Medical Specialties Commons^™

Cushioned On The Way Up, Controlled On The Way Down During Resuscitative Endovascular Balloon Occlusion Of The Aorta (Reboa): Investigating A Novel Compliant Balloon Design For Optimizing Safe Overinflation Combined With Partial Reboa Ability, Adam Power, Asha Parekh, Neil Parry, Laura J Moore

Faculty, Staff and Student Publications

Background: There are a variety of devices capable of performing resuscitative endovascular balloon occlusion of the aorta (REBOA), with most containing compliant balloon material. While compliant material is ideal for balloon inflation due to its "cushioning" effect, it can be problematic to "control" during deflation. The COBRA-OS (Control Of Bleeding, Resuscitation, Arterial Occlusion System) was designed to optimize inflation and deflation of its compliant balloon and was tested in vitro and in vivo with respect to its overinflation and partial REBOA abilities.

Methods: For overinflation, the COBRA-OS was inflated in three differently sized inner diameter (ID) vinyl tubes until balloon …

Traumatized Triad Of Complementopathy, Endotheliopathy, And Coagulopathy – Impact On Clinical Outcomes In Severe Polytrauma Patients, Zhangsheng Yang, Tuan D Le, Milomir O Simovic, Bin Liu, Tamara L Fraker, Tomas S Cancio, Andrew P Cap, Charles E Wade, Jurandir J Dallelucca, Yansong Li

Faculty, Staff and Student Publications

Complementopathy, endotheliopathy, and coagulopathy following a traumatic injury are key pathophysiological mechanisms potentially associated with multiple-organ failure (MOF) and mortality. However, the heterogeneity in the responses of complementopathy, endotheliopathy, and coagulopathy to trauma, the nature and extent of their interplay, and their relationship to clinical outcomes remain unclear. Fifty-four poly-trauma patients were enrolled and divided into three subgroups based on their ISS. Biomarkers in blood plasma reflecting complement activation, endothelial damage, and coagulopathy were measured starting from admission to the emergency department and at 3, 6, 12, 24, and 120 hours after admission. Comparative analyses showed that severely injured patients …

Palliative Endoscopic Salvage Of A Functionally Obstructed Gastrojejunostomy - Report Of Technique, Elias A Chamely, Bryan Hoang, Nadim S Jafri, Melissa M Felinski, Kulvinder S Bajwa, Peter A Walker, Jaideep Barge, Erik B Wilson, Putao Cen, Shinil K Shah

Faculty, Staff and Student Publications

BACKGROUND: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

CASE DESCRIPTION: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical …

Management Of Biliary Stones In Bariatric Surgery, Francisco Tustumi, João Emílio Lemos Pinheiro Filho, Lucas Cata Preta Stolzemburg, Leonardo Carvalho Serigiolle, Thiago Nogueira Costa, Denis Pajecki, Marco Aurélio Santo, Sérgio Carlos Nahas

Faculty, Staff and Student Publications

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.

Plain language summary: Management of biliary stones in …

Invasive Haemophilus Influenza Type B In An Infant During The Covid-19 Pandemic: The Return Of Diseases We Hoped Never To See Again…, Christy Tabarani, Stephen A Fletcher, Gloria P Heresi, Susan H Wootton

Faculty, Staff and Student Publications

No abstract provided.

Regenerative Medicine Technologies Applied To Transplant Medicine An Update, Astgik Petrosyan, Filippo Montali, Andrea Peloso, Antonio Citro, Lori N Byers, Catherine La Pointe, Mara Suleiman, Alice Marchetti, Eoin P Mcneill, Allison L Speer, Wai Hoe Ng, Xi Ren, Benedetta Bussolati, Laura Perin, Paolo Di Nardo, Vincenzo Cardinale, Jerome Duisit, Alexandra Rose Monetti, John Richard Savino, Amish Asthana, Giuseppe Orlando

