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Paediatric Surgical Outcomes Across Ontario, Damian Dylkowski 2016 The University of Western Ontario

Paediatric Surgical Outcomes Across Ontario, Damian Dylkowski

Electronic Thesis and Dissertation Repository

BACKGROUND: The purpose of this study was to determine the volume of three complex paediatric procedures at the tertiary care centres in Ontario over the last 20 years in three disciplines, analyze outcomes and explore the possibility of an outcome volume relationship.

METHODS: A population based cohort study of patients undergoing TEF repair, Pyeloplasty and V-P shunt insertion at 4 paediatric centres in Ontario between 1993 and 2013 was carried out. Administrative data sets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences (ICES).

RESULTS: In TEF repair and Pyeloplasty, there was significant difference ...


Optimal Timing Of Free Flap Breast Reconstruction In A Highly Radiated Population, W. Mohiuddin, Kamini D. Patel, Steven E. Copit, MD, Patrick J. Greaney, MD, FACS 2016 Thomas Jefferson University Hospital Division of Plastic and Reconstructive Surgery

Optimal Timing Of Free Flap Breast Reconstruction In A Highly Radiated Population, W. Mohiuddin, Kamini D. Patel, Steven E. Copit, Md, Patrick J. Greaney, Md, Facs

Department of Surgery Posters

Introduction

There has been an increasing use of postmastectomy radiation therapy (PMRT) in breast cancer patients, especially in cases of large tumors (T3 or greater) or node-positive disease (N1 or greater).1 When radiation for the treatment of breast cancer is expected, tissue-based breast reconstruction is generally preferred to implant-based reconstruction. This distinction is attributed to the high rate of complications with postoperative radiation after implant-based reconstruction, ranging from 20% to 70%.2

In cases when the need for radiation is likely, breast reconstruction with autologous tissue is typically deferred until the completion of the radiation therapy. Reasons for deferring ...


The Effects Of Tranexamic Acid On Mortality Rate In Trauma Patients Compared To Trauma Patients With No Tranexamic Acid Treatment, Bradley Earl Tolar 2016 University of Southern Mississippi

The Effects Of Tranexamic Acid On Mortality Rate In Trauma Patients Compared To Trauma Patients With No Tranexamic Acid Treatment, Bradley Earl Tolar

Doctoral Nursing Capstone Projects

Traumatic injury is the leading cause of death for many age groups. Traumatic accidents caused over 130,000 deaths in the United States in 2014. This DNP project studied the effects of Tranexamic acid on mortality rate in trauma patients. After the completion of a needs assessment at a local level II trauma center, a literature review was performed. The literature showed a decrease in mortality rate when patients were administered Tranexamic acid within 3 hours of injury with statistically significant statistics. Also, the data from the literature showed no correlation between vascular occlusive events and Tranexamic acid use in ...


The Role And Regulation Of Inhibitor Of Kappa B Kinase In The Impaired Monocyte Response., Norman James Galbraith 2016 University of Louisville

The Role And Regulation Of Inhibitor Of Kappa B Kinase In The Impaired Monocyte Response., Norman James Galbraith

Electronic Theses and Dissertations

Trauma, major surgery and systemic infection can lead to a subsequent immunosuppressed state which can predispose patients to nosocomial infection and death. Approximately a sixth of patients will have impaired monocyte function, as determined by decreased HLA-DR expression or decreased TNF-α production in response to ex-vivo lipopolysaccharide (LPS) stimulation. This project aimed to develop an in-vitro model of impaired monocyte function using isolated monocytes from healthy volunteers, to study the effect of monocyte impairment on IκK signaling, and determine the role of IκK in the impaired monocyte response. These studies have provided the following results:

  1. Monocytes treated with low dose ...


Modern Evaluation Of Abdominal Trauma, Errington C. Thompson, MD, Chadwick J. Knight, MD 2016 Marshall University

Modern Evaluation Of Abdominal Trauma, Errington C. Thompson, Md, Chadwick J. Knight, Md

Errington Thompson

Abdominal trauma can be mysterious to some physicians. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, ultrasound and CT scans, patients can be quickly and efficiently evaluated.


Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality From 2007 To 2014, Rashid Jooma, Masood Ali Shaikh 2016 Agha Khan University

Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality From 2007 To 2014, Rashid Jooma, Masood Ali Shaikh

Department of Surgery

Abstract

According to World Health Organization's estimate for Pakistan, there were 25,781 (95% CI: 20,979-30582) Road Traffic Collision (RTC) fatalities in year 2013. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five major public and private hospitals' emergency departments in Karachi. For the eight-year period, from 2007-2014, 9129 fatalities were recorded. Males accounted for 8008 (87.7%) all RTC fatalities. Highest number of fatalities were recorded in the 21-25 age group with 1329 (15.3%) fatalities, while fatalities in 16-30 years old, recorded 3446 (39.7%) of all fatalities ...


