Surgery Commons^™

Stereotactic Body Radiation Therapy (Sbrt) For Patients With Stage I Non-Small Cell Lung Cancer Is Applicable To More Tumors Than Sublobar Resection, Andrew Song, Nathaniel R. Evans Iii, Scott W. Cowan, Jenny Guo, Tingting Zhan, Bo Lu, Maria Werner-Wasik

Department of Radiation Oncology Faculty Papers

Background: Virtually all patients with medically inoperable stage I non-small cell lung cancer (NSCLC) can receive stereotactic body radiation therapy. However, the percentage of such patients in whom sublobar resection is technically feasible is unknown. This discrepancy can confound clinical trial eligibility and designs comparing stereotactic body radiation therapy vs. sublobar resection.

Methods: A total of 137 patients treated with stereotactic body radiation therapy for lung lesions (3/2013-11/2017) underwent retrospective review. Diagnostic CT chest and PET/CT images, stereotactic body radiation therapy dates, and demographic data were collected on 100 of 137 patients. Two experienced board-certified thoracic surgeons independently reviewed anonymized …

Lipofilling As An Adjuvant Therapy For Postburn Grafted Hand: Functional And Aesthetic Outcome., Esraa Fathy, Magdy Abd-Almoktader Abdel-Kreem, Mostafa Mikki

Al-Azhar International Medical Journal

Background : Background: Fat transfer is widely used as an adjuvant therapy to achieve the deficiencies faced minor burning regeneration. Aim of the study: The study aimed to represent our experience with autologous fat grafting in improving hand function and cosmesis in cases that undergo skin grafts after burns to the hand dorsum. Patient and methods: A case series study where patients aged 16-60 with post-burn grafted hand contractures, evaluating functional and aesthetic outcomes after a single session of lipofilling; A case series study carried out from May 2019 to August 2020 on twenty patients with post-burn grafted hand contractures. …

Dexmedetomidine Is An Excellent Additive To Local Anaesthesia For Postoperative Analgesia In Bilateral Third Molar Teeth Extraction Surgery, Ahmed Elsawy, Ahmed Khalifa

Al-Azhar International Medical Journal

Background: We led this study to investigate the effect of injection of Dexmedetomidine as an additive to Lidocaine in the inferior alveolar nerve for patients undergoing lower bilateral impacted tooth extraction regarding postoperative pain, duration of postoperative analgesia, the over-all quantity of analgesia demanded in the first 24 h postoperatively, and the surgeon and the patient satisfaction. Patients and methods: Sixty patients were included, so that 30 patients were in the Dexmedetomidine group and the other 30 in the Adrenaline group. The inferior alveolar nerve block was done bilaterally after general anaesthesia using Lidocaine with Dexmedetomidine or Adrenaline. The primary …

Outcome Of Endoscopic Third Ventriculostomy In Infants, Elsayed Aboalhasan, Abdelhaleem Mousa, Islam Alaghory

Al-Azhar International Medical Journal

Background:.Hydrocephalus in infancy is usually treated with a ventriculo-peritoneal (VP) shunt, however, endoscopic third ventriculostomy (ETV) is a successful procedure of treatment for obstructive hydrocephalus. Aim of the Work: to analyze the outcome of ETV as a treatment for hydrocephalus in infants aged less than 1 year. Patients and Methods: : An analytical prospective study conducted on 40 obstructive hydrocephalus in infants younger than one year of age treated via ETV approach in Al Azhar university hospitals in the period September 2017 to September 2020. Follow up of patients done clinically and radiologically over 6 months. Results: The study included …

Dorsal Approach For Impacted Comminuted Distal Radius Fracture By Open Reduction And Internal Fixation By Plate And Screws With Bone Grafting, Mohamed Abdel-Fattah, Ahmed Mohammed, Ahmed Badawy

Al-Azhar International Medical Journal

Background: The distal radius fracture is the most common fracture seen in an emergency, making up 17% of all fractures. It is complex to treat affected comminuted distal radius fracture. Especially when the fractures are dorsally comminuted, internal fixation via a dorsal approach should be considered. Objective: To evaluate the results of dorsal plating in patients with impacted comminuted distal radius fracture. Patients and methods: This study was done at Al-Azhar University Hospitals, Air-Force military hospital & El-Mattaryah teaching hospital, during the period of December 2019 and December 2020. 13 males and 7 females (20 fractures) aged 22 to 59 …

The Philadelphia Surgery Conference: A Value Analysis Of A Hands-On Surgical Skill-Building Event., Luke Dipasquale, Robert Libera, Chi Chi Do-Nguyen, Elizabeth Brehman, Vishwant Tatagari, Heather Waring, Denah Appelt, Arthur Sesso

PCOM Scholarly Papers

Context: Limited opportunities exist to practice technical skills and to be exposed to various surgical specialties during preclinical medical education.

Objectives: To assess the value of workshop-based educational opportunities to medical students during preclinical training.