Faculty, Staff and Student Publications

Regenerative medicine (RM) is changing how we think and practice transplant medicine. In regenerative medicine, the aim is to develop and employ methods to regenerate, restore or replace damaged/diseased tissues or organs. Regenerative medicine investigates using tools such as novel technologies or techniques, extracellular vesicles, cell-based therapies, and tissue-engineered constructs to design effective patient-specific treatments. This review illustrates current advancements in regenerative medicine that may pertain to transplant medicine. We highlight progress made and various tools designed and employed specifically for each tissue or organ, such as the kidney, heart, liver, lung, vasculature, gastrointestinal tract, and pancreas. By combing both …

Recurrent Hgnet-Mn1 Altered (Astroblastoma Mn1-Altered) Of The Foramen Magnum: Case Report And Molecular Classification, Sricharan Gopakumar, Malcolm F Mcdonald, Himanshu Sharma, Claudio E Tatsui, Gregory N Fuller, Ganesh Rao

Faculty, Staff and Student Publications

Background: Astroblastoma is a rare primary brain tumor of unclear origin, often occurring in young patients less than 30-years-old. It typically arises supratentorially and is diagnosed based on histological features including vascular hyalinization and perivascular pseudorosettes. Recent molecular characterization of primary CNS high-grade neuroepithelial tumors with meningioma I alteration (HGNET-MN1) found that HGNET-MN1 and tumors with morphological signatures of astroblastoma clustered together. Further analysis revealed such astroblastomas have MN1 alteration and the 2021 WHO classification of tumors of the CNS now recognizes astroblastoma MN1-altered as a new entity.

Case description: Here, we present the case of …

Radiation Of Meningioma Dural Tail May Not Improve Tumor Control Rates., Keenan Piper, Siyuan Yu, Mohammad Taghvaei, Christian Fernandez, Nikolaos Mouchtouris, Rupert D Smit, Clifford Yudkoff, Sarah Collopy, Maikerly Reyes, Pascal Lavergne, Michael Karsy, Giyarpuram Prashant, Wenyin Shi, James J. Evans

Student Papers, Posters & Projects

Introduction: Dural tails are thickened contrast-enhancing portions of dura associated with some meningiomas. Prior studies have demonstrated the presence of tumor cells within the dural tail, however their inclusion in radiation treatment fields remains controversial. We evaluated the role of including the dural tail when treating a meningioma with stereotactic radiation and the impact on tumor recurrence.

Methods: This is a retrospective, single-institution, cohort study of patients with intracranial World Health Organization (WHO) grade 1 meningioma and identified dural tail who were treated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) from January 2012 to December 2018. SRS and …

Management Of Perioperative Anticoagulation In A Patient With Antiphospholipid Antibody Syndrome Undergoing Cardiac Surgery: A Case Report, Sanjana A Malviya, Yi Deng, Sayyed O Gilani, Alec A Hendon, Melissa A Nikolaidis, Micah S Moseley

Faculty, Staff and Students Publications

Patients with Antiphospholipid syndrome (APLS) are at high risk for both bleeding and thrombotic complications during cardiac surgery involving cardiopulmonary bypass (CPB). In this case we present a patient with APLS and Immune Thrombocytopenic Purpura who successfully underwent aortic valve replacement (AVR) with CPB despite recent craniotomy for subdural hematoma evacuation. Anticoagulation for CPB was monitored by targeting an Activated Clotting Time (ACT) that was 2× the upper limit of normal. A multidisciplinary approach was essential in ensuring a safe and successful operation.

Analysis Of Short-Term Efficacy Of Gasless Single-Port Laparoscopic Inguinal Lymphadenectomy Through Vulva Incision For Vulvar Cancer, Jin Ding, Piaopiao Teng, Xiaoming Guan, Yonghong Luo, Huafeng Ding, Suhua Shi, Xiufen Zhou, Guantai Ni

Faculty, Staff and Students Publications

OBJECTIVE: To investigate the feasibility and short-term efficacy of gasless single-port laparoscopic inguinal lymphadenectomy through vulva incision (VEIL-V).

