Surgery Commons^™

Effect Of Lead On The Prenatal And Postnatal Development Of Kidney In Albino Rat And The Possible Protective Effect Of Vitamin C (Light And Electronmicroscopic Study), Ahmed Yousef, Mohamed Al Assaly, Mohamad Zahran

Al-Azhar International Medical Journal

Background: Lead poisoning between pregnant women is a significant public health problem, as it affects development of fetuses. Objective: To evaluate the histological changes in the kidney of rat pups at gestational day 18 and at postnatal day 21and the impact of co-treatment with vitamin C. Material and Methods: Twelve adult female rats and six adult male rats were used in this study. Twelve pregnant female rats were divided into two equal groups (prenatal and postnatal). Each group was divided into three subgroups. Group (ІA, IIA): served as control group. Group (IB): given 10mg/Kg of lead orally from the first …

Study Of Chronic Atrophic Gastritis In Patients With Autoimmune Thyroid Disease, Mostafa Elmahalawy, Abdemonem Barrak, Bahy Eldean Elbahnasawy

Al-Azhar International Medical Journal

ABSTRACT Background: Patients with autoimmune thyroid disease (ATD) may have a greater frequency of anti-parietal cell antibodies (APCA) than the general population. Aim of the study: The study's goal is to look at chronic atrophic gastritis in people who have autoimmune thyroid illness. Patients and Methods: In 60 ATD patients, APCA was detected using an indirect immunofluorescence test: 33(55%) had Graves' disease and 27(45%) had Hashimoto's thyroiditis. A systematic questionnaire was used to assess gastrointestinal symptoms, prior history of thrombosis, arthralgia, and other autoimmune disorders in patients and their families. Individuals with both positive and negative APCA were compared. Patients …

Bilateral Fascial Plan Block For Post Abdominoplasty Pain Control; Erector Spinae Plane Block Contrasted With Transversus Abdominis One, Ahmed Elsawy, Saeed Abdelhameed

Al-Azhar International Medical Journal

Background: Abdominoplasty is a popular aesthetic procedure. Both patients and doctors are concerned about post-operative pain and discomfort. erector spinae plane block (ESP) with ultrasound guidance (UG) was an excellent analgesic technique in bariatric surgery. Objectives; to evaluate the intensity and duration of analgesia (ESP) technique to that provided by the transversus abdominis plane (TAP) technique were done bilaterally with (UG) post abdominoplasty. Study Design; A single-blinded, clinical, prospective, randomized study. Patients and Methods; 51 patients received bilateral (UG) block: (ESP) group (n = 25), and (TAP) group (n = 26), Using the same dosage and volume of local anesthetics. …

Evaluation Of Physiotherapy Impact On Rotator Cuff Shoulder Tendinopathy In Hypothyroid And Diabetic Patients, Hany Aly, Ashraf Aamer, Abdullah Gaafar, Mohamed Belih

Al-Azhar International Medical Journal

Background: Rotator cuff, acute or chronic tendonitis, is affected by diabetes and hypothyroidism. Physiotherapy plays a pivotal role in the outcome and improvement of rotator cuff tendinopathy. This cross-sectional study was conducted on forty patients with shoulder pain to study the impact of different physiotherapy modalities programs in both hypothyroid and diabetic rotator shoulder cuff tendinitis. Results: The mean of range of motion (ROM) among hypothyroid patients was 22.3±25.69 at first visit and increased to 77.7±65.02, whereas, the mean ROM among diabetic patients was 31.00 ±24.153 at first visit and increased to 101.55 ± 61.90. The ROM was of high …

Sildenafil Versus Aspirin With Intrauterine Growth Restriction, Ahmed Hussein, Fahd Mohamed, Ahmed Taha, Hisham Ali

Al-Azhar International Medical Journal

Background: Fetus growing restriction (FGR) or intra-uterine growth restriction (IUGR) is definite nowadays as the fetal failures of growing possibility and represented as one of the most discussed problems in obstetrics, which was in nonstop searching for improvements in term of definitions, classifications, diagnosing and managements. Aim and objectives; was how to assess the consequence of Sildenafil and Aspirin in Doppler indices and the neonatal outcome in cases with placental non-sufficiency and FGR? Subjects and methods; this work was a randomized clinical study performed at Samalot General Hospital from March 2020 till March 2021. Result; There is significant change among …

Effect Of Hepatitis C Virus On Duration Of Pregnancy And The Incidence Of Congenital Anomalies Of The Fetus, Abd El-Rahman Soliman, Abdelmoniem Zakaria, Bassem Abd El-Aziz

