Medicine and Health Sciences Commons^™

Fracture Of The Scapula With Intrathoracic Penetration In A Skeletally Mature Patient, Cary C. Schwartzbach, Hani Seoudi, Amy E. Ross, Kimberly M. Hendershot, Linda Robinson, Alireza Maekzadeh

Department of Surgery Faculty Publications

To our knowledge, intrathoracic displacement of a fractured scapula has only been described in two reports involving adolescents^1,2. We present the case of a skeletally mature adult with a scapular fracture that penetrated the thoracic cage without causing a pneumothorax. We speculate as to how the adult scapula can deform in a manner consistent with this rare injury. As the patient had advanced Alzheimer disease, the family consented to the publication of data concerning this case.

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Neck Recurrence In Early Carcinoma Tongue, Mubasher Ikram, Sadaf Fatima Jafferbhoy, Maisam Abbas Shiraz Onali

Section of Otolaryngology, Head & Neck Surgery

Objective: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck.

Methods: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years.

Results: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were …

Open Versus Laparoscopic Pyloromyotomy For Pyloric Stenosis: A Prospective, Randomized Trial., Shawn D. St Peter, G W. Holcomb Iii, Casey M. Calkins, J Patrick Murphy, Walter S. Andrews, Ronald J. Sharp, Charles L. Snyder, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pyloric stenosis, the most common surgical condition of infants, is treated by longitudinal myotomy of the pylorus. Comparative studies to date between open and laparoscopic pyloromyotomy have been retrospective and report conflicting results. To scientifically compare the 2 techniques, we conducted the first large prospective, randomized trial between the 2 approaches.

METHODS: After obtaining IRB approval, subjects with ultrasound-proven pyloric stenosis were randomized to either open or laparoscopic pyloromyotomy. Postoperative pain management, feeding schedule, and discharge criteria were identical for both groups. Operating time, postoperative emesis, analgesia requirements, time to full feeding, length of hospitalization after operation, and complications …

Incorporating Endoscope In Middle Ear Surgery, Shehzad Ghaffar, Mubasher Ikram, Ahsan Raza

Section of Otolaryngology, Head & Neck Surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the …

Peritoneal Perfusion With Oxygenated Perfluorocarbon Augments Systemic Oxygenation., Shamus R Carr, Joshua P Cantor, Atul S Rao, Thiru V Lakshman, Joshua E Collins, Joseph S Friedberg

Department of Surgery Faculty Papers

BACKGROUND: Despite maximal ventilatory support, many patients die from hypoxia in the setting of potentially reversible pulmonary failure. There remains a pressing need for additional pulmonary supportive care measures, especially techniques that do not require systemic anticoagulation. The objective of our experiments was to determine whether systemic oxygenation could be increased in a large animal, with induced hypoxia, by perfusing the abdominal cavity with oxygenated perfluorocarbons.

METHODS: Fifteen pigs with a mean (+/- SD) weight of 45 +/- 5 kg were intubated and rendered hypoxic by ventilating them with a blend of nitrogen and oxygen to achieve subatmospheric concentrations of …

L’Imagination Du Corps Greffé : Filtres Bilingues, Mireille Rosello

Présence Francophone: Revue internationale de langue et de littérature

Contemporary narratives featuring organ transplants speak of a painful but also life-saving contact when the “donor” body is African and the receiving body is European. At this point the surgical operation and that of the imagination assume a whole other dimension, as the inequality and interdependence of these two bodies invite the reader to re-imagine the links between the concept of the “body,” on the one hand, and culture and language, on the other. This article looks at the transplanted body as an imagining machine capable of articulating a vision of itself different from the one that words impose upon …

Incidence And Outcome Of Cardiopulmonary Resuscitation In Patients With Shunted Single Ventricle: Advantage Of Right Ventricle To Pulmonary Artery Shunt., Eric M. Graham, Geoffrey A. Forbus, Scott M. Bradley, Girish S. Shirali, Andrew M. Atz

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

In Search Of The Anglophone Doctor In Jacques Ferron’S Story “Le Petit William”, Vivian C. Mcalister, Christiane I. Mcalister

Surgery Publications

The story of ‘Le Petit William’ (Contes anglais, 1964) is based on Ferron’s experiences as a general practitioner in the Gaspé in 1946. A medical event, use of the maternal left lateral position by a sage-femme to deliver a baby boy, becomes allegory. The sage-femme had learned the technique from a visiting Anglophone doctor. A simple joke, which superficially appears to be the story’s culmination, takes on a sombre political tone when considered in the light of the Latin epigraph. Trips to the Gaspé, a review of the history of obstetrics and speculation are used in this paper to understand …

