Medical Specialties Commons^™

The Surgeon Speaks-Carlo Ramirez, Md, Facs

Jefferson Surgical Solutions

No abstract provided.

Kidney Transplant Program Offers Many Options And Encourages Living Donors

Jefferson Surgical Solutions

No abstract provided.

Preoperative Drainage In Pancreatic Cancer., Eugene P Kennedy, Ernest L Rosato, Charles J Yeo

Department of Surgery Faculty Papers

Van der Gaag et al. conclude that preoperative biliary drainage in patients undergoing surgery for cancer of the head of the pancreas increases complications. Previous studies have shown that stenting is associated with a doubling in the risk of wound infection and an overall slightly increased risk of any complication.

Stuck Together: Searching For A Model Of Peritoneal Adhesions Using The August Rat, James W. Bathe

Honors Theses

Fibrous adhesions, a by-product of the healing process, often appear post-surgically as a result of peritonitis related to the surgery. These adhesions can be either primarily "scar tissue" or excess "healthy tissue," and are the leading cause of intestinal obstruction in modern medicine. Shockingly, adhesions occur in up to 96% of patients undergoing intra-abdominal surgery. Adhesions can lead to multiple complications other than obstructions such as inadvertent enterotomy at the time of adhesiolysis, chronic pain, and female infertility. Additional complications arise from the adhesions preventing the free movement of organs and causing strangulations. The causes of the peritonitis, and therefore …

Is Early Correction Of Congenital Ventricular Septal Defect A Better Option In A Developing Country, Awais Ashfaq, Hassaan Ashraf Zia, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

OBJECTIVE: To assess and evaluate the effectiveness of early ventricular septal defect (VSD) repair in a developing country by comparing the outcomes in two age groups.

METHODS: A total of 39 patients underwent VSD repair at a tertiary care hospital in Karachi over a period of 2.5 years. Patients were divided into Group 1 (years) and Group 2 (2-18 yrs). Perioperative and postoperative variables were reviewed retrospectively for each patient and compared with the development of complications and the effect on postoperative recovery times. The data was analyzed using Mann Whitney test for continuous variables and Fischer's exact test for …

Occipital Nerve Stimulator Systems: Review Of Complications And Surgical Techniques, Steven Falowski, Dajie Wang, Arvind Sabesan, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Introduction: Stimulation of the occipital nerves is becoming more widely accepted in the treatment of occipital neuritis and migraine disorders.

Objective: Presently, equipment available for spinal cord stimulation is adapted for insertion into the subcutaneous space over the occipital nerves. Many technical factors need to be reassessed to optimize the therapy.

Methods: We performed a retrospective review of patients implanted from 2003 to 2007 at a single center. We aimed to analyze the rate of surgical complications related to implantation technique. A total of 28 patients were present for analysis. Patients were followed up to 60 months with a mean …

Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah

Department of Anaesthesia

BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Surgical Response To Catastrophe - Learning From Canada’S Experience Abroad, Vivian Mcalister

Data and Test Instruments

No abstract provided.

Clinical Outcome Of Iridotomy With Argon-Yag Laser At A Tertiary Care Center In Karachi, Pakistan, Rashid Baig, Aziz Khan

Section of Ophthalmology

Objective: To assess the the efficacy and early and late complications of Argon-YAG combined laser iridotomy in the outpatient department of a tertiary care hospital.
Methods: This was a prospective observational study conducted at Aga Khan University Hospital Karachi, Pakistan. After detailed history taking and clinical examination, patients who had goniscopically evident closed angles and a positive provocative test were selected for laser iridotomy. They underwent iridotomy using Argon laser followed by YAG laser. The main outcome measures were patency of iridotomy at 6 months, angle grading at 6 months and early and late complications.
Results: Overall 40 eyes of …

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

On Pump Coronary Surgical Revascularization In A Patient With Chronic Immune Thrombocytopenic Purpura, Saulat Fatimi, Danesh K Kella, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

We performed on-pump coronary artery bypass graft surgery on a 54-year-old female, known case of chronic Idiopathic Thrombocytopenic Purpura (ITP), hypertension and dyslipidaemia who had presented to us with progressive exertional shortness of breath and chest pain. The decision of going on with CABG was made after two weeks of preoperative treatment with prednisolone. Her platelet counts pre-operatively and on the 4th post-operative day were 135 x 10(9)/L and 32 x 10(9)/L. She had an unremarkable post-operative recovery, without requiring whole blood or platelet transfusions. We recommend preoperative steroid treatment in patients with chronic ITP undergoing CABG.

