Medical Specialties Commons^™

The Genetics Of Neuroendocrine Prostate Cancers: A Review Of Current And Emerging Candidates, M Hammad Ather, Tahmeena Siddiqui

Department of Surgery Docs

Prostate cancer (PC) displays a strong familial link and genetic factors; genes regulating inflammation may have a pivotal role in the disease. Epigenetic changes control chromosomal integrity, gene functions, and, ultimately, carcinogenesis. The most widely studied epigenetic event in PC is aberrant DNA methylation (hypo- and hypermethylation); besides this, chromatin remodeling and micro RNA (miRNA) are other studied alterations in PC. These all lead to genomic instability and inappropriate gene expression. Causative dysfunction of histone modifying enzymes results in generic and locus-specific changes in chromatin remodeling. miRNA deregulation also contributes to prostate carcinogenesis, including interference with androgen-receptor signaling and apoptosis. …

Macrophage Imbalance (M1 Vs. M2) And Upregulation Of Mast Cells In Wall Of Ruptured Human Cerebral Aneurysms: Preliminary Results., David Hasan, Nohra Chalouhi, Pascal Jabbour, Tomoki Hashimoto

Department of Neurosurgery Faculty Papers

BACKGROUND: M1 and M2 cells are two major subsets of human macrophages that exert opposite effects on the inflammatory response. This study aims to investigate the role of macrophage M1/M2 imbalance and mast cells in the progression of human cerebral aneurysms to rupture.

METHODS: Ten patients with cerebral aneurysms (five ruptured and five unruptured) underwent microsurgical clipping. During the procedure, a segment of the aneurysm dome was resected and immunostained with monoclonal antibodies for M1 cells (anti-HLA DR), M2 cells (anti-CD 163), and mast cells (anti-tryptase clone AA). A segment of the superficial temporal artery (STA) was also removed and …

Region 11 Meld Na Exception Prospective Study, Robert A. Fisher, Douglas M. Heuman, Ann M. Harper, Martha K. Behnke, Alastair D. Smith, Mark W. Russo, Steven Zacks, John W. Mcgillicuddy, James Eason, Michael K. Porayko, Patrick Northup, Michael R. Marvin, Johnathan Hundley, Satheesh Nair

Surgery Faculty Publications

Introduction. Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation.

Material and methods. From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception.

Results. Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to …

Primary Closure Without Diversion In Management Of Operative Blunt Duodenal Trauma In Children, Katherine Smiley, Tiffany Wright, Sean Skinner, Joseph A. Iocono, John M. Draus

Surgery Faculty Publications

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages < 14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. …

Mirizzi's Syndrome Masquerading As Cholangiocarcinoma: A Case Report, Muhammad Rizwan Khan, Sameer Ur Rehman

Department of Surgery Docs

Introduction: Mirizzi's syndrome is a rarely observed disorder that presents with obstructive jaundice. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar clinical and imaging findings, and a pre-operative diagnosis may be a serious challenge.CASE PRESENTATION: We present the case of a 44-year-old Asian man with Mirizzi's syndrome who was initially diagnosed as having cholangiocarcinoma based on his clinical presentation, raised cancer antigen …

Dentoalveolar Heights In Skeletal Class I Normodivergent Facial Patterns, Zafar-Ul-Islam, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To determine the dentoalveolar heights (mm) in skeletal class I normodivergent facial pattern and compare the same heights in male and female subjects.

STUDY DESIGN: Cross-sectional observational study.

PLACE AND DURATION OF STUDY: Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from July to October 2009.

METHODOLOGY: Eighty one subjects were selected from the orthodontic record at the Aga Khan University Hospital Karachi. The inclusion criteria were an age range of 12 to 30 years and skeletal class I normodivergent facial pattern with exclusion criteria of prior orthodontic treatment, restored teeth and craniofacial anomalies/syndromes. The pre-treatment cephalographs of the …

Correlates Of Morbidity And Mortality In Severe Necrotizing Pancreatitis, K. M. Pal, Pashtoon Murtaza Kasi, Mohammad Tayyeb, S. M. Faisal Mosharraf, Zafar Fatmi

Community Health Sciences

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus …

Facial Fracture Management: Operative Trends, Ramon Garza, Iii Md, Joshua M. Adkinson Md, Jarom N. Gilstrap Md, Sherrine Eid Mph, Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of melanoma is dramatically increasing worldwide. We hypothesized that the ratio of metastatic to examined lymph node ratio (LNR) would be the most important prognostic factor for stage III patients.

