Surgery Commons^™

Department Of Surgery Update, January 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

Management Of Siewert's Type Iii Gastroesophageal Junction Adenocarcinoma In A 52 Year Old Female, Adam Bourgon, Minia Hellan, Rebecca N. Tuttle

Department of Surgery Faculty Publications

A 52 year old female presented with a Siewert's type III gastroesophageal junction (GEJ) adenocarcinoma treated with neoadjuvant chemotherapy, laparoscopic-robotic total gastrectomy, and adjuvant chemoradiation.

Vacuum Assisted Closure-Utilization As Home Based Therapy In The Management Of Complex Diabetic Extremity Wounds, Kamran Hafeez, Haroon Ur Rashid, Ghulam Mustafa Karim Khani, Darshan Kumar, Sunil Kumar

Section of Orthopaedic Surgery

Objective: Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience.
Methods: This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or …

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar

Section of Neurosurgery

Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost many …

Dr. Mary Edwards Walker: Years Ahead Of Her Time., Dre M. Irizarry, Bs, Nicole Salomone, As, Karen A. Chojnacki, Md, Charles J. Yeo, Md, Scott W. Cowan, Md, Linda J. Bogar, Md

Department of Surgery Gibbon Society Historical Profiles

Women phsycians in the United States were virtually nonexistent in the early to mid-1800s. Traditional medical schools still did not accept women, and few secretarian or eclectic medical schools were beginning to open their doors to female students. In 1849 at Geneva College, Elizabeth Blackwell became the first woman to achieve a medical degree in the United States.1 At the time of the Civil War, the few women who had managed to obtain medical degrees mainly served as nurses in the war, because society was not yet ready to accept the female physician.2 Dr. Mary Edwards Walker would help change …

Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context, Svea Closser, Rashid Jooma, Emma Varley, Naina Qayyum, Sonia Rodrigues, Akasha Sarwar, Patricia Omidian

Section of Neurosurgery

Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a …

Malignant Ectopic Thyroid Tissue With Distant Metastasis: A Case Report, Shehla Tabassum, Najmul Islam, Saulat H. Fatimi, Mubasher Ikram, Arsalan Ahmed, Maseehuz Zaman

Department of Medicine

Introduction: Ectopic thyroid tissue is the most common form of thyroid dysgenesis. But primary malignant transformation in ectopic thyroid tissue is quite a rare entity, with follicular malignancy being the dominant form at ectopic sites. Very infrequently, malignant ectopic thyroid tissue can present with metastasis to lymph nodes. But we report a case of malignant ectopic thyroid tissue over manubrium sterni with distant metastasis.
Case presentation: A 42-year-old Pakistani female presented with gradually increasing swelling on anterior aspect of manubrium sterni for last 6 months. She had no goitre and was clinically and biochemically euthyroid. Rest of systemic exam …

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitrofor adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

At What Age Should Screening Mammography Be Recommended For Asian Women?, Junko Tsuchida, Masayuki Nagahashi, Omar M. Rashid, Kazuaki Takabe, Toshifumi Wakai

Surgery Publications

Although regular screening mammography has been suggested to be associated with improvements in the relative survival of breast cancer in recent years, the appropriate age to start screening mammography remains controversial. In November 2009, the United States Preventive Service Task Force published updated guidelines for breast cancer, which no longer support routine screening mammography for women aged 40–49 years, but instead, defer the choice of screening in that age group to the patient and physician. The age to begin screening differs between guidelines, including those from the Task Force, the American Cancer Society and the World Health Organization. It remains …

Iroa: The International Register Of Open Abdomen., Frederico Coccolini, Fausto Catena, Giulia Montori, Marco Ceresoli, Roberto Manfredi, Gabriela Elisa Nita, Ernest E. Moore, Walter Biffl, Rao Ivatury, James Whelan, Gustavo Fraga, Ari Leppaniemi, Massimo Sartelli, Salomone Di Saverio, Luca Ansaloni

Surgery Publications

Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to …

Enucleation After Embolization Of Liver Failure-Causing Giant Liver Hemangioma, Amit Sharma, Matthew Kaspar, Mohammad Siddiqui, Joohyun Kim