Acellular Dermal Regeneration Template For Soft Tissue Reconstruction Of The Digits., John S. Taras, Anthony Sapienza, Josh B. Roach, John P. Taras

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects.

METHODS: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had …

Impact Study Of A Central Lines Simulation Training Program Using Kirkpatrick’S Four-Level Evaluation Model, James P. Orlando Edd, Andrew C. Miller Do, William Bond Md, Ms, Valerie A. Rupp Rn, Bsn, Bryan G. Kane Md, Cindy Umbrell Rn, Msn, Michael Pasquale Md

Department of Emergency Medicine

No abstract provided.

Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan

Section of General Surgery

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases.
Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed.
Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

Improving Schizophrenia Diagnosis Through Biomarkers: An Upcoming Prospect, Syed Mohammad Asad Zaidi, Abdul Latif Bikak, Rameez-Ul Hassan

Medical College Documents

No abstract provided.

Appendicitis: When Simple Becomes Not So Simple, Elizabeth H. Ey, Jeffrey C. Pence

Department of Surgery Faculty Publications

No abstract provided.

Eosinophilic Cholangitis And Cholangiopathy: A Sheep In Wolves Clothing, Catherine Nashed, Sujit Vijay Sakpal, Victoria Shusharina, Ronald Scott Chamberlain

Department of Surgery

BACKGROUND: Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract which can cause biliary obstruction. Similar to other disease processes involving the bile ducts, this disorder can pose a difficult diagnostic challenge as it can mimic cholangiocarcinoma.

METHODS: A systematic search of the scientific literature was carried out using PubMed to access all publications related to EC. Search keywords that were utilized included "eosinophilic cholangitis," "etiology," "treatment," and "obstructive jaundice." Results. Twenty-three cases of EC have been reported. Nineteen patients (82.6%) who presented with EC remain disease-free; 15 of these 19 patients (78.9%) with followup time remain …

Sulforaphane Induces Cell Cycle Arrest By Protecting Rb-E2f-1 Complex In Epithelial Ovarian Cancer Cells, Christopher S. Bryant, Sanjeev Kumar, Sreedhar Chamala, Jay Shah, Jagannath Pal, Mahdi Haider, Shelly Seward, Aamer M. Qazi, Robert Morris, Assaad Semaan, Masood A. Shammas, Christopher Steffes, Ravindra B. Potti, Madhu Prasad, Donald W. Weaver, Ramesh B. Batchu

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Sulforaphane (SFN), an isothiocyanate phytochemical present predominantly in cruciferous vegetables such as brussels sprout and broccoli, is considered a promising chemo-preventive agent against cancer. In-vitro exposure to SFN appears to result in the induction of apoptosis and cell-cycle arrest in a variety of tumor types. However, the molecular mechanisms leading to the inhibition of cell cycle progression by SFN are poorly understood in epithelial ovarian cancer cells (EOC). The aim of this study is to understand the signaling mechanisms through which SFN influences the cell growth and proliferation in EOC.

Results

SFN at concentrations of 5 - 20 …

Elevated Csf Outflow Resistance Associated With Impaired Lymphatic Csf Absorption In A Rat Model Of Kaolin-Induced Communicating Hydrocephalus, Gurjit Nagra, Mark E. Wagshul, Shams Rashid, Jie Li, J Pat Mcallister Ii, Miles Johnston

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

We recently reported a lymphatic cerebrospinal fluid (CSF) absorption deficit in a kaolin model of communicating hydrocephalus in rats with ventricular expansion correlating negatively with the magnitude of the impediment to lymphatic function. However, it is possible that CSF drainage was not significantly altered if absorption at other sites compensated for the lymphatic defect. The purpose of this study was to investigate the impact of the lymphatic absorption deficit on global CSF absorption (CSF outflow resistance).