Surgery For Prolactinomas, Ashfaq A. Razzaq, Rashid Jooma

Section of Neurosurgery

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. however certain subgroups of these patients are better managed by surgical excision. the indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. the factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, csf fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause csf leak following medical therapy. the size …

Cerebral Embolism: Distal Subclavian Disease As A Rare Etiology, Iram Naz, Ziad Sophie

Section of Cardiothoracic Surgery

Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome (TOS) and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke.

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Trans-Mastoid Approach To Otogenic Brain Abscess, Ashfaq A. Razzaq, Rashid Jooma, Shahid Ahmed

Section of Neurosurgery

The treatment of otogenic brain abscess initially involves excision or aspiration of the abscess through a temporal or sub-occipital route depending on its location. This is followed by a mastoidectomy by the ENT surgeon to eradicate the primary source of infection. During the last three years, we have approached such lesions through a mastoidectomy followed by excision of the abscess through the same approach. This trans-mastoid approach is technically feasible in following the tract of suppuration, and clearing the cause and effect of pathology, at the same sitting. This paper describes our initial experience with the trans-mastoid approach to otogenic …

Life Threatening Mediastinal Haematoma: A Complication Of Central Venous Catheterization, Omer Ashraf, Hasanat Sharif

Section of Cardiothoracic Surgery

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve. One should be careful in selection of venous access and be aware of alternatives routes.

Prevalence Of Diabetic Retinopathy Among Individuals Screened Positive For Diabetes In Five Community Based Eye Camps In Northern Karachi Pakistan, Jamal-U- Din, Mohammad Babar Qureshi, Akhtar Jamal Khan, Mohammad Daud Khan, Khabir Ahmed

Department of Surgery

Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan’s largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all …

Visual-Spatial & Visual-Motor Function In Pediatric Heart Transplant Recipients, Stephanine Dianne Griffone

Loma Linda University Electronic Theses, Dissertations & Projects

Heart surgery is commonly used to repair congenital heart defects and to perform heart transplantation. The associated hypoxia before or during the surgery may cause damage in the parasaggital area of the cerebral cortex, with resulting difficulty during tasks requiring visual-spatial and visual-motor skills. This study compares the performance of children who received a heart transplant during infancy to that of nonclinical children with no medical complications on three visual-motor measures, three visual-spatial measures, and two computerized visual-spatial tasks - a Block Design Matching task and a Mental Rotation task. The children who received a heart transplant achieved significantly lower …

New Trends In Shock Resuscitation, Christopher Michetti

Christopher P. Michetti, M.D., F.A.C.S.

No abstract provided.

Prophylaxis Of Dvt With Enoxaparin In Patients Undergoing Total Knee Replacement, Abid Ullah Khan Niazi, Masood Umer, Mohammad Umar

Section of Orthopaedic Surgery

Objective: To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery.
Methods: Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT.
Results: Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound …

Long Scarf Injuries, Arshad A. Siddiqui, Muhammad Shahzad Shamim, Rashid Jooma, Ather Enam

Section of Neurosurgery

Long scarf (Dopatta) traditionally worn by females in South-East Asia have been described to make the females prone to sustain specific injuries when they ride pillion on the cycle powered rickshaw or motor bike. Two cases of females have been described.

Coronary Artery Bypass Surgery In Guillain Barre Syndrome, Omer Ashraf, Hasanat Sharif

Department of Surgery

Guillain Barre Syndrome (GBS) is a rare autoimmune inflammatory polyneuropathy with established acute phase morbidity and mortality. Despite the positive outcome in majority of cases, there is hesitance in subjecting these patients to major surgical interventions under general anaesthesia. This case documents the successful undertaking of major coronary artery grafting under cardiopulmonary bypass and general anaesthesia, in a GBS patient. A review of the pathology is presented and the controversy addressed.

Cataract Blindness And Visual Outcome Of Cataract Surgery In A Tribal Area In Pakistan, K M. Anjum, B M. Qureshi, M A. Khan, Azam Ali, Khabir Ahmad

Department of Surgery

Abstract

Aim: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged ⩾50 years in Orakzai Agency, Pakistan.

