Medicine and Health Sciences Commons^™

A New Cecal Slurry Preparation Protocol With Improved Long-Term Reproducibility For Animal Models Of Sepsis, Marlene E. Starr, Allison M. Steele, Mizuki Saito, Bill J. Hacker, B. Mark Evers, Hiroshi Saito

Surgery Faculty Publications

Sepsis, a life-threatening systemic inflammatory response syndrome induced by infection, is widely studied using laboratory animal models. While cecal-ligation and puncture (CLP) is considered the gold standard model for sepsis research, it may not be preferable for experiments comparing animals of different size or under different dietary regimens. By comparing cecum size, shape, and cecal content characteristics in mice under different experimental conditions (aging, diabetes, pancreatitis), we show that cecum variability could be problematic for some CLP experiments. The cecal slurry (CS) injection model, in which the cecal contents of a laboratory animal are injected intraperitoneally to other animals, is …

Developmental And Cultural Perspectives On Children’S Postoperative Pain Management At Home, Brooke N. Jenkins, Michelle A. Fortier

Psychology Faculty Articles and Research

Outpatient surgery is extremely common in children, and approximately 4 million children experience significant pain after surgery in the USA each year. Management of children's postoperative pain in the home setting is suboptimal and is impacted by characteristics of children and parents, as well as the larger family and cultural context. In particular, developmental status of the child, parental beliefs regarding pain expression and analgesic use in children, cultural values and language barriers can affect management of children's postoperative pain. Targeting the myriad barriers to children's pain management by capitalizing upon the use of tailored interventions may help bridge the …

Even Perfusion Pump-Integrated Blood Oxygenator, Dongfang Wang, Joseph B. Zwischenberger

Surgery Faculty Patents

A blood oxygenator includes an integral pneumatic pump disposed substantially within a housing thereof, an inlet blood flow redirector, and an outflow blood collector. An atrium provided at an inlet of the oxygenator promotes even delivery of blood to the oxygenator. In use, the oxygenator provides an even dispersion of blood therethrough, establishing even perfusion and reducing areas of stagnant blood flow.

The Utilization Of The Pressure Volume Tool To Determine The Lower Inflection Point During Extracorporeal Membrane Oxygenation (Ecmo), Kenneth Miller Med, Rrt-Nps, Rita Pechulis Md, Fccp, James K. Wu, Dorothea T. Watson Do

Patient Care Services / Nursing

No abstract provided.

The Utilization Of Independent Lung Ventilation Via High Frequency Percussive Ventilation (Hfpv) During Extracorporeal Membrane Oxygenation (Ecmo), Kenneth Miller Med, Msrt, Rrt-Accs, Nps, Ae-C, Faarc, Rita Pechulis Md, Fccp, James K. Wu, Chad Traub Rrt-Accs, Dorothea T. Watson Do

Patient Care Services / Nursing

No abstract provided.

Development Of A Translational, Tissue-Engineered Approach To Replacement Of Myocardial Infarct Scar Tissue, Jason Schulte

All Dissertations

Myocardial infarction (MI) affects nearly 600,000 individuals each year, and the resulting damage initiates a pathophysiological progression towards congestive heart failure (CHF). A shortage of donor organs precludes heart transplantation as a practical solution, and neither surgical intervention nor stem cell therapy have yielded consistent and sufficiently positive results in clinical investigation. To prevent CHF, prospective therapies must target the cause of the maladaptive cardiac remodeling which precedes it--the nonfunctional, dyskinetic infarct scar--and aim to replace it with functional cardiac muscle. Tissue engineering holds promise for the development of novel therapies to either halt or reverse post-MI cardiac remodeling. However, …

Use Of Fresh Parental Fibular Allograft For Reconstruction Of Skeletal Defects After Limb Salvage Surgery, Muhammad Masood Kadir, Raza Askari, Sher Baz

Department of Surgery

Abstract

OBJECTIVE:

To share early experience with paediatric patients having undergone skeletal reconstruction after limb salvage surgery.

METHODS:

A reterorespective audit study was conducted at Aga Khan University Hospital, Karachi, from 1994 to 2011 An audit of the institutional tumour registry was done and relevant cases of paediatric patients having undergone skeletal reconstruction after limbsalvage surgery were tracked. Outcomes were objectively assessed through Musculoskeletal Tumour Society score. International Society of Limb Salvage grading was used to measure union of the graft to the host bone.

