Surgery Commons^™

Paediatric Traumatic Brain Injury: Presentation, Prognostic Indicators And Outcome Analysis From A Tertiary Care Center In A Developing Country, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Babar Khan, Dr Saqib Kamran Bakhshi, Muhammad Ehsan Bari

Section of Neurosurgery

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score …

Department Of Surgery Update, October 2016, 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.

Body Image And Quality Of Life Among Postsurgical Bariatric Patients, Amy Leigh White

Psychology Theses & Dissertations

In recent decades, bariatric surgery has become an increasingly popular intervention for the treatment of morbid obesity. Bariatric surgery leads to substantial improvements in physical health (e.g., weight loss, increased life expectancy) and psychological health (e.g., body image, quality of life). After bariatric surgery, many patients undergo subsequent surgical procedures to remove excess skin (“body contouring”), which are also associated with positive medical and psychological outcomes.

The present study sought to expand upon existing research into the psychosocial outcomes of bariatric surgery, investigate correlates of patients’ desire for body contouring, and determine whether presurgical motivations were associated with postsurgical outcomes. …

Lower Red Cell Transfusion Rates With Use Of Tranexamic Acid In Single-Stage Bilateral Total Knee Arthroplasty: A Retrospective Audit, Muhammad Aziz, Salman Bin Mahmood,, Riaz Hussain Lakdawala, Tashfeen Ahmad

Department of Surgery Docs

Abstract

Bilateral total knee arthroplasty (BTKA) patients may require blood transfusion which has its risks. Anti-fibrinolytic drugs such as aprotinin, aminocaproic acid and tranexamic acid (TXA) have reduced transfusion requirements in major surgery. This retrospective audit was performed to assess effectiveness of TXA in reducing blood transfusion rate in single-stage sequential BTKA cases operated by a single surgeon. Records of 91 patients given TXA and 80 controls who were operated before 2012 and not given TXA were reviewed. TXA was given 15mg/kg intravenously (IV) before tourniquet deflation and 3 hours postoperatively.Blood transfusion was done in 9(10%) patients in the TXA …

Delayed Presentation Of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy, Fazal Wahab Khan, Ayesha Muhammad, Mohsin Abbas, Syed Usman Bin Mahmood, Benish Fatima, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy …

Functional Outcomes After Successful Lower Extremity Arterial Injuries Repair, Zia Ur Rehman, Ziad Sophie, Lekhraj. Mal

Department of Surgery Docs

bstract

The study was conducted to measure functional outcome of patients who had successful lower extremity arterial reconstruction after vascular injury at a tertiary care centre in Karachi over 5 years from January 2008 to December 2013. In this descriptive cohort study, the functional outcomes were assessed with lower extremity functional scale (LEFS). The mean age the 75 patients in the study was 32±11 years. Limb salvage was successful in 72(96%) cases. The most common injured artery was superficial femoral artery 30(40%) followed by popliteal artery 19(25%). The most common method of repair was end-to-end using either polytetrafluoroethylene (PTFE) graft …

Versatility Of The Anterolateral Thigh Flap: An Akuh Experience, Muhammad Fazlur Rehman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan

Department of Surgery Docs

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects …

Bacterobilia In Acute Cholecystitis: Bile Cultures' Isolates, Antibiotic Sensitivities And Antibiotic Usage. A Study On A Pakistani Population, Yousaf Bashir Hadi, Muhammad Waqas, Hafiz Muhammad Umer,, Ammar Alam, Abdul Rehman Alvi, Muhammad Rizwan Khan, Amir Hafeez Shariff

Department of Surgery Docs

Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. …

Cervical Mediastinoscopy In The Diagnosis Of Lymphadenopathy In South Asia., Sulaiman B Hasan, Fazal Wahab Khan, Shiraz Hashmi, Ahsan Ehtesham, Rizwana Ahmed Magsi, Syed Shahabuddin

Department of Surgery Docs

Abstract

We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No …

Pediatric Laparoscopic Surgery; Initial Experience From Pakistan; First 100 Cases In Single Center, Hassan Ishaq, Saqib Hamid Qazi, Sohail Dogar, Muhammad Younus Khan Durrani,, Ahmad Vaqas Faruque