METHODS: We retrospectively reviewed our institutional database of melanoma patients and identified 168 patients who underwent lymph node dissection (LND) for stage III disease between 1993 and 2007. Patients were divided into three groups based on LNR (≤10%, n = 93; 10-≤25%, n = 45; and >25%, n = 30). Univariate and multivariate analysis was performed using Cox proportional hazards model.

RESULTS: The median survival time of …

Right Ventricular Rupture And Tamponade Caused By Malposition Of The Avalon Cannula For Venovenous Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Kentaro Yamane, Gregary D. Marhefka, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for …

Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C. Berger, Jeffrey M Farma

Department of Surgery Faculty Papers

The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …

Is Placement Of An Intra-Abdominal Drain Necessary After Hartmann’S Procedure For Perforated Diverticulitis?, Mychailo Fulmes Md, Phd, Avi S. Galler, David S. Bub, Robert J. Sinnott, John S. Park, Matthew M. Philp Md

Department of Surgery

No abstract provided.

Radioactive Counts And Sentinel Node Positivity In Breast Cancer Patients; A Single Surgeon’S Longitudinal Experience, Daniel F. Barnas Md, Aaron D. Bleznak Md, Facs

Department of Surgery

No abstract provided.

Value Of Routine Immunohistochemical (Ihc) Analysis Of Colorectal Cancer To Genetic Counseling Referrals, Avi Galler, Mychailo Fulmes Md, Phd, John Park, David Bub, Michael J. Weiss, Tara Namey, Ann Marie Augustyn, Robert Sinnott

Department of Surgery

No abstract provided.

An Evaluation Of Warfarin Use And 30-Day Hemorrhage In Bariatric Surgery, Amanda M. Curry, Richard Boorse Md, Peter J. Bechtel Md, Cathy Fuhrman Rn, Msn, Cathleen Webber Rn, Mshs, Suzanne L. Smith Mba, Rrt, Tas

Department of Surgery

No abstract provided.

Critical Assessment Of Outcomes In Acute Aortic Dissection (Type A) At A Community Hospital: A 10 Year Review, Timothy S. Misselbeck, James K. Wu Md, Stephen Deturk Ba, Michael F. Szwerc Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Surgery

No abstract provided.

An Analysis Of Quality Outcomes In Patients Having A Hysterectomy: Robotics Vs The Vaginal Approach, Martin A. Martino Md, Jocelyn Shubella, Elizabeth A. Berger Do

Department of Obstetrics & Gynecology

No abstract provided.

Benchmarking Quality Metrics For Endometrial Cancer Patients: Robotics Vs. Laparoscopy, Martin A. Martino Md, Jocelyn Shubella, Shamol Williams Msii, Rachel Morcrette Pa-C, Jeremy Patriarco, Hai-Yen Nguyen Md, Amy Hordendorf, M Bijoy Thomas Md, Richard Boulay Md

Department of Obstetrics & Gynecology

No abstract provided.

How To Effectively Reduce Costs Associated With Robotic Surgery: Is This Even Possible?, Martin A. Martino Md, Jocelyn Shubella, Wesly Menard, Jeremy Patriarco, Brian Leader, Rachel Miller Pa-C, Megan Allen Rn, M Bijoy Thomas Md, Richard Boulay Md

Department of Obstetrics & Gynecology

No abstract provided.

Robotic Surgery Outcomes After The Learning Curve: Does Robotic Surgery Improve The Quality Health Outcome “Readmission <30 Days” In Patients Having Hysterectomy For Benign Disease?, Elizabeth A. Berger Do, Jocelyn Shubella, Martin A. Martino Md

Department of Obstetrics & Gynecology

No abstract provided.

Challenging Cases In Pediatric Trauma: Management Of The Open Abdomen, Firas Madbak Md, William D. Hardin Jr, Md, Facs, Faap

Department of Surgery

No abstract provided.

Increase In Renal Transplantation Of Sensitized Recipients Following The Introduction Of Virtual Crossmatching: One Center’S Experience, Michael J. Moritz Md, Lynsey S. Biondi Md, Patricia Kimble Bs, Robert Cirocco Phd

Department of Surgery

No abstract provided.

