Medicine and Health Sciences Commons^™

Extracorporeal Membranous Oxygenation Mimics Aortic Dissection On Cat Scan., Philip Batista, Nicholas C. Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

A 66 year-old female presented with refractory acute congestive heart failure, cardiogenic shock, and ventricular tachyarrhythmia. Veno-arterial extracorporeal membrane oxygenation (ECMO) was placed via femoral cannulation for salvage and stabilized. CAT scan of the chest performed as a part of heart transplant work-up, demonstrated an unequal distribution of intravenous contrast in the aortic arch (Figure 1). Radiologist’s preliminary reading was of “aortic dissection” while in fact this is truly “normal ECMO flow”.

Successful Management Of Severe Liver Failure On Venoarterial Extracorporeal Membrane Oxygenation Using Molecular Adsorbent Recirculating Systeme., Shigeki Tabata, Nicholas Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

A 49-year-old female with Adriamycin induced cardiomyopathy presented with decompensated biventricular congestive heart failure. Despite multiple Inotropes, the patient’s hemodynamics deteriorated and she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) placement as a bridge to decision. Pre-ECMO workup showed liver dysfunction with elevated total bilirubin of 5.9 mg/dl, normal liver enzymes and liver ultrasound image. Tentative diagnosis of “end-stage liver failure” was made without a biopsy. Shortly after initiation of ECMO, the patient developed massive hemoptysis which was successfully managed with continuation of ECMO and ventilator management. [i] The patient’s total bilirubin continued to increase to peak of 56 mg/dl on …

Patient Safety In The Cardiac Operating Room: Human Factors And Teamwork: A Scientific Study From The American Heart Association, Joyce A. Wahr, Richard L. Prager, J. H. Abernathy Iii, Elizabeth A. Martinez, Eduardo Salas, Patricia C. Seifert, Robert C. Groom, Bruce D. Spiess, Bruce E. Searles, Thoralf M. Sundt Iii, Juan A. Sanchez, Scott A. Shappell, Michael H. Culig, Elizabeth H. Lazzara, David C. Fitzgerald, Vinod H. Thourani, Pirooz Eghtesady, John S. Ikonomidis, Michael R. England, Frank W. Selke, Nancy A. Nussmeier

Publications

The cardiac surgical operating room (OR) is a complex environment in which highly trained subspecialists interact with each other using sophisticated equipment to care for patients with severe cardiac disease and significant comorbidities. Thousands of patient lives have been saved or significantly improved with the advent of modern cardiac surgery. Indeed, both mortality and morbidity for coronary artery bypass surgery have decreased during the past decade. Nonetheless, the highly skilled and dedicated personnel in cardiac ORs are human and will make errors. Refined techniques, advanced technologies, and enhanced coordination of care have led to significant improvements in cardiac surgery outcomes.

Patient Safety In The Cardiac Operating Room: Human Factors And Teamwork: A Scientific Statement From The American Heart Association [Aha Scientific Statement], Joyce A. Wahr, Nancy A. Nussmeier, Richard L. Prager, Scott A. Shappell, J. H. Abernathy, Et Al.

Scott Shappell

Surgical Removal Of Urethral And Bladder Stones In Female Asian Elephant (Elephas Maximus) By Episiotomy And Urethrotomy, Nikorn Thongtip, Benjapol Lorsanyaluck, Manakorn Sukmak, Sirinart Chaichanathong, Naris Thengchaisri, Pornchai Sunyathitiseree, Worawidh Wajjwalku

The Thai Journal of Veterinary Medicine

A 45-year-old female Asian elephant (Elephas maximus) was presented with urinary incontinence and solid masses at the perineal area. Vaginoscopy revealed stricture of the vaginal vestibule. Trans skin and rectal ultrasonography demonstrated presence of hyperechogenic uroliths. Episiotomy and urethrotomy were performed after standing sedation with xylazine and perineal infiltration with lidocaine. Total of 8 kg urethral calculi were retrieved manually. Calcium carbonate was identified as the main component of the stones. Due to acute urinary obstruction after the operation, an episiotomy was left open allowing urine to pass through the incision. Following urine scalding, necrotic tissues were detected along the …

Horner's Syndrome Secondary To Neuroblastoma, Roberto A. Cruz, T. K. Tran, Nicky R. Holdeman, Christian Cajavilca, Rosa A. Tang

School of Medicine Publications and Presentations

Horner’s syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. The etiology is due to an interruption in the sympathetic innervation to the eye. A prompt diagnosis is crucial, given that Horner’s syndrome could be a manifestation of a life-threatening condition. A thorough case history and clinical evaluation must be employed to arrive at the diagnosis. An important means for confirming Horner’s syndrome is pharmacological testing, which is also used to localize the level where the sympathetic chain is compromised. Following the diagnosis and localization of the lesion, an algorithm should be followed to determine the …