Methods: 1600 individuals aged ⩾50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes.

Results: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold …

Cutting Rate Effect On Temperature During Cortical Bone Sawing, Hamid Khalili Parsa, Ger Reilly, Brendan Mccormack

Conference Papers

When bone is cut the occurrence of thermal damage to the bone is of major concern to the surgeon. If the temperature exceeds 44°C for longer than 1 min, bone repair is impaired (Eriksson et al, 1984) and necrosis may occur. Repeated use of cutting blades may reduce the cutting efficiency (Wevers et al, 1987; Toksvig-Larsen et al, 1992). Wevers et al also found that there is a greater force required to cut cortical bone using a blunt saw compared to new one.

Indentation Fracture Of Bovine Cortical Bone: Acoustic Emission Technique, Ashkan Safari, Ger Reilly, Brendan Mccormack

Conference Papers

Indentation cutting may result in microcracking and main crack growth which was previously reported. In this study, we recorded the AE signals produced by cracking processes during cutting on cortical bone, measuring the cutting force and correlating between load-displacement curves and AE activities.

The Role Of Radiation Therapy On Medically Inoperable Clinically Localized Non-Small Cell Lung Patients: London Regional Cancer Program (Lrcp) Clinical Experience, Michael Lee, Edward Yu, Robert Ash, Patricia Tai, Larry Stitt, George Rodrigues, Rashid Dar, Mark Vincent, Richard Inculet, Richard Malthaner

Oncology Presentations

Lung cancer is the most frequent cause of cancer death in both men and women in North America. In 2006, an estimated 22,700 Canadians will be diagnosed with lung cancer and 19,300 will die of it (Canadian Cancer Statistics 2006).

Approximately 15-20% of NSCLC patients present with early or localized disease.

Surgical resection of T1-2N0 NSCLC remains the treatment of choice for this population, and results in a 5-year survival rate of 50-70%.

Patients deemed medically inoperable have been treated with non-surgical therapies, such as radiation therapy(RT), while some patients have simply been observed without any tumor therapy because of …

Cyclosporin Versus Tacrolimus For Liver Transplanted Patients, Elizabeth Haddad, Vivian Mcalister, Elizabeth Renouf, Richard Malthaner, Mette S. Kjaer, Lise Lotte Gluud

Surgery Publications

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients …

Gastric Stromal Tumors: Clinical Presentations, Diagnosis And Outcome, Dildar Hussain, Hasnain Zafar, Asad Jamil Raja

Section of General Surgery

Objective: To determine the clinical presentations, of gastric stromal tumors with diagnostic methods, pathology and outcome after surgery.
Study Design: A case series.
Duration and Setting: From January 1988 to December 2002 at The Aga Khan University Hospital, Karachi.
Patients and Methods: All patients of age 14 years and above, diagnosed histopathologically to have gastric stromal tumors were included. The data of these patients was collected retrospectively from January 1988 to December 1998, and prospectively from January 1999 to December 2002. All the patients were studied as a single group.
Results: There were 11 patients. Their mean age was …

Earthquake Relief Experience Of Aga Khan University Trauma Team, Masood Umer, Haroon Rashid, Hasnain Zafar, Kamran Majeed

Section of General Surgery

The volatile geo-political situation of the country after the events of September 11, compelled the department of Surgery at Aga Khan University (AKU) to initiate the formation of a comprehensive disaster plan and trauma team. Since its inception the trauma team has stood the test of time during multiple disaster situations in Karachi. This includes the bus bombing of the French engineers, Hyderi mosque bomb blast and various other bomb blasts inside the city of Karachi. All these disasters were successfully managed within the premises of AKU. This earthquake relief activity was the first of its kind when the AKU …

Necrotizing Fasciitis Of The Breast, Saira Nizami, Kamran Mohiuddin, Mohisin-E-Azam, Hasnain Zafar, Muhammad Ashraf Memon

Section of General Surgery

Necrotizing fasciitis is a potentially fatal condition that can affect any part of the body. It can occur after trauma, around foreign bodies in surgical wounds, or can be idiopathic. We describe a case of necrotizing fasciitis involving the breast following an initial debridement of an inflammatory lesion.

Restoration Of Glenohumeral Motion In Erb's Palsy By Tendon Transfers, Syed Kamran Ahmed, Pervaiz Mehmood Hashmi

Section of Orthopaedic Surgery

Background: Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy.
Methods: This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System …