Department of Surgery Docs

Abstract

In a developing country like Pakistan, laparoscopic surgeries are not considered favourable by many, possibly because of high costs or a lack of expertise. It is an established fact that laparoscopic surgery offers better surgical treatments with a shorter hospital stay and fewer complications. The current retrospective study was conducted at a tertiary care hospital in Karachi and comprised of laparoscopy cases performed by a single surgeon from March 2012 to September of 2014. A total of 100laparoscopic surgeries were performed; mostly appendectomies 49(49%) and undescended testes (UDTs) 34(34%). Overall, there were 70(70%) male patients. The mean age of …

Neurosurgery Training In Pakistan: Follow-Up Survey And Critical Analysis Of National Training Programmes., Dr Saqib Kamran Bakhshi, Muhammad Waqas, Muhammad Mehboob Alam, Muhammad Shahzad Shamim, Mohsin Qadeer

Department of Surgery Docs

No abstract provided.

Paediatric External Ventricular Drains: Experience From A Tertiary Care Hospital Of A Developing Country, Abbas Qalab, Rayaan Asad, Mahnaz Hakeem,, Maria Ahmad, Anwar Haq, Aneela Darbar

Department of Surgery Docs

Abstract

The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial …

Paediatric Traumatic Brain Injury: Presentation, Prognostic Indicators And Outcome Analysis From A Tertiary Care Center In A Developing Country, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Babar Khan, Saqib Kamran Bakhshi, Muhammad Ehsan Bari

Department of Surgery Docs

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score …

Is Grown Up Congenital Heart (Guch) Disease Different In A Developing Country?, Syed Shahabuddin, Shiraz Hashmi, Syed Ezze Rakhshan,, Jamal Kabeer Khan, Shahid Ahmed Sami, Muneer Amanullah

Department of Surgery Docs

Abstract

In the current era grown up congenital heart disease (GUCH) patients undergoing surgical interventions are increasing. Most of the interventions in the developed countries are either complex or redo-operations in patients who had previously undergone repair, palliation or correction. However, in the developing countries most of the interventions are primary and corrective. This descriptive retrospective study comprised GUCH patients who underwent surgical intervention for congenital heart disease (CHD) at Aga Khan University Hospital, Karachi, from January 2006 to December 2015. A total of 195 patients had been treated surgically with a mean age of 31.0±13.5 years. Majority of the …

Bringing Efficiency Into Practice: A Quality Improvement Initiative To Reduce Operating Room Turnaround Time, Hasanat Sharif, , Noman Shehzad, Joveria Farooqi, Sana Karim

Department of Surgery Docs

Abstract

Operating room (OR) turnaround time (TAT) is the minimal essential time required for cleaning of OR and preparation for the next case. The TAT inversely affects OR efficiency. Several factors related to personnel, equipment and scheduling have been identified as causes of increased TAT. We conducted the study to identify factors that affect OR TAT and to propose recommendations for its reduction. The retrospective study, conducted at Aga Khan University Hospital, Karachi, comprised TAT records related to March 2014. Of the 88 cases, 22(25%) showed a delay. Upon Pareto analysis it was found that in 8(36.6%) cases there was …

Breast Reconstruction At The Aga Khan University - A 10 Year Audit, Samiullah Abdullah, , Asif ,Ahsan, Tahir Shafi Khan

Department of Surgery Docs

Abstract

Considering the high incidence of breast cancer and the subsequent need for a mastectomy, the number of patients having breastreconstruction remains relatively low the world over. Most studies from the west show that anywhere between 5% to around 50% of women proceed to reconstruction following a complete mastectomy. There is a great paucity of literature on the subject in Pakistan. Anecdotal and unofficial accounts would suggest that less than a fraction of 1% of women in Pakistan undergo reconstruction following a mastectomy.We reviewed our cases retrospectively over a 10 year study period from January 2005 to December 2014 with …

Does Obesity Affects Early Infection After Total Knee Arthroplasty. A Comparison Of Obese Vs Non Obese Patients, Waseem Ahmed, Riaz Hussain Lakdawala, Yasir Mohib, Aurangzeb Qureshi, Rizwan Haroon Rashid

Department of Surgery Docs

Abstract

Surgical site infection (SSI) is a disastrous complication after total knee arthroplasty (TKA) which can cause prosthesis loosening and may end up in septicaemia. The incidence of infection reported to be in the range of 0.3-12.4% for primary TKA. Significantly higher infection rate is found in the morbidly obese patients. The current study compared the immediate rate of post-total knee replacement wound infection in the obese versus non-obese population. The cross-sectional study was conducted at Aga Khan University Hospital (AKUH) and comprised patients undergoing TKA for primary knee osteoarthritis. Surgical outcome was measured by the Southampton wound infection score …