Al-Azhar International Medical Journal

Background; In spite of reports of raised rates of hypertensive problems, pre-mature births, and cholestasis, the influence of mother HCV infections on gestation complications and obstetrical outcomes hasn’t been extensively defined. Aim and objectives; The current work aimed to examine the influence of Hepatitis C virus (HCV) infections during pregnancy on the duration of gestation as well as its possible effect on the incidence of congenital anomalies of the fetus. Subjects and methods; This work was a prospective observational case-control research had been done at Al-Hussein and Sayed Galal hospitals, Al-Azhar University during the period from December 2020 to June …

Evaluation Of Leech Therapy In Flap Venous Congestion, Aya Zidan, Mohamed Almarakby, Ayman Altramsy, Asmaa Dahy

Al-Azhar International Medical Journal

Background: One of the common problems in flap surgery is venous congestion. The literature contains a plethora of alternative procedures to surgical revision for dealing with this issue. The leech therapy is one of these procedures. In the present study, leech therapy was used for the treatment of twenty cases with venous congested flaps. The technique, results and complications will be presented and discussed. Aim of the study: The aim of this study is to spotlight on the efficacy of leech therapy in salvage of venous congested flaps. Patients and Methods: A prospective clinical study was carried out on 20 …

Endoleaks: Current Concepts And Treatments - A Narrative Review, Zia Ur Rehman

Department of Surgery

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. …

Prognostication And Risk Factors Of Status Epilepticus In Patients Treated In Neurointensive Care Units, Emad Shaheen

Al-Azhar International Medical Journal

Background: Status epilepticus (SE) can lead to sequelae or even death. Identifying characteristics associated with poor outcome is crucial in guiding patient treatment, To our information, there is no data illustrating the prevalence and outcome of cases with critical tumor illness with AMS accompanied to non-convulsive seizures (NCS) or NCSE, Aim and objectives: the aim of the study was to evaluate risk factors and prognosing in cases with Status epilepticus (SE) treated in neurointensive care units, Subjects and methods: This was a retrospective cohort investigation, in which 50 cases had SE-episodes were included, We in retrospect analyzed all SE-episodes managed …

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Umbilical Access In Laparoscopic Surgery In Infants Less Than 3 Months: Single Institution Retrospective Review, James Fraser, Kayla B. Briggs, Wendy Jo Svetanoff, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St Peter, Tolulope A. Oyetunji

Presentations

PURPOSE: Umbilical access in laparoscopic surgery has been cited as a potential factor for increased complications in low birth weight infants and those less than three months old. Previous series noted a self-reported complication rate of 10.6% among 329 pediatric surgeons via anonymous survey, citing carbon dioxide (CO2) embolism as the most common complication. We report four-year outcomes with blunt transumbilical laparoscopic access to examine the safety of this technique. METHODS: Following IRB approval, a retrospective database of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016-2019 at a tertiary care academic …

Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis Of Patients Undergoing Concomitant Labral Repair And Ligamentum Teres Debridement Versus Isolated Labral Repair, Blake Bodendorfer, Thomas Alter, Steven Defroda, Andrew Wolff, Dominic Carreira, John Cristoforetti, Dean Matsuda, John Salvo, Benjamin Kivlan, Shane Nho

Department of Orthopaedic Surgery Faculty Papers

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy. Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary …

Reconsidering Perioperative Antibiotic Use In Elective Laparoscopic Cholecystectomy, Kayla B. Briggs, James Fraser, Wendy Jo Svetanoff, Charles L. Snyder, Pablo Aguayo, David Juang, Rebecca M. Rentea, Jason D. Fraser, Shawn D. St. Peter Md, Tolulope A. Oyetunji

Posters

Introduction: Prophylactic preoperative antibiotics (PPA) are questionable in cases with a low rate of surgical site infection (SSI). We report institutional PPA usage and SSI rates after elective laparoscopic cholecystectomy in a children’s hospital. Methods: Children <18 years old who underwent outpatient laparoscopic cholecystectomy between 7/2010 and 8/2020 were included. SSI was defined as clinical signs of infection, requiring antibiotics, within 30 days of surgery. Results: 502 patients met inclusion criteria; 50% were pre-operatively diagnosed with symptomatic cholelithiasis, 47% biliary dyskinesia, 2% hyperkinetic gallbladder, and 1% gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). 60% (n=301) of patients received PPA while 40% (n=201) did not; 1.3% (n=4) of those who received PPA developed SSI compared to 5.5% (n=11) of those who did not (p=0.01). Though PPA use was associated with an 84% reduction in risk of SSI on multivariate analysis (p=0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics while the remainder were treated with outpatient antibiotics. Gender, age, BMI, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA (Table 1). Conclusion: Given the relatively low morbidity of the superficial SSI, conservative use of PPA should be carefully considered in outpatient laparoscopic cholecystectomy to avoid contributing to antibiotic-related complications.