Surgery Publications

Patient: Female, 73

Final Diagnosis: Giant liver hemangioma

Symptoms: Abdominal discomfort • abdominal enlargement • Icterus

Medication: —

Clinical Procedure: Enucleation after embolization of liver failure-causing giant liver

Specialty: Surgery

Objective:

Unusual clinical course

Background:

Hepatic hemangioma is a congenital tumor of the mesenchymal tissues of the liver. While typically benign, these tumors can occasionally grow to sufficient size to cause a number of symptoms, including pain, severe hepatic dysfunction, or, rarely, consumptive coagulopathy. In such instances, surgical treatment may be warranted.

Case Report:

We present a case of a symptomatic giant hepatic hemangioma in an elderly patient who presented …

Giant Aortic Root Aneurysm Associated With Postductal Coarctation Of Aorta, Raquib Ahmed Faruqui, Fazal Wahab Khan, Benish Fatima, Saulat H. Fatimi

Section of Cardiothoracic Surgery

The aorta is a large blood vessel that carries blood from the heart to the rest of thebody. The aortic root consists of the aortic valve and the openings for thecoronary arteries (the coronary ostia). An aortic aneurysm is an abnormal bulgein the wall of the aorta. If an aneurysm develops in the aortic root, the aorta candilate and the aortic valve can leak. If the aneurysm continues to expand, it canrupture and can cause life-threatening internal bleeding.Aneurysms of the aortic root are often due to degenerative disease of media.Aneurysm of the aortic root often affects patients in their second …

The Effect Of Music Therapy Interaction On Child And Parental Preoperative Anxiety In Parents Of Children Undergoing Day Surgery, Christopher R. Millett

Theses and Dissertations--Music

Young children who experience high levels preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Music therapy interventions addressing a variety of procedural outcomes have been met with success. The purpose of this study was to investigate the comparative effectiveness of two music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers.

A total of 40 pediatric patient and caregiver dyads were included in …

Cocoon Abdomen - A Rare Cause Of Intestinal Obstruction., Zia Ur Rehman

Department of Surgery Docs

Abstract

INTRODUCTION:

Sclerosing encapsulating peritonitis or abdominal cocoon is a rare condition of unknown etiology in which intestinal obstruction result from encasement of variable length of bowel by dense fibro collagenous membrane.

PRESENTATION OF CASE:

A case of young male is reported who presented with features of small bowel obstruction with tender mass in the right iliac fossa. CT scan suggested features of internal herniation. On exploration, he was found to have small intestine, large intestine, stomach and liver covered with a thick cocoon like membrane. The membrane was gently peeled off the small intestine. The patient recovered well and …

Practices Of Tracheal Suctioning Technique Among Health Care Professionals: Literature Review, Rozina Khimani, Fauziya Ali Dr., Salma Rattani, Mohammad Sohail Awan

Department of Surgery Docs

The current study aims to assess tracheal suctioning practices among health care practitioners; nurses, critical care technicians and physiotherapist. Employing literature review as the methodology, multiple databases were searched focusing on three phases of tracheal suctioning (a) the pre suctioning phase, (b) the suctioning phase, (c) the post suctioning phase and complications related to tracheal suctioning. It was concluded that to provide quality care it is important that the evidence based practice guidelines should be followed.

Ocular Manifestation, Complications And Aetiological Factors In Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, Shaukat Ali Chhipa, Sadia Masood, Yasir Salarzai, Qazi Assad Khan, Khabir Ahmad, Sara Sajid

Department of Surgery Docs

Abstract

OBJECTIVE:

To describe the ocular manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrosis among inpatients at a tertiary care hospital.

METHODS:

The retrospective observational descriptive study was carried out at the Aga Khan University Hospital, Karachi, and comprised data on age, gender, aetiology and ocular findings related to patients diagnosed with Stevens-Johnson Syndrome/ToxicEpidermal Necrosis between January 2000 and December 2011. SPSS 19 was used for statistical analysis.

