotic Control, there are nearly three million drug dependants in Pakistan, but no data is available to determine the prevalence among medical or anaesthesia personnel. …

Medical Ethics: A Slow But Sustained Revolution In Pakistan’S Healthcare, Muhammad Shahid Shamim, Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

One Year Survival With Poorly Differentiated Metastatic Pancreatic Carcinoma Following Chemoembolization With Gemcitabine And Cisplatin., Daniel B Brown, Carin F Gonsalves, Charles J Yeo, Agnes K Witkiewicz, Brian I Carr

Department of Radiology Faculty Papers

While hepatic arterial chemoembolization is efficacious for a number of malignancies, there is scant data regarding treatment of pancreatic adenocarcinoma. We report a complete radiographic response at one year from diagnosis of metastatic pancreatic carcinoma. Gemcitabine/cisplatin based chemoembolization may be of potential benefit for patients with liver-dominant metastases from pancreatic carcinoma. Given the typical survival of 6 months or less in this patient group with standard therapies, further research is warranted.

Losartan Associated Anaphylaxis And Angioneurotic Oedema, Syed Faraz Kazim, Muhammad Shahid

Section of General Surgery

A case of anaphylaxis and angioedema induced by angiotensin II receptor blocker (ARB), losartan is reported. A 37 years old hypertensive female presented to the Emergency Department with swelling over the face especially the lips, urticarial rash all over the body, and dyspnoea within an hour of losartan administration. She did not have any previous history of drug allergies. The patient was managed with epinephrine. Although angioneurotic oedema and anaphylaxis are well documented adverse effects of angiotensin converting enzyme (ACE) inhibitors, very few cases of these adverse reactions with ARBs have been reported in medical literature.

Comparison Of Three Mixed Dentition Analysis Methods In Orthodontic Patients At Akuh, Sarwat Memon, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare the actual sum of canine and premolars and that predicted from three mixed dentition prediction methods in orthodontic patients at the Aga Khan University Hospital (AKUH), Karachi.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: Orthodontic clinic at the Aga Khan University Hospital from June 2002 to December 2007.

METHODOLOGY: Data were collected using pretreatment records including orthodontic files and plaster casts of 121 orthodontic patients. Digital caliper was used to measure the mesiodistal widths of permanent teeth from 1st molar to 1st molar in mandibular arch, and central incisors and 1st molars in maxillary …

Emergency Reversal Of Antiplatelet Agents In Patients Presenting With An Intracranial Hemorrhage: A Clinical Review, Peter G. Campbell, Md, Anish Sen, Bs, Sanjay Yadla, Md, Pascal Jabbour, Md, Jack Jallo, Md, Phd

Department of Neurosurgery Faculty Papers

Abstract

Objective: Prehospital use of antiplatelet agents has been associated with an increased risk for ICH as well as a secondary increase in ICH volume after the initial hemorrhage. Strategies to reestablish platelet aggregation are used in clinical practice, but without any established guidelines or recommendations. This article serves to evaluate the literature regarding “reversal” of antiplatelet agents in neurosurgical populations.

Methods: PUBMED and MEDLINE databases were searched for publications from 1966 to 2009 relating to intracranial hemorrhage and antiplatelet agents. The reference sections of recent articles, guidelines and reviews were reviewed and pertinent articles identified. Studies were classified by …

Craniocerebral Aspergillosis: A Review Of Advances In Diagnosis And Management, Muhammad Shahzad Shamim, Ather Enam, Rushna Ali, Saleha Anwar

Section of Neurosurgery

Craniocerebral aspergillosis is a rare but dangerous central nervous system infection. The infection has a spectrum of presenting features, mostly affecting immunocompromised individuals. The incidence appears to be on the rise that has been especially observed in the immunocompetent population. A high index of suspicion, a comprehensive understanding of the infectious process and advanced laboratory and radiological diagnostic techniques, allow early diagnosis. Surgery, followed by systemic antifungal medications, remains the cornerstone of management. Early administration of empirical anti-fungal agents along with immunomodulators may further improve prognosis. Immunocompetent patients tend to have better outcomes as compared to those who are immunocompromised. …

Late Onset Postpneumonectomy Empyema Presenting 24 Years After Pneumonectomy, Saulat Hasnain Fatimi, Umair Khalid, Sanna Fatima, Taimur Saleem

Section of Cardiothoracic Surgery

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious …

Giant Unresectable Lymphangioma Of The Trunk Managed Via Intra-Tumour Injections Of Bleomycin, Umair Khalid, Saulat Hasnain Fatimi, Taimur Saleem

Section of Cardiothoracic Surgery

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; …