Ultrasound Is The Optimal Choice For Guidance In Difficult Hysteroscopy., J. Kresowik, Craig Syrop, Bradley Van Voorhis, Ginny Ryan

Bradley J Van Voorhis

OBJECTIVES: To compare costs and complications associated with ultrasound-guided hysteroscopy vs laparoscopy-guided hysteroscopy vs hysteroscopy alone for the surgical repair of intrauterine septa and synechiae. METHODS: This was a retrospective cohort study. Charts of all patients undergoing reparative surgery for intrauterine synechiae or uterine septa at our academic institution between 2000 and 2008 were reviewed. A total of 159 procedures were included in the study, categorized into concurrent laparoscopic guidance (n = 69), ultrasound guidance (n = 52) or no guidance (n = 38). Data regarding billing, surgical case logs and complications were collected for these procedures. Using these data, …

The Design Of Patient-Specific Implants To Treat Bone Cancer, Shelby Marks

Honors Theses

Benign and malignant tumors often arise in bone due to metastasizing cancer. Thirty years ago limbs affected by tumors were treated with amputation, now with new technology, limb‐saving surgery is used most of the time; however, these surgical methods have limitations. Research shows a trend of using allografts and metallic implants to fill the bone gap once the tumor is resected. In some cases sections up to one third of the femur can be removed, sometimes disrupting the joint. There are many problems such as the integration and risk of failure in these implants. A more patient specific approach can …

Ultrasound Is The Optimal Choice For Guidance In Difficult Hysteroscopy., J. Kresowik, Craig Syrop, Bradley Van Voorhis, Ginny Ryan

Ginny L. Ryan

OBJECTIVES: To compare costs and complications associated with ultrasound-guided hysteroscopy vs laparoscopy-guided hysteroscopy vs hysteroscopy alone for the surgical repair of intrauterine septa and synechiae. METHODS: This was a retrospective cohort study. Charts of all patients undergoing reparative surgery for intrauterine synechiae or uterine septa at our academic institution between 2000 and 2008 were reviewed. A total of 159 procedures were included in the study, categorized into concurrent laparoscopic guidance (n = 69), ultrasound guidance (n = 52) or no guidance (n = 38). Data regarding billing, surgical case logs and complications were collected for these procedures. Using these data, …

State-By-State Variation In Emergency Versus Elective Colon Resections: Room For Improvement., Augustine C. Obirieze, Mehreen Kisat, Caitlin W. Hicks, Tolulope A. Oyetunji, Eric B. Schneider, Darrell J. Gaskin, Elliott R. Haut, David T. Efron, Edward E. Cornwell, Adil H. Haider

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Compared with elective surgical procedures, emergency procedures are associated with higher cost, morbidity, and mortality. This study seeks to investigate potential state-by-state variations in the incidence of emergent versus elective colon resections.

METHODS: A retrospective analysis of all adult patients (aged ≥18 years) included in the Nationwide Inpatient Sample from 2005 to 2009 who underwent hemicolectomy (right or left) or sigmoidectomy was conducted. Discharge-level weights were applied, and generalized linear models were used to assess the odds of a patient undergoing emergent versus elective colon surgery nationally and for each state after adjusting for patient and hospital factors. Odds …

A Case Of Congenital Unilateral Absence Of The Vas Deferens, Bi Mo, Vishnu Garla, Lawrence M. Wyner M.D.

Surgery

Background

Congenital unilateral absence of the vas deferens occurs in 0.5%–1.0% of males. It has been associated with various genitourinary abnormalities, including renal agenesis. We report a case of congenital unilateral absence of the vas deferens found incidentally during vasectomy in a patient with known unilateral renal agenesis.

Case presentation

A 24-year-old male presented to our urology clinic requesting vasectomy. His past history was significant for left renal agenesis. Following successful right vasectomy, several attempts to locate the left vas deferens were unsuccessful. We diagnosed congenital unilateral absence of the vas deferens. Follow-up semen analysis showed azoospermia.

