Medicine and Health Sciences Commons^™

Compliance With Surgical Care Improvement Project Blood Glucose--A Marker For Euglycemia, But Does It Put Our Patients At Risk?, Isaac R Whitman, Maura Murphy, Marta M Gilson, Amy Campfield, Michel Haddad, Elizabeth Moxey, Glenn J R Whitman

Department of Surgery Faculty Papers

To improve outcomes in open heart surgery (OHS) patients, the Surgical Care Improvement Project (SCIP) requires 6 am postoperative day (POD) 1 and 2 blood glucose (BG) to be ≤200mg/dL. This study examined risk factors for SCIP noncompliance when using an insulin infusion protocol (IIP) and evaluated this SCIP metric as a surrogate for glycemic control. The authors divided 99 consecutive OHS patients, all subjected to 1 uniform IIP, into 2 groups: Group 1-SCIP compliant (n=79) and Group 2-SCIP noncompliant (n=20). They determined mean BG for the first 48 postoperative hours, percent of total time with hyperglycemia (% time BG …

Delayed Diagnosis Of Hand Injuries In Polytrauma Patients (Poster), Joshua M. Adkinson Md, Muhammad Shuja Shafqat Md, Sherrine Eid Mph, Marshall G. Miles Do

Department of Surgery

No abstract provided.

Civilian Trauma Care - Learning From The Military Experience, Vivian C. Mcalister

Vivian C. McAlister

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another. The objective of this presentation is to review military trauma care in Afghanistan for aspects that may influence civilian practice at home.

• Comprehensive trauma care system: guidelines,

registry, review

• Protocols for care: damage control; massive

blood transfusion policy; mass casualty care

• Techniques: resuscitative thoracotomy;

decompressive craniectomy; pelvic-gluteal

hemorrhage control

• Rehabilitation: Mild traumatic brain injury

• Delegated medical acts: medics / PAs

Conventional Isolated Aortic Valve Replacement In Octogenarians: A 10-Year Single Center Experience, James K. Wu Md, Justin D. Roberts Do, Gregory S. Troutman Bs, Michael J. Weiss Mph, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Timothy S. Misselbeck, Raymond L. Singer Md

Department of Surgery

No abstract provided.

The Development Of A Decision Aid For Patients With Ulcerative Colitis Deciding Between Ileostomy Or Ileal Anal-Pouch Reconstruction, Luc A. Dubois

Electronic Thesis and Dissertation Repository

Objectives: To develop a prototype decision aid used to assist ulcerative colitis patients when deciding between ileal pouch-anal anastomosis (IPAA) and ileostomy.

Methods: Three separate systematic reviews (quality of life studies, IPAA studies, ileostomy studies) were conducted to populate the decision aid with outcome probabilities. Meta-regression was used to select appropriate pooled outcomes.

Results: Of 3920 studies reviewed, 9 studies reported on quality of life, 67 on outcomes following IPAA, and 11 following ileostomy. No difference in quality of life was found between procedures. Among IPAA patients, pooled pouch failure rate was 5.5%, with pouchitis being the most common complication …

Differential Expression Of Chemokines In A Mouse Model Of Wound Healing, Susan H. Jackman, Matthew B. Yoak, Shivaleela Keerthy, Bonnie L. Beaver

Susan H. Jackman

Macrophages have a multifaceted role in wound healing. While their initial activity may be in the degradation and elimination of damaged tissue, macrophages also produce and secrete a variety of mediators that can participate in the repair process as well. To perform these functions, macrophages must be recruited to a wound site. Our purpose was to examine the temporal and spatial expression of macrophage chemoattracting cytokines (chemokines) at a surgical wound site. A surgical wound was prepared on the dorsal aspect of B6AFI/J mice. Biopsies were obtained from the wound and a comparable nonwounded area between 6 and 72 hr …

Differential Expression Of Chemokines In A Mouse Model Of Wound Healing, Susan H. Jackman, Matthew B. Yoak, Shivaleela Keerthy, Bonnie L. Beaver

Bonnie L. Beaver

Macrophages have a multifaceted role in wound healing. While their initial activity may be in the degradation and elimination of damaged tissue, macrophages also produce and secrete a variety of mediators that can participate in the repair process as well. To perform these functions, macrophages must be recruited to a wound site. Our purpose was to examine the temporal and spatial expression of macrophage chemoattracting cytokines (chemokines) at a surgical wound site. A surgical wound was prepared on the dorsal aspect of B6AFI/J mice. Biopsies were obtained from the wound and a comparable nonwounded area between 6 and 72 hr …

A Clinical Prediction Model For Long-Term Functional Outcome After Traumatic Spinal Cord Injury Based On Acute Clinical And Imaging Factors., Jefferson R Wilson, Robert G Grossman, Ralph F Frankowski, Alexander Kiss, Aileen M Davis, Abhaya V Kulkarni, James S Harrop, Bizhan Aarabi, Alexander Vaccaro, Charles H Tator, Marcel Dvorak, Christopher I Shaffrey, Susan Harkema, James D Guest, Michael G Fehlings