RESULTS:

Of the total 9 patients, 5(55.6%) were males and 4(44.4%) were females with an …

Our Experience With Van Nes Rotationplasty For Locally Advanced Lower Extremity Tumours, Raza Askari, Masood Umer, Mohsin-E-Azam, Haroon Rashid

Department of Surgery

Abstract

OBJECTIVE:

To present an early experience with the time-tested technique of Van Ness Rotationplasty to save distal lmbs.

METHODS:

Van Nes Rotationplasty for locally advanced lower extremity tumours. A reterorespective audit was conducted at Aga Khan University Hospital, Karachi, and comprised cases of bone and soft tissue sarcoma who underwent Van Ness Rotationplasty over seven years from January 2005 to December 2011. Demographic data, family history, past history, co-morbids, date since diagnosis, duration of symptoms, type of tumour, metastasis, pre-op and post-op functional status, recurrence and survival were collected.

RESULTS:

Of the 351 cases of bone and soft tissue …

La Cesárea Y El Parto Natural: Las Opiniones De Profesionales De La Salud En La Provincia De Buenos Aires / Cesarean Section And Natural Birth: The Opinions Of Health Provinces In The Province Of Buenos Aires, Jacqueline Chipkin

Independent Study Project (ISP) Collection

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized …

Pupillometry: A Non-Invasive Technique For Pain Assessment In Paediatric Patients., Mark A. Connelly, Jacob T. Brown, Gregory L. Kearns, Rawni A. Anderson, Shawn D. St Peter, Kathleen A. Neville

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic medications in adults. The aim of this observational study was to explore proof of concept for the use of this technique in paediatric patients. Changes in pupil parameters before and after opioid exposure also were evaluated.

DESIGN AND SETTING: This was a single-centre, prospective study conducted at an academic paediatric medical centre.

PATIENTS: Children 9-17 years of age undergoing elective surgical correction of pectus excavatum were enrolled into a protocol approved by the human ethical committee (institutional review board).

INTERVENTIONS: Pupil size and reactivity were measured using …

Variability Of Magnification On Digital Pelvic Radiographs From Patients With Fractures Of The Femoral Neck - A Retrospective Audit, Akbar Jaleel Zubairi, Tashfeen Ahmad

Department of Surgery

Abstract

OBJECTIVE:

To determine the variability in magnification of radiographs in an emergency setting.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent Austin Moore hemiarthroplasty over a two-year periodfrom 1st January 2006 to 31st December 2007. Magnification factor was determined using measurements obtained from preoperative and postoperative radiographs and comparing them with the actual size of implant used. Intra-observer and inter-observer reliability of measurements were calculated. SPSS 19 was used for data analysis.

RESULTS:

Of the 63 patients studied, 25(39.7%) were males and 38(60.3%) were females with an overall …

Rare Presentation Of Pancreatitis Secondary To Intussusception Of Duodenal Duplication Cyst, A Pediatric Case Report, Valentina Shakhnovich, Jennifer Colombo, Amita A. Desai, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Competing Interests Of Undergraduate Medical Education And Industry: Integration Into Longitudinal Curricular Themes., Shahryar Noordin, Sheilla Pinjani

Department of Surgery

Abstract

Recent changes in curricula around the globe with emphasis on teaching/learning and assessing professionalism in medical schools has been the priority. With the changing public expectations and professional demands, it has become imperative to develop clear guidelines and policies for students and faculty to better understand and meet the expectations of them as part of professionalism. In order to analyse this problem and highlight potential solutions, a literature search was conducted using Eric, Medline, Google Scholar and CINAHL Plus databases from 1985 to February 2013. We reviewed publications regarding the relationship between the pharmaceutical and device industry and medical …

Dynamic Hip Screw Fixation For Inter-Trochanteric Fractures: Determinants Of Outcomes, Adil Aijaz Shah, Santosh Kumar, Abdull Rehman

Department of Surgery

bstract

OBJECTIVE:

To evaluate factors associated with revision of dynamic hip screw implant in patients undergoing the procedure for the fixation of intertrochanteric fractures.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone dynamic hip screw fixation surgery between 2008 and 2012. Medical records and data for all patients were obtained from the medical records office. For all patients, the record files were systematically reviewed using a structured, pre-defined data extraction sheet. SPSS 20 was used statistical analysis.