Lvhn: The Level Ii Accreditation Journey, Cathyann Feher Rn,Msn, Karen L. Kutner Mba, Michael M. Badellino Md,Facs

Department of Surgery

No abstract provided.

Earlier Surgical Intervention In Congenital Heart Disease Results In Better Outcome And Resource Utilization, Roheena Z. Panni, Awais Ashfaq, Muhammad M. Amanullah

Section of Cardiothoracic Surgery

Background:Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively, among Patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan.

Methods:

A prevalence based cost of illness Study Design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children Results:The mean age at the time of surgery in group …

A Critical Analysis Of The Current State Of Neurosurgery Training In Pakistan, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Saniya Siraj Godil, Rajesh Kumar, Arshad Ali Siddiqui

Section of Neurosurgery

Objective: To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan.
Methods: This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan.
Results: Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's …

Factors Influencing The Opinion Of Individuals In Determining Tumour Spread After Biopsy, Tayyaba Z. Ansari, Adnan A. Zaidi, Asra Parekh, Owais Iqbal, Nehal Masood, Ahmed Mateen, Tehseen Fatima

Section of General Surgery

Background: People often have concerns regarding tumour spread after biopsy which leads to a delay in seeking expert medical advice. The data regarding this perception is scanty. Therefore, we conducted this cross sectional study to explore the beliefs and perceptions of individuals regarding tumour spread after biopsy and the basis of those beliefs.
Methods: The survey was conducted in outPatient areas of two different tertiary care hospitals of Karachi namely Aga Khan University Hospital Karachi (AKUH) and Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN). We interviewed 600 individuals and documented their responses on a questionnaire. There were 400 responders …

Cerebrospinal Fluid Rhinorrhea: An Institutional Perspective From Pakistan, Muhammad Zubair Tahir, Muhammad Babar Khan, Muhammad Umair Bashir, Shabbir Akhtar, Muhammad Ehsan Bari

Section of Neurosurgery

Background:The management of cerebrospinal fluid (CSF) rhinorrhea has evolved over the last two decades. We present here a review of our 11-year data on CSF rhinorrhea and its management at a tertiary care hospital in a developing country, with particular reference to the diagnosis, surgical management and outcome of the disease.
Methods: The medical charts of all Patients with a diagnosis of CSF rhinorrhea over an 11-year period were reviewed. The etiology of CSF rhinorrhea was classified into three categories: spontaneous, iatrogenic and traumatic. All the Patients were divided into three categories based on the type of management as …

Contact Lens-Related Visual Loss: A Case Series From Karachi, Tanveer Anjum Chaudhry, Sarah Sarfraz, Qazi Assad Khan, Khabir Ahmad

Section of Ophthalmology

All cases of corneal ulcers, presenting at the Aga Khan University Hospital, Karachi between January 2006 and December 2010 were reviewed. Information was obtained regarding socio-demography, the cause of ulcer, prior treatment and visual acuity. Afterwards, contact-lens specific information such as the type of lens and purpose and duration of lens usage was obtained from the participants by phone interviews.
There were 59 persons with unilateral ulcers and 4 had bilateral presentation. The mean age of the study participants was 27.79 +/- 14.51 years while the median age as 24 years. Of these, 87 %had a visual acuity less than …

The Evolution Of Cauterization: From The Hot Iron To The Bovie., Michelle F. Deleon, Ms, Charles J. Yeo, Md, Pinckney Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

The Bovie electrocautery has become a fundamental tool of modern-day surgery, particularly for its integral role in hemostasis, yet despite this landmark invention and its widespread use, there is very little said about the man behind the machine: William T. Bovie. It would be thousands of years from the inception of cautery in medicine until the birth of Dr. Bovie and his device. However, his work in biophysics and collaboration with Dr. Harvey Cushing would revolutionize surgical practice in the early 20th century and forever ingrain his name into the field of surgery.

Variations In Practice Patterns Among Neurosurgeons And Orthopaedic Surgeons In The Management Of Spinal Disorders, Manzar Hussain, Sadaf Nasir, Amber Moed, Ghulam Murtaza

Section of Neurosurgery

Study design: This is a case series.
Purpose: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.
Overview of literature: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.
Methods: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. …