METHODS: The data of 9 patients diagnosed as vulvar squamous cell carcinoma who underwent single-port laparoscopic inguinal lymph node dissection through vulvectomy incision were retrospectively analyzed. And 13 patients who underwent laparoscopic inguinal lymph node dissection through lower abdominal subcutaneous approach as the control group (VEIL-H). The operation time, blood loss, numbers of unilateral lymph nodes, hospitalization time, and complications between the two groups were compared.

RESULTS: The operation time of VEIL-V was 56.11 ± 5.94 min, which were shorter than that …

Single-Port Laparoscopic Sacrospinous Ligament Suspension Via The Natural Vaginal Cavity (Svnotes) For Pelvic Prolapse: The First Feasibility Study, Yuanyuan Lyu, Huafeng Ding, Jin Ding, Yonghong Luo, Xiaoming Guan, Guantai Ni

Faculty, Staff and Students Publications

Objective

This study aims to investigate the feasibility and short-term efficacy of single-port laparoscopic-assisted transvaginal natural cavity endoscopic sacrospinous ligament suspensions (SvNOTES).

Methods

A total of 30 patients diagnosed with anterior or/and middle pelvic organ prolapse Stages III and IV underwent natural vaginal cavity (SvNOTES), and 30 patients who underwent conventional sacrospinous ligament (SSLF) were used as a control group. The operation time, blood loss, postoperative POP-Q score, length of hospital stay, and complications were compared between the two groups.

Results

The operation time for SvNOTE was (60 ± 13) min, which was longer than (30 ± 15) min for …

Plastic Multilayered Closure Versus Orthopedic Surgeon Closure After Spinal Instrumentation In Pediatric Neuromuscular Scoliosis, Ekene U Ezeokoli, Poornima L Tamma, Neritan Borici, Ifeoma Inneh, Edward P Buchanan, Brian G Smith

Faculty, Staff and Students Publications

OBJECTIVE: To compare wound complication rates between orthopedic closure (OC) and plastic multilayered closure (PMC) in patients undergoing primary posterior spinal fusion for neuromuscular scoliosis (NMS). We hypothesize that multilayered closure will be associated with better postoperative outcomes.

METHODS: We collected data on pediatric patients diagnosed with NMS who underwent first time spinal instrumentation between 1 January 2018 and 31 May 2021. Patient demographics, length of surgery, spinal levels fused and operative variables, wound complication rate, treatments, and need for wound washout were reviewed in depth and recorded.

RESULTS: In total, 86 patients were reviewed: 46 with OC and 40 …

Jacuzzi-Induced Pneumoperitoneum: Case Report And Literature Review, Obteene Azimi-Ghomi, Dieter Brummund, Vasiliy Ovakimyan, Gerardo Kahane

HCA Healthcare Journal of Medicine

Radiographically-detected pneumoperitoneum in the setting of acute onset abdominal pain is a classic case among surgical emergencies. The spectrum of etiology ranges from benign to catastrophic, and the ability to differentiate depends in large part on the history and physical exam findings. Included among non-surgical types of pneumoperitoneum are (1) post-operative, (2) diagnostic/experimental, (3) gynecologic tract air entry, (4) the difference in intra- and extra-alveolar pressures, pneumothorax-associated and (5) miscellaneous. Jacuzzi-induced pneumoperitoneum is an extremely rare form of non-surgical pneumoperitoneum. We discuss a case of a 32-year-old female presenting with pneumoperitoneum and acute onset abdominal pain secondary to vaginal insertion …

Consequential Surgeries Limit Recurrence Of Skin Malignancies In Xeroderma Pigmentosum: A Case Report, Ahmad Kurnia, Diani Kartini, Novinda Herwirastri, Zoya M. Adyasa

The New Ropanasuri Journal of Surgery

Xeroderma Pigmentosum (XP) is a rare inherited skin malignancy with no causative treatment options. Reporting a 23-year-old woman with xeroderma pigmentosum who underwent several surgical tumor removals followed by further five procedures to apply tissue expander, facial resurfacing using full-thickness skin grafts with a donor from abdominal. The next series was tumor resection in the chin, forehead, nasal reconstruction, tumor removal on bilateral third digits, and defect closure. No recurrence after nine years of postoperative monitoring with an aesthetically acceptable result.