Clinical Factors Associated With The Non-Operative Airway Management Of Patients With Robin Sequence., Frank P Albino, Benjamin C. Wood, Kevin D Han, Sojung Yi, Mitchel Seruya, Gary F. Rogers, Albert K. Oh 2016 George Washington University

Clinical Factors Associated With The Non-Operative Airway Management Of Patients With Robin Sequence., Frank P Albino, Benjamin C. Wood, Kevin D Han, Sojung Yi, Mitchel Seruya, Gary F. Rogers, Albert K. Oh

Surgery Faculty Publications

BACKGROUND: The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention.

METHODS: The authors retrospectively reviewed the medical charts of infants with RS evaluated ...


Standardization Of Postoperative Transitions Of Care To The Pediatric Intensive Care Unit Enhances Efficiency And Handover Comprehensiveness, Anthony Sochet, Ashley Simms, Grace Ye, Nihal Godiwala, Lauren Hebert, Christine O. Corriveau 2016 George Washington University

Standardization Of Postoperative Transitions Of Care To The Pediatric Intensive Care Unit Enhances Efficiency And Handover Comprehensiveness, Anthony Sochet, Ashley Simms, Grace Ye, Nihal Godiwala, Lauren Hebert, Christine O. Corriveau

Pediatrics Faculty Publications

Introduction: To determine the impact of standardization of postoperative transitions of care to the pediatric intensive care unit on handover efficiency and the quality of healthcare data exchange.

Methods: This was a prospective, pre–post observational study after standardization of postoperative transitions in a 44-bed pediatric intensive care unit in a 313-bed tertiary care pediatric hospital from April to July 2015. Standardization was completed using a multidisciplinary handover checklist. Primary outcomes were efficiency expressed as mean handover duration and the comprehensiveness of healthcare data exchange.

Results: Forty-seven postoperative transitions were observed of which 23 were preintervention and 24 were postintervention ...


Catamenial Pneumothorax: A Case Report., Hina Inam, Sumera Inam,, Munaim Tahir 2016 Aga Khan University

Catamenial Pneumothorax: A Case Report., Hina Inam, Sumera Inam,, Munaim Tahir

Department of Surgery

Abstract

Catamenial pneumothorax (CP) is a rare and complex clinical condition caused by endometrial tissues, commonly found in reproductive women (age 15-49 years).Its diagnosis is often delayed or overlooked by clinicians, which may result in recurrent hospitalizations and other complications. A case of Catamenial pneumothorax is presented of a 38-year-old young married woman, admitted to hospital with signs and symptoms including chest pain and shortness of breath that started with her menstrual period. Right pneumothorax was observed in the Chest x-ray. Patient underwent Video-assisted thoracoscopic surgery (VATS). Patient was kept under observation, and was discharged when stable with no ...


Management Of Co-Existing Lung Cancer And Endobronchal Hamartomas, Mark H. Cooper, MD 2016 Marshall University, Huntington, WV

Management Of Co-Existing Lung Cancer And Endobronchal Hamartomas, Mark H. Cooper, Md

mark Cooper

Abstract:

The coexistence of lung cancer with an endobronchial hamartoma is infrequent, and requires accurate oncologic evaluation of the endobronchial lesion prior to potential surgical treatment of the lung cancer. We describe a patient who presented with an undiagnosed endobronchial mass and and a biopsy-proven lung cancer which were successfully managed by a staged approach using initial bronchoscopic resection of the endobronchial lesion and subsequent lobectomy for squamous cell lung cancer.


Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, MD, Zachary Sanford, Constantinous Constantinou, MD 2016 Marshall University: School of Medicine

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Constantinous Constantinou

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial ...


Surgical Management Of Penile Cancer--Report Of Two Cases., M Amjad Noor, Hammad Ather, M Nasir Sulaiman, Farhat Abbas 2016 Aga Khan University

Surgical Management Of Penile Cancer--Report Of Two Cases., M Amjad Noor, Hammad Ather, M Nasir Sulaiman, Farhat Abbas

Hammad Ather

Introduction

Penile carcinoma (PC) is a rare tumor, accounting for 0.4-0.6% of all male malignancies. There are remarkable racial and geographic differences in the prevalence of penile cancer. In United States, 1% of all male cancers are penile malignancies, with annual incidence of 1-2 new cases per 100,000 men. In certain areas of South America, Asia and Africa the frequency is as high as 10-20% of all male cancers. Many areas in Asia however, have very low figures; in Taiwan for example it comprised only 0.25% of all male cancers1. Penile carcinoma is most frequent ...


Predictors Of Lymph Node Involvement In Bladder Cancer Treated With Radical Cystectomy, Zaheer Alam, M Hammad Ather, Anila Jamshaid, Khurram Muhammad Siddiqui, Muhammad Nasir Sulaiman 2016 Aga Khan University

Predictors Of Lymph Node Involvement In Bladder Cancer Treated With Radical Cystectomy, Zaheer Alam, M Hammad Ather, Anila Jamshaid, Khurram Muhammad Siddiqui, Muhammad Nasir Sulaiman

Hammad Ather

OBJECTIVE: To identify the clinical variables associated with prevalence of lymph node metastasis in patients with bladder cancer treated by radical cystectomy and lymphadenectomy for primary bladder cancer.