Methods: One hundred and 75 medical and physician assistant students from 10 medical schools attended the 2019 Philadelphia Surgery Conference. All students received STOP THE BLEED® bleeding control training and participated in four workshops, chosen from a list of 23, that demonstrated a variety of surgical skills. Data collection was accomplished using both a pre- and postconference survey to assess changes in confidence of personal …

Outcome After Surgical Stabilization Of Rib Fractures Versus Nonoperative Treatment In Patients With Multiple Rib Fractures And Moderate To Severe Traumatic Brain Injury (Cwis-Tbi), Jonne T. H. Prins, Esther M. M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva-Corina Caragounis, Jeff Choi, D. Benjamin Christie Iii, Peter A. Cole, William B. Devoe, Julie Whitis

School of Medicine Publications and Presentations

Background: Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI.

Methods: A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, …

Relationship Of Natural Occlusal Plane With Different Anatomical Landmarks, Mehwish Khan, Syed Murtaza Raza Kazmi, Farhan Raza Khan, Sameer Quraeshi

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects.
Methods: The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn …

Comparison Of Two Different Methods In The Removal Of Oil-Based Calcium Hydroxide From Root Canal System: A Triple-Blinded Randomised Clinical Trial, Momina Motiwala, Sheikh Bilal Badar, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the effectiveness of rotary master apical file (RMAF) with ultrasonic activation of endodontic file (UAF) in the removal of silicon oil-based calcium hydroxide (SOBCH) from the canal.
Methods: Ethical review committee approval and informed consent was obtained. 60 cases with necrotic teeth in which silicon oil-based intracanal medicament (Metapex) was to be placed were randomised in one of the two groups using sealed envelopes containing assignment codes for medicament removal: RMAF and UAF group. After standard protocol of coronal access, cleaning and shaping, silicon oil-based SOBCH was placed using a Lentulo spiral. A periapical radiograph was taken …

The Virtual Mock Oral Examination: A Multi-Institutional Study Of Resident And Faculty Receptiveness., Joseph F. Goodman, Prashant Saini, Alexander J. Straughan, Christopher D. Badger, Punam Thakkar, Philip E. Zapanta

Surgery Faculty Publications

No abstract provided.

Glioma Stem Cells As Immunotherapeutic Targets: Advancements And Challenges, Keenan Piper, Lisa Depledge, Michael Karsy, Charles Cobbs

Department of Neurosurgery Faculty Papers

Glioblastoma is the most common and lethal primary brain malignancy. Despite major investments in research into glioblastoma biology and drug development, treatment remains limited and survival has not substantially improved beyond 1–2 years. Cancer stem cells (CSC) or glioma stem cells (GSC) refer to a population of tumor originating cells capable of self-renewal and differentiation. While controversial and challenging to study, evidence suggests that GCSs may result in glioblastoma tumor recurrence and resistance to treatment. Multiple treatment strategies have been suggested at targeting GCSs, including immunotherapy, posttranscriptional regulation, modulation of the tumor microenvironment, and epigenetic modulation. In this review, we …

Analysis Of 114 Pedigrees Of Renal Stone Patients: A Retrospective Review, Syed Raziuddin Biyabani, Jamsheer Jehangir Talati, Daniya Umer, Zehra Kazmi, Hussam Uddin Soomro, Rubab Mansoor

Section of Urology

Background: Renal and ureteric stones (RS) can form due to genetic, metabolic, environmental, and diet-hydration related factors. Studies have shown that patients with family history (FH) of RS have higher likelihood of recurrence.
Materials and methods: We conducted a retrospective cross-sectional study on 114 pedigrees to investigate the impact of FH on recurrence of RS and examine patterns of inheritance. Results: Family history of renal stone disease was found in 42% of all patients. There was a significant increase of stone recurrence in RS patients with a positive FH (p=0.001). Seventy-one percent of patients with recurrent stones had at least …

Acute Necrotizing Pancreatitis: Has Conservative Management Replaced Surgery? Perspective From A Tertiary Care Centre In Pakistan: A Cross-Sectional Study, Fatima Mannan, Roger Christopher Gill, Abdul Ahad Sohail, Abdul Rehman Alvi, Khabir Ahmad

Department of Surgery

Background: The main purpose of this study was to review the trends in management of patients presenting with acute necrotizing pancreatitis (ANP) over the last seven years and its effect on morbidity and mortality.
Methods: A cross-sectional study was conducted on all patients presenting with the diagnosis of acute necrotizing pancreatitis to the Aga Khan University Hospital in between the year 2008-2015. The study population was broadly categorized in to two groups based on the way these were managed. The first group consisted of patient who underwent surgery for acute necrotizing pancreatitis while the second group was composed of those …

Allocation Of Anchors During Labral Repair: A Multicenter Cohort Analysis Of Labral Treatment In Hip Arthroscopy., Ryan P Mcgovern, John J Christoforetti, Benjamin R Kivlan, Shane J Nho, Andrew B Wolff, John P Salvo, Dean Matsuda, Thomas J Ellis, Allston J Stubbs, Dominic S Carreira

Rothman Institute Faculty Papers

Background: While previous studies have established several techniques for suture anchor repair of the acetabular labrum to bone during arthroscopic surgery, the current literature lacks evidence defining the appropriate number of suture anchors required to effectively restore the function of the labral tissue.

