Medical Specialties Commons^™

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review., Andrew Jack, Wyatt L Ramey, Joseph R Dettori, Zane Tymchak, Rod J Oskouian, Robert A Hart, Jens R Chapman, Dan Riew

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common …

The Identification Of Long Non-Coding Rna Zfas1 Through An Exploratory Rna-Sequencing Analysis And Its Association With Epithelial-To-Mesenchymal Transition In Colon Cancer Adenocarcinoma., Stephen J. O'Brien

Electronic Theses and Dissertations

Colorectal adenocarcinoma is the fourth most common cancer diagnosed worldwide and is a significant cause of morbidity and mortality. This dissertation performed an exploratory RNA-sequencing analysis comparing gene expression between colon adenocarcinoma tissue and paired normal colon epithelium. After identification of a number of lncRNAs that were increased in expression in colon adenocarcinoma compared to normal colon epithelium, we aimed to validate the expression and investigate their function in vitro. Specifically, we focused on the lncRNA ZFAS1 and its association with epithelial-to-mesenchymal transition. These studies found the following: 1. Seven candidate lncRNAs were identified from the exploratory RNA-sequencing analysis to …

Percutaneous Venoplasty For Central Venous Stenosis: Effect On Patient's Symptoms And Patency Of Arteriovenous Accesses, Zia Ur Rehman, Abdul Hakeem Memon, Raza Sayani, Nida Zahid

Department of Surgery Docs

Objective: To determine symptomatic relief and patency rate of arteriovenous (AV) fistulae and grafts after venoplasty in patients with central venous stenosis (CVS) on hemodialysis.
Study Design: Case series.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2012 to December 2017.
Methodology: The data of patients who had one session of successful venoplasty for CVS were reviewed. The outcomes measured were symptomatic recovery and improvement in the patency of AV accesses. Symptomatic recovery was termed 'complete', when there was complete symptomatic relief after venoplasty; and 'partial' when the procedure was technically successful, but symptoms were …

Distal Splenorenal Shunt (Dsrs) In Children With Extrahepatic Portal Hypertension, Zia Ur Rehman, Zafar Nazir

Department of Surgery Docs

Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.

Brief History Of Spinal Neurosurgical Societies In The United States: Part 1., Sasha Vaziri, Daniel K. Resnick, Christopher P. Ames, James S. Harrop, Christopher I. Shaffrey, Kern Singh, Justin S. Smith, Daniel J. Hoh

Department of Neurosurgery Faculty Papers

No abstract provided.

Burnout, Job Dissatisfaction, And Mental Health Outcomes Among Medical Students And Health Care Professionals At A Tertiary Care Hospital In Pakistan: Protocol For A Multi-Center Cross-Sectional Study, Syed Hamza Mufarrih, Aeman Naseer, Nada Qaisar Qureshi, Zohaib Anwar, Nida Zahid, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Biological & Biomedical Sciences

Burnout, a state of vital exhaustion, has frequently been related to work-related stress and job dissatisfaction. Given the emotionally and physically challenging nature of their work, high rates of burnout have been reported among health care professionals. This may put them at a higher risk for of suffering from adverse mental health outcomes, including depression, anxiety and stress. In our study, we aim to assess the prevalence i of and associations among burnout and job dissatisfaction and adverse mental health outcomes in a developing country, where the challenges faced by the health care system are unique. Facilities are over-burdened and …

Pediatric Brainstem Gliomas: An Institutional Experience, Altaf Ali Laghari, Mirza Zain Baig, Muhammad Ehsan Bari, Aneela Darbar, Naureen Mushtaq, Umme E Hani Abdullah, Daniya Aziz Khan

Section of Neurosurgery

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute.
Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis.
Results: The mean age of our cohort …

The Early "Unnatural" History Following Surgical Repair Of Ventricular Septal Defects., Sathish M. Chikkabyrappa, Justin T. Tretter, Arpan R. Doshi, Sujatha Buddhe, Puneet Bhatla, Achi Ludomirsky

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of …

Management Of Traumatic Subarachnoid Hemorrhage By The Trauma Service: Is Repeat Ct Scanning And Routine Neurosurgical Consultation Necessary?, Stephen W. Cooper, Kimberly B. Bethea, Trevor J. Skrobut, Rod G. Gerardo, Juan Torres-Reveron, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13-15) who presented over a 5-year …

Method Of Predicting Obesity Comprising Measuring Neurotensin, B. Mark Evers, Jing Li, Paul Dobner, Olle Melander