A Rare Entity: Case Report Of Recurrent Hypertrophic Pyloric Stenosis, Astrid A. Gleaton, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. …

Implementing A Clinical Practice Guideline For Pediatric Appendicitis Safely Reduced Health Care Use And Improved Antimicrobial Stewardship, Jack Vernamonti, Robin Cotter, Jennifer Jubulis, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.

Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.

Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).

Discussion: Through implementing the …

Post-Operative Use Of Hme Filter‑Protected Open Tracheostomy Circuit During The Covid-19 Pandemic, Way Siong Koh, Irene Ng, Megan Downing

Journal of Perioperative Nursing

Introduction

In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs.

Methods

We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of …

Innate Immune Activation By Checkpoint Inhibition In Human Patient-Derived Lung Cancer Tissues, Teresa W. M. Fan, Richard M. Higashi, Huan Song, Saeed Daneshmandi, Angela L. Mahan, Matthew S. Purdom, Therese J. Bocklage, Thomas A. Pittman, Daheng He, Chi Wang, Andrew N. Lane

Center for Environmental and Systems Biochemistry Faculty Publications

Although Pembrolizumab-based immunotherapy has significantly improved lung cancer patient survival, many patients show variable efficacy and resistance development. A better understanding of the drug’s action is needed to improve patient outcomes. Functional heterogeneity of the tumor microenvironment (TME) is crucial to modulating drug resistance; understanding of individual patients’ TME that impacts drug response is hampered by lack of appropriate models. Lung organotypic tissue slice cultures (OTC) with patients’ native TME procured from primary and brain-metastasized (BM) non-small cell lung cancer (NSCLC) patients were treated with Pembrolizumab and/or beta-glucan (WGP, an innate immune activator). Metabolic tracing with ¹³C₆-Glc/ …

Blood-Based Multi-Cancer Detection Using A Novel Variant Calling Assay (Deepgentm): Early Clinical Results, Rebecca M. Tuttle, Frederic Ris, Minia Hellan, Jonathan Douissard, Jorge J. Nieva, Frederic Triponez, Yanghee Woo, David Geller, Nicolas C. Buchs, Leo Buehler, Stefan Moenig, Christope E. Iselin, Wolfram Karenovics, Patrick Petignat, Giang Thanh Lam, Manuela Undurraga Malinervo, James R. Ouellette, Debashish Bose, Nael Ismail, Christian Toso

Department of Surgery Faculty Publications

This is an early clinical analysis of the DEEPGENTM platform for cancer detection. Newly diagnosed cancer patients and individuals with no known malignancy were included in a prospective open-label case-controlled study (NCT03517332). Plasma cfDNA that was extracted from peripheral blood was sequenced and data were processed using machine-learning algorithms to derive cancer prediction scores. A total of 260 cancer patients and 415 controls were included in the study. Overall, sensitivity for all cancers was 57% (95% CI: 52, 64) at 95% specificity, and 43% (95% CI: 37, 49) at 99% specificity. With 51% sensitivity and 95% specificity for all stage …

A Collection Of Research In Transplantation Surgery: The Importance Of Assessing Outcomes In A Field Dependent On The Availability Of Limited Resources, Amy J. Hargrove

Theses & Dissertations

This thesis is a collection of three independent projects related to transplantation surgery. In summary, project I involves an assessment of long-term quality of life outcomes of intestinal transplantation in pediatric patients who are now in adulthood, with comparison to other solid organ transplant patients. Health related quality of life surveys were completed in 14 adult patients who underwent intestine, liver, or kidney transplants as children. Project II evaluates pre-surgical characteristics of patients undergoing liver transplant to assess predictive factors for the need of venovenous bypass utilization intraoperatively by assessing trends at the University of Nebraska Medical Center in 95 …

Gum Chewing, Added To Conventional Feeding, Reduces Risk Of Post-Operative Ileus After Elective Hip And Knee Arthroplasty Procedures In Elderly Population: A Protocol For A Parallel Design, Open-Label, Randomized Controlled Trial, Obada Hussein Hasan, Laraib Mazhar, Ahsun Jiwani, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Postoperative ileus (poi) is defined as a temporary cessation of bowel movement after a surgical procedure. Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance. Literature reports "sham feeding" (gum-chewing) effect as an increase in chewing and saliva which enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion. Therefore, we aim to assess the effect of adding gum-chewing to the conventional postoperative feeding regimen on restoring postoperative bowel function and length of stay in hospital of patients undergoing elective hip …