Purpose/Hypothesis: To define the location and size of labral tears identified during hip arthroscopy for acetabular labral treatment in a large multicenter cohort. The secondary purpose was to differentiate the number of anchors used during arthroscopic labral repair. The hypothesis was that the location and size of the labral tear as well as the number of anchors …

A Surrogate Frax Model For Pakistan, G Naureen, H Johansson, Romaina Iqbal, Lena Jafri, Aysha Habib Khan, Masood Umer, E Liu, L Vandenput, M Lorentzon, N C. Harvey, E V. Mccloskey, J A. Kanis

Community Health Sciences

A surrogate FRAX® model for Pakistan has been constructed using age-specific hip fracture rates for Indians living in Singapore and age-specific mortality rates from Pakistan.
Introduction: FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the International Society for Clinical Densitometry and International Osteoporosis Foundation have recommended the development of a surrogate FRAX model, based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.
Objective: This paper describes the development …

Development And Validation Of A Prediction Model For Stroke, Cardiac, And Mortality Risk After Non-Cardiac Surgery., Sang H Woo, Gregary D. Marhefka, Scott W. Cowan, Md, Lily Ackermann, Md

Department of Medicine Faculty Papers

Background: Commonly used cardiovascular risk calculators do not provide risk estimation of stroke, a major postoperative complication with high morbidity and mortality. We developed and validated an accurate cardiovascular risk prediction tool for stroke, major cardiac complications (myocardial infarction or cardiac arrest), and mortality after non-cardiac surgery.

Methods and Results: This retrospective cohort study included 1 165 750 surgical patients over a 4-year period (2007-2010) from the American College of Surgeons National Surgical Quality Improvement Program Database. A predictive model was developed with the following preoperative conditions: age, history of coronary artery disease, history of stroke, emergency surgery, preoperative serum …

Non-Invasive Predictors Of Response To Tamsulosin For Benign Prostatic Obstruction, Mohammad Shoaib, Muhibullah Bangash, Wajahat Aziz, Hammad Ather

Section of Urology

Objectives: To identify non-invasive predictors of response to tamsulosin 0.4 mg in patients with benign prostatic obstruction (BPO).
Methods: Males ≥ 50 years of age with lower urinary tract symptoms (LUTS) suggestive of BPO for over three months were included in the study. We assessed change in the mean International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) after six weeks of medical therapy. Clinical and uroflowmetry parameters were compared between two groups of patients with >25% vs. <25% change in the IPSS after treatment. Pre- and post-treatment post-void residue (PVR), Qmax, and IPSS were compared by independent t-test, univariate/multivariate regression analysis.
Results: A total of 121 patients were included. At presentation, the mean prostate size was 35.7±12.2 grams and the mean IPSS …

Surgical Residency Workload, Perceptions And Educational Value: Implications For Competency- Based Medical Education, Eric Walser

Electronic Thesis and Dissertation Repository

Introduction: Surgical training has transitioned to competency-based medical education. There is incomplete understanding of current resident workload and how workload is perceived by trainees and faculty.

Methods: A prospective time-motion study was conducted in a Canadian general surgery training program. A web-based survey was used to compare observational data with faculty and learner perceptions of actual and ideal resident workloads and the educational value of workload components.

Results: 54 clinical periods were assessed (662.8 hours, 6375 individual events). 39.7% of time was spent on direct patient care, 33.2% on indirect patient care and 7.5% on education, including

Conclusion: Curriculum changes …

Return To Play Rates After Ulnar Nerve Transposition And Decompression Surgery: A Retrospective Analysis., Christopher J Hadley, Anant Dixit, John Kunkel, Alex E White, Michael G. Ciccotti, Steven B. Cohen, Christopher C Dodson

Rothman Institute Faculty Papers

Background: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.

Methods: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing …

Surgical Patients’ Hospital Experience Scores: Neighborhood Context Conceptual Framework, Ashley Wendell Kranjac, Dinko Kranjac, Michelle A. Fortier, Pat Patton, Brad Giafaglione, Zeev N. Kain

Sociology Faculty Articles and Research

Objective:

Through geocoding the physical residential address included in the electronic medical record to the census tract level, we present a novel model for concomitant examination of individual patient-related and residential context-related factors that are associated with patient-reported experience scores.

Summary Background Data:

When assessing patient experience in the surgical setting, researchers need to examine the potential influence of neighborhood-level characteristics on patient experience-of-care ratings.

Methods:

We geocoded the residential address included in the electronic medical record (EMR) from a tertiary care facility to the census tract level of Orange County, CA. We then linked each individual record to the …