Different Approaches Of Suspected Unilateral And Bilateral Maxillary Sinus Myxoma, Two Rare Cases Report, Marlinda Adham, Ferucha Moulanda

The New Ropanasuri Journal of Surgery

Maxillary sinus myxoma is a rare benign tumor with locally aggressive behavior and can infiltrate surrounding structures. Surgical intervention is considered the primary procedure with several approaches for wider tumor exposure, complete tumor removal, and better wound healing. In this article, two cases of suspected unilateral and bilateral maxillary sinus myxoma were presented with different approaches applied for both cases. We managed two patients, a 37-year-old male with mass at right maxilla and a 60-year-old male with mass at both maxillae. Physical examination, radiology imaging, and pre-operative histopathology examination showed maxillary sinus myxoma. The total maxillectomy procedure with Weber Ferguson …

Factors Affecting Renal Function On Ileostomy In Dr. Cipto Mangunkusumo General Hospital: A Cross-Sectional Study, Lam Sihardo, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Every year, about 30—60 ileostomy with various underlying diseases and indications were created in Dr. Cipto Mangunkusumo General Hospital (CMGH). There were a lot of complications attributable to these creations; one is the decline of renal function. The study goal was to find out factors influencing the renal function of ileostomy in CMGH.

Method. A cross-sectional study was conducted using medical records in April – May 2021. Samples were taken using the purposive sampling method. Inclusion criteria include male or female patients who underwent ileostomy closure in CMGH in the last four years with complete BMI, ileostomy creation and …

Survival Rate Of Critically Ill Coronavirus Disease 2019 Patients On Tracheostomy In Indonesia, Aris Ramdhani, Dita Aditianingsih, Raihanita Zahra, Muhammad A. Putra, Wuryantoro Soeharto, Melvin D.B. Kwa

The New Ropanasuri Journal of Surgery

Introduction. During COVID-19 global pandemic, tracheostomy is often performed on critically ill COVID-19 patients. There is no available data on the survival rate of critically ill COVID-19 patients on tracheostomy in Indonesia. This study aimed to find the survival rate of critically ill COVID-19 patients on tracheostomy in Indonesia.

Methods. A descriptive survival analysis study enrolled critically ill COVID-19 patients in RSUI who underwent a tracheostomy procedure. Baseline data, including clinical characteristics and laboratory findings before tracheostomy, were recorded. Survival analysis was conducted using the Kaplan-Meier plot.

Results. Forty-two subjects were enrolled in the study: 25 males (59.5%) and 17 …

The New Version Of Accreditation For Higher Education In Health, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

No abstract provided.

Prognostic And Predictive Factors Of Mortality In Burn Patients At Dr. Cipto Mangunkusumo General Hospital, Indonesia, Muhamad Irfan A. Hasibuan, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Introduction. Some prognostic– and predictive factors in burn have never been investigated in Indonesian specific characteristics, which is delayed treatment. A study was conducted to determine prognostic and predictive factors in this specific characteristic.

Method. A retrospective cohort focused on burn mortality in extensive burns managed in CMGH from 1998–2010. Some known prognostic– and predictive factors and unknown ones were the variables of interest. Bivariate and multivariate using logistic regression analysis proceeded to find out these factors.