METHODS: Review of records of Ninety-five patients who underwent radical cystectomy and pelvic lymph node (LN) dissection during the period of 1995-2008 from a prospectively maintained database. Eighteen patients were excluded due to lack of data on the nodal status, leaving 77 evaluable patients. Associations between LN metastasis and age, gender, duration of disease, number of transurethral resection (TUR) prior to cystectomy, pathological grade and tumour stage was analyzed. Data was analyzed ...


Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System., Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam 2016 Aga Khan University

Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System., Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam

Hammad Ather

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.

Study Design: An analytical descriptive study. Place and

Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.

Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics.

Results: Of all the RC performed at this hospital 89 patients received ...


Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan., Syed M. Nazim, M Hammad Ather, Farhat Abbas 2016 Aga Khan University

Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan., Syed M. Nazim, M Hammad Ather, Farhat Abbas

Hammad Ather

OBJECTIVE: To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010. METHODOLOGY: Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients. RESULTS: A total of 29 patients (23 males and 6 females) with mean age of ...


Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan., Syed M. Nazim, M Hammad Ather, Farhat Abbas 2016 Aga Khan University

Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan., Syed M. Nazim, M Hammad Ather, Farhat Abbas

Hammad Ather

OBJECTIVE: To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010. METHODOLOGY: Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients. RESULTS: A total of 29 patients (23 males and 6 females) with mean age of ...


Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System., Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam 2016 Aga Khan University

Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System., Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam

Hammad Ather

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.

Study Design: An analytical descriptive study. Place and

Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.

Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics.

Results: Of all the RC performed at this hospital 89 patients received ...


Correlation Of Three Immunohistochemically Detected Markers Of Neuroendocrine Differentiation With Clinical Predictors Of Disease Progression In Prostate Cancer., M Hammad Ather, Farhat Abbas, Nuzhat Fauqui, Mohammad Israr, Shahid Pervez 2016 Aga Khan University

Correlation Of Three Immunohistochemically Detected Markers Of Neuroendocrine Differentiation With Clinical Predictors Of Disease Progression In Prostate Cancer., M Hammad Ather, Farhat Abbas, Nuzhat Fauqui, Mohammad Israr, Shahid Pervez

Hammad Ather

Background: The importance of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade is gaining acceptance. There is limited literature on the relative significance of three commonly used markers of NE differentiation i.e. Chromogranin A (CgA), Neuron specific enolase (NSE) and Synaptophysin (Syn). In the current work we have assessed the correlation of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade and to determine the relative value of various markers. Materials and methods: Consecutive samples of malignant prostatic specimens (Transurethral resection of ...


Early Experimental Results Of Using A Novel Delivery Carrier, Hyaluronan-Phosphatidylethanolamine (Ha-Pe) Which May Allow Simple Bladder Instillation Of Botulinum Toxin A As Effectively As Direct Detrusor Muscle Injection., Mohamed G. El Shatoury 2016 The University of Western Ontario

Early Experimental Results Of Using A Novel Delivery Carrier, Hyaluronan-Phosphatidylethanolamine (Ha-Pe) Which May Allow Simple Bladder Instillation Of Botulinum Toxin A As Effectively As Direct Detrusor Muscle Injection., Mohamed G. El Shatoury

Electronic Thesis and Dissertation Repository

Intra-detrusor Botulinum Toxin-A (BTX-A) injection is the gold standard treatment for detrusor overactivity in clinical practice when medical treatment fails. Despite satisfactory results of BTX-A injection, the endoscopic procedure still has risks of anaesthetic and operative complications. Several studies have investigated more simple ways to deliver BTX-A to the detrusor muscle but with limited success. In our study, we assessed the evidence of BTX-A delivery using a newly modulated hyaluronan-phosphatidylethanolamine (HA-PE) carrier in a rat model through BTX-A-HA-PE bladder instillations. We used histological evidence of SNAP-25 protein cleavage and detection of Alexa FluorÒ594-labelled BTX-A as a proof of physical BTX-A ...


Compact Heat Exchanger For Veno-Venous Perfusion-Induced Systemic Hyperthermia Systems, Dongfang Wang, Joseph B. Zwischenberger 2016 University of Kentucky

Compact Heat Exchanger For Veno-Venous Perfusion-Induced Systemic Hyperthermia Systems, Dongfang Wang, Joseph B. Zwischenberger

Surgery Faculty Patents

A compact heat exchanger for vena-venous perfusion-induced hyperthermia includes an integral pneumatic pump and a hollow tubule heat exchange array. A vena-venous perfusion-induced hyperthermia system incorporating the compact heat exchanger is described. The heat exchanger provides a compact, efficient design allowing a lesser heat exchanging surface area and lesser required pumping power compared to conventional systems. In turn, the system provides a shorter blood circuit compared to conventional systems, allowing maintaining a lower blood temperature than such conventional systems while supplying sufficiently heated blood to patient visceral organs to provide a therapeutic effect, such as in supplementing chemotherapy drugs.


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