Surgery Faculty Patents

The presently disclosed subject matter relates to a method for predicting increased risk of obesity on a non-obese subject. More particularly, the presently disclosed subject matter relates to a method of predicting increased risk of obesity in a non-obese subject by determining a level of neurotensin expression in a biological sample from the subject and comparing the level of neurotensin expression in the sample with a control level. The presently disclosed subject matter further relates to a method of preventing and/or treating obesity in a subject in need thereof by administering to the subject an effective amount of an agent …

Floor Of Mouth Thyroglossal Duct Cyst: A Rare Embryologic Course., John Kerr, Weston L Niermeyer, Peter B Baker, Tendy Chiang

Surgery Articles

A thyroglossal duct cyst (TGDC) is a common pediatric midline neck mass. Most TGDCs occur in the region of the hyoid bone but have been found less commonly in areas from the oral cavity to the sternum. We present the first reported case of a multifocal floor of mouth (FOM)/cervical TGDC representing an atypical embryonic course. We also review atypical presentations of TGDC and provide a summary of cases involving FOM and multifocal cysts.

Progression-Free But No Overall Survival Benefit For Adult Patients With Bevacizumab Therapy For The Treatment Of Newly Diagnosed Glioblastoma: A Systematic Review And Meta-Analysis., Nagham Kaka, Karim Hafazalla, Haider Samawi, Andrew Simpkin, James Perry, Arjun Sahgal, Sunit Das

Department of Neurosurgery Faculty Papers

Glioblastoma (GBM) is the most common high-grade primary brain tumor in adults. Standard multi-modality treatment of glioblastoma with surgery, temozolomide chemotherapy, and radiation results in transient tumor control but inevitably gives way to disease progression. The need for additional therapeutic avenues for patients with GBM led to interest in anti-angiogenic therapies, and in particular, bevacizumab. We sought to determine the efficacy of bevacizumab as a treatment for newly diagnosed GBM. We conducted a literature search using the PubMed database and Google Scholar to identify randomized controlled trials (RCTs) since 2014 investigating the safety and efficacy of bevacizumab in the treatment …

Pediatric Moyamoya Presenting As A Subarachnoid Hemorrhage From A Ruptured Anterior Cerebral Artery Aneurysm., Mohammad Hassan A. Noureldine, Ibrahim Saikali, Anis Nassif, Rita Chahinian, Ahmad Sweid, Raghid Kikano, Michel Mawad

Department of Neurosurgery Faculty Papers

BACKGROUND: The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children.

CASE DESCRIPTION: We herein report the first case, to our knowledge, of an extremely rare subarachnoid hemorrhage presentation of a child with a ruptured anterior cerebral artery dissecting aneurysm secondary to a newly discovered, unilateral Moyamoya-like pathology.

CONCLUSIONS: MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic …

Safe And Effective Use Of A Hands-Free Intracorporeal Retractor For Suture-Based Liver Retraction During Minimally Invasive Bariatric Procedures: Results Of A Large Case Series, Roger De La Torre, Matthew Sappington, Tom Smith, Jeremy Bryner, David Mantilla, J Stephen Scott

General Surgery

Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure.

Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 …

Microbial Profile And Antibiotic Susceptibility Trend In Postoperative Endophthalmitis: A 12-Year Review, Rashid Baig, Pushpa Bhawan Mal, Khabir Ahmed, Salman Naveed Sadiq, Sidra Zafar, Ghazala Jabeen, Saajan Kukreja

Section of Ophthalmology

Objective: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis.
Results: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were …

Creation Of Radiocephalic Arteriovenous Fistula In A Patient With Failed Brachiocephalic Arteriovenous Fistula, Zia Ur Rehman

Department of Surgery Docs

Abstract are not provided by the author/publisher

Diabetes And Its Effect On Abdominal Aortic Aneurysm Growth Rate In Hispanic Patients, Monica Betancourt-Garcia, Kristina Vatcheva, Amrit Thakur, Prateek Gupta, Eugene Postevka, Ricardo Martinez, R. Armour Forse

School of Mathematical & Statistical Sciences Faculty Publications

Background

The growth rate of abdominal aortic aneurysms (AAA) can vary depending on age, baseline diameter, blood pressure, race, and history of smoking. Paradoxically, previous studies show evidence of a protective effect of diabetes on the rate of AAA expansion despite its well-established role in the morbidity and mortality of cardiovascular disease. This study aims to investigate the impact diabetes plays on AAA growth within a Hispanic population.