Methods

Kaolin was injected into the basal cisterns of Sprague Dawley rats. The development of hydrocephalus was assessed using magnetic resonance imaging …

Hypertonic Saline For Peri-Operative Fluid Management, Vivian Mcalister, Karen E. A. Burns, Tammy Znajda, Brian Church

Surgery Publications

BACKGROUND: Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium.

OBJECTIVES: To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions.

SELECTION CRITERIA: We included randomized clinical trials where HS was compared to …

Intussusceptions In Adults: Clinical Features And Operative Procedures, Ziaur Rehman, Abdul Rehman Alvi, Salma Khan

Section of General Surgery

Objective: To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions.
Study Design: Case series.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1988 to December 2008.
Methodology: Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 …

Hepatic Vein And Inferior Vena Caval Thrombus Extending Into The Right Atrium: A Rare Complication Of Amoebic Liver Abscess, Ziaur Rehman, Abdul Rehman Alvi, Shahida Bibi

Section of General Surgery

Amoebic liver abscess is an endemic in developing countries but few cases of associated vascular complications have been reported. The authors report a very rare vascular complication of hepatic veins and inferior vena caval (IVC) thrombosis extending into the right atrium in a young male with large amoebic liver abscess. Optimal result was achieved with early diagnosis on CT scan, percutaneous drainage of abscess, intravenous metronidazole, peri-operative anticoagulation, sternotomy and thrombectomy.

Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome In A Pakistani Pedigree, Tanveer Anjum Chaudhry, Mirza Umair Khalid, Taimur Saleem, Khabir Ahmad

Section of Ophthalmology

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare developmental ocular disorder. We report this condition affecting 4 members of a Pakistani family across three generations. A 2-year-old girl was brought to the clinic by her father for the correction of her shortened palpebral fissures. Examination findings were consistent with BPES. The girl's father, paternal grandfather and paternal aunt also had identical features. The distance between the medial canthi of the index case was 30 mm, and the lengths of vertical and horizontal palpebral fissure were 6 mm and 20 mm, respectively. BPES must be considered an important differential diagnosis in patients …

Overview Of Surgical Management Of Infectious Non-Suppurative Brain Lesions (Part 2), Muhammad Shahzad Shamim, Ather Enam, Syed Faizan Ali, Rushna Pervez Ali, Mohammad Wasay

Section of Neurosurgery

No abstract provided.

Brachial Artery Aneursym With “Blue Finger Syndrome” After Ligation Of An Arterio-Venous Fistula, Ramon Garza, Iii Md, Dale A. Dangleben Md, John F. Welkie Md

Department of Surgery

No abstract provided.

Impact Of An Interprofessional Central Venous Catheter Insertion Training Program, James P. Orlando Edd, Andrew Miller Do, William Bond Md, Ms, Valerie A. Rupp Rn, Bsn, Bryan G. Kane Md, Cindy Umbrell Rn, Msn, Michael Pasquale Md, Elizabeth Verheggen Phd, Elliot J. Sussman Md, Mba

Department of Emergency Medicine

No abstract provided.

A Novel Mechanism Of Cell Growth Regulation By Cell Cycle And Apoptosis Regulatory Protein (Carp)-1, Yan Jiang, Vineshkumar T. Puliyappadamba, Liyue Zhang, Wenjuan Wu, Anil Wali, Michael B. Yaffe, Joseph A. Fontana, Arun K. Rishi

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

CARP-1/CCAR1, a perinuclear phospho-protein, regulates signaling by adriamycin, steroids, or growth factors. However, intracellular events that regulate CARP-1-dependent cell growth are not fully understood.

Results

Here we investigated whether CARP-1 is involved in signaling induced by the protein kinase A inhibitor H89. Treatments of human breast cancer cells with H89 resulted in apoptosis that involved enhanced CARP-1 threonine phosphorylation and expression. Depletion of CARP-1, on the other hand, abrogates apoptosis induced by H89. CARP-1 binds with signal transducer TAZ and over-expression of TAZ inhibits apoptosis by CARP-1. CARP-1 (651-759) interacts with a novel, N-terminal epitope of TAZ. H89 …