Department of Neurosurgery Faculty Papers

To improve clinicians' ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. Data were obtained from two large prospective SCI datasets. Functional independence measure (FIM) motor score at 1 year follow-up was the primary outcome, and functional independence (score ≥ 6 for each FIM motor item) was the secondary outcome. A linear regression model was created with the primary outcome modeled relative to clinical and imaging predictors obtained within 3 days of injury. …

Massive Haemoptysis On Veno-Arterial Extracorporeal Membrane Oxygenation., Meredith Harrison, Scott W. Cowan, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

A 49-year old female presented with severe heart failure with end-organ dysfunction and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to a decision for end-organ recovery. While on ECMO, the patient developed massive haemoptysis after a Swan-Ganz catheter manipulation. The haemoptysis was not controllable by conventional methods including bronchoscopy with cold saline and epinephrine lavage, bronchial blocker or angiography. The endotracheal tube was clamped to provide tamponade and the patient relied on full ECMO support for 36 h. After the haemoptysis resolved, the endotracheal tube was unclamped. The patient developed adult respiratory distress syndrome and was …

Complications Of Total Hip Replacement, Kashif Abbas, Ghulam Murtaza, Masood Umer, Haroon Rashid, Irfan Qadir

Section of Orthopaedic Surgery

Objective: To determine the factors causing complications in unilateral total hip replacement.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, between 2000 and 2010.
Methodology: During the study period, 199 patients underwent elective unilateral total hip replacement at the Aga Khan University Hospital. Patients were divided into two groups on the basis of postoperative complications within 30 days of surgery. Significant factors at 5% significance level on univariate analysis were further analyzed by multivariate logistic regression.
Results: Postoperative complications occurred in 39 patients (19.6%); dislocation being most common in 13 patients (6.5%), followed …

Baron Guillaume Dupuytren: When Brilliance Combats Professionalism., Sean M. Devitt, Md, Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Baron Guilluame Dupuytren was a French anatomist and surgeon who practiced during the 1800s and is considered by some to be the most brilliant and gifted surgeons of his time. His contributions to the field of surgery are quite extensive, yet his eccentric personality and attitude toward his colleagues, students, and patients raises a very interesting question: could Dr. Dupuytren (Fig. 1) and his many contributions to the field of surgery have thrived in today’s era of professionalism? The concept of professionalism is emphasized to medical students starting from day one of their medical training. How would Dr. Dupuytren, an …

Tension Pneumothorax On Extracorporeal Membrane Oxygenation Leading To Significant Pneumoperitoneum., Hitoshi Hirose, Nicholas C. Cavarocchi, Kathleen Holoyda

Department of Surgery Faculty Papers

Veno-venous and veno-arterial extracorporeal membrane oxygenation (ECMO) therapy is used to support the cardiac and pulmonary systems in the setting of acute failure. Maintaining adequate ECMO flow is crucial for the success of the therapy. Sudden decrease in venous return on ECMO has multiple etiologies, such as intravascular hypovolemia, malposition or kink of the venous cannula, suction occlusion of a cannula, and venous or arterial thrombi. Pathology within the chest, including pneumothorax, tension hemothorax and pericardial tamponade, may also decrease the ECMO flow because of compression of the cannula and decreased atrial volume. Air from a tension pneumothorax may be …

The Influence Of Prognostic Factors And Adjuvant Chemoradiation On Survival After Pancreaticoduodenectomy For Ampullary Carcinoma., Timothy N Showalter, Tingting Zhan, P Rani Anne, Inna Chervoneva, Edith P Mitchell, Charles J Yeo, Ernest L Rosato, Eugene P Kennedy, Adam C Berger

Department of Surgery Faculty Papers

INTRODUCTION: The prognosis after pancreaticoduodenectomy (PD) for ampullary carcinoma (AC) is superior to that of pancreatic cancer. Decisions regarding adjuvant therapy are influenced by factors such as nodal status, stage, and grade, but the influence of these individual variables on survival is unclear.