Methods

Data were collected from patients who were predominantly Mexican-American at a single hospital site. Baseline and follow-up measures for AAA diameter were obtained from serial imaging studies. Demographics, medical history, the …

Convergent Ablation For The Treatment Of Long Standing Persistent Atrial Fibrillation - A Single Center Experience, Syed Rafay Ali Sabzwari, Lohit Garg Md, Nikhil A. Mehta Md, James R. Kimber, Hiwot Ayele, James K. Wu Md, Babak Bozorgnia Md

Department of Medicine

Introduction: The treatment of long standing persistent atrial fibrillation (AF) is very challenging and conventional catheter ablation strategies have provided only modest success. They often require multiple procedures and anti-arrhythmics to maintain sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation.

Hypothesis: Convergent ablation is an overall safe and effective procedure for the treatment of long standing persistent AF.

Methods: From February 2015 to September 2017, 30 patient (20 males) with long standing persistent AF underwent convergent ablation at a large tertiary care center. Rest of …

False In Name Only-Gastroduodenal Artery Pseudoaneurysm In A Recurrently Bleeding Patient: Case Report And Literature Review., M. Binetti, A. Lauro, R. Golfieri, S Vaccari, V D'Andrea, I. R. Marino, M. Cervellera, M. Renzulli, V. Tonini

Department of Surgery Faculty Papers

INTRODUCTION: Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year old man with a gastroduodenal artery (GDA) pseudoaneurysm manifest as recurrent hæmorrhage.

AREAS COVERED: We highlight the possible ætiologies, clinical presentations, diagnostic tools and treatment options for this condition. In this instance, the patient was successfully treated by selective angio-embolization.

EXPERT COMMENTARY: A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hæmorrhage. At present, angio-embolization is first-line therapy.

Relationship Between Smoking Habit And Sperm Parameters Among Patients Attending An Infertility Clinic, Rehana Rehman, Nida Zahid, Sofia Amjad, Mukhtiar Baig, Zohair Jamil Gazzaz

Department of Biological & Biomedical Sciences

Background: This study aimed to estimate stress markers, oxidative stress (OS), reproductive hormones and sperm parameters in male smokers and non-smokers and observe the impact of oxidative stress markers and smoking on sperm count, motility and morphology in a selected population of Karachi, Pakistan.
Methods: This cross-sectional study was conducted from July 2017 to July 2018 at Aga Khan University (AKU), in Karachi, Pakistan. The subjects were recruited from the Sindh Institute of Reproductive Medicine (SIRM), Karachi based on defined inclusion criteria. The subjects were categorized into fertile and infertile based on cut off values of sperm parameters as recommended …

Nucleus Pulposus Primary Cilia Alter Their Length In Response To Changes In Extracellular Osmolarity But Do Not Control Tonebp-Mediated Osmoregulation., Hyowon Choi, Vedavathi Madhu, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The nucleus pulposus (NP) cells adapt to their physiologically hyperosmotic microenvironment through Tonicity-responsive enhancer binding protein (TonEBP/nuclear factor of activated T-cell5 [NFAT5])-mediated osmoregulation. Primary cilia in different organs serve diverse roles including osmosensing, but its contribution to NP cell osmoadaptive response is unknown. A high percentage of cultured primary NP cells possessed primary cilia that changed length in response to osmotic stimuli. Stable silencing of Intraflagellar Transport 88 (Ift88) or Kinesin Family Member 3 A (Kif3a) to inhibit the formation of primary cilia did not affect hyperosmotic upregulation of TonEBP. While ShKif3a blocked hyperosmotic increase of TonEBP-Transactivation Domain (TAD) activity, …

A Novel Polyelectrolyte Multilayer Nanofilm-Based Synthetic Bioresorbable Antimicrobial Matrix Accelerated Healing Of Chronic Wounds In A Prospective Clinical Evaluation, Sarah Waterman Manning Md, David A. Humphrey, Michael J. Schurr, Eric C. Crawford, Gaurav Pranami, William Shillinglaw, Lorinda K. Baker, Michael J. Schurr

General Surgery

No abstract provided.

The Utility Of Impedance Cardiography In Hemodynamic Monitoring Of Patients With Sepsis, James Butz, Yizhi Shan, Andres Samayoa, Orlando C. Kirton, Thai Vu

Abington Jefferson Health Papers

BACKGROUND: Commonly used biochemical indicators and hemodynamic and physiologic parameters of sepsis vary with regard to their sensitivity and specificity to the diagnosis. The aim of this preliminary study was to evaluate non-invasive impedance cardiography as a monitoring tool of the hemodynamic status of patients with sepsis throughout their initial volume resuscitation to explore the possibility of identifying additional measurements to be used in the future treatment of sepsis.