Results. Out of all factors investigated, the variables that showed a significant correlation were: TBSA, inhalation injury, Baux score, revised …

Cutaneous Horn On The Right Supraclavicular Region In An Adolescent Female, A Rare Case Report, Rohit Gupta, Manoj Kumar, Ruchi Sinha, Reva Shankar Sahu

The New Ropanasuri Journal of Surgery

Cutaneous horn (CH) is an outgrowth from the skin surface, composed of keratin, and associated with benign to malignant skin lesions. We report a case of CH in a 15-year-old female associated with Keratoacanthoma. It is uncommon in young people and is associated with a good prognosis because of its benign nature. This case needs to be reported as it highlights the rare occurrence of this condition in the younger age group and its good prognosis. Surgical excision is the treatment of choice, with histopathologic diagnosis playing a critical role in determining the nature and further treatment of this condition …

Intraoperative Acoustics: Auditory Cues In Hip Reconstructive Surgery, Jeffrey M. Henstenburg, Walaa Abdelfadeel, Anthony J. Boniello, Joseph Schmitz, Jeffrey J. Vakil, Andrew M. Star

Rothman Institute Papers

Background: Orthopaedic surgeons rely on visual and tactile cues to guide performance in the operating room (OR). However, there is very little data on how sound changes during orthopaedic procedures and how surgeons incorporate audio feedback to guide performance. This study attempts to define meaningful
changes in sound during vital aspects of total hip arthroplasty (THA) within the spectrum of human hearing.

Methods: 84 audio recordings were obtained during primary elective THA procedures during sawing of the femoral neck, reaming of the acetabulum, acetabular cup impaction, polyethylene liner impaction, femoral broaching, planning of the femoral calcar and press-fit of a …

Candida Pericarditis Presenting With Cardiac Tamponade And Multiple Organ Failure After Combined Damage Control Thoracotomy And Laparotomy With Splenectomy In A Trauma Patient: Case Report And Review Of Literature, R. A. Siller, Jeffrey Skubic, J. L. Almeda, Adolfo E. Kaplan

School of Medicine Publications

Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and …

Thyroidectomy In Mechanical Circulatory Support - A Salvage Treatment For Thyrotoxicosis-Induced Cardiogenic Shock: Case Series, Rody G. Bou Chaaya, Lauren M. Saint, Onyedika J. Ilonze Md, Mph

The VAD Journal

Amiodarone is frequently used to treat arrhythmias in patients supported with left ventricular assist devices. Long term amiodarone use can cause hyperthyroidism ultimately leading to cardiomyopathy and sometimes thyrotoxicosis-induced cardiogenic shock (CS). We describe two cases of thyrotoxicosis-induced CS rescued by successful thyroidectomy under mechanical circulatory support (MCS) – one with a Heartmate III (Abbott Laboratories) and another supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO). In refractory CS, the initiation of V-A ECMO as a bridge to recovery is critical. In thyrotoxicosis-induced CS that is refractory to medical therapy requiring MCS, thyroidectomy is feasible, and a growing body of …

Decreasing Pre-Procedural Fasting Times: A Benchmark Study, Sheila Gasparek

MSN Capstone Projects

On a busy Surgical Trauma unit, scheduled procedures and operations are often delayed for priority emergent cases. Patients admitted to the unit with delayed procedures often endure extended fasting times beyond the six-hour intention of standard nothing by mouth (NPO) after midnight fasting order. With prolonged fasting times, patients inquire about pending surgery times and dietary options. Some providers may allow ice chips, but most doctors prefer patients to remain NPO in case Operating Room availability opens for surgery, leaving already anxious and uncomfortable patients more frustrated as prolonged fasting affects patients’ physical and psychological well-being (Anderson & Comrie, 2009). …

Reduced Risk Of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From A United States Claims Database, Chengyuan Wu, Sean J Nagel, Rahul Agarwal, Monika Pötter-Nerger, Wolfgang Hamel, Ashwini Sharan, Allison T Connolly, Binith Cheeran, Paul S Larson

Department of Neurosurgery Faculty Papers

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.