METHODS: A prospective tumor registry database was queried to identify patients who underwent PD for AC at Thomas Jefferson University between Jan 1997 and Apr 2009. The study was conducted with the approval of the institutional review board. Data were collected through review of hospital and departmental charts. Overall survival (OS) was analyzed using univariate and multivariate …

Cerebral And Lower Limb Near-Infrared Spectroscopy In Adults On Extracorporeal Membrane Oxygenation, Joshua K Wong, Thomas N Smith, Harrison T Pitcher, Hitoshi Hirose, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Percutaneous femoral venoarterial (VA) or jugular venovenous (VV) extracorporeal membrane oxygenation (ECMO) can result in delivery of hypoxic blood to the brain, coronaries, and upper extremities. Additionally, VA-ECMO by percutaneous femoral artery cannulation may compromise perfusion to the lower limbs. Use of near-infrared spectroscopy (NIRS) detects regional ischemia and warns of impending hypoxic damage. We report the first known series with standardized monitoring of this parameter in adults on ECMO. This is an institutional review board-approved single institution retrospective review of patients with NIRS monitoring on ECMO from July 2010 until June 2011. Patients were analyzed for drops in NIRS …

Mechanical Complications Following Acute Myocardial Infarction, Awais Ashfaq, Hasanat Sharif

Department of Surgery

Objective: To outline the outcome and management of patients with acute myocardial infarction presenting with mechanical complications such as post-infarction ventricular septal defect, mitral regurgitation and left ventricular rupture.Methods: The retrospective study, conducted in September and October, 2010 at the Aga Khan University Hospital, Karachi, included cases from January 1990 to December 2009. Only 18 cases were found who had presented with such complications. They were assessed for demographics as well as pre-operative, per-operative and post-operative management patterns. Data was analysed using SPSS version 17.0.Results: Out of the 18 patients, 10 had post-infarction ventricular septal defect, while 8 had mitral …

Healing Of Cornea Following An Electric Burn, Tanveer Anjum Chaudhry, Farheen Shaikh, Khabir Ahmad

Department of Surgery

ABSTRACT Electrical injuries have become a significant health problem in developing countries because of increase in access to electricity in the last few decades and lack of adequate safety measures. Electrical injuries of eyes are relatively uncommon. A case report of a rapid and complete corneal healing accompanied by satisfactory visual recovery after an electric burn event in a 20-year-old male is reported. The patient had accidental exposure to high voltage live wire while he was repairing it, resulting in severe ocular and superficial body burn. He was not wearing any protective equipment at the time of injury. On examination, …

1 Canadian Field Hospital In Haiti: Surgical Experience In Earthquake Relief, Max Talbot, Bethann Meunier, Vincent Trottier, Michael Christian, Tracey Hillier, Chris Berger, Vivian Mcalister, Scott Taylor

Vivian C. McAlister

The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. L’hôpital déployable des Forces canadiennes, le 1er Hôpital de campagne du Canada, a …

Augmented Image-Guidance For Transcatheter Aortic Valve Implantation, Pencilla Lang

Electronic Thesis and Dissertation Repository

The introduction of transcatheter aortic valve implantation (TAVI), an innovative stent-based technique for delivery of a bioprosthetic valve, has resulted in a paradigm shift in treatment options for elderly patients with aortic stenosis. While there have been major advancements in valve design and access routes, TAVI still relies largely on single-plane fluoroscopy for intraoperative navigation and guidance, which provides only gross imaging of anatomical structures. Inadequate imaging leading to suboptimal valve positioning contributes to many of the early complications experienced by TAVI patients, including valve embolism, coronary ostia obstruction, paravalvular leak, heart block, and secondary nephrotoxicity from contrast use.

A …

The Effect Of Pre-Operative Coumadin Therapy On Patients Who Develop Hemorrhagic Events Post Bariatric Surgery, Richard Boorse Md, Peter J. Bechtel Md, Cathleen Webber Rn, Mshs, Suzanne L. Smith Mba, Rrt, Tas, Cathy Fuhrman Rn, Msn

Department of Surgery

No abstract provided.

Point-Of-Care Ultrasound Used To Exclude Penile Fracture, Adam Ash, Joel Miller, David Preston

Surgery Faculty Publications

This is a case report of a superficial penile hematoma that was difficult to distinguish clinically from a penile fracture. Such cases occur with relative frequency, and because definitive treatment is an urgent surgery, timely diagnosis is essential to avoid complications. Typical imaging modalities such as cavernosonography and magnetic resonance imaging can be invasive (cavernosonography) or time consuming (magnetic resonance imaging) and may not be readily available. Ultrasound has been used successfully in such cases, and, in this case, we used point-of-care ultrasound combined with a brief period of observation to exclude penile fracture.

Neurosurgical Electives: Operating Room Survival Guide, M Shahzad Shamim, Zain A. Sobani

Section of Neurosurgery

No abstract provided.