RESULTS:

Out of 317 patients who had undergone the procedure, …

Functional And Radiological Outcome Of Intramedullary Nailing Vs. Plate Fixation For Humeral Shaft Fractures. Does Treatment Method Bring Any Difference?, Pervaiz Hashmi, Yasir Mohib

Department of Surgery

Abstract

BACKGROUD:

Operative Management of Humeral shaft fractures may be accomplished with the help of Plate fixation or IM Nails. Controversy exists as to which modality is superior to the other in terms of fewer complications and better functional and radiologicaloutcome.

OBJECTIVE:

To compare the differences in radiological and functional outcome of humeral shaft fractures managed by platefixation and antegrade intramedullary nails.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of Patients managed surgically for uncomplicated humeral shaft fractures between 2007 and 2012. The patients were followed up for one year at clinic, …

Here's The New Champ : Dr. Shirali Announces App For Infants With Heart Defects, Children's Mercy Hospital

Our Story Continues

News articles about the Cardiac High-Acuity Monitoring Program developed under Dr. Gigish Shirali's leadership which reduces mortality among children with single ventricle heart defects. This CHAMP app has since been used by other children's hospitals with continued success.

Surgical Suturing Training With Virtual Reality Simulation Versus Dry Lab Practice: An Evaluation Of Performance Improvement, Content, And Face Validity, Michael J. Amirian, Samuel M. Lindner, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

The purpose of this study is to evaluate the effectiveness of virtual reality (VR) simulation versus dry lab suturing practice at improving suturing performance in robotic surgery. Nineteen novice participants with no prior robotic suturing experience were randomized to two groups, VR simulation and dry lab, which consisted of inanimate training on a da Vinci Si surgical system. Each group underwent baseline suturing evaluation, then trained on the Simbionix™ Suturing Module (SSM) or undertook suturing practice using the da Vinci Surgical System in a dry lab. Final suturing performance was evaluated using the objective suture scoring method. Participants in the …

Comfort Care And Symptom Management, Shawnna Cannaday, Rn, Msn, Fnp-Bc, Theresa P. Yeo, Phd, Mph, Acnp

Pancreatic Cancer & Related Diseases Symposium

Discuss Common Concerns in Supportive Care

•Grief

•Pain

•Nausea / Constipation / Diarrhea

•Anxiety / Depression

•Fatigue / Tiredness

•Decision making

Heart Of The Matter, Children's Mercy Hospital

Our Story Continues

The Ward Family Heart Center at Children’s Mercy has received approval to begin performing pediatric heart transplants, making it the first healthcare facility in the Kansas City region to offer the life-saving procedure to pediatric patients.

Leading the Children’s Mercy heart transplant team are two nationally recognized experts:

James D. St. Louis, MD, is a board-certified thoracic and cardiac surgeon with more than 15 years of pediatric experience. Dr. St. Louis previously was the Director of Pediatric Cardiac Transplantation at the University of Minnesota Amplatz Children’s Hospital.

Aliessa P. Barnes, MD, is a board-certified pediatric cardiologist specializing in pediatric heart …

What's Good For The Heart Is Good For The Shoulder? Commentary On An Article By Chang-Meen Sung, Md, Et Al.: "Are Serum Lipids Involved In Primary Frozen Shoulder? A Case-Control Study"., Mark D Lazarus

Rothman Institute Faculty Papers

No abstract provided.

Bmp4 And Lgl1 Are Down Regulated In An Ovine Model Of Congenital Diaphragmatic Hernia, Heather M A Emmerton-Coughlin, K Kathryn Martin, Jacky S S Chiu, Lin Zhao, Leslie A Scott, Timothy R H Regnault, Andreana Bütter

Surgery Publications

BACKGROUND/PURPOSE: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH) remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP) 4 and other factors such as late gestation lung protein 1 (LGL1), are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model.

METHODS: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was …

Department Of Surgery Update, November/December 2014, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue for November and December of 2014 contains a message from the chair, pictures from the ACS Alumni Reception, a list of important dates, committee meetings, a list of presentations and more.