Indications Of Enucleations And Eviscerations Performed At A Tertiary Eye Care Unit: A Case Series., Rashid Baig, Maheen Akhtar Syed, Khabir Ahmad, Tanveer Anjum Chaudhry

Department of Surgery Docs

Abstract

The retrospective study was planned to look at the indications of eye enucleations and eviscerations, and comprised all such procedures done at the Aga Khan University Hospital, Karachi, from January 2006 to December 2015. Data was collected regarding age at the time of procedure, gender, procedure type, indication for enucleation or evisceration, type of implant if used and complications. Of the 66 eyes of 65 individuals, 47 (71.2%) underwent evisceration and 19 (28.8%) enucleation. The mean age at the time of the procedures was 37.86±23.09 years. The indication for enucleation or evisceration were keratitis 14(21.2%), introcular tumours 13(19.7%), trauma …

Nosocomial Infections In The Icu: Pens And Spectacles As Fomites, Haris Farooq Murad, Khawaja Muhammad Inam Pal

Department of Surgery Docs

Abstract Nosocomial infections are a major cause of morbidity and mortality. Non-medical objects known as fomites may have a role in their genesis. We investigated the significance of writing pens and spectacles asfomites. The study was conducted at Aga Khan University Hospital, Karachi, from July 2013 to September 2013. Cultures were taken from pens and/or spectacles of resident nurses, doctors and nursing assistants in intensive care unit (ICU). Organisms important in ICU nosocomial infections were targeted. Seven rounds ofsampling over 3 weeksled to 55 pen and 5 spectacle samples. Growth was seen in 3(5.5%) pen samples and 1(20%) spectacle sample. …

Improvement In Quality Of Lifesix Months After Primary Total Hip Arthroplasty In A Pakistani Population., Akbar Jaleel Zubair, Syed Usman Bin Mahmood,, Moiz Ali, Shahryar Noordin

Department of Surgery Docs

Abstract

This prospective, cohort study was carried out to assess the improvement in quality of life of patients undergoing elective primary total hip arthroplasty (THA). It was conducted at the orthopaedic department of the Aga Khan University Hospital, Karachi, from June 2014 to May 2015, and comprised patients who had undergone THA. A total of 89 patients having a mean age of 41.5±12.0 years with a baseline core outcomes measure index (COMI)-hip score of > 3.5 were included. A decrease in COMI-hip score by >3 points six months post-operatively was considered improvement in quality of life. Patient satisfaction with restriction to …

Occlusal Outcome Of Non-Extraction And All First Premolars Extraction Treatment In Patients With Class-I Malocclusion., Adeel Tahir Kamal, Attiya Shaikh, Mubassar Fida

Department of Surgery Docs

Abstract

OBJECTIVE:

Class-1 malocclusion commonly presents with crowding and poses an aesthetic concern to patients. An orthodontist may encounter a variety of dental problems and must handle them strategically to establish adequate occlusal relationships. Hence, this study was conducted to evaluate the occlusal characteristics of patients who have undergone non-extraction or all first premolars extraction treatment for class I malocclusion using the peer assessment rating (PAR) index.

METHODS:

The pre-treatment and post treatment dental casts of 94 subjects with class-I malocclusion were retrospectively screened. The sample was distributed into two groups, i.e., nonextraction and all first premolars extraction groups. The …

Exploration Of Variations In Positions Of Upper And Lower Incisors, Overjet, Overbite, And Irregularity Index In Orthodontic Patients With Dissimilar Depths Of Curve Of Spee., Nita Kumari, Mubassar Fida, Attiya Shaikh

Department of Surgery Docs

Abstract

OBJECTIVE:

The position and arrangement of teeth as well as the entire scheme of occlusion differs from one individual to the other .The purpose of this study was to examine differences in position and inclination of incisors, overjet, overbite and lower arch crowding in subjects with different depths of curve of Spee and to determine correlations between depth of curve of Spee and these variables.