Giant Cell Reparative Granuloma Of Temporal Bone: Case Report Of A 62-Year-Old Male, Muhammad Waqas, Naeem Sultan Ali, Muhammad Zubair Tahir, Syed Ather Enam, Zeeshan-Ud-Din, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Giant cell reparative granuloma (GCRG) is an uncommon non‑neoplastic reactive tumor which occurs almost exclusively within the mandible and maxilla. GCRG of the temporal bone is a rare condition. It has been found to affect predominantly adolescents and adults (age: 10‑25 years). We report a case of a 62‑year‑old male with GCRG of left temporal bone who presented to us with progressive left temporal swelling for 3 months. It was associated with hearing loss. There was no history of trauma. A non‑contrast computed tomography scan brain showed a locally destructive lesion involving squamous temporal bone closely related to the left …

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

Section of Urology

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 …

Short-Term Complications After Bilateral Internal Mammary Artery Grafting--A Retrospective Study, Hashim Muhammad Hanif, Zeb Ijaz Saeed, Adil Sheikh, Syed Shahabuddin, Hasanat Sharif

Section of Cardiothoracic Surgery

Objectives: To analyze our experience of conducting Bilateral Internal Mammary Artery (BIMA) grafting, using both pedicled and free grafts for coronary revascularization, assessing the safety and efficacy of the procedure and comparing any differences observed between the two techniques of harvesting the grafts.Methods: A retrospective cross sectional study was conducted in July 2010 in which all 48 patients undergoing bilateral internal mammary artery grafting for coronary bypass surgery at the Aga Khan University Hospital from 1996 to 2010 were reviewed and evaluated. The main outcome measures were perioperative mortality and early morbidity with particular reference to cerebrovascular accidents, sternal wound …

Long-Term Effect Of Carotid Surgery In Asymptomatic Stenosis., Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Analytic Lymph Node Number Establishes Staging Accuracy By Occult Tumor Burden In Colorectal Cancer., Terry Hyslop, David S. Weinberg, Stephanie Schulz, Alan Barkun, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND AND OBJECTIVES: Recurrence in lymph node-negative (pN0) colorectal cancer suggests the presence of undetected occult metastases. Occult tumor burden in nodes estimated by GUCY2C RT-qPCR predicts risk of disease recurrence. This study explored the impact of the number of nodes analyzed by RT-qPCR (analytic) on the prognostic utility of occult tumor burden.

METHODS: Lymph nodes (range: 2-159) from 282 prospectively enrolled pN0 colorectal cancer patients, followed for a median of 24 months (range: 2-63), were analyzed by GUCY2C RT-qPCR. Prognostic risk categorization defined using occult tumor burden was the primary outcome measure. Association of prognostic variables and risk category …

Malignant Peripheral Nerve Sheath Tumor (Mpnst): An Overview With Emphasis On Pathology, Imaging And Management Strategies., Timothy C. Beer

Jefferson Hospital Staff Papers and Presentations

MPNSTs are rare malignancies that are classically associated with pre-existing plexiform neurofibromas in neurofibromatosis type 1 (NF-1) patients, but also occur in association with radiation as well as sporadically in patients with no known risk factors. The typical presentation of sporadic MPNST is a new painless enlarging mass. The typical presentation of MPNST in an NF-1 patient is rapid enlargement or new onset of pain associated with a pre-existing plexiform neurofibroma. Although both MPNST and benign neurofibromas share in common the absence of neurofibromin function due to loss of both NF-1 alleles, malignant transformation to MPNST requires several additional aberrations, …

Post-Traumatic Apexogenesis Of Immature Non-Vital Permanent Incisors, Robia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Injury to an immature permanent tooth may result in cessation of dentin deposition and root maturation leaving an open root apex and thin dentinal walls that are prone to fracture. Endodontic treatment is often complicated and protracted with an uncertain prognosis frequently resulting in pre-mature tooth loss. There are several advantages of promoting apexogenesis in immature teeth with open apices. It encourages a longer and thicker root to develop thus decreasing the propensity of long term root fracture. This case report highlights the role of Hertwig root sheath and dental papilla in continued root formation of immature permanent tooth, even …

Development And Validation Methodology Of The Nuss Procedure Surgical Planner, Krzysztof J. Rechowicz

Computational Modeling & Simulation Engineering Theses & Dissertations

Pectus excavatum (PE) is a congenital chest wall deformity which is characterized, in most cases, by a deep depression of the sternum. A minimally invasive technique for the repair of PE (MIRPE), often referred to as the Nuss procedure, has been proven to be more advantageous than many other PE treatment techniques. The Nuss procedure consists of placement of a metal bar(s) underneath the sternum, thereby forcibly changing the geometry of the ribcage. Because of the prevalence of PE and the popularity of the Nuss procedure, the demand to perform this surgery is greater than ever. Therefore, a Nuss procedure …

Mcdowell, Ephraim, 1771-1830 - Relating To (Sc 2551), Manuscripts & Folklife Archives

MSS Finding Aids

Finding aid only for Manuscripts Small Collection 2551. First day of issue cover for stamp celebrating the 150th anniversary of the first successful ovariotomy, performed by Ephraim McDowell. Includes a brief printed history of the surgery, as well as a printed letter from the Danville, Kentucky Chamber of Commerce announcing the commemorative stamp.