Design: Retrospective, contemporaneous cohort study.

Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.

Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, …

Genetic Susceptibility To Hepatocellular Carcinoma In Chromosome 22q13.31, Findings Of A Genome-Wide Association Study., Zhanwei Wang, Anuradha S Budhu, Yi Shen, Linda Lou Wong, Brenda Y Hernandez, Maarit Tiirikainen, Xiaomei Ma, Melinda L Irwin, Lingeng Lu, Hongyu Zhao, Joseph K Lim, Tamar Taddei, Lopa Mishra, Karen Pawlish, Antoinette Stroup, Robert Brown, Mindie H Nguyen, Jill Koshiol, Maria O Hernandez, Marshonna Forgues, Hwai-I Yang, Mei-Hsuan Lee, Yu-Han Huang, Motoki Iwasaki, Atsushi Goto, Shiori Suzuki, Koichi Matsuda, Chizu Tanikawa, Yoichiro Kamatani, Dean Mann, Maria Guarnera, Kirti Shetty, Claire E Thomas, Jian-Min Yuan, Chiea Chuen Khor, Woon-Puay Koh, Harvey Risch, Xin Wei Wang, Herbert Yu

Surgery Faculty Publications

Background and Aim: Chronic hepatitis C virus (HCV) infection, long-term alcohol use, cigarette smoking, and obesity are the major risk factors for hepatocellular carcinoma (HCC) in the United States, but the disease risk varies substantially among individuals with these factors, suggesting host susceptibility to and gene-environment interactions in HCC. To address genetic susceptibility to HCC, we conducted a genome-wide association study (GWAS).

Methods: Two case-control studies on HCC were conducted in the United States. DNA samples were genotyped using the Illumian microarray chip with over 710 000 single nucleotide polymorphisms (SNPs). We compared these SNPs between 705 HCC cases and …

Laparoscopic Assisted Robotic Radical Prostatectomy With Pelvic Lymph Node Dissection Using Viable Cryopreserved Umbilical Tissue To Improve Cavernosal Nerve Function., Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason Hafron

Conference Presentation Abstracts

Radical prostatectomy is the preferred treatment for patients with clinically localized prostate cancer and is typically performed using a robotic approach. Surgical techniques that preserve the neurovascular bundle minimize the risk of incontinence and erectile dysfunction post-operatively. Umbilical cord tissue is a relatively new technique, which has been shown to reduce inflammation and promote regenerative healing. In this video we show a robotic radical prostatectomy with bilateral nerve sparing technique utilizing a cryopreserved umbilical cord allograft nerve wrap.

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

The Effect Of Saline Flush After Rocuronium Bolus On Intubating Conditions In Adult Patients Undergoing Elective Surgery: A Randomized Controlled Trial, Ian Odari, Vitalis Mung’Ayi, Rajpreet Bal, David Odaba

Anaesthesiology, East Africa

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time to avoid hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time. All these methods have positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, we investigated the effects of a 20 ml saline bolus following intravenous rocuronium at 0.6 mg/kg on the proportions of patients with excellent intubating conditions …

Surgical Management Of Subclavian And Proximal Axillary Artery Injuries, Zia Ur Rehman, Suleman Yousaf, Tehmeed Ahmad

Department of Surgery Docs

Subclavian and proximal axillary arterial injuries are rare and difficult to manage. Eight patients were managed from January 2008 to December 2018 at The Aga Khan University Hospital, Karachi, Pakistan with mean age of 36.13 ± 14.48 years. All patients had penetrating injuries, from gunshot in 5 (62.5%), bomb blast in 2 (25%), and stab wound in 1 (12.5%) case. Six (75%) patients presented in haemodynamically stable condition. The mean time between the injury and patient presentation was 28 ± 8.39 hours. The injuries were approached via supraclavicular incision in 3 (37.5%) patients, infraclavicular incisions in 2 (25%) patients and …