METHODS:

The sample comprised of 114 patients (55 females and 59 males) with fully erupted permanent second molars (age 12-25 years), having no history of previous orthodontic treatment, no craniofacial anomalies, and no missing …

Better Outcome Of Splenectomy In Younger Patients Suffering From Chronic Immune Thrombocytopenia, Sabah Saqib, Rizwan Hashim, Hasnain Zafar

Department of Surgery Docs

Abstract Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splenectomy. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised adult patients who underwent splenectomy for ITP from October 2005 to December 2015. Of the 51 patients, 37(72.5%) were females and 14(27.5%) were males. The overall median age was 32 years (interquartile range: 18-65 years). Complete response was seen in 43(84.3%) patients, 2(4%) had response …

Age Estimation Of A Sample Of Pakistani Population Using Coronal Pulp Cavity Index In Molars And Premolars On Orthopantomogram, Sheikh Bilal Badar, Rabia Ghafoor, Farhan Raza Khan, Muhammad Hasan Hameed

Department of Surgery Docs

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analysed on Orthopantomogram. TCI was calculated for unrestored mandibular premolars and molars. Pearson's correlation was applied to assess correlation between chronological age and TCI. Besides, 30(37.5%) subjects were male and 50(62.5%) female, and 140(44.4%) teeth were of male subjects and 175(55.6%) were of females. The mean correlation coefficient between chronological age and …

Prevalence Of Musculoskeletal Disorders Among Dentists In Teaching Hospitals In Karachi, Muhammad Hasan Hameed, Rabia Ghafoor, Farhan Raza Khan, Sheikh Bilal Badar

Department of Surgery Docs

Work-related musculoskeletal pain is common among healthcare professionals, including dentists. This crosssectional study was conducted to determine the prevalence of work-related musculoskeletal disorders (MSDs) among dentists. This study was carried out from January to April 2016 at various teaching hospitals of Karachi, and comprised 230 dentists. A self-administered questionnaire, adapted from a validated Nordic questionnaire, was distributed among the participants. Descriptive statistics were computed and associations of interest were analysed using chi-square test. Of the 230 forms, 182(79.11%) were included after leaving out the incomplete ones. The overall prevalence of MSDs was 138(75.8%). The most frequent reasonsfor MSDs were lack …

Rotational Mal-Alignment After Reamed Intramedullary Nailing For Tibial Shaft Fracture, Sher Khan, Yasir Mohib, Rizwan Haroon Rashid, Haroon Rashid

Department of Surgery Docs

Abstract

Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study was planned to evaluate the frequency of rotational mal-alignment after reamed tibia IMnailing. This cross-sectional study was conducted at Aga khan University Hospital, Karachi, and comprised patients with tibia shaft fractures managed with IMnailing from January to December 2014. All the patients were assessed intra-operatively for rotational alignment using the knee and ankle fluoroscopic images. There were 81 patients with a …

Versatility Of The Anterolateral Thigh Flap: An Akuh Experience, Muhammad Fazlur Rehman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan

Department of Surgery Docs

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects …

Two Incision Mini Open Carpal Tunnel Release- A Minimally Invasive Alternative To Endoscopic Release, Pervaiz Hashmi, Rizwan Haroon Rashid, Moiz Ali, Yasir Mohib, Naveed Baloch

Department of Surgery Docs

Abstract

Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisions. It was conducted at the Aga Khan University Hospital, Karachi, and comprised patients undergoing surgical release of carpal tunnel syndrome (CTS) between January 2011 and December 2014. Of the 54 patients,38(70.4%) cases were of right-sided CTS. The mean operating time was 12.5±4.9 minutes. Complete relief from symptoms was observed in all the patients and the only complication noted was superficial infection in …

Peri-Operative Determinants Of Prolonged Cicu Stay After Coronary Artery Bypass Graft Surgery In Elderly At A Private Tertiary Care Hospital: A Case Control Study, Fazal Khan, Shiraz Hashmi, Syed Saad Naeem,, Benish Fatima, Hashim Hanif, Mubashir Zareen Khan, Saulat Hasnain Fatimi

Department of Surgery Docs

Abstract

OBJECTIVE:

To explore peri-operative risk factors associated with prolonged stay in cardiac intensive care unit among patients undergoing isolated coronary artery bypass grafting.

METHODS:

This retrospective case control study was conducted at the Aga Khan University Hospital, Karachi, comprised medical records of patients who had undergone cardiothoracic revascularisation surgery from January 2006 to December 2013. The patients were grouped into cases and controls at a ratio of 1:2 on the basis of length of stay at cardiac intensive care unit, i.e. >72 hours andanalysis.

RESULTS:

Of the 999 patients, 333(33.3%) were cases and 666(66.6%) were controls. The mean age …

Evaluation And Management Of Sleep Disorders In The Hand Surgery Patient., Michael P. Gaspar, Patrick M. Kane, Sidney M. Jacoby, Patrick S. Gaspar, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.