METHODS: Nine patients who presented to the emergency room and received a surgical consultation during a 3-month period in 2016, meeting the clinical criteria of sepsis defined by systemic inflammatory response …

Drug-Induced Autoimmune Hepatitis From Hydralazine Leading To Acute Liver Failure And Liver Transplantation, Jasleen Grewal, Angela Doan, Annie S. Hong, Arpit Amin, Jason V. Scapa, Ramy Hanna, Francisco Durazo, Beshoy Yanny

School of Medicine Faculty Research

We describe a woman with no previous liver disease who developed drug-induced autoimmune hepatitis from hydralazine prescribed to her for hypertension. Despite the discontinuation of the medication, she developed acute liver failure and subsequently underwent successful liver transplantation. She survived and had a good clinical outcome.

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Sclerosing Peritonitis Presenting As Complete Mechanical Bowel Obstruction: A Case Report, Sabah Saqib, K. M. Inam Pal

Section of General Surgery

Introduction: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction.
Case Presentation: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis …

Recovery Priorities In Degenerative Cervical Myelopathy: A Cross-Sectional Survey Of An International, Online Community Of Patients., Benjamin Davies, Oliver Mowforth, Iwan Sadler, Bizhan Aarabi, Brian Kwon, Shekar Kurpad, James S Harrop, Jefferson R Wilson, Robert Grossman, Michael G Fehlings, Mark Kotter

Department of Neurosurgery Faculty Papers

OBJECTIVES: To establish the recovery priorities of individuals suffering with degenerative cervical myelopathy (DCM).

DESIGN: A cross-sectional, observational study.

SETTING: Patients from across the world with a diagnosis of DCM accessed the survey over an 18-month period on Myelopathy.org, an international myelopathy charity.

PARTICIPANTS: 481 individuals suffering from DCM completed the online survey fully.

MAIN OUTCOME MEASURES: Functional recovery domains were established through qualitative interviews and a consensus process. Individuals were asked about their disease characteristics, including limb pain (Visual Analogue Scale) and functional disability (patient-derived version of the modified Japanese Orthopaedic Association score). Individuals ranked recovery domains (arm and …

Chronic Vulvar Paget’S Disease: A Therapeutic Challenge With A Review Of The Literature, Bouhani Malek, Zemni Ines, Fertani Yasmine, Bouzaiene Hatem, Rahal Khaled

Journal of Mind and Medical Sciences

Vulvar Paget’s disease is an uncommon adenocarcinoma of the female genital tract, occuring more often in postmenopausal Caucasian women and accounting for 1-2% of all vulvar malignancies. A 39-year-old female patient was examined for the erythematous and pruritic vulvar lesion, with biopsy and histological examination revealing vulvar Paget’s disease. We did not diagnose any associated neoplasm. The patient underwent four surgical resections for relapsed disease, varying from local excision to extended excision, including radical vulvectomy, with esthetic coverage. The margins were involved. Due to the extended target volumes, radiotherapy was rejected and the patient underwent a local topical therapy with …

Breast Implant Illness: A Step Forward In Understanding This Complex Entity And The Impact Of Social Media, Răzvan Danciu, Cristina N. Marina, Valeriu Ardeleanu, Romeo Marin, Răzvan V. Scăunașu, Laura Răducu

Journal of Mind and Medical Sciences

Introduction. The number of implant-related complaints is constantly rising, a phenomenon probably accentuated by the extensive use of social media by patients. Material and method. A group of signs and symptoms considered to be caused by mammary implants is known as “Breast Implant Illness”. This paper analyzes the increased number of posts by patients on social media in which they describe their symptoms, their disappointment with the decision of using breast implants, and the beneficial effects of explantation. The case of a patient with breast implants who visited our clinic is reported here. The patient complained of two palpable masses, …

Can Intraoperative Manometry Influence The Outcome Of The Surgical Treatment Of Achalasia?, Lucian Alecu, Iulian Slavu, Adrian Tulin, Daniela Mihaila, Robert Ivascu, Liliana Mirea

Journal of Mind and Medical Sciences

Introduction. Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus. Material and method. The retrospective study extended over 1 year. The collected variables were: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Results. We identified 8 patients. The mean operative time was 100 minutes. The use of manometry determined an increase in time of 30 to 40 minutes. Manometry was successfully achieved in all cases, although in one case the sensor could not pass through the lower esophagus, …