RESULTS:

There were 87 patients; 48(55.2%) of them being males.The overall mean age was 33.2±22.2 years, ranging from 1 month to 84 years. The most common aetiology was idiopathic 20(23%) followed by non-steroidal inflammatory …

Small Intestinal Bacterial Overgrowth In Post Oesophagectomy And Gastrectomy Patients, Melissa Dooley

Masters

A review of patients who underwent a hydrogen breath test for Small Intestinal Bacterial Overgrowth, following an oesophagectomy or gastrectomy was carried out in the Gastrointestinal Function Unit, St. James’s Hospital, Dublin. The aim of this research was to look at the incidence of Small Intestinal Bacterial Overgrowth and create an optimal protocol for Hydrogen Breath Testing with the hope of improving patient compliance and reducing clinic waiting times. Factors such as lifestyle, multimodal therapy, tumour morphology, and gender were analysed in relation to positive Hydrogen Breath Test results in this patient group. Patients were selected following a referral from …

Multi-Surface Simplex Spine Segmentation For Spine Surgery Simulation And Planning, Rabia Haq

Computational Modeling & Simulation Engineering Theses & Dissertations

This research proposes to develop a knowledge-based multi-surface simplex deformable model for segmentation of healthy as well as pathological lumbar spine data. It aims to provide a more accurate and robust segmentation scheme for identification of intervertebral disc pathologies to assist with spine surgery planning. A robust technique that combines multi-surface and shape statistics-aware variants of the deformable simplex model is presented. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user-assistance is …

The Da Vinci Robotic Surgical Systems In Atrial Septal Defect Repair, Coronary Artery Bypass Graft And Mitral Valve Repair, Randy Yergenson

Physician Assistant Scholarly Project Posters

Historically, these cardiac interventions have been performed using partial or complete open sternotomy.
1. Coronary artery bypass grafting (CABG)
2. Atrial septal defect (ASD) repair,
3. Mitral valve repair and/or replacement

In 2000, the Federal Food and Drug Administration approved the use of the da Vinci Robotic Surgical System. Less invasive surgical option.

Quantitative Spatial Frequency Fluorescence Imaging In The Sub-Diffusive Domain For Image-Guided Glioma Resection, Mira Sibai, Israel Veilleux, Jonathan T. Elliott, Frederic Leblond, Brian Wilson

Dartmouth Scholarship

Intraoperative 5- aminolevulinic acid induced-Protoporphyrin IX (PpIX) fluorescence guidance enables maximum safe resection of glioblastomas by providing surgeons with real-time tumor optical contrast. However, visual assessment of PpIX fluorescence is subjective and limited by the distorting effects of light attenuation and tissue autofluorescence. We have previously shown that non-invasive point measurements of absolute PpIX concentration identifies residual tumor that is otherwise non-detectable. Here, we extend this approach to wide-field quantitative fluorescence imaging by implementing spatial frequency domain imaging to recover tissue optical properties across the field-of-view in phantoms and ex vivo tissue.

Renal And Hematological Effects Of Clcf-1, A B-Cell-Stimulating Cytokine Of The Il-6 Family., Virginia J. Savin, Mukut Sharma, Jianping Zhou, David Gennochi, Timothy Fields, Ram Sharma, Ellen T. Mccarthy, Tarak Srivastava, Jos Domen, Aurélie Tormo, Jean-François Gauchat

Manuscripts, Articles, Book Chapters and Other Papers

CLCF-1 is a cytokine known for B-cell stimulation and for neurotrophic properties. We have identified CLCF-1 as a potential injurious factor in the human renal disease focal segmental glomerulosclerosis (FSGS). We investigated its effects on renal cells and renal function in in vitro and in vivo studies. Methods include measurement of the effect of CLCF-1 on phosphorylation of target molecules of the JAK/STAT pathway, on cytoskeleton and cell morphology in cultured podocytes, on albumin permeability of isolated rat glomeruli, and on tissue phosphorylation and urine albumin after acute or chronic CLCF-1 injection. In addition, cell sorting was performed to determine …