Robert Edward Gross (1905-1988): Ligation Of A Patent Ductus Arteriosus And The Birth Of A Specialty., Alexander V. Chalphin, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Stacey Milan, Md

Department of Surgery Gibbon Society Historical Profiles

The early 20th century saw an explosion in surgical expertise. Specialties dedicated to delicate organs such as the heart and vulnerable populations, like children, were in their infancy. Dr. William E. Ladd, the father of pediatric surgery, founded the first dedicated department of pediatric surgery at Boston Children’s Hospital in 1910. At the time, attempts at cardiac surgery almost universally ended in death of the patient. The first successful surgical treatment of the cardiac valves would not occur for another 15 years, and the great vessels would remain out of reach for decades more. Dr. Robert E. Gross, the shy …

Choledochal Cyst--A Different Disease In Newborns And Infants, Zafar Nazir, Munira Abdul Aziz

Department of Surgery

Abstract

We report experience of managing Choledochal Cyst (CC) in different paediatric ages. Eleven neonates and infants (aged 0-8 months) and 24 paediatric cases (aged 2.5 - 18 years) were managed over 24 years (1988 to 2012). Neonates and infants presented with jaundice, acholic stools and abdominal mass whereas most of the paediatric cases presented with intermittent non-specific abdominal pain. Morphology of CC was mostly cystic in neonates whereas it was fusiform in majority (62%) of paediatric cases. Biliary amylase was high and correlated with the presence of abnormal pancreaticobiliary junction (PBJ) in 20 /24 paediatric patients. Obstruction at the …

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Department of Medicine

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy.

Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice …

Mode Of Coronary Revascularization And Short Term Clinical Outcomes In Patients With Chronic Kidney Disease, Ashique Ali Khoso, K. Kazmi, Saqiba Tahir, Hasanat Sharif, Safia Awan

Department of Surgery

Abstract

BACKGROUND AND OBJECTIVE:

Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients.

METHODS:

In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with …

Plaque Index In Multi-Bracket Fixed Appliances, Zafar Ul Islam, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the plaque index in patients receiving multi-bracket fixed orthodontic treatment for various factors like age, gender, socio-economic status, brushing practices, meal habits, types of brackets, types of ligations, use of mouthwash and duration of treatment.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Orthodontics Clinic, The Aga Khan University Hospital, from September to November 2011.
Methodology: Socio-demographic and clinical modalities were defined and recorded for 131 patients having multi-bracket fixed appliances. The plaque index of subjects were recorded according to the Silness and Loe plaque index method. Independent sample t-test was used to see difference …

Technical Performance Score Is Associated With Outcomes After The Norwood Procedure., Meena Nathan, Lynn A. Sleeper, Richard G. Ohye, Peter C. Frommelt, Christopher A. Caldarone, James S. Tweddell, Minmin Lu, Gail D. Pearson, J William Gaynor, Christian Pizarro, Ismee A. Williams, Steven D. Colan, Carolyn Dunbar-Masterson, Peter J. Gruber, Kevin Hill, Jennifer Hirsch-Romano, Jeffrey P. Jacobs, Jonathan R. Kaltman, S Ram Kumar, David Morales, Scott M. Bradley, Kirk Kanter, Jane W. Newburger, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

Objectives: The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial.

Methods: We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, …

A Unique Mri Presentation Of Fungal Infection In The Brain, Muhammad Bilal Salman Khan, Saad Shafqat, Ather Enam

Section of Neurology

Fungal infections of CNS are common in certain geographic locations. MRI with or without contrast is a useful prediagnostic tool. However, the findings may sometimes be misleading. In this case report, the authors present unusual imaging findings in the MRI of fungal infection in an immunocompetent host, whereby hyper-intense signals were seen on T2-weighted images and patchy post-contrast enhancement was observed with surrounding edema. These findings were suggestive of a neoplastic lesion but it was identified as aspergillosis on subsequent histopathology. This unusual MRI finding of CNS highlights the need to consider fungal infection as a differential diagnosis of all …

Predictors Of Infections Following Cranioplasty: A Retrospective Review Of A Large Single Center Study., Mario Zanaty, Nohra Chalouhi, Md, Robert M Starke, Rohan Chitale, Md, Shannon Hann, Md, Cory D Bovenzi, Mark P Saigh, Eric W Schwartz, Emily S I Kunkel, Alexandra S Efthimiadis-Budike, Pascal Jabbour Md, Richard Dalyai, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

Introduction. The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty. Method. Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed. Results. Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% …