Conclusion

As vasectomies …

A Magnetic-Resonance-Imaging-Compatible Remote Catheter Navigation System., Mohammad Ali Tavallaei, Yogesh Thakur, Syed Haider, Maria Drangova

Medical Biophysics Publications

A remote catheter navigation system compatible with magnetic resonance imaging (MRI) has been developed to facilitate MRI-guided catheterization procedures. The interventionalist's conventional motions (axial motion and rotation) on an input catheter - acting as the master - are measured by a pair of optical encoders, and a custom embedded system relays the motions to a pair of ultrasonic motors. The ultrasonic motors drive the patient catheter (slave) within the MRI scanner, replicating the motion of the input catheter. The performance of the remote catheter navigation system was evaluated in terms of accuracy and delay of motion replication outside and within …

Molecular Imaging To Target Transplanted Muscle Progenitor Cells, Kelly Gutpell, Rebecca Mcgirr, Lisa Hoffman

Anatomy and Cell Biology Publications

Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disorder that affects 1 in 3,500 boys, and is characterized by progressive muscle degeneration(1, 2). In patients, the ability of resident muscle satellite cells (SCs) to regenerate damaged myofibers becomes increasingly inefficient(4). Therefore, transplantation of muscle progenitor cells (MPCs)/myoblasts from healthy subjects is a promising therapeutic approach to DMD. A major limitation to the use of stem cell therapy, however, is a lack of reliable imaging technologies for long-term monitoring of implanted cells, and for evaluating its effectiveness. Here, we describe a non-invasive, real-time approach to evaluate the success of myoblast …

Predictors Of Adherence To Home Rehabilitation Exercises Following Anterior Cruciate Ligament Reconstruction, Howard A. Tennen

UCHC Articles - Research

Purpose/Objective

Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery.

Research Method/Design

Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively.

Results

Participants reported a high level of adherence to the prescribed regimen. Home exercise …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Faculty Papers

No abstract provided.

Patient Comfort And Multimodal Analgesia: Effects Of Preoperative Ibuprofen, Rodney Nash

Nursing Theses and Capstone Projects

Multimodal therapy for surgical patients is explified by use of a combination of a non-steroidal anti-inflammatory and an opioid to control visceral pain by decreasing both inflammation and pain transmission. Perioperative or postoperative use of multimodal therapy has been shown to provide adequate surgical pain relief while decreasing the total dose of opioids required. This project demonstrated that preoperative use of ibuprofen for women undergoing total laparoscopic hysterectomy decreased the total dose of opioids consumed in a 24-hour period, and increased the likelihood of the patient reaching her pain goal target at discharge. This finding adds to the literature support …

Improved Quality Of Life After Surgery For Pelvic Organ Prolapse In Nepalese Women, Rolina Dhital, Keiko Otsuka, Krishna C. Poudel, Junko Yasuoka, Ganesh Dangal, Masamine Jimba

Krishna C. Poudel

Background: Pelvic organ prolapse (POP) is a common gynecological condition that can affect quality of life (QOL) in women. In Nepal, the prevalence of POP is high, but many affected women are still deprived of treatment. Vaginal hysterectomy with pelvic floor repair is one of the common treatment options for advanced POP. However, QOL outcomes after surgery have not been reported in low-income countries. Thus, we aimed to examine changes in QOL among Nepalese women with POP after such surgery. Methods: This longitudinal study was conducted in the selected central and peripheral hospitals in Nepal where vaginal hysterectomy was being …

Incomplete Polyp Resection During Colonoscopy—Results Of The Complete Adenoma Resection (Care) Study, Heiko Pohl, Amitabh Srivastava, Steve P. Bensen, Peter Anderson, Richard I. Rothstein, Stuart R. Gordon, L Campbell Levy, Arifa Toor, Todd A. Mackenzie, Thomas Rosch, Douglas J. Robertson

Dartmouth Scholarship

Although the adenoma detection rate is used as a measure of colonoscopy quality, there are limited data on the quality of endoscopic resection of detected adenomas. We determined the rate of incompletely resected neoplastic polyps in clinical practice.We performed a prospective study on 1427 patients who underwent colonoscopy at 2 medical centers and had at least 1 nonpedunculated polyp (5-20 mm). After polyp removal was considered complete macroscopically, biopsies were obtained from the resection margin. The main outcome was the percentage of incompletely resected neoplastic polyps (incomplete resection rate [IRR]) determined by the presence of neoplastic tissue in post-polypectomy biopsies. …

Coblation-Assisted Lewis And Mackay Operation (Coblamo): New Technique For Tongue Reduction In Sleep Apnoea Surgery, Stuart Mackay, N Jefferson, L Grundy, R Lewis

Faculty of Science, Medicine and Health - Papers: part A

Background: Obstructive sleep apnoea is a common condition that is unfortunately associated with a high rate of patient non-compliance regarding device use. Newer surgical interventions have focused on procedures at the palate level, using variants of palatoplasty and transpalatal advancement. However, the extent of tongue reduction surgery required remains controversial. The authors propose an in-between variant that combines midline glossectomy resection (with minimal mucosal sacrifice) and lateral coblation tongue channelling. Method: Four patients underwent a coblation-assisted Lewis and MacKay operation, which is a new technique for tongue reduction. This involved a midline glossectomy combined with lateral coblation channelling of the …

Effects Of Intravenous Diclofenac On Postoperative Sore Throat In Patients Undergoing Laparoscopic Surgery At Aga Khan University Hospital, Nairobi: A Prospective, Randomized, Double Blind Controlled Trial, Thang'a P., Dorothy Kamya, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated.

Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat.

Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and …

Errors In Device Localization In Mri Using Z-Frames., Jeremy Cepek, Blaine A Chronik, Aaron Fenster

Brain and Mind Institute Researchers' Publications

The use of a passive MRI-visible tracking frame is a common method of localizing devices in MRI space for MRI-guided procedures. One of the most common tracking frame designs found in the literature is the z-frame, as it allows six degree-of-freedom pose estimation using only a single image slice. Despite the popularity of this design, it is susceptible to errors in pose estimation due to various image distortion mechanisms in MRI. In this paper, the absolute error in using a z-frame to localize a tool in MRI is quantified over various positions of the z-frame relative to the MRI isocenter, …

Extracorporeal Membranous Oxygenation Mimics Aortic Dissection On Cat Scan., Philip Batista, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

A 66 year-old female presented with refractory acute congestive heart failure, cardiogenic shock, and ventricular tachyarrhythmia. Veno-arterial extracorporeal membrane oxygenation (ECMO) was placed via femoral cannulation for salvage and stabilized. CAT scan of the chest performed as a part of heart transplant work-up, demonstrated an unequal distribution of intravenous contrast in the aortic arch (Figure 1). Radiologist’s preliminary reading was of “aortic dissection” while in fact this is truly “normal ECMO flow”.

A New Model For Partial Immobilization Of Rat Hind Limb After Achilles Tendon Excision/Reinterposition, Cansin Güngörmüş, Mehmet Alper Çeti̇nkaya, Alper Demi̇rutku

Turkish Journal of Veterinary & Animal Sciences

There have been several attempts to repair the Achilles tendon by surgery or replacement with graft materials. Because tissue repair is a complex process, tendon healing occurs slowly. In rats, immobilization of the limb is essential during recovery. There are immobilization methods such as plaster or fiber casting. According to prolonged recovery, most of the procedures cause skin ulceration, decrease in weight, restrictions in checking the surgery area, and slipping out of the cast. Our aim was to apply a suture around the defect for immobilization. Tendons of 30 male Wistar rats (250 ± 50 g and aged 8 ± …

Clinical Manifestations Of 16 Oropharyngeal Tularemia Patients: Experience Of A Referral Hospital In The City Of Konya, Turkey, Mesut Sabri̇ Tezer, Gülteki̇n Övet, Necat Alataş, Mehmet Hakan Görgülü, Ersen Koç, Mehmet Aki̇f Öztürk

Turkish Journal of Medical Sciences

In recent years, tularemia's importance has been reemerging in Turkey. However, the majority of tularemia cases were reported in the northern cities of Turkey. In this study, we report 16 oropharyngeal tularemia patients living in rural areas of the city of Konya, which is located in the southern zone of the Central Anatolia Region of Turkey. Materials and methods: Sixteen patients (12 males, 4 females; mean age: 33.7 years, range: 10–73 years) were included in this study. All patients were admitted to our clinic for the evaluation of intractable cervical mass lesions. The diagnosis of tularemia was made after exclusion …

A Review Of Comparison Of Complications Of Vaginal Hysterectomy With And Without Concomitant Surgery For Sui: A 5 Years’ Experience At A Tertiary Care Hospital Of Pakistan, Raheela Mohsin Rizvi, Munnazza Akhtar, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH …

Open Versus Laparoscopic Hiatal Hernia Repair., Terrence M. Fullum, Tolulope A. Oyetunji, Gezzer Ortega, Daniel D. Tran, Ian M. Woods, Olusola Obayomi-Davies, Orighomisan Pessu, Stephanie R. Downing, Edward E. Cornwell

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The literature reports the efficacy of the laparoscopic approach to paraesophageal hiatal hernia repair. However, its adoption as the preferred surgical approach and the risks associated with paraesophageal hiatal hernia repair have not been reviewed in a large database.

METHOD: The Nationwide Inpatient Sample dataset was queried from 1998 to 2005 for patients who underwent repair of a complicated (the entire stomach moves into the chest cavity) versus uncomplicated (only the upper part of the stomach protrudes into the chest) paraesophageal hiatal hernia via the laparoscopic, open abdominal, or open thoracic approach. A multivariate analysis was performed controlling for …